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About Speech-Language Impairment
Limitations in speech and language may result from a number of different impairments and disorders. An individual may be limited due to problems with articulation, voice strength, language expression, or may be non-vocal. Following is a list of speech and language disorders including information from the American Speech-Language, Hearing Association (ASHA).
- Aphasia is impaired expression or comprehension of written or spoken language. Aphasia is often caused by stroke, brain injury or Alzheimer's dementia.
- Dysarthria results in difficulty pronouncing words like "cat" or sounds like "sh" and "ba." Dysarthria may be caused by a degenerative neurological disorder or alcohol intoxication.
- Dysphonias can be present in one of two forms, adductor or abductor. The adductor type produces a strained or strangled voice quality. Abductor sounds like chronic hoarseness or breathy and effortful speech.
- Esophageal speech is a technique whereby a person takes air in through the mouth, traps it in the throat, and then releases it. As the air is released, it makes the upper parts of the throat/esophagus vibrate and produces sound. This sound is still shaped into words with the lips, tongue, teeth, and other mouth parts.
- Stuttering results in repetition, blocks or inability to say certain words, and/or the prolonging of words. An individual who stutters may also have distorted movements and facial expressions when trying to speak.
- Nodules are most frequently caused by vocal abuse or misuse. Polyps may be caused by prolonged vocal abuse, but may also occur after a single, traumatic event to the vocal folds. Speech may be hoarse, breathy, and painful to produce.
Additionally, speech and language limitations might occur due to stroke, cerebral palsy, amyotrophic lateral sclerosis (ALS), Huntington’s Disease, oral and laryngeal cancer, hearing impairment, traumatic brain injury, dementia, chronic laryngitis, and vocal cord paralysis.
Speech-Language Impairment and the Americans with Disabilities Act
The ADA does not contain a definitive list of medical conditions that constitute disabilities. Instead, the ADA defines a person with a disability as someone who (1) has a physical or mental impairment that substantially limits one or more "major life activities," (2) has a record of such an impairment, or (3) is regarded as having such an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act (ADAAA).
Accommodating Employees with Speech-Language Impairment
People with speech-language impairments may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people who are aging will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist
Questions to Consider:
- What limitations is the employee experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training?
Situations and Solutions:
The following situations and solutions are real-life examples of accommodations that were made by JAN customers. Because accommodations are made on a case-by-case basis, these examples may not be effective for every workplace but give you an idea about the types of accommodations that are possible.
An accountant with spasmodic dysphonia needed time off periodically to travel out of state in order to get specialized medical treatment to manage his condition.
He also experienced a breathy voice quality that limited his ability to speak loudly for several days after each treatment. The employer granted periodic leave and provided equipment to amplify his voice on the telephone as needed.
A professor with stuttering experienced an exacerbation of his condition and needed to start attending speech therapy on a weekly basis to manage his symptoms.
He asked that his course schedule be modified, so that he could change one of his courses to an online format, and have his other classes and office hours scheduled around his therapy sessions for the duration on the next semester. The employee modified the professor’s teaching schedule.
A receptionist who was recovering from vocal surgery had difficulty speaking loudly enough for customers to hear her when she greeted them.
She also experienced vocal fatigue when speaking on the phone. Her employer purchased a voice amplifier for face to face use and one designed for telephone use as well, so that she did not have to strain her voice to speak more loudly.
A volunteer reader in a library had a weak voice due to a previous infection that damaged her vocal cords. She
She was given a voice amplifier so she would not have to strain her vocal cords trying to talk loud enough for the children to hear her.
A university employee with cerebral palsy used a speech generating communication device to meet her communication needs at work and elsewhere.
Her device worked well with her personal cellphone, but she needed a speakerphone in order to take calls on the office phone line. Due to workplace changes, she needed to start sharing an office with two coworkers. Her employer purchased an adapter for the device so that she could use her device with the telephone more discreetly.
A scientist with autism spectrum disorder was able to speak at times, but also experienced episodes when she found it difficult to speak and needed to use a speech device or speech generating app.
She was preparing to present her research at a conference. She pre-recorded audio to go with her slides and brought a tablet with a speech generating app with her in case she needed it during the question and answer portion of her presentation.