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Contents vii
Assessment of Articulation and Phonology: Learning to Read and Reading to Learn. . . . . . . . . . . 165
Evidence-Based Practice. . . . . . . . . . . . . . . . . . . . . . . . . 97 Literacy Disorders in Children. . . . . . . . . . . . . . . . . . . . . 166
Treatment for Articulation Disorders: Common Problems of Children
Evidence-Based Practice. . . . . . . . . . . . . . . . . . . . . . . . 103 with Literacy Disabilities. . . . . . . . . . . . . . . . . . . . . . . . 167
Treatment for Phonological Disorders: Assessment of Reading and Writing Abilities:
Evidence-Based Practice. . . . . . . . . . . . . . . . . . . . . . . . 105 Evidence-Based Practice. . . . . . . . . . . . . . . . . . . . . . . . 169
Scientists–Humanists–Artists . . . . . . . . . . . . . . . . . . . . . 106 Intervention for Reading and Writing Problems:
Emotional and Social Effects of Articulation Evidence-Based Practice. . . . . . . . . . . . . . . . . . . . . . . . 170
and Phonological Disorders. . . . . . . . . . . . . . . . . . . . . 107 Multicultural Considerations. . . . . . . . . . . . . . . . . . . . . . 171
Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Emotional and Social Effects of Literacy
Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Chapter 6 Motor Speech Disorders Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
in Children . . . . . . . . . . . . . . . . . . . . 112
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Chapter 9 Attention-Deficit/Hyperactivity
Childhood Apraxia of Speech. . . . . . . . . . . . . . . . . . . . . 114 Disorders and Auditory
Childhood (Developmental) Dysarthria . . . . . . . . . . . 120 Processing Disorders. . . . . . . . . . . . 175
Augmentative and Alternative Communication. . . 125 Attention-Deficit/Hyperactivity Disorders. . . . . . . . . 176
Emotional and Social Effects of Motor Auditory Processing Disorders . . . . . . . . . . . . . . . . . . . . 181
Speech Disorders in Children . . . . . . . . . . . . . . . . . . . 128 Emotional and Social Effects of Attention-Deficit/
Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Hyperactivity Disorders and Auditory
Processing Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . 188
UNIT 4 Language and Cognitive Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Disorders of Children 133 Chapter 10 Autism Spectrum Disorders and

Developmental Disabilities. . . . . 192
Chapter 7 Language Disorders in Children. . . . 134 Autism Spectrum Disorder . . . . . . . . . . . . . . . . . . . . . . . 193
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Developmental Disabilities . . . . . . . . . . . . . . . . . . . . . . . 204
Definitions of Language Disorder. . . . . . . . . . . . . . . . . 135 Emotional and Social Effects of Autism Spectrum
Specific Language Impairment . . . . . . . . . . . . . . . . . . . 137 Disorder and Developmental Disabilities. . . . . . . . 213
Language Disorders and Learning Disabilities. . . . . 142 Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Assessment of Language:
Evidence-Based Practice. . . . . . . . . . . . . . . . . . . . . . . . 146
Chapter 11 Traumatic Brain Injury
Treatment of Language Disorders:
in Children . . . . . . . . . . . . . . . . . . . 220
Evidence-Based Practice. . . . . . . . . . . . . . . . . . . . . . . . 151 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Emotional and Social Effects Speech, Language, Cognitive, and Swallowing
of Language Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . 156 Disorders with Pediatric TBI. . . . . . . . . . . . . . . . . . . . . 223
Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Behavioral Effects of Traumatic Brain Injury
in Children and Adolescents. . . . . . . . . . . . . . . . . . . . 224
Chapter 8 Literacy Disorders in Children. . . . 161 Mild Traumatic Brain Injury (Concussion)
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 in Infants, Children, and Adolescents. . . . . . . . . . . . 225
The Difference Between Learning to Understand Multicultural Considerations. . . . . . . . . . . . . . . . . . . . . . 236
Speech and Learning to Read. . . . . . . . . . . . . . . . . . . 163 Emotional and Social Effects of Traumatic
Emergent Literacy/Preliteracy Period Brain Injury in Children and Adolescents. . . . . . . . 236
(Birth–Kindergarten) . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
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viii Contents
UNIT 5 Fluency Disorders in Clefts of the Lip and Alveolar Ridge. . . . . . . . . . . . . . . 302
Clefts of the Hard and Soft Palates . . . . . . . . . . . . . . . . 303
Children and Adults 241 Multicultural Considerations. . . . . . . . . . . . . . . . . . . . . . 306
Problems Associated with Cleft Lip and Palate . . . . 306
Chapter 12 Essentials of Fluency Disorders . . . 242
Surgical Management of Cleft Lip and Palate. . . . . . 310
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 Assessment: Evidence-Based Practice. . . . . . . . . . . . . 311
Normal Disfluency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 Treatment of Speech, Resonance, and
Defining Stuttering. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244 Velopharyngeal Dysfunction:
General Information About Stuttering . . . . . . . . . . . . 248 Evidence-Based Practice. . . . . . . . . . . . . . . . . . . . . . . . 314
Theories of the Etiology of Stuttering . . . . . . . . . . . . . 250 Emotional and Social Effects of Cleft Lip
Cluttering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 and Palate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316
Evaluation of Children with Fluency Disorders: Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
Treatment of Children with Fluency UNIT 7 Neurological Disorders
Disorders: Evidence-Based Practice . . . . . . . . . . . . . 257 in Adults 323
Working with Adolescents and Adults with
Fluency Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Chapter 15 Language Disorders in Adults. . . 324
Emotional and Social Effects of Stuttering. . . . . . . . . 264
Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Etiologies of Neurogenic Speech, Language,
Cognitive, and Swallowing Disorders . . . . . . . . . . . 325
UNIT 6 Phonation and The Aphasias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Resonance Disorders 269 Emotional and Social Effects of Aphasia. . . . . . . . . . . 345
Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346
Chapter 13 Voice Disorders in Children
Chapter 16 Cognitive-Linguistic
and Adults . . . . . . . . . . . . . . . . . . . 270
Disorders in Adults . . . . . . . . . . . . 349
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350
Prevalence of Voice Disorders. . . . . . . . . . . . . . . . . . . . . 272
Traumatic Brain Injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . 350
Causes of Voice Disorders. . . . . . . . . . . . . . . . . . . . . . . . . 272
Impairments Resulting from Traumatic Brain Injury. . . 357
Classification of Voice Disorders. . . . . . . . . . . . . . . . . . . 273
Assessment of Cognitive Impairments
Voice Disorders Related to Functional Secondary to Traumatic Brain Injury:
Etiologies and Faulty Usage. . . . . . . . . . . . . . . . . . . . . 274 Evidence-Based Practice. . . . . . . . . . . . . . . . . . . . . . . . 360
Voice Disorders Related to Organic Etiologies . . . . . 281 Treatment of Traumatic Brain Injury:
Voice Disorders Related to Neurological Evidence-Based Practice. . . . . . . . . . . . . . . . . . . . . . . . 361
Etiologies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283 Right-Hemisphere Syndrome. . . . . . . . . . . . . . . . . . . . . 363
Multicultural Considerations. . . . . . . . . . . . . . . . . . . . . . 284 Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
Assessment of the Voice: Evidence-Based Practice. . . . 284 Emotional and Social Effects of Cognitive
Voice Treatment: Evidence-Based Practice. . . . . . . . . 288 Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Emotional and Social Effects of Voice Disorders . . . 295 Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Chapter 17 Motor Speech Disorders
Chapter 14 Cleft Lip and Palate . . . . . . . . . . . 300 in Adults. . . . . . . . . . . . . . . . . . . . . 378
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Etiologies of Cleft Lip and Palate. . . . . . . . . . . . . . . . . . 302 Apraxia of Speech . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
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Contents ix
Dysarthria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383 Chapter 20 Hearing Assessment,

Emotional and Social Effects of Motor Amplification, and Aural
Speech Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387 Rehabilitation. . . . . . . . . . . . . . . . 434
Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435
Chapter 18 Swallowing Disorders/ Hearing Assessment: Evidence-Based Practice . . . . 435
Dysphagia . . . . . . . . . . . . . . . . . . . 390 Treatment of Individuals with Hearing
Impairments: Evidence-Based Practice. . . . . . . . . . 446
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
The Roles of Speech-Language Pathologists . . . . . . 452
Causes of Dysphagia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Aural Rehabilitation: Evidence-Based Practice. . . . . 453
The Normal Swallow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Emotional and Social Effects of Hearing
Disorders of the Four Phases of Swallowing. . . . . . . 395
Impairments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 458
Assessment of Dysphagia:
Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 459
Treatment of Dysphagia:
Evidence-Based Practice. . . . . . . . . . . . . . . . . . . . . . . . 400 UNIT 9 Counseling Skills for Speech-
Multicultural Considerations. . . . . . . . . . . . . . . . . . . . . . 404 Language Pathologists and
Emotional and Social Effects of Swallowing Audiologists 463
Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404
Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406
Chapter 21 Essential Counseling Principles
for Speech-Language Pathologists
UNIT 8 Hearing Disorders and Audiologists. . . . . . . . . . . . . . 464
in Children and Adults 409 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465
Definition of Counseling for Speech-Language
Chapter 19 Anatomy and Physiology Pathologists and Audiologists. . . . . . . . . . . . . . . . . . . 466
of Hearing and Types and Using Counseling Skills Versus Being
Causes of Hearing Impairment . . . 410 a Counselor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411 Boundaries and Scope of Practice Within
Counseling Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
Anatomy and Physiology of the Hearing
Mechanism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411 Counseling: Science and Art. . . . . . . . . . . . . . . . . . . . . . 472
Auditory Nervous System. . . . . . . . . . . . . . . . . . . . . . . . . 416 Overlap in the Work of Speech-Language
Pathologists, Audiologists, and Psychologists. . . . 473
How We Hear. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
Personal Qualities of Effective Helpers. . . . . . . . . . . . . 473
Types and Causes of Hearing Impairments. . . . . . . . 418
Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477
Communication Disorders of Individuals
with Hearing Impairments. . . . . . . . . . . . . . . . . . . . . . 428
Epilogue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479
Emotional and Social Effects of
Hearing Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431 Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481
Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431 Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 504
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Preface
▸▸ Introduction published in journals around the world that adds
important information to our understanding of the
Essentials of Communication Sciences and Disorders, many disorders we work with and provides direc-
Second Edition was written for students just beginning tions for assessment and treatment. Second, this text
their education in speech-language pathology and was written for an international market: speech-
audiology (communication sciences and disorders). language pathology and audiology are practiced in
The Essentials text focuses on what is considered to countries around the world. Third, it is important
be the essential information that beginning stu- for students to realize that in many countries where
dents need, and is based on the skills and knowledge they may choose to travel or live and work, they will
specified in the American Speech-Language-Hearing have a fraternity of speech-language pathologists
Association’s (ASHA) 2005 Standards for the Cer- (SLPs) and audiologists with whom they can imme-
tificate of Clinical Competence (CCC) that address diately relate.
the Knowledge and Skills Acquisition Summary
(KASA), as well as ASHA’s 2016 Scope of Practice for
Speech-Language Pathology and 2004 Scope of Prac- ▸▸ Key Features
tice for Audiology.
Essentials was carefully organized for the benefit of
students and for ease in teaching. Each chapter begins
▸▸ Overview with learning objectives, a list of key terms, a chapter
outline, and an introduction.
This text was designed for students to learn and When an important term is first introduced in the
enjoy reading about the essentials of communication text, it is placed in bold type to highlight it. The terms
sciences and disorders. One thing students will imme- are also defined in a comprehensive glossary.
diately notice is that all of the illustrations, photos, Throughout the text, “Insight Questions” encour-
and figures are in full color. Students will also find the age students to consider how they might relate the
writing clear and understandable, with many colorful information presented to their personal lives, or how
stories and examples of real-life cases. In other words, the information may relate to them in ways they had
we have created an inviting place for students to learn. not expected.
The text presents the most recent literature in
each chapter. It also cites literature that is not often
mentioned in introductory texts. It includes many
references from professional journals outside of
speech-language pathology and audiology that are
relevant to our professions. These resources were
included to help students understand that important
information from other professions relates directly
and indirectly to our work.
Notably, Essentials includes literature from
numerous foreign journals that are not usually cited
by an American author. This was done for several
reasons. First, there is a vast amount of literature
x
Preface xi
Chapters include both case studies and personal ■■ Motor Speech Disorders in Children (includes
clinical stories that are relevant to the material. These discussion of childhood apraxia of speech and
features are intended to help paint a vivid picture of childhood dysarthria)
our professions, long before students have the oppor- ■■ Attention-Deficit/Hyperactivity Disorders and
tunity to participate in a clinical practicum. Auditory Processing Disorders
■■ Autism Spectrum Disorders and Developmental
Disabilities
■■ Traumatic Brain Injury in Children
■■ Cognitive-Linguistic Disorders in Adults
■■ Swallowing Disorders/Dysphagia
■■ Essential Counseling Principles for Speech-
Language Pathologists and Audiologists
There are new and expanded discussions of the fol-
lowing topics:
■■ Childhood apraxia of speech
■■ Childhood (developmental) dysarthria
■■ Emotional and social effects of attention-deficit/
hyperactivity disorders and auditory processing
disorders
■■ Treatment of communication deficits related to
autism spectrum disorder: evidence-based p
ractice
■■ Concussion in sports
■■ Treatment of traumatic brain injury: evidence-
based practice
■■ Right hemisphere syndrome
■■ Dementia
Multicultural considerations are discussed in

nearly all chapters, as the text material relates specifi-
cally to this important area. ▸▸ Instructor and Student
Each chapter includes a summary that highlights
some of the basic concepts discussed.
Resources
Numerous study questions are also provided at There are some important, new support tools in the
the end of each chapter that are based on Bloom’s second edition:
(1956) taxonomy of educational objectives. That is, ■■ Videos of most of the disorders discussed in the
three general levels of question difficulty are presented book.
for each chapter: (1) knowledge and comprehension, ■■ Modifiable (customizable) PowerPoint slides for
(2) application, and (3) analysis and synthesis. By each chapter. The author has created slides for
answering these questions, students can demonstrate each chapter, which individual instructors can
several levels of learning. Each chapter ends with an build on.
extensive list of references that students may use to ■■ A Test Bank for each chapter. Beyond the end-
research the information and concepts presented. of-chapter study questions, the author has
created a test bank of various kinds of questions
(true/false, multiple choice, short answer, essay)
▸▸ New to the Second Edition with various levels of difficulty (easy, moderate,
Several new and expanded chapters in this text dis- difficult).
cuss specific topics that were more briefly discussed in Please visit www.go.jblearning.com/Fogle2e for addi-
large chapters in the first edition: tional information on how to access these resources.
xii Preface
▸▸ Audience Conceptual Approach to the Text

The conceptual approach to this text is based on sev-
Some other groups of students (besides future SLPs
eral considerations that are themes throughout the
and audiologists) will find the Essentials text helpful—
chapters:
students who take an introductory course in speech-
language pathology and audiology who may not intend ■■ First and foremost, Essentials is evidence based;
to major in communication sciences and disorders. that is, it is built on the best available up-to-date
During the years I taught the introductory course, research on theories, assessment, and treatment of
students from a wide range of majors took the course the many disorders clinicians may encounter.
because someone recommended it, it sounded interest- ■■ The text has a life span approach, covering age
ing, or it just fit into their schedules. Some of these stu- groups from newborns to individuals at the end
dents find the information very interesting and change of life.
their majors. For them, the course was serendipitous. ■■ A team approach is emphasized, with the most
These students often brought into their new major important person on the team being the person
valuable perspectives from their past majors, such as with the communication disorder.
pre-medicine, pre-dentistry, pre-pharmacy, education, ■■ Therapy always involves working with the central
psychology, business, and many others. The professions and peripheral nervous systems.
of speech-language pathology and audiology are all ■■ People of all ages with communication impair-
the richer for welcoming students from other majors. ments often have emotional and social reactions
Nevertheless, students who take the introduction to to their problems. As clinicians, we must work
communication sciences and disorders course and do with our clients and patients holistically; in other
not change their major will also benefit from having words, we must work with the whole person and
an understanding of how this course and this text can not just the disorders that we diagnose and treat.
relate to their future professions and jobs, particularly Likewise, the family members of our clients and
in education and the healthcare fields. In addition, stu- patients often experience their own emotional
dents later realize that much of what they learn can help and social effects from their loved one’s problems.
their personal lives as parents and possible caregivers ■■ There is a joy in being a therapist—a person in a
to family members. As instructors of the introductory helping profession. As clinicians, we receive much
course, we know the information we present relates satisfaction from our work. People recognize that
to life in general, rather than just to the disciplines of we are excited about our work even after doing
speech-language pathology and audiology. therapy for many years.
Acknowledgments
This text emphasizes the team approach when working Advantage, Inc., a medical interpreter training com-
with clients and patients. Likewise, the writing of this pany. She has traveled worldwide with a medical team
text was a team approach, with many people contrib- serving children with cleft palate, spending the last
uting their time, energy, and talents to my education, 7 years developing sustainable services in Lima, Peru.
professional development, and ultimately this writing. She is coauthor, with Dr. Yvette Hyter, of the 2017
Mr. Rex Fisher, my high school biology and anat- textbook Culturally Responsive Practices in Speech,
omy and physiology teacher, and eventually my friend, Language, and Hearing Sciences.
introduced me to the fascinating study of science and Rotary International and Rotaplast International
the human body. These lessons became the founda- Cleft Palate Teams provided opportunities for me to
tions of my life’s work. travel to Venezuela, Egypt, and India to work with
Dr. Joseph Sheehan and Mrs. Vivian Sheehan infants, children, and adults with cleft lips and pal-
inspired my interest in stuttering, trained me well at ates; photographs from those “missions” have been
the Psychology Adult Stuttering Clinic at the Univer- included in this text. Rotary International sent me to
sity of California, Los Angeles (UCLA), and encour- Oradea, Romania, in 2014 and 2017 to work with chil-
aged me to pursue my doctorate in speech-language dren on the autism spectrum at the Pyramid Learn-
pathology. Dr. Dean Williams, professor and expert in ing Center with Ioana Coromaki and her therapists.
stuttering at the Wendell Johnson Speech and Hearing The libraries of Macquarie University, Sydney,
Center, University of Iowa, was my mentor and disser- Australia; Canterbury University, Christchurch, New
tation advisor. His statement to the students in one of Zealand; and the University of Reading, Reading,
his classes remains an inspiration to me: “I hope all of England, provided excellent facilities for research for
you find someone who helps you become more than the international emphasis of this text.
what you ever thought you could be.” Dr. Williams Nancy Barcal, M.A., CCC-SLP, owner of Granite
was that person for me. Bay Speech in Roseville, California, generously pro-
Dr. Marlene Salas-Provance contributed signifi- vided the many clients for videotaping, and Kimberli
cantly to the multicultural considerations material Door, B.S., SLPA, skillfully videotaped those clients,
throughout this text. Dr. Salas-Provance is an ASHA allowing students to view children and adults with
Fellow and a recipient of ASHA’s Certificate of Rec- various speech, language, and cognitive disorders.
ognition for Special Contributions in Multicultural United Cerebral Palsy of Sacramento, California,
Affairs and ASHA’s Certificate of Recognition for Out- allowed me to interview and videotape two of their adult
standing Contributions in International Achievement. clients for students to better understand the adult lives
She is past Coordinator of ASHA’s Special Interest of individuals with cerebral palsy, both congenital and
Group 14, Communication Disorders and Sciences acquired through a childhood traumatic brain injury.
in Culturally and Linguistically Diverse Populations; Allen D. Sato is the person who keeps my comput-
past president of the Hispanic Caucus, an ASHA- ers working; without his help and support, the manu-
related professional organization; a founding steering script for this text could not have been completed.
committee member and coordinator of ASHA’s Special Laura Paglucia, Acquisitions Editor of Jones &
Interest Group 17, Global Issues in Communication Bartlett Learning, who asked me to write the second
Sciences and Related Disorders; and a past member edition of this textbook, Mary Menzemer, Editorial
of ASHA’s Multicultural Issues Board. She is a pro- Assistant, Alex Schab, Associate Production Editor,
fessor and an Associate Dean of Academic and Stu- and Merideth Tumasz, Rights & Media Specialist, who
dent Affairs in the School of Health Professions at the carefully worked with me throughout this project. All
University of Texas Medical Branch, Galveston. Dr. of the excellent people at Jones & Bartlett Learning
Salas-Provance is also president and CEO of B ilingual who have been a pleasure to work with.
xiii
xiv Acknowledgments
Carol Fogle, RN, my wife of more than 45 years, ■■ John K. Gould, Elms College
has given me love, support, and encouragement for all ■■ Angela D. Haendel, Concordia University
of my projects, allowing me to contribute to the pro- Wisconsin
fession I love. My daughters Heather Brooke M orris ■■ Ruth Renee Hannibal, Valdosta State University
and Heather Lea Fogle are appreciated and loved for ■■ Allison Haskill, Augustana College
being such joys in my life. Carlos Ruiz and Jayne Mor- ■■ Yvette D. Hyter, Western Michigan University
ris, my birthparents, who never had the opportunity ■■ Shatonda Jones, Rockhurst University
to know me, or me to know them. Special appreciation ■■ Yolanda Keller-Bell, North Carolina Central
goes to my new families who accepted me into theirs. University
Finally, I would like to thank the following individuals ■■ Susan Kidwell, San Joaquin Delta College
for providing feedback that helped improve the sec- ■■ Maureen K. McEntee, Rhode Island College
ond edition in many ways: ■■ Caroline Menezes, University of Toledo
■■ Christina Akbari, Arkansas State University
■■ Juliana O. Miller, University of South Carolina
■■ Iris Johnson Arnold, Tennessee State University
■■ Lekeitha R. Morris, Delta State University
■■ Karen Ball, Queens College, City University of
■■ Bryan Ness, California Baptist University
New York
■■ Celeste R. Parker, Jackson State University
■■ Janine L. S. Bartley, Grand Valley State University
■■ Matthew H. Rouse, Biola University
■■ Susan K. Bohne, Brooklyn College, City University
■■ Whitney Schneider-Cline, University of Nebraska
of New York Kearney
■■ Dawn C. Botts, Appalachian State University
■■ Laurie M. Sheehy, University of Toledo
■■ Janet Bradshaw, Armstrong State University
■■ Janice Carter Smith, Western Kentucky University
■■ Debra L. Burnett, Kansas State University
■■ Linda J. Spencer, Rocky Mountain University of
■■ Thalia J. Coleman, Appalachian State University Health Professions
■■ Regina L. Enwefa, Southern University and A&M
■■ Amanda Stead, Pacific University
College
■■ Karen Thatcher, Samford University
■■ Stephen Enwefa, Southern University and A&M
■■ Mary Ann Thomas, University of Louisiana Mon-
College roe
■■ Kelli Evans, Western Washington University
■■ Nancy Thule, Alexandria Technical and Commu-
■■ Fern D. Fellman, Bridgewater State University nity College
■■ Kris Foyil, University of Tulsa
■■ Rosalie Marder Unterman, Touro College
■■ Melissa P. Garcia, Texas A&M International
■■ Colleen F. Visconti, Baldwin Wallace University
University
■■ Elise M. Wagner, Columbia University
■■ Elizabeth Zylla-Jones, Auburn University
About the Author

Paul T. Fogle, Ph.D., courses on Introduction to Speech-Language Pathol-
CCC-SLP (Fogle is pro- ogy and Audiology, Anatomy and Physiology of
nounced with a long o, Speech, Speech Science, and Organic Disorders.
as in FO-GULL), has At the graduate level, he taught Neurology and
been studying, training, Neurological Disorders in Adults, Motor Speech

and working in speech- Disorders,
Cerebral Palsy, Dysphagia/Swallowing
language pathology for Disorders, Gerontology, Voice Disorders, Cleft Palate
more than 45 years. and Oral‒Facial A nomalies, and Counseling Skills for
Although he earned all Speech-Language Pathologists.
of his degrees in speech- Dr. Fogle has worked extensively in hospitals,
language pathology, he including Veterans Administration Hospitals, univer-
minored in psychology sity hospitals, and acute, subacute, and convalescent
throughout each degree. hospitals. He has maintained a year-round private
He earned his Bachelor practice for more than 35 years. He has presented
of Arts in 1970 and his Master of Arts in 1971, both at numerous seminars, workshops, and short courses on
California State University, Long Beach. After receiving a variety of topics at state, ASHA, and international
his M.A., he worked for 2 years as an aphasia classroom conferences and conventions, including the Interna-
teacher for the Los Angeles County Office of Educa- tional Association of Logopedics and Phoniatrics,
tion and started the first high school aphasia class in the International Conference on Speech-Language
California, teaching and working with adolescents
Pathology, and the Asia-Pacific Society for the Study
who had sustained traumatic brain injuries, strokes, of Speech-Language Pathology and Audiology.
and other neurological impairments. Dr. Fogle has presented all-day workshops in cities
Between 1970 and 1973, Dr. Fogle worked as a throughout the United States and in countries around
therapist at the University of California, Los Angeles the world on counseling skills for speech-language
(UCLA) Psychology Adult Stuttering Clinic, training pathologists and audiologists, and on auditory process-
under Dr. Joseph Sheehan and Mrs. Vivian S heehan. ing disorders and attention-deficit disorders. He has
Concurrently, he trained at Rancho Los Amigos worked on numerous medical‒legal cases as an expert
Medical Center in Southern California performing witness in several states for more than 30 years, testi-
human brain autopsy. fying in depositions, court hearings, and court trials.
Dr. Fogle earned his doctorate in 1976 from the Dr. Fogle’s primary publications have been
University of Iowa. He specialized in neurological textbooks and clinical materials. He is the author of
disorders in adults and children and stuttering. His Foundations of Communication Sciences and Disorders
dissertation was directed by Dr. Dean Williams and he (Delmar Cengage Learning, 2008) and coauthor of
was awarded membership in Sigma Xi, the Scientific Counseling Skills for Speech-Language Pathologists and
Research Society of North America, for his research. Audiologists (first edition 2004, second edition 2012,
Although he minored in psychology throughout all of Delmar Cengage Learning), Ross Information Process-
his degrees, in the early 1990s, he began training in ing Assessment-Geriatric (first edition 1996, second
counseling psychology, educational psychology, clin- edition 2012, Pro-Ed), the Classic Aphasia Therapy
ical psychology, and family therapy (Marriage, Child, Stimuli (CATS) (Plural Publishing, 2006), and The
Family Therapy). Most recently he has been studying Source for Safety: Cognitive Retraining for Independent
neuropsychology. Living (LinguiSystems [now Pro-Ed], 2008). His web-
Dr. Fogle is a Professor Emeritus. During his 35 site is www.PaulFoglePhD.com and his email address
ndergraduate
years as a university professor he taught u is paulfoglephd@gmail.com.
xv
Letter to Students
Dear Students, Third, people of all ages with communication
Welcome! Thank you for purchasing this text for impairments have emotional and social reactions
the beginning of your study about the professions of to their problems. A problem may be physical—for
speech-language pathology and audiology. I hope you example, a cleft palate or a hearing loss—but there are
find not just interest in the information, but a genuine always emotional and social effects of the problem. As
joy in its learning. If you do, there is a good chance clinicians, we must work with our clients and patients
that joy will remain with you throughout your educa- holistically—by addressing the whole person and not
tion and life as you continue to learn about and work just the disorders that we diagnose and treat. Likewise,
in these remarkable professions. family members of our clients and patients commonly
You will find several themes throughout this text have their own emotional reactions to their loved one’s
that will help you in your learning and work as either a problems. The therapy we provide one person often has
speech-language pathologist or an audiologist. subtle to profound effects on the lives of a constellation
First, our work always follows a team approach. of people. If you become a speech-language pathologist
The most important person on the team is the person or audiologist, you will touch countless lives.
with the communication disorder, because without Fourth, there is a joy to being a therapist, a person
that person no other team members are needed. in a helping profession. We give our time, energy, and
Second, all of our therapy is “brain therapy.” In talents to others, but we receive back more than we give.
other words, whether we are working with a child Yes, you can make a living and support yourself with
or an adult with an articulation disorder, language your profession. However, we go into our profession
disorder, fluency disorder, neurological disorder, or and stay in it not so much because of the income we
other disorder, we are working with neurons, axons, derive from it, but because of the satisfaction we receive
dendrites, and synapses within the person’s brain to from knowing that we have helped others have better
change the muscles that relax and contract for specific lives. Ultimately, that becomes our greatest reward.
behaviors to occur. More subtly, when we are helping I hope you enjoy reading and studying this text as
people change their attitudes, beliefs, feelings, and much as I enjoyed writing it for you.
reactions toward their communication problems (e.g.,
stuttering), we are working with the brain. Best Wishes, Paul T. Fogle, Ph.D., CCC-SLP
www.PaulFoglePhD.com
xvi
UNIT 1
Communication
Disorders and the
Professionals Who
Work with Them
CHAPTER 1 Essentials of Communication and
Its Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
CHAPTER 2 The Professionals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
© nature photos/Shuterstock
1
CHAPTER 1
Essentials of Communication
and Its Disorders
KEY TERMS
acquired disorder General American English (GAE)/ phonology
aphasia Standard American English (SAE) pragmatics
aphonia grammar prevalence
articulate (articulation) habilitate (habilitation) (mental or cognitive) process
articulation disorder handicap (processing)
audiologist hearing impairment (hearing loss) prosody (prosodic)/melody (melodic)
clinician hypernasal (hypernasality) quality of life
cluttering hyponasal (hyponasality)/denasal receptive language
cognition (denasality) rehabilitate (rehabilitation)
cognitive disorder (cognitive impairment resonance disorder
impairment) incidence semantics
communicate inner speech (self-talk) sensorineural hearing loss
(communication) intelligible (intelligibility) speech
communication disorder language speech disorder
(communicative disorder) language delay speech-language pathologist (SLP),
conductive hearing loss language difference speech pathologist, or speech
congenital disorder language disorder therapist
consonant linguistics stuttering (disfluency)
context literacy syllable
dementia modality syndrome
disability morpheme syntax
disorder morphology traumatic brain injury (TBI) or head
dysphonia motor speech disorder trauma
etiology organic disorder voice disorder (dysphonia)
expressive language phoneme vowel
functional disorder phonological disorder
2
Introduction 3
LEARNING OBJECTIVES
After studying this chapter, you will be able to:
■■ State the modalities of communication.
■■ Describe the essential components of oral language: phonology, morphology, syntax, semantics, and pragmatics.
■■ Briefly explain each of the major communication disorders.
■■ Explain the emotional and social effects of communication disorders on the person and family.
CHAPTER OUTLINE
Introduction ■■ Definitions ■■ Hearing Impairments
The Study of Human Communication ■■ Prevalence Emotional and Social Effects
Communication Modalities Classification of Communication of Communication Disorders
Oral/Spoken Language Disorders Chapter Review
■■ Linguistics ■■ Disorders of Articulation ■■ Chapter Summary
•• Phonology ■■ Disorders of Language ■■ Study Questions
•• Morphology •• Language Disorders in Children •• Knowledge and

•• Syntax •• Language Disorders in Adults Comprehension
•• Semantics ■■ Disorders of Fluency •• Application
•• Pragmatics ■■ Disorders of Voice •• Analysis and
Reading and Writing ■■ Disorders of Resonance Synthesis
Disorders of Communication ■■ Disorders of Cognition ■■ References
▸▸ Introduction Communicate: Any means

by which individuals relate
their wants, needs, thoughts,
Welcome! You are beginning the study of a basic human need: the need to commu- feelings, and knowledge to
nicate. When two people are interacting, a message is always being communicat- another person.
ed, even when neither person is speaking. The old adage still holds true: We cannot
not communicate. Our ability to communicate is often taken for granted until we Communication disorder:
An impairment in the ability
have some difficulty communicating or see someone else having difficulty. This
to receive, comprehend, or
text is about the difficulties that children and adults of all ages (newborns to end of send messages, verbally,
life) have with communication disorders. As clinicians, we need to have a solid nonverbally, or graphically;
foundation in the understanding of the modalities of communication—that is, the any articulation, language,
various ways we communicate. Although speech-language pathologists (SLPs) voice, resonance, cognitive,
and audiologists focus on the auditory‒verbal modalities (hearing and speaking), or hearing impairment that
interferes with conveying
nonverbal modalities (body language and facial expressions) are also essential to or understanding a person’s
our ability to understand what a person is saying and communicate our own mes- wants, needs, thoughts,
sages in return. feelings, and knowledge.
In a way, good communication is like a dance in which each person takes
turns leading and following. The individuals try to stay “in step” with each other, Clinician: Healthcare,
rehabilitation, and educational
“reading” every nuance of choice of words, tone of voice, inflections (variations professionals, such as
of pitch during speech), pauses, hesitations, facial expressions, postures, and ges- physicians, nurses, physical
tures (i.e., total communication) so that the conversation has an easy and enjoy- therapists, occupational
able flow. When we meet someone new, it usually does not take long before we therapists, speech-language
decide whether we can “dance” well together and whether we even want to try to pathologists, audiologists,
psychiatrists, or psychologists,
dance again.
involved in clinical practice who
We use communication to survive and thrive in our homes, communities, base their practice on direct
schools, and work places. With a communication disorder, however, surviving and observation and treatment of
thriving can be much more difficult. patients and clients.
4 Chapter 1 Essentials of Communication and Its Disorders
INSIGHT ▸▸ The Study of Human Communication

QUESTION The evolution of communication from basic sounds and signs to more sophisti-
cated systems is one of the most important developments in human history. Cave
Much of your paintings of geometric symbols and animals, dated from more than 30,000 years
education in speech- ago, are among the earliest forms of communication designed to preserve human
language pathology experiences. More than 3000 years ago, Egyptians used pictographic hieroglyphs as
and audiology involves
a formal writing system, with symbols for words and letters of the Egyptian alpha-
learning professional
bet being carved into stone and later painted on papyrus.
terminology. How do
you feel about that? In the modern era, Wolfgang von Kempelen (1734–1804), a Hungarian author
and inventor, described, illustrated, and constructed mechanical devices that could
Modalities: Any sensory produce speech sounds for words. His devices (FIGURE 1-1) were composed of bel-
avenue through which lows for the lungs, a vibrating reed for the vocal folds, and a leather tube whose shape
information may be received, helped produce different vowel sounds, with constrictions controlled by fingers for
that is auditory, visual, tactile, generating consonants. To study the production of plosive sounds (e.g., p, b, t, d, k,
taste, and olfactory (smell). g), von Kempelen included movable “lips” and a hinged “tongue” in his device. The
Speech-language
device could produce intelligible whole words and short sentences. Von Kempelen
pathologist: A professional may be considered the first speech scientist (Gedeon, 2006).
who is specifically educated
and trained to identify,
evaluate, treat, and prevent
speech, language, cognitive,
▸▸ Communication Modalities
and swallowing disorders. Communication means conveying messages through one or more modalities
(FIGURE 1-2). We have three primary modes to receive communications: auditory,
Audiologist: A professional
who is specifically educated
visual, and tactile. Likewise, we have three primary modes to send communica-
and trained to identify, tions: verbal (including grunts and other noises), graphic (including writing and
evaluate, treat, and prevent illustrations), and gestural (including facial expressions, gestures, and body lan-
hearing disorders, plus select guage). As clinicians, we learn to be increasingly aware of the interactions of these
and evaluate hearing aids, modalities and the effects of subtle to complete breakdowns in these modalities.
and habilitate or rehabilitate
We normally think of communication as occurring between two or more peo-
individuals with hearing
impairments. ple; however, much of what we “hear” every day is us talking to ourselves. We
commonly have an internal monologue (known as inner speech or self-talk)
Inner speech/self-talk: going on inside our heads that we refer to as thinking. We silently (and sometimes
The nearly constant internal not so silently) talk to ourselves and even argue with ourselves, wrestling with
monologue a person has decisions ranging from the mundane (“Where am I going to have lunch?”) to the
with himself at a conscious profound (“What am I going to do with my life?”). Our verbal communication is
or semiconscious level that
involves thinking in words; a
conversation with oneself.
(a) (b)
FIGURE 1-1 Von Kempelen’s (1791) (a) “lungs” and “voice box” and (b) articulating mouth.
Courtesy of Deutsches Museum, Munich, Archive, CD29908; Courtesy of Deutsches Museum, Munich, Archive, BN37401.
Oral/Spoken Language 5
Visual
Visual Graphic
Gesture
Auditory
Oral
FIGURE 1-2 Modalities of communication.
mostly a reflection of our wants, needs, thoughts, feelings, and knowledge (i.e.,
sharing information).
However, spoken words may communicate only a small portion of a person’s
total message. SLPs and audiologists also need to become skilled in “reading” facial
expressions and nonverbal communication (Fogle, 2009). Burgoon, Guerrero, and
Floyd (2009) reviewed more than 100 studies on verbal (oral) and nonverbal (body
postures, gestures, eye contact, and facial expressions) communication and, among
other points, determined the following:
■■ Verbal content is more important for factual, abstract, and persuasive com-
munication; nonverbal content is more important for judging emotions and
attitudes.
■■ When verbal and nonverbal channels conflict, adults rely more on nonverbal
cues (i.e., people believe what they see more than what they hear).
When we think of communication disorders, we usually think of talking
and listening. Indeed, most of your education and training in speech-language Language: A socially shared
pathology and audiology will focus on these modalities. Nevertheless, because code or conventional system
communication may involve three primary language input modalities (audito- for representing concepts
through the use of arbitrary
ry, visual, and tactile) and three primary output modalities (verbal, graphic, and
symbols (sounds, letters,
gestural), SLPs and audiologists work with more than just speech and hearing. gestures), and rule-governed
Any or all of the input and output modalities may be involved in a communica- combinations of those
tion disorder. symbols.
Syllable: Either a single

vowel (V) or a vowel and one
▸▸ Oral/Spoken Language or more consonants (C); for
example V+ consonant (VC),
When sounds are organized into syllables and words are organized into gram- VCC, CV, CCV, CVC, etc.
matical sentences, spoken language is generated. Language has been defined as “a
Prosody (prosodic)/melody
socially shared code or conventional system for representing concepts through the (melodic): Voice inflections
use of arbitrary symbols [sounds and letters] and rule-governed combinations of used in a language such as
those symbols [grammar]” (Owens, 2015). Spoken language is our primary and stress, intensity, changes in
usually most efficient form of communication. There are approximately 7000 “liv- pitch, duration of a sound,
ing languages” (languages widely used as a primary form of communication by and rhythm that help listeners
understand the true intent of
specific groups of people) and an unknown number of dead or extinct languages
a message and that convey
(Lewis, 2015). the emotional aspects of a
Spoken language gives the listener not only the content (the words in the mes- message, such as happiness,
sage) but also the prosody (prosodic)/melody (melodic) that helps the listener sadness, fear, or surprise.
understand the true intent of the message by using voice inflections to empha-
size or deemphasize aspects of the spoken language (e.g., the difference between “I
scream” and “ice cream”). Prosody is important in conveying the emotional aspects
of messages, such as happiness, sadness, fear, and surprise. When we cannot see a
person’s face (e.g., while on the telephone), we usually can still discern the emotions
behind the messages based on the prosody.
Linguistics
Linguistics: The scientific study Linguistics is the scientific study of language, and linguists are individuals who
of the structure and function specialize in the study of linguistics. Traditionally, linguists divide language into
of language and the rules that several components: phonemes (sounds), morphemes (groups of sounds
govern language; includes
the study of phonemes,
that form words or parts of words), syntax (rules for combining words into
morphemes, syntax, semantics, sentences), semantics (meaning of the language or message), and pragmatics
and pragmatics. (the rules governing the use of language in social situations). Linguistic compe-
tence is a person’s underlying knowledge about the system of rules of a language.
Phonemes: The shortest
arbitrary unit of sound in Linguistic competence helps us recognize when a sentence is grammatically
a language that can be correct or incorrect.
recognized as being distinct
from other sounds in the
language.
Phonology
Phonology is the study of speech sounds (phonemes) and the rules for using
Morphemes: The smallest
unit of language having a
them to make words in a language. The English language has a limited number of
distinct meaning, for example, phonemes, but an almost limitless variety of sound combinations can be used in
a prefix, root word, or suffix. words and to make up new words. Each year, hundreds of words are added to our
language that must follow phonological rules. Consider, for example, all of the new
Syntax: The rules that dictate
the acceptable sequence, words that were created when televisions first arrived on the scene or when com-
combination, and function puters were being invented.
of words in a sentence; the For new words to be accepted by the public, certain phonological rules for
way in which words are put combining sounds must be followed. For example, a single letter is not used as a
together in a sentence to new word, nor is a combination of more than two consonants with no vowels.
convey meaning.
A combination of three or more vowels also is not considered to follow English
Semantics: The study phonological rules. Some foreign languages are difficult for English speakers to
of meaning in language learn because their phonologies use consonant and vowel combinations not used
conveyed by words, phrases,
in English. Also, many people trying to learn English as a second language find it
and sentences.
difficult because the pronunciation of a word may vary considerably depending on
Pragmatics: The rules the context, and the differences in the pronunciation can significantly change a
governing the use of word’s meaning. Examples include “He could lead if he got the lead out,” “The girl
language in social situations;
includes the speaker–listener
had tears in her eyes because of the tears in her dress,” and “Since there is no time
relationship and intentions like the present, he decided to present the present.”
and all elements in the Authors of fiction books sometimes create new words by following phonolog-
environment surrounding the ical rules of English. For example, J. R. R. Tolkien, in The Lord of the Rings trilogy,
interaction—the context. created a great number of new words, including hobbit, glede, and Fallohides. J. K.
Phonology: The study of Rowling, the author of the Harry Potter books, also created quidditch and muggle
speech sounds and the (muggle is now in the New Oxford English Dictionary). These words “sound like
system of rules underlying they could be words,” just as any new technical word must follow accepted English
sound production and sound phonological rules to eventually become part of our vocabulary (e.g., byte, mega-
combinations in the formation
of words.
byte, and telecommunication).
Speech: The production

of oral language using Morphology
phonemes for communication Morphology is the study of the way words are formed out of basic units of
through the process of language—morphemes. Morphemes are one or more letters or sounds that may
respiration, phonation,
be used as prefixes, such as uncomfortable; base (root) words, such as comfort; or
resonation, and articulation.
suffixes, such as able. When a morpheme is able to stand alone—that is, when it
Oral/Spoken Language 7
does not need any other morphemes attached to it to make it a true word—it is Consonant: Speech sounds
called a free morpheme (e.g., culture, accept, and comfort). Morphemes that cannot articulated by either stopping
the outgoing air stream or
stand alone and must be attached to a free morpheme are referred to as bound
creating a narrow opening
morphemes (e.g., prefixes such as pre-, dis-, and mis-; suffixes such as the plural of resistance using the
-s, the past tense -d, and the gerund -ing; and base words such as -celerate- and articulators.
audio-). TABLE 1-1 shows how prefixes, base words, and suffixes (morphemes) com-
Vowel: Voiced speech sounds
bine to make whole words. from the unrestricted passage
of the air stream through
Syntax the mouth without audible
stoppage or friction.
Syntax and morphology are the two major categories of language structure (i.e.,
grammar). Syntax refers to the rules for acceptable sequences (order) and word Context: The circumstances
or events that form the
combinations in sentences. Various languages have different word orders for sen- environment within which
tences. In an English declarative sentence, the subject comes before the verb: “David something exists or takes
is going to work.” However, when the subject (David) and the auxiliary or helping place; also, the words, phrases,
verb (is) are reversed in order, the sentence becomes a question: “Is David going to or narrative that come before
work?” English syntax has the adjective preceding the noun (e.g., the green room); and after a particular word or
phrase in speech or a piece of
in contrast, the syntax of Spanish and French has the adjective following the noun
writing that helps to explain its
(e.g., the room green). Most English sentences flow from subject to verb to objects full meaning.
or complements.
Native speakers of a language develop a “grammatical intuition” that helps Morphology: The study of
the structure (form) of words.
them recognize when a sentence is not quite grammatically correct, but they may
have some difficulty pinpointing or explaining what is not correct about it. When Grammar: The rules of the
people who have learned English as a second language are speaking, they may use use of morphology and syntax
in a language.
some incorrect word order or omit morphemes (e.g., the plural -s) that a native
speaker of English recognizes and may be a little uncomfortable with, feeling a
need to correct the non-native speaker.
Semantics
Semantics is the study of meaning in language that is conveyed by the words, INSIGHT
phrases, and sentences communicated. Semantics may be thought of as the content QUESTION
expressed by the speaker and the content understood by the listener. Miscommuni-
cation occurs when there is a discrepancy between the two. How good is your
Social and cultural factors play significant roles in the way we use and under- grammatical intuition;
stand language. For example, a word’s meaning in one region of the United States that is, how easily do
may be quite different from its meaning in another region. In many western regions you automatically
detect or recognize
of the United States, dinner is the evening meal; in contrast, in many midwestern
grammatical errors in
and southern regions, dinner is the noon meal and supper is the evening meal. In other people’s speech?
English-speaking countries, significant differences also can arise in the use of dif- In your own speech?
ferent words for the same thing. For example, in England a restroom is sometimes
TABLE 1-1 Examples of Whole Words, Prefixes, Base Words, and Suffixes
Whole Word Prefix Base Word Suffix
miscommunication mis communicate tion
indefensible in defense ible
disorienting dis orient ing

called a water closet (WC) and in Australia a napkin is a diaper. The differences in
the semantic use of words and the meanings of words can certainly affect commu-
nication, even among people who do not have communication disorders.
Pragmatics
Pragmatics comprises the rules governing the use of language in social situations.
Some elements included in pragmatics are the relationship of the people talking
(e.g., friend, relative, or stranger), the context or environment they are in (e.g.,
social versus business), and the intentions of the communication (e.g., friendliness
or hostility). The context in which a message is framed significantly affects its true
meaning. Pragmatics places greater emphasis on the functions of language than on
the structure of language.
Pragmatics is culturally based or influenced. For example, in some regions of
the world, such as the Middle East, an initial business meeting may be devoted to
sharing about family and friends, and the business may not be discussed until a
later meeting. Also, the beginning of each new business meeting may be devoted to
extended casual conversation rather than moving to the task at hand. When busi-
ness people do not know the cultural traditions of the people with whom they are
dealing, disastrous consequences may result.
▸▸ Reading and Writing

Many speech-language pathologists, particularly in the public schools, are involved
Literacy: The ability to in the area of literacy with children who have reading and writing problems. Read-
communicate through written ing and writing may be more challenging for the brain to process (mental or
language, both reading and
cognitive process) and, therefore, more difficult to develop than auditory‒verbal
writing.
abilities. In a way, we have two languages: listening‒speaking (auditory‒verbal or
process (mental or aural‒oral) and reading‒writing (visual‒graphic). The auditory‒verbal language is
cognitive process): developed in the early years of life; however, the reading‒writing language does not
The things individuals do
with their brains (minds)
normally start developing until the early years of schooling. Also, a person may
that involve attention, become verbal and be considered a good communicator, but that does not mean he
perception, memory, ideation, is an equally good reader or writer.
imagination, belief, reasoning,
use of language, volition,
emotion, and others; the
process of thinking.
▸▸ Disorders of Communication
When we listen to someone talk, we typically (consciously or subconsciously) pay
Articulation: The modifying attention or notice several features. We notice the person’s articulation and how
of the airstream (voiced clearly and easily we can understand him or her. We pay attention to the person’s
and unvoiced sounds) voice and whether we think it is appropriate for the person’s age and gender, and
into distinctive sounds of
a language to produce
whether it is relatively clear and pleasant. We hear whether a person has a resonance
speech. In speech-language problem and sounds like she is either “talking through her nose” or has a “stuffy
pathology, the movement of nose.” We listen for the person’s language skills and determine whether good syn-
the articulators (mandible, lips, tax is being used with a reasonably appropriate choice of words. We notice wheth-
tongue, and soft palate) to er the person’s speech is relatively fluent or whether she has unusual pauses and
produce sounds of speech.
hesitations, repetitions of sounds and words, or prolongations of sounds. We also
notice whether the person’s hearing is adequate when we are talking with her or
whether we have to speak more loudly than normal or repeat ourselves often. We
also may notice whether the person seems embarrassed or frustrated with her own
communication. In social conversations, when we notice problems in any of these
areas, we usually try not to let the speaker know that we are aware of them. However,
in our professional work as speech-language pathologists and audiologists, we need
to recognize, analyze, diagnose, and treat a person’s communication disorders.
Classification of Communication Disorders 9
Definitions
A communication disorder may be defined as an impairment in the ability to Disorder: As defined by the
receive, comprehend, or send messages, verbally, nonverbally, or graphically. Alter- World Health Organization
natively, based on the earlier definition of communication (i.e., any means by which (WHO), any loss or abnormality
of psychological, physiological,
individuals relate their wants, needs, thoughts, feelings, and knowledge to another or anatomical structure or
person), a communication disorder may be defined as any speech, language, cog- function that interferes with
nitive, voice, resonance, or hearing impairment that interferes with conveying or normal activities.
understanding a person’s wants, needs, thoughts, feelings, and knowledge.
As professionals, SLPs and audiologists try to maintain objectivity in their defi-
nitions of terms and diagnoses of communication disorders. In reality, the sub-
jective feelings of clients and patients and their listeners are what determine how
much a communication disorder actually affects an individual. Some individuals
have very negative reactions to even minor communication problems, whereas
others appear (or try to appear) remarkably tolerant, unconcerned, or unaware of
even fairly significant problems. In essence, a communication disorder can affect a
person’s quality of life, and the tasks of SLPs and audiologists are to habilitate or Quality of life: A global
rehabilitate our clients and patients to help improve their quality of life, and the concept that involves a
quality of life of their families. Note that the term handicap is generally avoided person’s standard of living,
personal freedom, and
when referring to communication disorders because of its negative connotations, the opportunity to pursue
with the terms disability and impairment now more commonly used. happiness; a measure of
a person’s ability to cope
successfully with the
Prevalence full range of challenges
The term prevalence refers to the estimated number of individuals diagnosed encountered in daily living;
with a particular disorder, disability, or disease at a given time in a region or coun- the characterization of health
concerns or disease effects on
try. The term incidence refers to the total number of new diagnoses of a disorder, a person’s lifestyle and daily
disability, or disease in the population of a region or country over a 1-year period functioning.
(or some other specified time span). The prevalence of disorders is more clinically
Habilitate: The process of
relevant and, therefore, more commonly reported than the incidence.
developing a skill or ability
It is nearly impossible to determine the precise prevalence of communication dis- to be able to function within
orders in the United States or any country. Moreover, general estimates likely under- the environment; the initial
count the number of individuals with these disorders, because not all c ommunication learning and development of
disorders are diagnosed or diagnosed with the same criteria, or systematically reported a new skill.
to calculate their totals. In the United States, one in seven children has a developmental, Rehabilitate: Restoration to
mental, or behavioral disorder that may involve speech, language, and/or cognition. normal or to as satisfactory a
More than 25% of all children with learning or physical disabilities also have one or status as possible of impaired
more communication disorders (e.g., speech, language, literacy, cognitive, and/or hear functions and abilities.
ing). Males are more likely to have communication disorders at all ages than females Handicap: As defined by the
(American Speech-Language-Hearing Association [ASHA], 2008a; Bitsko, Holbrook, World Health Organization
Robinson, et al., 2016; Catts & Kamhi, 2012). (WHO), loss or limitation of
opportunities to take part in
the life of the community on
▸▸ Classification of Communication Disorders an equal level with others;

a congenital or acquired
physical or intellectual
There are numerous approaches to classification of speech disorders and lan- limitation that hinders a
guage disorders. (In addition to the term disorder, clinicians often use the words person from performing
impairment or disability, or more colloquially, problem or difficulty.) In general, specific tasks.
communication disorders are divided into those affecting articulation (articulation
disorders, phonological disorders, and motor speech disorders), language (recep-
tive language and expressive language), fluency (stuttering and cluttering), voice
(aphonia and dysphonia), resonance (hypernasality and hyponasality), cognition
(developmental and acquired disorders), literacy (reading and writing disorders),
and hearing (conductive, sensorineural, and mixed losses) (FIGURE 1-3). Although
a swallowing disorder (discussed in the Swallowing Disorders/Dysphagia chapter) is
Disability: As defined by the Articulation disorders

World Health Organization
(WHO), any restriction or
lack of ability to perform an Articulation Phonological disorders
activity in the manner or
within the range considered
Motor speech disorders
normal for a human being; the
impairment, loss, or absence Receptive language disorders
of a physical or intellectual
function; physical disability is
Language
any impairment that limits the
physical functions of limbs or
gross or fine motor abilities; Expressive language disorders
sensory disability is impairment
of one of the senses (e.g., Stuttering
hearing or vision); intellectual
disability encompasses Fluency
intellectual deficits that
may appear at any age (e.g.,
following a severe TBI). Cluttering
Impairment: Any loss or Dysphonia

abnormality of psychological,
physiological, or anatomical
Voice
structure or function.
Prevalence: The estimated Aphonia

total number of individuals
Hypernasality
diagnosed with a particular
disorder at a given time in a
population, or the percentage Resonance
of people in a population with
the disorder.
Hyponasality
Incidence: The rate at which a
disorder appears in the normal Developmental disorders
population over a period,
typically 1 year. Cognition
Speech disorders: Any Acquired disorders

deviation or abnormality of
speech outside the range of Reading disorders
acceptable variation in a given
environment. Literacy
Language disorders: An
impairment of receptive Writing disorders
and/or expressive linguistic
symbols (morphemes, Conductive loss
words, semantics, syntax,
or pragmatics) that affects Hearing Sensorineural loss
comprehension and/
or expression of wants,
needs, thoughts, feelings, Mixed loss
or knowledge through the
verbal, written, or gestural FIGURE 1-3 Major categories of communication disorders.
modalities.
not technically a communication disorder, it is a major area of concern for SLPs,

particularly in medical settings.
SLPs and audiologists often try to determine dichotomies (i.e., either this
or that) when classifying disorders. For example, a disorder may be considered
c ongenital or acquired, organic or functional, an articulation disorder or a phono- Congenital disorders:

logical disorder, a receptive language disorder or an expressive language disorder, a A disorder that is present at
birth.
child communication disorder or an adult communication disorder, or a stroke or
traumatic brain injury, etc. In many cases, two or more disorders may occur con- Syndrome: A complex of
currently (i.e., a mixed, coexisting, or comorbid disorder), such as in a child who signs and symptoms resulting
has articulation and language disorders or in an adult who has both language and from a common etiology
or appearing together that
cognitive disorders. presents a clinical picture of a
Congenital disorders are those that are present at birth and are usually con- disease or inherited anomaly.
sidered either hereditary (e.g., some syndromes), problems caused during preg-
Acquired disorders: A
nancy (e.g., maternal drug or alcohol abuse), or a complication at birth (e.g., fetal
disorder that begins after
anoxia [no oxygen] or hypoxia [inadequate oxygen]). Acquired disorders are an individual has developed
those that begin after an individual has developed normal communication abilities, normal communication
such as a hearing loss from loud noise exposure, or a speech, language, or cognitive abilities, such as a hearing loss
disorder caused by a traumatic brain injury (TBI; head trauma). from loud noise exposure or a
When considering the etiology or cause of a disorder, some clinicians use speech, language, or cognitive
disorder caused by a traumatic
the terms functional disorder and organic disorder. A functional disorder is brain injury.
a problem or impairment that has some behavioral or emotional components but
no known anatomic, physiologic, or neurological basis. An organic disorder has an Traumatic brain injury (TBI)/
head trauma: An acquired
anatomic, physiologic, or neurological basis and may have behavioral or emotional
injury to the brain caused by
components. In some cases, it is difficult to clearly determine whether a disorder is an external force that results
purely or primarily an organic disorder or a functional disorder (organic disorders in partial or total functional
commonly have functional components). disability, including physical,
communication, cognitive, and
psychosocial impairments.
Disorders of Articulation
An articulation disorder is present when a child cannot correctly produce (say) Etiology: The cause of an
speech sounds used in the child’s language. Most articulation disorders are the re- occurrence (e.g., a medical
sult of inaccurate placement of the tongue. A phonological disorder is present problem that results in a
when errors occur in several phonemes, and these errors form patterns in which a disorder or disability).
child is simplifying individual sounds or combinations of sounds (i.e., the child is Functional disorder: A
unintentionally trying to make the sounds easier for himself to say). Approximately problem or impairment
92% of SLPs working in public schools report serving children with articulation or with no known anatomical,
phonological disorders (ASHA, 2010). physiological, or neurological
Motor speech disorders occur in some children (childhood apraxia of speech basis that may have behavioral
or emotional causes or
and dysarthria [e.g., with cerebral palsy]), but are more commonly observed in components.
adults. Motor speech disorders are the result of neurological impairments or differ-
ences that affect motor (i.e., movement) planning (programming), coordination, or Organic disorder: A problem
or impairment with a known
the strength of the articulators for the rapid and complex movements needed for
anatomical, physiological, or
smooth, effortless, and intelligible speech. In adults, motor speech disorders are neurological basis.
most often caused by strokes, TBIs, or neuromuscular diseases (i.e., diseases of the
nervous system that affect the muscles), such as Parkinson’s disease.
Articulation disorder:
The incorrect production of
Disorders of Language speech sounds due to faulty
placement, timing, direction,
Many children have difficulty developing normal language abilities, and these diffi-
pressure, speed, or integration
culties may become increasingly apparent as the child gets older and more sophis- of the movements of the
ticated language is expected. Adults who have had normal language all of their lives mandible, lips, tongue, or
may have acquired language impairments because of neurological disorders such velum.
as strokes or head injuries. Phonological disorder:
Errors of phonemes that form
Language Disorders in Children patterns in which a child
simplifies individual sounds or
Language disorders in children can vary greatly in how they manifest during language sound combinations.
development in both receptive language (how well a child understands what she
Motor speech disorder: hears) and expressive language (how well a child can verbally communicate her
Impaired speech intelligibility messages), with age of a child being a significant factor. Children who have difficulty
that is caused by a
neurological impairment
understanding language commonly have difficulty expressing themselves. Some chil-
or difference that affects dren are slow to develop language and may be considered to have a language delay,
the motor (movement) but then develop normal language. Parents often refer to these children as “slow talk-
planning or the strength of ers” and “late talkers.” Language disorders are associated with more than 75% of chil-
the articulators needed for dren who have learning disabilities (Barnes, Fletcher, & Fuchs, 2007).
rapid, complex movements in
Causes of language disorders may include hearing loss, traumatic brain injury,
smooth, effortless speech.
autism, various genetic syndromes, and intellectual disabilities. Most children with
Intelligible: The degree of such disorders have articulation disorders in conjunction with their language dis-
clarity with which an utterance orders or language delays (ASHA, 2008a). Approximately 90% of SLPs working
is understood by the average in schools report that they work with children who have language impairments
listener, which is influenced
by articulation, rate, fluency,
(ASHA, 2010).
vocal quality, and intensity Children’s culturally and linguistically diverse backgrounds can significantly
(loudness) of voice. affect their expressive language. However, expressive language affected by cultural
and linguistic diversity is not a disorder—it is a difference. Language differences
Receptive language: What
a person understands of what
are variations in speech and language production that are the result of a person’s cul-
is said. tural, linguistic, and social environments (Saad, 2009). When determining whether
a particular child’s language is a disorder or a difference, we must consider two
Expressive language: The
norms: General American English (GAE), also known as Standard American
words, grammatical structures,
and meanings that a person English (SAE), and the cultural norms of the child (Paul & Norbury, 2012). A 1983
uses verbally. American Speech-Language-Hearing Association position paper on social dialects
stated, “No dialect variety of English is a disorder or a pathological form of speech
Language delay: An
abnormal slowness in
or language. Each social dialect is considered adequate as a functional and effective
developing language skills variety of English” (p. 24).
that may result in incomplete
language development.
Language Disorders in Adults
Language difference: Impaired language in adulthood may be a continuation of the language problems
Variations in speech and of a child or adolescent. Nevertheless, we typically think of language disorders in
language production that adults as being acquired because of neurological impairments such as strokes and
are the result of a person’s head injuries. These adults have lived their entire lives, often at very high function-
cultural, linguistic, and social
ing levels, and then because of medical problems or accidents develop communi-
environments.
cation disorders that they could never have imagined. Damage to the brain’s left
General American English hemisphere can cause both language impairments (aphasia) and motor speech
(GAE)/Standard American disorders. It is estimated that between 5% to 10% of adults have neurological
English (SAE): The speech of
native speakers of American
impairments that result in language disorders (ASHA, 2008c).
English that is typical of
the United States and that
excludes phonological forms
Disorders of Fluency
easily recognized as regional Stuttering (disfluency) is likely the most common problem people think of when
dialects (e.g., Northeastern they think of a speech disorder. Probably most adults have encountered someone
or Southeastern) or limited who stutters, and the media (including cartoons) have parodied people who stutter
to particular ethnic or social
countless times. Stuttering is usually heard as repetitions of sounds, syllables, or
groups, and that is not
identified as a nonnative words; prolongations of sounds; and abnormal stoppages or “silent blocks” while a
American accent; the child or adult is talking. There can be visible tension and struggle behaviors, such as
norm of pronunciation by blinking the eyes, looking away just as the person begins to stutter, and a variety of
national radio and television facial grimaces and unusual arm, hand, and other body part movements. Stuttering
broadcasters. can be one of the most emotionally difficult communication disorders (Bloodstein &
Bernstein Ratner, 2008). Approximately 5% of preschool-age children have epi-
sodes of disfluency, and in the general population approximately 1% of school-age
children and adults stutter (Yairi & Ambrose, 2013).
Cluttering is considered a fluency disorder that shares some characteristics
of stuttering but differs in several important ways. Cluttered speech is a bnormally
fast, with omissions of sounds and syllables so that words sound compressed or Aphasia: An impairment in
truncated (reduced in length). A person who clutters has abnormal patterns of language processing that
may affect any or all input
pausing and phrasing, and has bursts of speech that may be unintelligible.
modalities (auditory, visual,
and tactile) and any or all
Disorders of Voice output modalities (speaking,
writing, and gesturing).
A voice disorder (dysphonia) occurs when the loudness, pitch, or quality (i.e.,
Stuttering (disfluency): A
“smoothness”) of a person’s voice is outside the normal range for the person’s age, gen-
disturbance in the normal flow
der, or the speaking environment, or when the voice is unpleasant to hear. Children and time patterning of speech
and adults can have severe voice disorders that leave them without a functional voice characterized by one of more
for communicating essential messages. Most voice disorders in children and adults of the following: repetitions
are diagnosed as dysphonias in which the person’s voice sounds rough, raspy, or of sounds, syllables, or words;
hoarse. Dysphonia may be caused by laryngitis, masses on the vocal folds (e.g., vocal prolongations of sounds;
abnormal stoppages or “silent
nodules [cheerleader’s nodules]), neurological damage that causes weakness of the blocks” within or between
vocal folds, or psychological causes, such as tension in the vocal mechanism words; interjections of
(larynx). Aphonia is a complete loss of voice, which is rare, and typically has unnecessary sounds or words;
psychological causes such as emotional stress. Following the complete loss of circumlocutions (talking
voice, the person may use whispering or writing to communicate and often avoids around an intended word); or
sounds and words produced
communicating. Voice disorders have been reported to occur in 6% to 23% of
with excessive tension.
children, and a lmost 30% of SLPs report that they serve children or adults with
voice disorders (ASHA, 2008a). Cluttering: Speech that is
abnormally fast with omission
Disorders of Resonance of sounds and syllables of
words, abnormal patterns
Resonance disorders involve abnormal structures or functioning of the hard and of pausing and phrasing,
soft palates (the roof of the mouth, front to back) that cause the voice to be directed and often spoken in bursts
into the oral cavity (mouth) for oral sounds or directed into the nasal cavities for that may be unintelligible;
frequently includes
nasal sounds (i.e., /m/, /n/, and “ng”). Most resonance disorders in children are the
abnormalities in syntax,
result of cleft palates, which have an overall prevalence of approximately 0.001% semantics, and pragmatics.
to 0.002% in the general population (i.e., 1 to 2 per 1,000 live births) (Peterson-
Falzone, Hardin-Jones, & Karnell, 2009). Voice disorder (dysphonia):
Any deviation of loudness,
Hypernasality is the result of clefts of the hard and soft palates or weakness pitch, or quality of voice that
of the soft palate. In hypernasality, oral consonants and vowels that should exit the is outside the normal range
mouth instead pass into the nasal passages, where they are resonated (i.e., increased of a person’s age, gender,
vibration and amplification of sounds). Listeners perceive the person’s speech as or geographic cultural
though the person is “talking through his nose.” Hyponasality (denasality) occurs background that interferes
with communication, draws
because of partial or complete obstruction of the nasal passages (e.g., enlarged
unfavorable attention to
adenoids), causing the /m/, /n/ and “ng” sounds to not have their normal nasal itself, or adversely affects the
resonance. Acquired resonance disorders in adults are usually the result of a weak speaker or listener.
soft palate that is caused by strokes and head injuries.
Dysphonia: A general term
that means a voice disorder,
Disorders of Cognition with the person’s voice
typically sounding rough,
Cognition is the act or process of thinking and learning that involves attention, raspy, or hoarse.
perception of stimuli, memory, organization and categorization of information,
Aphonia: A complete loss of
reasoning, judgment, and problem solving. Cognitive disorders in children voice followed by whispering
are usually associated with intellectual disabilities. The majority of children who for oral communication that
have intellectual disabilities also have mild to profound language delays, with typically has psychological
some children never developing functional language skills or the ability to live causes such as emotional
independently. Relatively intact cognitive abilities are important for development stress.
of both speech and language.
Adults may have acquired cognitive disorders, which are usually the result of
damage to the right hemisphere or the frontal lobes of the brain. Cognitive dis-
orders affect attention, perception of stimuli, organization and categorization
Resonance disorder: of information, memory, reasoning, judgment, and problem solving—in a

Abnormal modification of word, thinking. Mild to moderate TBIs can result in significant cognitive disor-
the voice by passing through
ders in individuals of all ages, and severe neurological impairments can result
the nasal cavities during
production of oral sounds in any combination of aphasia, motor speech disorders, and cognitive disorders.
(hypernasality) or not passing Approximately 1% to 2% of children and adults have TBIs that result in long-term
through the nasal cavities disability (Zaloshnja, Miller, Langlois, & Selassie, 2008).
during production of nasal Many elderly people develop dementia, a neurological disorder that is a pro-
sounds (hyponasality). gressive deterioration of cognitive functioning and personality. Alzheimer’s disease
Hypernasality: A resonance is just one form of dementia. Approximately 8% to 15% of people between 65 and
disorder that occurs when 70 years of age have some level of dementia; this percentage increases significantly
oral consonants and vowels with every additional 5 years of age (Plassman, Langa, Fisher, et al., 2007).
enter the nasal cavity because
of clefts of the hard and soft
palates or weakness of the Hearing Impairments
soft palate, causing a person
to sound like he is “talking Hearing is the foundation for development of speech and language. Hearing
through his nose.” impairments can cause numerous speech and language delays and disorders
in children that can affect them throughout their lives. Hearing loss is the most
Hyponasality (denasality):
Lack of normal resonance for common of all physical impairments. In infants and children, approximately 1 in
the three English phonemes, every 22 newborns in the United States has some kind of hearing problem, and
/m/, /n/, and /ng/ caused 1 in every 1000 infants has a severe to profound hearing loss. In addition, 83 out
by partial or complete of every 1000 school-age children have a significant hearing loss (ASHA, 2008b;
obstruction in the nasal tract. National Dissemination Center for Children with Disabilities, 2010). Approxi-
Cognition: The act or process mately 4.5% of adults 18 to 44 years of age, 14% of adults 45 to 64 years of age, and
of thinking or learning that 54% of adults 65 years of age and older have some degree of hearing loss (Pleis &
involves perceiving stimuli, Lethbridge-Cejku, 2007).
memory, abstraction,
Adults may acquire hearing impairments at any age from loud noises, medical
generalization, reasoning,
judgment, and problem problems that affect the ear, or the progressive hearing losses that often come with
solving; closely related to age. The two primary types of hearing impairments are conductive and sensorineu-
intelligence. ral. A conductive hearing loss is a decrease in the loudness of a sound because
Cognitive disorders: An
of poor conduction of sound through the outer or middle ear. Conductive hearing
impairment of attention, losses can have numerous causes, including malformations of the outer ear, occlu-
perception of stimuli (auditory, sion (blockage) of the ear canal from ear wax, damage to the eardrum or the three
visual, tactile, taste, smell), small bones in the middle ear, or middle ear infections.
memory, reasoning, judgment, In a sensorineural hearing loss, a reduction of hearing sensitivity occurs
and problem solving.
because of a disorder of the inner ear or the auditory nerve that carries the
information to the brain. This type of hearing loss typically results in d ifficulty
Dementia: A neurological
disease that causes
discriminating speech sounds. Infants may be born with sensorineural hearing
intellectual, cognitive, and losses, or they may develop losses in childhood because of infections such as
personality deterioration that measles, mumps, and chickenpox. In older children, adolescents, and young
is more severe than what adults, sensorineural hearing losses are often caused by listening to loud music
would occur through normal for long periods of time. (The most likely cause of hearing loss among teens and
aging.
college students is the use of MP3 and MP4 players and headphones or earbuds
that can present loud music to the ears without disturbing other people [ASHA,
Hearing impairment:
Abnormal or reduced function
2016; Moore, 2010]). In older adults, sensorineural hearing losses are common
in hearing resulting from an with advancing age.
auditory disorder.
Conductive hearing loss: A

reduction in hearing sensitivity
▸▸ Emotional and Social Effects
because of a disorder of the
outer or middle ear.
of Communication Disorders
Communication disorders can have untold emotional and social effects on people of
all ages. Many of these effects are likely undocumented and even u
nacknowledged
by the individuals. However, beyond the individuals with the communication
Chapter Review 15
isorders are the parents, grandparents, siblings, husbands and wives, and other
d Sensorineural hearing
family members who are bewildered and anguished by their loved one’s communi- loss: A reduction of hearing
sensitivity produced by
cation problems. A communication disorder affects a family—not just the person
disorders of the cochlea and/
who has it. Thus, it is essential to educate the family about the communication or the auditory nerve fibers
disorder that their loved one has (Flasher & Fogle, 2012; Tye Murray, 2012). Each of the vestibulocochlear (VIII
chapter in this text that deals with a disorder has a discussion of the emotional and cranial) nerve.
social effects of that disorder on the person and the family.
As clinicians, we always need to keep in mind the entire person (and the fam-
ily) with whom we are working, rather than focusing solely on the disorder the
person has. We need to place considerable importance on developing good, caring,
working relationships with clients and their families to optimally carry out therapy
and provide the necessary family education and training. Good people skills and
counseling skills are essential when working with clients of all ages and their fami-
lies (Flasher & Fogle, 2012).
Chapter Review
Chapter Summary is more important for judging emotions and
attitudes.
Speech-language pathologists and audiologists work
2. Explain how prosody helps us communicate.
with all areas of communication, including hearing,
3. Discuss the importance of good pragmatics
speaking, reading, writing, and nonverbal commu-
when working with clients and their families.
nication. We work with all areas of speech and lan-
4. Discuss how being familiar with the major
guage, including phonology, morphology, syntax,
categories of communication disorders could
semantics, and pragmatics. Communication disor-
be helpful in your personal life.
ders may affect articulation, language, fluency, voice,
5. Discuss the importance of appreciating and un-
resonance, cognition, and hearing. Communica-
derstanding the emotional and social effects of
tion disorders can have untold emotional and social
language disorders in children.
effects on children, adolescents, and adults, and their
families.
Analysis and Synthesis
Study Questions 1. Explain what is meant by this statement: “We
Knowledge and Comprehension cannot not communicate.”
2. Explain the differences between speech and
1. List the four speech systems. language.
2. Explain morphology. In two three-syllable 3. Compare the similarities and differenc-
words, indicate each morpheme. es of linguistic competence and grammatical
3. Define pragmatics and explain some of its intuition.
elements. 4. Discuss how determining dichotomies might
4. Define communication disorder. be helpful in diagnosing a speech or language
5. Explain receptive language and expressive disorder.
language. 5. Discuss how cognitive disorders in children
might affect their language abilities.
Application
1. When talking with clients and their families,
References
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behavioral, and developmental disorders in early childhood— Pleis, J. R., & Lethbridge-Cejku, M. (2007). Summary health
United States, 2011‒2012. Morbidity and Mortality Weekly statistics for U.S. adults: National Health Interview Survey,
Report, 65(9), 221‒226. 2006. National Center for Health Statistics. Vital Health
Bloodstein, O., & Berstein Ratner, N. (2008). Handbook on Statistics, 10(235), Table 11.
stuttering (6th ed.). Clifton Park, NY: Delmar Cengage Saad, C. (2009). Differences or disorders? ASHA Leader,
Learning. 14, 24‒25.
Burgoon, J. K., Guerrero, L., & Floyd, K. (2009). Nonverbal Tye Murray, N. (2012). Counseling for adults and children who
communication. New York, NY: Pearson. have hearing loss. In L. Flasher & P. Fogle, Counseling skills
Catts, H. W., & Kamhi, A. G. (2012). Language and reading for speech-language pathologists and audiologists (2nd ed.,
disabilities (3rd ed.). New York, NY: Pearson. pp. 287‒311). Clifton Park, NY: Delmar Cengage Learning.
Flasher, L. V., & Fogle, P. T. (2012). Counseling skills for speech- Yairi, E., & Ambrose, N. G. (2013). Epidemiology of stuttering:
language pathologists and audiologists (2nd ed.). Clifton Park, 21st century advances. Journal of Fluency Disorders, 38(2),
NY: Delmar Cengage Learning. 66‒87.
Fogle, P. T. (2009). Counseling skills: Recognizing and interpreting Zaloshnja, E., Miller, T., Langlois, J. A., & Selassie, A. W. (2008).
nonverbal communication (body language, gestures, and Prevalence of long-term disability from traumatic brain injury
facial expressions). Gaylord, MI: Northern Speech/National in the civilian population of the United States, 2005. Journal of
Rehabilitation Services. Head Trauma Rehabilitation, 23(6), 394–400.
CHAPTER 2
The Professionals
KEY TERMS
acute care hospital evidence-based practice (EBP) speech-language pathology assistant
American Speech-Language-Hearing inpatient (SLPA)
Association (ASHA) National Student Speech-Language- subacute hospital
clinical fellowship year (CFY) Hearing Association (NSSLHA) swallowing disorders (dysphagia)
convalescent hospital outpatient symptoms
diagnosis scope of practice telecommunication devices for the
evaluation (assessment) signs deaf (TDD)
LEARNING OBJECTIVES
After studying this chapter, you will be able to:
■■ List the people whom speech-language pathologists and audiologists help, beyond the clients and patients
directly receiving therapy.

■■ Explain the importance of the American Speech-Language-Hearing Association to the professions of speech-
language pathology and audiology.

■■ List the people who may be involved in the team approach in a school setting and a hospital setting.
■■ Explain the basics of the scope of practice of speech-language pathologists and audiologists.
■■ List the variety of work settings in which speech-language pathologists and audiologists practice.
CHAPTER OUTLINE
Introduction ■■ Audiology Organizations •• Scope of Practice
Beginning Your Study of Speech- ■■ Student Organizations Evaluation of
Language Pathology and Audiology Professional Ethics Communication and
A Brief History of the Professions The Team Approach Swallowing Disorders
Professional Organizations Communication Disorders Diagnosis of
■■ State Organizations Professionals Communication and
■■ International Organizations ■■ Speech-Language Pathologists Swallowing Disorders
(Continued)
17
18 Chapter 2 The Professionals
(Continued)
Treatment of •• Work Settings Chapter Review
Communication and •• Employment Outlook ■■ Chapter Summary
Swallowing Disorders ■■ Speech, Language, and Hearing ■■ Study Questions
•• Work Settings Scientists •• Knowledge and Comprehension

•• Employment Outlook ■■ Speech-Language Pathology •• Application
■■ Audiologists Assistants •• Analysis and Synthesis
•• Scope of Practice ■■ Audiology Assistants ■■ References
▸▸ Introduction
Speech-language pathology and audiology are wonderful professions filled with
caring and amiable professionals who serve interesting people with challenging
disabilities. You will likely find these professions to be increasingly fascinating
as you study them. In these fields, it eventually becomes nearly impossible to
separate the individual from the profession: The knowledge and skills you learn
as a speech-language pathologist or audiologist become an important part of
who you are as a person and how you interact and communicate with others.
▸▸ Beginning Your Study of Speech-Language

Pathology and Audiology
This text is designed to answer your questions about speech-language pathology
and audiology. As you journey through its chapters, you will likely recognize that
the scope of these professions is broader than you initially imagined. Speech-
language pathologists and audiologists learn and are concerned about people from
the moment of conception to their last breath of life. At every age, infants, chil-
dren, adolescents, young adults, middle-aged adults, and elderly adults may expe-
rience unique challenges that affect their speech, language, cognitive, hearing, and
swallowing functions. You will learn about many of these challenges through this
course and this text. If you decide to major in communication disorders, you will
learn about each of the areas introduced in this text in more depth. Conversely, if
you choose to take only this course, you will still find this information to be invalu-
able throughout your adult life.
Some clinicians believe that speech-language pathology and audiology are the
best majors for preparing students for adult life and parenthood. During their edu-
cation and training, students learn about the following subjects:
■■ Normal and abnormal development of infants and children
■■ How to work with children both on a one-on-one basis and in small groups of
two or three
■■ How to talk with children about what is bothering them as well as how to talk
with parents regarding their concerns about their children
■■ How to motivate children to work hard to improve their communication and
academic skills
■■ How to work with children who are fearful of failure and who need special care
to learn to trust you and themselves
■■ How to work with adults and elderly people with a variety of neurological
problems
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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)
The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.
NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.
MAKONDE LOCK AND KEY AT JUMBE CHAURO

This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]
MODE OF INSERTING THE KEY
With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
“We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
BRAZIER
Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT
SMOOTHING WITH MAIZE-COB
CUTTING THE EDGE

FINISHING THE BOTTOM
LAST SMOOTHING BEFORE

BURNING
FIRING THE BRUSH-PILE

LIGHTING THE FARTHER SIDE OF
THE PILE
TURNING THE RED-HOT VESSEL
NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK
DRAWING THE BARK OFF THE LOG
REMOVING THE OUTER BARK

BEATING THE BARK
WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT
MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN

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Essentials of Communication Sciences

& Disorders 2nd Edition, (Ebook PDF)

UNIT 4 Language and Cognitive Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

Disorders of Children 133 Chapter 10 Autism Spectrum Disorders and

Dysarthria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383 Chapter 20 Hearing Assessment,

Multicultural considerations are discussed in

▸▸ Audience Conceptual Approach to the Text

About the Author

■■ Briefly explain each of the major communication disorders.

•• Phonology ■■ Disorders of Language ■■ Study Questions

•• Morphology •• Language Disorders in Children •• Knowledge and

▸▸ Introduction Communicate: Any means

INSIGHT ▸▸ The Study of Human Communication

FIGURE 1-2 Modalities of communication.

Syllable: Either a single

Speech: The production

miscommunication mis communicate tion

indefensible in defense ible

disorienting dis orient ing

▸▸ Reading and Writing

▸▸ Classification of Communication Disorders an equal level with others;

Disability: As defined by the Articulation disorders

Impairment: Any loss or Dysphonia

Prevalence: The estimated Aphonia

Speech disorders: Any Acquired disorders

not technically a communication disorder, it is a major area of concern for SLPs,

c­ ongenital or acquired, organic or functional, an articulation disorder or a phono- Congenital disorders:

Resonance disorder: of ­ information, memory, reasoning, judgment, and problem solving—in a

Conductive hearing loss: A

directly receiving therapy.

language pathology and audiology.

•• Work Settings Scientists •• Knowledge and Comprehension

▸▸ Beginning Your Study of Speech-Language

Newala, too, suffers from the distance of its water-supply—at least

The water-supply of New Newala is in the bottom of the valley,

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAKONDE LOCK AND KEY AT JUMBE CHAURO

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

Some consolation was afforded me by a brassfounder, whom I

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

LAST SMOOTHING BEFORE

FIRING THE BRUSH-PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

MANUFACTURE OF BARK-CLOTH AT NEWALA

You might also like

UNIT 4 Language and Cognitive Chapter Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

Disorders of Children 133 Chapter 10 Autism Spectrum Disorders and

Dysarthria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383 Chapter 20 Hearing Assessment,

c ongenital or acquired, organic or functional, an articulation disorder or a phono- Congenital disorders:

Resonance disorder: of information, memory, reasoning, judgment, and problem solving—in a