Evidence-Based Communication Assessment and Intervention

by

Jeff Sigafoos, Ralf W. Schlosser

• LAST REVIEWED: 25 September 2018
• LAST MODIFIED: 25 September 2018
• DOI: 10.1093/obo/9780199756810-0206

Introduction

The evidence-based practice movement, which has its origins in the medical field, has been increasingly adopted and accepted in a range of other professions. This includes taking up the evidence-based practice movement in several fields relevant to the amelioration of communication disorders. Fields that have some relevance to the amelioration of communication disorders include: (a) speech-language pathology (SLP), (b) applied behavior analysis, (c) rehabilitation medicine, and (d) special education. The evidence-based practice movement is based on the premise that clinical policy and practice should be based, in part, on the best available research evidence of what works. Evidence-based practice (EBP) refers to both the actual policies and the procedures that have been shown, by good research, to be effective as well as to the process of integrating the best available research evidence with stakeholder perspectives and one’s own clinical expertise. Thus the three pillars of EBP are (a) the use of best available research evidence to guide policy and practice, (b) the integration of stakeholder perspectives into practice, and (c) the consideration of one’s own clinical expertise when making assessment and intervention decisions. Therefore, effective implementation of EBP requires three major activities: (a) identifying the best available evidence and (b) integrating that evidence with both, the perspectives of key stakeholders, and the (c) expertise of the clinicians involved. The aim of this article is to provide an overview of key resources relevant to EBP in communication assessment and intervention. These resources include major textbooks, journal articles, and online resources that will provide readers with contemporary and high-quality information about EBP, and the process of implementing EBP, with respect to communication assessment and intervention for a range of communication disorders.

Communication Disorders

Communication disorders affect a significant number of individuals. Several resources in this section include data on the nature and prevalence of communication disorders for different groups. Morris, et al. 2016 examines communication disorders among adults, whereas the National Institute on Deafness and Other Communication Disorders 2017 provides prevalence data on a range of communication disorders for both adults and children. Rosenbaum and Simon 2001 focuses on US children, while Lewis, et al. 2016 explores co-morbid problems among a sample of adolescents and young adults with histories of speech disorders. Various disorders can affect communication, including impairment of voice, speech production, and language development. A voice disorder, for example, could manifest as an impairment in voice timing, pitch, and/or voice volume. Speech production disorders, in contrast, include fluency problems (e.g., stuttering) and articulation problems. Other language impairments can affect one or more language systems; specifically, impairments related to phonology, semantics, pragmatics, morphology, and/or syntax. Some individuals present with little or no functional or intelligible speech and are considered to have a severe communication impairment, indicating the need for an augmentative or alternative communication (AAC) system, such as using manual signs, picture-based communication, a computer-based speech-generating device, or a mobile technology with an AAC-specific application. Disorders of voice, speech, and language can be temporary or permanent or congenital or acquired. They can have a wide range of causes, including deafness and hearing impairment, developmental disability, neurological impairment, injury, disease, and exposure to environmental toxins, abuse and neglect, and/or deficient language learning environments. Brookshire 2015 provides a comprehensive overview of communication disorders related to neurogenic/cognitive impairment, whereas Duffy 2013 focuses on motor speech disorders. Other sources stress other types of conditions that are associated with communication disorders, specifically (a) aphasia (Papathanasiou and Coppens 2017) and central processing disorders (American Speech-Language Hearing Association 2017). Communication disorders are heterogeneous in terms of the underlying nature, severity, and etiology. A major area of clinical research and practice focuses on the assessment and treatment of communication disorders. Dodge 2000 and Ukrainetz 2015 address issues in the design and delivery of school-based services for students with communication disorders, whereas Schindler, et al. 2010 outlines a particular approach suited to the management of communication disorders in rehabilitation contexts. Although communication assessment and intervention services are provided across the life span and in a range of contexts, including hospitals, homes, schools, and in community and clinical settings, the focus here is on children and youth who are served in schools. However, a few key references to bibliographic material are also included that have a more adult-oriented focus because such information may be relevant for those working with young adults who are still in the school system or who are transitioning from school to post-school settings. Important sources of epidemiological information on communication disorders are listed below.

• American Speech-Language Hearing Association. 2017. Definitions of communication disorders and variations. Rockville, MD: American Speech-Language Hearing Association.

  This document defines several classes of communication disorders, including speech disorder, language disorder, hearing disorder, and central auditory processing disorders (CAPD). Speech disorders include articulation, fluency, and voice disorders. Language disorders include problems with phonology, morphology, syntax, semantics, and pragmatics. CAPDs refer to deficits in the processing of information from auditory signals. The document is meant to provide guidance on the definition of communication disorders.

• Brookshire, Robert A. 2015. Introduction to neurogenic communication disorders. 8th ed. St. Louis, MO: Elsevier Mosby.

  This widely used and well-respected textbook provides a comprehensive introduction to the nature, assessment, and treatment of neurogenic cognitive communication disorders. Neurogenic cognitive communication disorders stem from damage to the nervous system due to injury or diseases affecting neurological functioning. The book reviews the neuroanatomy of the nervous system and covers the general assessment of language and cognitive functioning. The book also includes chapters covering assessment and treatment approaches for a number of commonly occurring conditions associated with neurogenic cognitive communication disorders. Specific conditions considered include aphasia, right-hemisphere syndrome, traumatic brain injury, dementia, and motor speech disorders.

• Dodge, Ellen Pritchard. 2000. Survival guide for school-based speech-language pathologists. Clifton Park, NY: Delmar.

  This book outlines processes for designing school-based speech and language programs. The book offers a practical, how-to approach for school-based implementation. It can also serve as a useful supplementary text for pre-service training. The book covers communication assessments, caseload management, parent-professional collaboration, writing individualized education plans, and progress monitoring. Examples related to range of communication disorders are provided (e.g., phonology, articulation, fluency, language, voice, autism, and hearing impairment). Issues related to addressing AAC, cultural diversity, and behavior disorders are also covered.

• Duffy, Joseph R. 2013. Motor speech disorders: Substrates, differential diagnosis, and management. 3d ed. St. Louis, MO: Elsevier Mosby.

  This textbook addresses issues and problems that arise in relation to the diagnosis of motor speech problems. It specifically addresses issues related to differential diagnosis of conditions with neurological versus nonorganic etiology. The book covers classification schemes and definitions of motor speech disorders. The range of motor speech disorders covered include various dysarthrias (e.g., flaccid, spastic, ataxic, hypokinetic, and hyperkinetic), apraxia of speech, and neurogenic mutism. Issues in the management of these various disorders are considered.

• Lewis, Barbara A., Emily Patton, Lisa Freebairn, et al. 2016. Psychosocial co-morbidities in adolescents and adults with histories of communication disorders. Journal of Communication Disorders 61:60–70.

  DOI: 10.1016/j.jcomdis.2016.03.004

  The authors studied 129 adolescents and 98 young adults who had a history of speech sound disorders in early childhood. The aim was to determine the extent of co-morbid psychosocial problems (e.g., hyperactivity, inattention, anxiety, and depression), employment status, and quality of life. The data indicated the likelihood of co-morbid psychosocial problems among adolescents with a history of language impairment. The results suggest the need for communication interventions to incorporate procedures to address and prevent psychosocial problems.

• Morris, Megan A., Sarah K. Meier, Joan M. Griffin, Megan E. Branda, and Sean M. Phelan. 2016. Prevalence and etiologies of adult communication disabilities on the United States: Results from the 2012 National Health Interview Survey. Disability and Health Journal 9.1: 140–144.

  DOI: 10.1016/j.dhjo.2015.07.004

  This study reports the results of a survey of 34,525 adults on voice, speech, and language problems. Approximately 10 percent of respondents reported voice, speech, and language disorders. Voice problems were most frequently reported (7.6 percent) followed by speech (3.0 percent), and language problems (1.5 percent). The results point to a gap between the frequency with which voice, speech, and language problems are reported versus those that are formally diagnosed, suggesting a need for improved diagnostic practices.

• National Institute on Deafness and Other Communication Disorders. 2017. Quick statistics about voice, speech, language. Bethesda, MD: National Institute on Deafness and Other Communication Disorders.

  This document from the National Institute on Deafness and Other Communication Disorders (NIDCD) lists prevalence estimates for several types of communication disorders, including voice disorders, speech disorders, and language disorders. Estimates are provided for different groups, including adults, children, boys versus girls, and black versus white children. Overall, the NIDCD estimates that communication disorders affect about 7 to 8 percent of the US population. The sources for these quick statistics include a number of empirical studies into the prevalence and risk factors for different groups and different communication disorders.

• Papathanasiou, Ilias, and Patrick Coppens, eds. 2017. Aphasia and related neurogenic communication disorders. 2d ed. Burlington, MA: Jones & Bartlett Learning.

  This edited textbook focuses on aphasia and other neurological disorders that arise from injury, damage, or diseases affecting the brain and nervous system. Content of this second edition reflect advances in neuroscience, particularly new knowledge gained from neuroimaging studies. Chapters focus on application of EBP in the clinical management of patients with aphasia as well as the need for clinicians to have an understanding of the theoretical bases that underlie therapy. A unique aspect of this book is the inclusion of case studies that illustrate a range of theoretical concepts.

• Rosenbaum, Sara, and Patti Simon, eds. 2001. Speech and language disorders in children: Implications for the Social Security Administration’s Supplemental Security Income Program. Washington, DC: National Academies Press.

  This report focuses on past and current trends in the prevalence, diagnosis, and treatment of speech and language disorders among US children. Speech and language disorders were reported to affect from 3 to 16 percent of children with approximately 2 percent of such children having sufficiently severe speech and language disorders to require assessment and treatment. Speech and language disorders often persist long term and require treatment. While few treatments exist for addressing underlying causes, improvement in the child’s communication, speech, and language functioning can be achieved through speech and language therapy.

• Schindler, Antonio, Giovanni Ruoppolo, and Umberto Barillari. 2010. Communication and its disorders: Definition and taxonomy from a phoniatric perspective. Audiological Medicine 8.4: 163–170.

  DOI: 10.3109/1651386X.2010.530023

  This paper describes communication disorders from the perspective of clinicians involved in the rehabilitation management of communication disorders. The authors refer to this perspective as the “phoniatric perspective.” Communication is conceptualized as a process of message exchange and, consequently, communication disorders are conceptualized as an impairment in the ability to either send or receive messages. The authors outline a taxonomy of communication disorders in terms of the underlying impairment of voice, speech, language, and hearing functions. The implications of their taxonomy for the clinical assessment and management of communication disorders and for clinical research are discussed.

• Ukrainetz, Teresa A. 2015. School-age language intervention: Evidence-based practices. Austin, TX: Pro-ED.

  The primary aim of this book is to explain to professionals how to go about teaching language and literacy skills to students. The book is intended for SLPs working in school settings. To this end, chapters include practical and evidence-based guidance related to providing intervention in naturalistic school contexts. The 689-page book is organized into sixteen chapters covering foundational aspects of providing language intervention in school settings, outlining specific intervention approaches (e.g., the Contextualized Skill Intervention Framework), and ameliorating specific types of complications, such as intervention for bilingual learners, environmentally at-risk students, memory problems, and teaching specific skills (e.g., spelling, reading).