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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
Evidence-Based Practice. . . . . . . . . . . . . . . . . . . . . . . . 253
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
Evidence-Based Practice. . . . . . . . . . . . . . . . . . . . . . . . 396
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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© nature photos/Shuterstock.

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.
Each chapter includes a summary that highlights
some of the basic concepts discussed.
Numerous study questions are also provided at
the end of each chapter that are based on Bloom’s
(1956) taxonomy of educational objectives. That is,
three general levels of question difficulty are presented
for each chapter: (1) knowledge and comprehension,
(2) application, and (3) analysis and synthesis. By
answering these questions, students can demonstrate
several levels of learning. Each chapter ends with an
extensive list of references that students may use to
research the information and concepts ­presented.
▸▸ New to the Second Edition
Several new and expanded chapters in this text dis-
cuss specific topics that were more briefly discussed in
large chapters in the first edition:
▸▸ Instructor and Student
Resources
There are some important, new support tools in the
second edition:
■■ Videos of most of the disorders discussed in the
book.
■■ Modifiable (customizable) PowerPoint slides for
each chapter. The author has created slides for
each chapter, which individual instructors can
build on.
■■ A Test Bank for each chapter. Beyond the end-
of-chapter study questions, the author has
­created a test bank of various kinds of questions
(true/false, multiple choice, short answer, essay)
with various levels of difficulty (easy, moderate,
­difficult).
Please visit www.go.jblearning.com/Fogle2e for addi-
tional information on how to access these resources.
xii Preface
▸▸ Audience
Some other groups of students (besides future SLPs
and audiologists) will find the Essentials text ­helpful—
students who take an introductory course in speech-­
language pathology and audiology who may not intend
to major in communication sciences and disorders.
During the years I taught the introductory course,
students from a wide range of majors took the course
because someone recommended it, it sounded interest-
ing, or it just fit into their schedules. Some of these stu-
dents find the information very interesting and change
their majors. For them, the course was serendipitous.
These students often brought into their new major
valuable perspectives from their past majors, such as
pre-medicine, pre-dentistry, pre-­pharmacy, education,
psychology, business, and many others. The professions
of speech-language pathology and audiology are all
the richer for welcoming students from other majors.
Nevertheless, students who take the introduction to
communication sciences and disorders course and do
not change their major will also benefit from having
an understanding of how this course and this text can
relate to their future professions and jobs, particularly
in education and the healthcare fields. In addition, stu-
dents later realize that much of what they learn can help
their personal lives as parents and possible caregivers
to family members. As instructors of the introductory
course, we know the information we present relates
to life in general, rather than just to the disciplines of
­speech-­language pathology and audiology.
Conceptual Approach to the Text
The conceptual approach to this text is based on sev-
eral considerations that are themes throughout the
chapters:
■■ First and foremost, Essentials is evidence based;
that is, it is built on the best available up-to-date
research on theories, assessment, and treatment of
the many disorders clinicians may encounter.
■■ The text has a life span approach, covering age
groups from newborns to individuals at the end
of life.
■■ A team approach is emphasized, with the most
important person on the team being the person
with the communication disorder.
■■ Therapy always involves working with the central
and peripheral nervous systems.
■■ People of all ages with communication impair-
ments often have emotional and social reactions
to their problems. As clinicians, we must work
with our clients and patients holistically; in other
words, we must work with the whole person and
not just the disorders that we diagnose and treat.
Likewise, the family members of our clients and
patients often experience their own emotional
and social effects from their loved one’s ­problems.
■■ There is a joy in being a therapist—a person in a
helping profession. As clinicians, we receive much
satisfaction from our work. People recognize that
we are excited about our work even after doing
therapy for many years.
© nature photos/Shuterstock.
Acknowledgments
This text emphasizes the team approach when working
with clients and patients. Likewise, the writing of this
text was a team approach, with many people contrib-
uting their time, energy, and talents to my education,
professional development, and ultimately this writing.
Mr. Rex Fisher, my high school biology and anat-
omy and physiology teacher, and eventually my friend,
introduced me to the fascinating study of science and
the human body. These lessons became the founda-
tions of my life’s work.
Dr. Joseph Sheehan and Mrs. Vivian Sheehan
inspired my interest in stuttering, trained me well at
the Psychology Adult Stuttering Clinic at the Univer-
sity of California, Los Angeles (UCLA), and encour-
aged me to pursue my doctorate in speech-language
pathology. Dr. Dean Williams, professor and expert in
stuttering at the Wendell Johnson Speech and Hearing
Center, University of Iowa, was my mentor and disser-
tation advisor. His statement to the students in one of
his classes remains an inspiration to me: “I hope all of
you find someone who helps you become more than
what you ever thought you could be.” Dr. Williams
was that person for me.
Dr. Marlene Salas-Provance contributed signifi-
cantly to the multicultural considerations material
throughout this text. Dr. Salas-Provance is an ASHA
Fellow and a recipient of ASHA’s Certificate of Rec-
ognition for Special Contributions in Multicultural
Affairs and ASHA’s Certificate of Recognition for Out-
standing Contributions in International Achievement.
She is past Coordinator of ASHA’s Special Interest
Group 14, Communication Disorders and Sciences
in Culturally and Linguistically Diverse Populations;
past president of the Hispanic Caucus, an ASHA-­
related professional organization; a founding steering
committee member and coordinator of ASHA’s Special
Interest Group 17, Global Issues in Communication
Sciences and Related Disorders; and a past member
of ASHA’s Multicultural Issues Board. She is a pro-
fessor and an Associate Dean of Academic and Stu-
dent Affairs in the School of Health Professions at the
University of Texas Medical Branch, ­Galveston. Dr.
Salas-Provance is also president and CEO of B ­ ilingual
Advantage, Inc., a medical interpreter training com-
pany. She has traveled worldwide with a medical team
serving children with cleft palate, spending the last
7 years developing sustainable services in Lima, Peru.
She is coauthor, with Dr. Yvette Hyter, of the 2017
textbook Culturally Responsive Practices in Speech,
Language, and Hearing Sciences.
Rotary International and Rotaplast International
Cleft Palate Teams provided opportunities for me to
travel to Venezuela, Egypt, and India to work with
infants, children, and adults with cleft lips and pal-
ates; photographs from those “missions” have been
included in this text. Rotary International sent me to
Oradea, Romania, in 2014 and 2017 to work with chil-
dren on the autism spectrum at the Pyramid Learn-
ing Center with Ioana Coromaki and her therapists.
The libraries of Macquarie University, Sydney,
Australia; Canterbury University, Christchurch, New
Zealand; and the University of Reading, Reading,
England, provided excellent facilities for research for
the international emphasis of this text.
Nancy Barcal, M.A., CCC-SLP, owner of Granite
Bay Speech in Roseville, California, generously pro-
vided the many clients for videotaping, and Kimberli
Door, B.S., SLPA, skillfully videotaped those clients,
allowing students to view children and adults with
various speech, language, and cognitive disorders.
United Cerebral Palsy of Sacramento, California,
allowed me to interview and videotape two of their adult
clients for students to better understand the adult lives
of individuals with cerebral palsy, both congenital and
acquired through a childhood traumatic brain injury.
Allen D. Sato is the person who keeps my comput-
ers working; without his help and support, the manu-
script for this text could not have been completed.
Laura Paglucia, Acquisitions Editor of Jones &
Bartlett Learning, who asked me to write the second
edition of this textbook, Mary Menzemer, Editorial
Assistant, Alex Schab, Associate Production Editor,
and Merideth Tumasz, Rights & Media Specialist, who
carefully worked with me throughout this project. All
of the excellent people at Jones & ­Bartlett Learning
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
© nature photos/Shuterstock.
About the Author
Paul T. Fogle, Ph.D.,
CCC-SLP (Fogle is pro-
nounced with a long o,
as in FO-GULL), has
been studying, training,
and working in speech-­
language pathology for
more than 45 years.
Although he earned all
of his degrees in speech-­
language pathology, he
minored in psychology
throughout each degree.
He earned his ­Bachelor
of Arts in 1970 and his Master of Arts in 1971, both at
­California State University, Long Beach. After receiving
his M.A., he worked for 2 years as an aphasia classroom
teacher for the Los Angeles County Office of Educa-
tion and started the first high school aphasia class in
California, teaching and working with adolescents
­ Pathology, and the Asia-Pacific Society for the Study
who had sustained traumatic brain injuries, strokes,
and other neurological impairments.
Between 1970 and 1973, Dr. Fogle worked as a
therapist at the University of California, Los Angeles
(UCLA) Psychology Adult Stuttering Clinic, ­training
under Dr. Joseph Sheehan and Mrs. Vivian S­ heehan.
Concurrently, he trained at Rancho Los Amigos
­Medical Center in Southern California performing
human brain autopsy.
Dr. Fogle earned his doctorate in 1976 from the
University of Iowa. He specialized in neurological
­disorders in adults and children and stuttering. His
dissertation was directed by Dr. Dean Williams and he
was awarded membership in Sigma Xi, the Scientific
Research Society of North America, for his research.
Although he minored in psychology throughout all of
his degrees, in the early 1990s, he began training in
counseling psychology, educational psychology, clin-
ical psychology, and family therapy (Marriage, Child,
Family Therapy). Most recently he has been studying
neuropsychology.
Dr. Fogle is a Professor Emeritus. During his 35
­ ndergraduate
years as a university professor he taught u
courses on Introduction to Speech-Language Pathol-
ogy and Audiology, Anatomy and Physiology of
Speech, Speech Science, and Organic Disorders.
At the graduate level, he taught Neurology and
Neurological Disorders in Adults, Motor Speech
­
Disorders, ­
­ Cerebral Palsy, Dysphagia/Swallowing
Disorders, Gerontology, Voice Disorders, Cleft Palate
and Oral‒Facial A ­ nomalies, and Counseling Skills for
Speech-Language Pathologists.
Dr. Fogle has worked extensively in hospitals,
including Veterans Administration Hospitals, univer-
sity hospitals, and acute, subacute, and convalescent
hospitals. He has maintained a year-round private
practice for more than 35 years. He has presented
numerous seminars, workshops, and short courses on
a variety of topics at state, ASHA, and international
conferences and conventions, including the Interna-
tional Association of Logopedics and Phoniatrics,
the International Conference on Speech-Language
of Speech-Language Pathology and Audiology.
Dr. Fogle has presented all-day workshops in cities
throughout the United States and in countries around
the world on counseling skills for speech-language
pathologists and audiologists, and on auditory process-
ing disorders and attention-deficit disorders. He has
worked on numerous medical‒legal cases as an expert
witness in several states for more than 30 years, testi-
fying in depositions, court hearings, and court trials.
Dr. Fogle’s primary publications have been
­textbooks and clinical materials. He is the author of
Foundations of Communication Sciences and Disorders
(Delmar Cengage Learning, 2008) and coauthor of
Counseling Skills for Speech-Language Pathologists and
Audiologists (first edition 2004, second edition 2012,
Delmar Cengage Learning), Ross Information Process-
ing Assessment-Geriatric (first edition 1996, second
edition 2012, Pro-Ed), the Classic Aphasia Therapy
Stimuli (CATS) (Plural Publishing, 2006), and The
Source for Safety: Cognitive Retraining for Independent
Living (LinguiSystems [now Pro-Ed], 2008). His web-
site is www.PaulFoglePhD.com and his email address
is paulfoglephd@gmail.com.
xv
© nature photos/Shuterstock.
Letter to Students
Dear Students,
Welcome! Thank you for purchasing this text for
the beginning of your study about the professions of
speech-language pathology and audiology. I hope you
find not just interest in the information, but a genuine
joy in its learning. If you do, there is a good chance
that joy will remain with you throughout your educa-
tion and life as you continue to learn about and work
in these remarkable professions.
You will find several themes throughout this text
that will help you in your learning and work as either a
speech-language pathologist or an audiologist.
First, our work always follows a team approach.
The most important person on the team is the person
with the communication disorder, because without
that person no other team members are needed.
Second, all of our therapy is “brain therapy.” In
other words, whether we are working with a child
or an adult with an articulation disorder, language
disorder, fluency disorder, neurological disorder, or
other disorder, we are working with neurons, axons,
dendrites, and synapses within the person’s brain to
change the muscles that relax and contract for specific
behaviors to occur. More subtly, when we are helping
people change their attitudes, beliefs, feelings, and
reactions toward their communication problems (e.g.,
stuttering), we are working with the brain.
xvi
Third, people of all ages with communication
impairments have emotional and social reactions
to their problems. A problem may be physical—for
example, a cleft palate or a hearing loss—but there are
always emotional and social effects of the problem. As
clinicians, we must work with our clients and patients
holistically—by addressing the whole person and not
just the disorders that we diagnose and treat. Likewise,
family members of our clients and patients commonly
have their own emotional reactions to their loved one’s
problems. The therapy we provide one person often has
subtle to profound effects on the lives of a constellation
of people. If you become a speech-language pathologist
or audiologist, you will touch countless lives.
Fourth, there is a joy to being a therapist, a person
in a helping profession. We give our time, energy, and
talents to others, but we receive back more than we give.
Yes, you can make a living and support yourself with
your profession. However, we go into our profession
and stay in it not so much because of the income we
derive from it, but because of the satisfaction we receive
from knowing that we have helped others have better
lives. Ultimately, that becomes our greatest reward.
I hope you enjoy reading and studying this text as
much as I enjoyed writing it for you.
Best Wishes, Paul T. Fogle, Ph.D., CCC-SLP
www.PaulFoglePhD.com
 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
© nature photos/Shuterstock.
© nature photos/Shuterstock.

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.
6 Chapter 1 Essentials of Communication and Its Disorders
Linguistics: The scientific study
of the structure and function
of language and the rules that
govern language; includes
the study of phonemes,
morphemes, syntax, semantics,
and pragmatics.
Phonemes: The shortest
arbitrary unit of sound in
a language that can be
recognized as being distinct
from other sounds in the
language.
Morphemes: The smallest
unit of language having a
distinct meaning, for example,
a prefix, root word, or suffix.
Syntax: The rules that dictate
the acceptable sequence,
combination, and function
of words in a sentence; the
way in which words are put
together in a sentence to
convey meaning.
Semantics: The study
of meaning in language
conveyed by words, phrases,
and sentences.
Pragmatics: The rules
governing the use of
language in social situations;
includes the speaker–listener
relationship and intentions
and all elements in the
environment surrounding the
interaction—the context.
Phonology: The study of
speech sounds and the
system of rules underlying
sound production and sound
combinations in the formation
of words.
Speech: The production
of oral language using
phonemes for communication
through the process of
respiration, phonation,
resonation, and articulation.
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 is the scientific study of language, and linguists are individuals who
specialize in the study of linguistics. Traditionally, linguists divide language into
several components: phonemes (sounds), morphemes (groups of sounds
that form words or parts of words), syntax (rules for combining words into
­sentences), semantics (meaning of the language or message), 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.
Linguistic competence helps us recognize when a sentence is grammatically
­correct or incorrect.
Phonology
Phonology is the study of speech sounds (phonemes) and the rules for using
them to make words in a language. The English language has a limited number of
phonemes, but an almost limitless variety of sound combinations can be used in
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
words that were created when televisions first arrived on the scene or when com-
puters were being invented.
For new words to be accepted by the public, certain phonological rules for
combining sounds must be followed. For example, a single letter is not used as a
new word, nor is a combination of more than two consonants with no vowels.
A combination of three or more vowels also is not considered to follow English
phonological rules. Some foreign languages are difficult for English speakers to
learn because their phonologies use consonant and vowel combinations not used
in English. Also, many people trying to learn English as a second language find it
difficult because the pronunciation of a word may vary considerably depending on
the context, and the differences in the pronunciation can significantly change a
word’s meaning. Examples include “He could lead if he got the lead out,” “The girl
had tears in her eyes because of the tears in her dress,” and “Since there is no time
like the present, he decided to present the present.”
Authors of fiction books sometimes create new words by following phonolog-
ical rules of English. For example, J. R. R. Tolkien, in The Lord of the Rings trilogy,
created a great number of new words, including hobbit, glede, and Fallohides. J. K.
Rowling, the author of the Harry Potter books, also created quidditch and muggle
(muggle is now in the New Oxford English Dictionary). These words “sound like
they could be words,” just as any new technical word must follow accepted English
phonological rules to eventually become part of our vocabulary (e.g., byte, mega-
byte, and telecommunication).
Morphology
Morphology is the study of the way words are formed out of basic units of
­language—morphemes. Morphemes are one or more letters or sounds that may
be used as prefixes, such as uncomfortable; base (root) words, such as comfort; or
­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

8 Chapter 1 Essentials of Communication and Its Disorders
Literacy: The ability to
communicate through written
language, both reading and
writing.
process (mental or
cognitive process):
The things individuals do
with their brains (minds)
that involve attention,
perception, memory, ideation,
imagination, belief, reasoning,
use of language, volition,
emotion, and others; the
process of thinking.
Articulation: The modifying
of the airstream (voiced
and unvoiced sounds)
into distinctive sounds of
a language to produce
speech. In speech-language
pathology, the movement of
the articulators (mandible, lips,
tongue, and soft palate) to
produce sounds of speech.
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
in the area of literacy with children who have reading and writing problems. Read-
ing and writing may be more challenging for the brain to process (mental or
cognitive process) and, therefore, more difficult to develop than auditory‒verbal
abilities. In a way, we have two languages: listening‒speaking (auditory‒verbal or
aural‒oral) and reading‒writing (visual‒graphic). The auditory‒verbal language is
developed in the early years of life; however, the reading‒writing language does not
normally start developing until the early years of schooling. Also, a person may
become verbal and be considered a good communicator, but that does not mean he
is an equally good reader or writer.
▸▸ Disorders of Communication
When we listen to someone talk, we typically (consciously or subconsciously) pay
attention or notice several features. We notice the person’s articulation and how
clearly and easily we can understand him or her. We pay attention to the person’s
voice and whether we think it is appropriate for the person’s age and gender, and
whether it is relatively clear and pleasant. We hear whether a person has a resonance
problem and sounds like she is either “talking through her nose” or has a “stuffy
nose.” We listen for the person’s language skills and determine whether good syn-
tax is being used with a reasonably appropriate choice of words. We notice wheth-
er the person’s speech is relatively fluent or whether she has unusual pauses and
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
Another random document with
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 Eliza Ripley

We sat, to rest, on benches in the old Place d’Armes. I looked at

those Pontalba buildings, that faded, dilapidated, ramshackle row,
and remembered how fine and imposing it was, in my day, and how I
had wished that father would take one of those elegant houses,
where we would be so near the French market, and the shop of
beads and shells, and monkeys and parrots.
We strolled up Royal Street, and the little girl saw the house in
which the Boufords lived, sixty years ago. The saucy child ventured
to remark she always had thought I visited nice people, but they
must have lived in shabby houses. I did not notice her comment, but
proceeded to point to the balcony where I stood to see a Mardi Gras
procession, a frolicsome lot of the festive beaux of the period, and to
catch the bonbons and confetti they threw at us from the landeaus
and gaily decked wagons. It was long after the Mardi Gras of the
thirties, and long, long before the Mardi Gras of to-day, a kind of
interregnum, that the young fashionable men were turning into a
festival. I recall Mrs. Slocomb’s disgust when Cuthbert fell ill of
pneumonia, after his exposure that day. Cuthbert Slocomb was
chubby and blond, and with bare neck and short sleeves, tied up
with baby blue ribbon, a baby cap similarly decorated, he made a
very good counterfeit baby, seated, too, in a high chair, with a rattle
to play with. The “mamma” had long black ringlets and wore a
fashionable bonnet. I have forgotten, if in fact I ever knew, what
youth represented the mamma. There were no masks, but the
disguises with paint, powder and wigs were sufficient to make them
unrecognizable. If Cuthbert Slocomb had not been ill, I probably
would not have known the “baby.”
 A New Orleans Cemetery.

During that visit I went to the cemetery Decoration Day. Mind you,
I have seen about forty Decoration days, North—but this one in my
own Southland, among my own beloved dead, has been the only
Decoration Day I have ever seen in a cemetery. (I wish my feelings
were not quite so strong.) Phine and I stood beside the tomb that
contains the dust of Gen. Albert Sidney Johnston, a man I had
known well, a contemporary and valued friend of my father’s, a man
whose children and grandchildren were dear to me. We saw the
solemn procession file in, and halt a little beyond us. The band
played “Nearer, My God, to Thee,” and hundreds of voices joined in
the musical prayer. I could not sing, I never could, but I could weep,
and my eyes were not the only moist ones in the assembly. Such a
throng of sober, sad people there was, such a lot of veterans, many
in shabby, weather-stained gray, that bore evidence of hard
service....
Phine had kept track of the people from whom I had been so long
separated that age had obliterated means by which I could recognize
them. As a veteran, in the shabby old gray (I felt like taking everyone
such by the hand), approached, Phine caught my arm and
whispered “Douglas West,” and at the same moment his eye met
mine with a flash of recognition. I had not seen Douglas for over
thirty years. And weren’t we glad to meet? on that ground, too, so
sacred to both of us. And didn’t we meet and meet and talk and talk,
many times thereafter, in Phine’s dear little parlor on Carondelet
Street? Indeed, we did.
Later on, Phine whispered, “You knew that man, I’ll tell you who he
is after he passes us.” A quite tottering, wrinkled, old man passed. I
gave him a good stare, shook my head. I did not know, nor think I
ever had known him. It was A. B. Cammack—who would have
believed it? He was a bachelor in 1850, the time when I thought a
man of thirty was an old man. We happened to be fellow passengers
on that fashionable A No. 1 steamboat, Belle Key. I was a frisky
young miss, and Mr. Cammack was, as I say, an old bachelor. He did
not know, nor want to know anybody on the boat, but it happened he
was introduced to our small party, at the moment of sailing, so we
had a reluctant sort of bowing acquaintance for the first day or so.
Broderie Anglaise was all the rage. Any woman who had time for
frivolité, as the Creoles called tatting, was busy working eyelets on
linen. Of course I had Broderie, too. Mr. Cammack gradually thawed,
and brought a book to read to me while my fingers flew over the
fascinating eyelets. The book, I distinctly remember, was “Aunt
Patsy’s Scrap Bag,” a medley of silly nonsensical stuff, written by a
woman so long dead and so stupid while she lived that nobody even
hears of her now, but Mr. Cammack was immensely entertaining and
witty, and we roared over that volume, and his comments thereon. I
have often dwelt on that steamboat episode, but I doubt if it ever
gave him a moment’s thought. I really think if it had been like my
meeting with Douglas West we might have had quite a bit of fun,
living again that week on the Belle Key. A hearty laugh, such as we
had together, so many years before, might have smoothed some of
the wrinkles from his careworn face, and a few crow’s feet out of
mine. But he never knew, possibly would not have cared if he had
known, that we almost touched hands in the crowd on that
Decoration Day.
 On and on we strolled, past a grand monument to the memory of
Dr. Choppin, whom I knew so well, and loved too, girl fashion, when
he was twenty, and who sailed away, boy fashion, to complete his
medical education in Paris. Maybe if we had met, in the flesh, on that
Decoration Day, it might have been a la Cammack. We never did
meet, after that memorable sailing away, but he has a tender niche
in my heart even yet, and I was pleased to see some loving hand
had decorated that sacred spot....
Phine and I strolled about after the ceremonies were completed.
She had a toy broom and a toy watering pot in the keeper’s cottage,
and was reluctant to leave before she had straightened and
freshened the bouquets we had placed on the tombs of the dead she
loved, and swept away the dust, and watered the little grass border
again.
A year ago she herself fell asleep and was laid to rest in the lovely
cemetery, and with her death the last close tie was broken that
bound me to New Orleans.
 Eliza Moore, tenth of the twelve children of Richard Henry and
Betsey Holmes Chinn, was born in Lexington, Kentucky, on the first
day of February, 1832.
Three years later Judge Chinn moved his family to New Orleans,
where he continued the practice of law until his death in ’47.
On August 24, 1852, Eliza Chinn and James Alexander McHatton
were married in Lexington, and for ten years thereafter they lived at
Arlington plantation on the Mississippi, a few miles below Baton
Rouge, leaving hastily in ’62, upon the appearance of Federal
gunboats at their levee.
During the remainder of the war they lived almost continuously in
army ambulances, convoying cotton from Louisiana across Texas to
Mexico.
In February, 1865, they went to Cuba, and lived there until the
death of Mr. McHatton, owning and operating, with mixed negro and
coolie labor, a large sugar plantation—“Desengaño.”
After her return to the United States Mrs. McHatton was married to
Dwight Ripley, July 9, 1873, and the remainder of her life was
passed in the North. In 1887 Mrs. Ripley published “From Flag to
Flag”—a narrative of her war-time and Cuban experiences, now out
of print.
The reminiscences which make up the present volume have been
written at intervals during the last three or four years. The final
arrangements for their publication were sanctioned by her the day
before she passed away—on July 13, 1912, in the eighty-first year of
her age.
E. R. N.

UNLIKE ANY OTHER BOOK.

A Virginia Girl in the Civil War.

 Being the Authentic Experiences of a Confederate Major’s Wife
who followed her Husband into Camp at the Outbreak of the War.
Dined and Supped with General J. E. B. Stuart, ran the Blockade to
Baltimore, and was in Richmond when it was Evacuated. Collected
and edited by Myrta Lockett Avary. 12mo. Cloth, $1.25 net;
postage additional.
“The people described are gentlefolk to the back-bone, and the reader must be
a hard-hearted cynic if he does not fall in love with the ingenuous and delightful girl
who tells the story.”—New York Sun.
“The narrative is one that both interests and charms. The beginning of the end of
the long and desperate struggle is unusually well told, and how the survivors lived
during the last days of the fading Confederacy forms a vivid picture of those
distressful times.”—Baltimore Herald.
“The style of the narrative is attractively informal and chatty. Its pathos is that of
simplicity. It throws upon a cruel period of our national career a side-light, bringing
out tender and softening interests too little visible in the pages of formal history.”—
New York World.
“This is a tale that will appeal to every Southern man and woman, and can not
fail to be of interest to every reader. It is as fresh and vivacious, even in dealing
with dark days, as the young soul that underwent the hardships of a most cruel
war.”—Louisville Courier-Journal.
“The narrative is not formal, is often fragmentary, and is always warmly
human.... There are scenes among the dead and wounded, but as one winks back
a tear the next page presents a negro commanded to mount a strange mule in
midstream, at the injustice of which he strongly protests.”—New York Telegram.
“Taken at this time, when the years have buried all resentment, dulled all
sorrows, and brought new generations to the scenes, a work of this kind can not
fail of value just as it can not fail in interest. Official history moves with too great
strides to permit of the smaller, more intimate events; fiction lacks the realistic,
powerful appeal of actuality; such works as this must be depended upon to fill in
the unoccupied interstices, to show us just what were the lives of those who were
in this conflict or who lived in the midst of it without being able actively to
participate in it. And of this type ‘A Virginia Girl in the Civil War’ is a truly admirable
example.”—Philadelphia Record.

D. APPLETON AND COMPANY, NEW YORK.

THE GREATEST LIVING ACTRESS.

Memories of My Life.
By Sarah Bernhardt. Profusely illustrated. 8vo. Ornamental
cloth, $4.00 net; postage 30 cents additional.
The most famous of living actresses, Sarah Bernhardt has lived
life to the full as a builder and manager of theatres, author, painter
and sculptor. She turned her theatre into a hospital during the Siege
of Paris. She played French classics in a tent in Texas. She wrote
“Memories of My Life” with her own hand, and with her own
inimitable verve.
“Great is Bernhardt, and great is any true description of her life, for nothing more
fascinatingly brilliant could have come from the mind of the most daring of
fictionists. The autobiography is as interesting to those who care nothing for the
theatre as to those devoted to it.”—Baltimore Sun.
“It is the work of a genius which feels and sees with instinctive insight and
understanding, and puts into words such a bright and varied panorama of life as it
has been given to few authors to portray.”—Cleveland Plain Dealer.
“Out of an overflowing reservoir of reminiscence the author pours out a flood of
anecdote and of dramatic story, and she always gives the idea that she is only
skimming the surface and that other treasures lie always below.”—San Francisco
Argonaut.
“The book is interesting and entertaining from cover to cover, and is related with
a vivacity that is engaging.”—Toledo Blade.
“The eventful life lived by Madame Bernhardt both on and off the stage is told
with great charm. Not only has the greatest actress of her generation more to tell
than the majority of persons who write memoirs, but she has the gift of recounting
the things that have befallen her with a real literary skill.”—Publishers’ Weekly.

D. APPLETON AND COMPANY, NEW YORK.

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