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Library of Congress Cataloging‐in‐Publication Data
Names: Damico, Jack S., 1952– editor. | Müller, Nicole, 1963– editor. | Ball, Martin J. (Martin John), editor.
Title: The handbook of language and speech disorders / edited Jack S. Damico, Nicole Müller, and Martin J. Ball.
Description: Second edition. | Hoboken, NJ : Wiley-Blackwell, 2021. | Series: Blackwell handbooks in linguistics | Includes bibliographical references and index.
Identifiers: LCCN 2021000253 (print) | LCCN 2021000254 (ebook) | ISBN 9781119606963 (hardback) | ISBN 9781119606970 (adobe pdf) | ISBN 9781119606994 (epub)
Subjects: LCSH: Speech disorders. | Language disorders. | Communicative disorders.
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List of Figures
3.1 Age‐related hearing loss not caused by disease, noise or substance exposure, as described in ISO 7029 (2012) for 40, 60 and 80 years of age. Data are the means from the male and female values: thick line is the median; boxes are the 25th and the 75th percentiles; and, whiskers are the 10th and the 90th percentiles. 54
3.2 Descriptive model of an average postlingually deafened CI candidate showing auditory performance as a function of hearing ability over the entire patient journey. The duration of the decline of moderate hearing loss (mHL) and severe/profound hearing loss (s/p HL) is assumed to be 20 and 10 years, respectively. 59
6.1 Concentric circles of influence that impact quality of life. 113
8.1 Data from 4,867 parent reports on their (US) children’s performance on the Words and Sentences form of the MBCDI. 155
8.2 Language Development Scale scores by family background for 132 UK children at 42 months. 156
14.1 The Wernicke-Lichtheim model. 290
14.2 The cognitive neuropsychological information processing model. 291
19.1 Trends in recovery from stuttering. Note the rapid decrease in stuttering for the “recovered group” (●), while a slower decrease is noted for the “persistent group” (◆). The control group shows little change (△). 427
19.2 The demands and capacities model—whenever demand exceeds capacity, stuttering can occur. 431
21.1 Main categories of cleft lip and/or palate. 469
21.2 Consonant errors typical of speech in children born with cleft palate (cleft speech characteristics). Palate in rest position for anterior and posterior CSCs. 473
22.1 The double sigmoid curve model illustrates the fine balance between tumor control and long-term radiation side-effects. As the radiation dose increases over time, the cells in the radiated tissue start dying. This process can be expressed as a sigmoid function. The tumor cells are more vulnerable to the radiation. However, the surrounding healthy tissue is also stressed by the radiation. The double sigmoid
viii List of Figures
curve model allows the radiation oncologist to determine a theoretical cutoff point at which the tumor is largely controlled but the side-effects are still tolerable for the patient. 499
22.2 Permanent tracheostoma following total laryngectomy. 502
22.3 Tracheostoma cover. 503
22.4 Heat and moisture exchanger (“artificial nose”). 504
22.5 Transcervical electrolarynx. 505
22.6 Sound production with a transcervical electrolarynx. 506
22.7 Position of the transcervical electrolarynx on the neck. 507
22.8 An oral electrolarynx. The metal box contains the batteries and the controls for the external oscillator. A tube is used to transmit the sound from the oscillator into the oral cavity. 507
22.9 Sound production with an oral electrolarynx. 508
22.10 A laryngectomee using an oral electrolarynx. 508
22.11 Production of esophageal speech. (a) Air is injected into the upper esophagus by building up pressure in the oral cavity. (b) As the air is ejected from the upper esophagus, it vibrates the upper esophageal sphincter and generates sound. 510
22.12 Sound production using a tracheoesophageal voice prosthesis. 512
22.13 Tracheoesophageal voice prostheses. 513
22.14 A large lateral lingual carcinoma. 516
22.15 Comparison of two patients with lateral lingual resections of similar sizes. (a) Reconstruction using a local closure approach. (b) Reconstruction using a radial forearm free-flap. 517
22.16 Patient with an extensive velopharyngeal resection. 520
22.17 Speech bulb appliance. 520
22.18 Patient with an extensive facial resection, including exenteration of the right eye. 521
Notes on Contributors
Hermann Ackermann has a Master’s degree in philosophy and psychology, and a medical degree (speciality: clinical neurology and neurophysiology). Besides his clinical training in the field of neurology, he did postgraduate work, especially on Parkinsonian and cerebellar dysarthria in the laboratory of Professor Wolfram Ziegler, Departments of Neuropsychology at the Max Planck Institute for Psychiatry, and the City Hospital Bogenhausen, Munich. Since 1996, he has been Professor of Neurological Rehabilitation at the Medical School, University of Tübingen, and head of the Research Group Neurophonetics at the HERTIE‐Institute for Clinical Neurosciences, University of Tübingen. He is also head of the Department of Neurological Rehabilitation at the Rehabilitation Center Hohenurach, Bad Urach, associated with the University of Tübingen. His research focuses on the brain correlates of speech production and speech perception, using functional magnetic resonance imaging and magnetoencephalography.
Elena Babatsouli is an Assistant Professor in the Department of Communicative Disorders at the University of Louisiana at Lafayette, the founding co‐editor of the Journal of Monolingual and Bilingual Speech, President of the Association of Monolingual and Bilingual Speech, and founder of the International Symposium on Monolingual and Bilingual Speech. She received a BA in English from Royal Holloway, University of London, an MA in Languages and Business from London South Bank University, and a PhD in Linguistics from the University of Crete. Elena’s research interests are on child/adult bilingual and monolingual (cross‐linguistically) phonological acquisition and assessment, second‐language acquisition, speech sound disorders, culturally responsive practices in speech and language sciences, phonetics/phonology, morphology, psycholinguistics, clinical linguistics, and measures/quantitative methods. She has thirty publications, five edited books, three conference proceedings, and two edited special issues in journals.
Martin J. Ball is Honorary Professor of Linguistics at Bangor University, Wales, having previously held positions in Wales, Ireland, the US, and Sweden. He holds a PhD from the University of Wales, and a DLitt from Bangor University. He
co‐edits the journals Clinical Linguistics and Phonetics and Journal of Multilingual and Bilingual Speech, as well as book series for Multilingual Matters and Equinox Publishers. He has published widely in communication disorders, phonetics, sociolinguistics, bilingualism, and Welsh linguistics. Recently he completed co‐editing the four‐volume Encyclopedia of Human Communication Sciences and Disorders for Sage publishers. He is an honorary fellow of the Royal College of Speech and Language Therapists, and a fellow of the Learned Society of Wales. He currently lives in Cork, Ireland.
Margaret Lehman Blake, PhD, CCC‐SLP, is a Professor in the Department of Communication Sciences and Disorders at the University of Houston. She earned her PhD from the University of Pittsburgh and completed a postdoctoral fellowship at the Mayo Clinic. Her research focuses on cognitive‐communication disorders associated with right hemisphere brain damage (RHD), to understand the underlying deficits and to develop treatments. She has authored many articles, chapters, and the book The Right Hemisphere and Disorders of Cognition and Communication. She has presented nationally and internationally on evidence‐based practice for disorders associated with RHD. She is a recipient of the University of Houston Teaching Excellence Award and has served as the President of the Academy of Neurologic Communication Disorders & Sciences (ANCDS).
Stephanie A. Borrie, PhD, is an Associate Professor of Communication Disorders at Utah State University. She is also the director of the Human Interaction Lab, which takes a dyadic approach to the study of speech communication. Her research investigates how listeners understand and adapt to speakers with dysarthria, laying the groundwork for listener‐targeted interventions to improve intelligibility of dysarthric speech. She also investigates the coordinative nature of spoken dialog, extending the study of speech impairment to the realm of conversation. Her research is currently funded by the National Institutes of Health, National Institute on Deafness and other Communication Disorders (USA). She serves as an editor for the Journal of Speech, Language, Hearing Research, a journal of the American Speech, Language, and Hearing Association.
Christine Brennan is an Assistant Professor in the Department of Speech, Language, and Hearing Sciences at the University of Colorado, Boulder, where she is also a member of the Institute of Cognitive Science and Intermountain Neuroimaging Consortium (INC). She holds a PhD and a clinical MA from Northwestern University, Illinois. She is a certified speech‐language pathologist and a cognitive neuroscientist. As the director of the ANCHAR Lab (Applied Neuroscience for Communication, Hearing, And Reading), her current research examines the relationship between speech sound processing and reading skill in children and adults with and without reading disabilities. She also engages in research examining clinical outcomes for children and adults with various types of learning disabilities, including developmental and intellectual disabilities. Presently, she is the only speech‐language pathologist serving on the professional
advisory board for the PRISMS (Parents and Researchers Interested in Smith‐Magenis Syndrome) organization. She lives in Louisville, Colorado.
Tim Bressmann is an Associate Professor in the Department of Speech‐Language Pathology at the University of Toronto. He studied at the University of Freiburg and Trinity College Dublin before obtaining an MA in Clinical Linguistics from the University of Bielefeld. He then worked as a clinician in different hospitals while also studying for his PhD in Phonetics at the University of Munich. Tim Bressmann’s research focuses on speech production in individuals with craniofacial syndromes and head and neck cancer. He is a Section Editor of the Cleft Palate‐Craniofacial Journal and an Associate Editor of Clinical Linguistics and Phonetics.
Bonnie Brinton is professor emeritus at Brigham Young University (BYU), Provo, Utah. Her work focuses on assessment and intervention with children who experience difficulty with social communication. Dr Brinton has been a professor at the University of Nevada, a research scientist at the Schiefelbusch Institute for Lifespan Studies, University of Kansas, and Dean of Graduate Studies at BYU. She is a fellow of the American Speech‐Language‐Hearing Association and received Honors of the Association in 2019.
Chris Code is Professorial Research Fellow in the Department of Psychology, Washington Singer Labs, University of Exeter, England. He is the Foundation Professor of Communication Sciences and Disorders at the University of Sydney and past Research Manager for Speakability, and Patron of AphasiaNow. He is also co‐founding Editor of the journal Aphasiology. His research interests include the cognitive neuroscience of language and speech, psychosocial consequences of aphasia, recovery and treatment of aphasia, the evolution of speech and language, number processing, and apraxia.
Louise Cummings is Professor in the Department of English and Associate Dean in the Faculty of Humanities at The Hong Kong Polytechnic University. She teaches and conducts research in pragmatics, clinical linguistics, and health reasoning. She is the author and editor of 18 books, including most recently Fallacies in Medicine and Health (Palgrave Macmillan, 2020), Language in Dementia (Cambridge University Press, 2020) and Pragmatic Language Disorders (Springer, 2021). She is editor of the book series Routledge Research in Speech‐Language Pathology. Louise Cummings has been a Visiting Fellow in the Department of Philosophy at Harvard University, and the Centre for Research in the Arts, Social Sciences and Humanities (CRASSH) at Cambridge University. She is a member of the Royal College of Speech and Language Therapists, the Health & Care Professions Council in the UK, and the Hong Kong Academy of Humanities.
Holly Damico is an Associate Professor at the University of Louisiana at Lafayette, and a Hawthorne‐BoRSF Endowed Professor. She co‐founded and co‐directs the Summer Language and Literacy Project. Her clinical and research interests include language and literacy acquisition and intervention as contextualized and social
transactional processes, with a focus on qualitative research methods. She has authored and co‐authored 18 peer‐reviewed book chapters and articles in those areas. She received the 2017–18 Rising Star Researcher Award in Liberal Arts at UL Lafayette.
Jack S. Damico is a clinical linguist and a speech‐language pathologist with a Master’s degree in communicative disorders and a PhD in linguistics. With over 12 years of clinical experience as a speech‐language pathologist in the public schools, medical settings, and in private practice, his research focuses on the authentic implications for individuals with atypical language and communication skills, and on the development of clinical applications to assist in overcoming communicative problems. Working primarily in the areas of aphasia in adults and language and literacy difficulties in children from both monolingual and bilingual backgrounds, he specializes in the utilization of various qualitative research methodologies to investigate language and communication as social action. An ASHA Fellow, he is the co-editor of the Journal of Interactional Research in Communication Disorders. He has recently joined the University of Colorado Boulder faculty after 28 years as the Doris B. Hawthorne Eminent Scholar Chair at the University of Louisiana at Lafayette.
Kathryn D. R. Drager, PhD, CCC‐SLP, is a Professor of Communication Sciences and Disorders, and Associate Dean for Research and Graduate Education in the College of Health and Human Development, at the Pennsylvania State University. Her research interests include AAC for individuals with severe expressive communication disorders, especially for children, adolescents, and adults with severe disabilities who are at the beginning stages of communication, including children with autism. She is also interested in issues faced by the global community in AAC. She has more than 60 publications and over 160 presentations at local, national, and international conferences. She has served several terms and is currently on the Associate Editor board of Augmentative and Alternative Communication.
Erinn H. Finke, PhD, CCC‐SLP, is an Associate Professor of Audiology and Speech Pathology, at the University of Tennessee Health Science Center. Her research is focused on understanding and improving friendship outcomes and interactions for individuals with autism spectrum disorder, including those who use augmentative and alternative communication. She is also interested in how technology (games and applications) can be used to provide a supportive context for social interactions. She has more than 20 publications and over 60 presentations at local, national, and international conferences. She is currently a Section Editor for the American Journal of Speech‐Language Pathology.
Paul Fletcher is Emeritus Professor of Speech and Hearing Sciences, University College Cork, Ireland. He previously held professorial positions at the University of Reading and the University of Hong Kong. He has published widely on language development and language impairment in children learning English, and more recently in children acquiring Cantonese and Mandarin. His primary
research interest is the acquisition of grammar, but he has also worked on vocabulary, particularly the assessment of vocabulary development in young children via parent report. He is a past president of the International Association for the Study of Child Language, and an honorary member of the Irish Association of Speech and Language Therapists.
Martin Fujiki is professor emeritus at Brigham Young University (BYU), Provo, Utah. His work focuses on social competence in children with developmental language disorders. Dr Fujiki has been a professor at the University of Nevada and BYU, and a research scientist at the Schiefelbusch Institute for Lifespan Studies, University of Kansas. He is a fellow of the American Speech‐Language‐Hearing Association and received Honors of the Association in 2015.
Robert Brinton Fujiki earned a BFA in Music‐Dance Theater and an MS in Communication Disorders from Brigham Young University. He is currently a PhD candidate at Purdue University. He has clinical and research experience in voice and swallowing disorders in adults and children.
Sandra L. Gillam is a Professor in the Department of Communicative Disorders and Deaf Education at Utah State University, and a past Vice President for Speech Language Pathology Practice for the American Speech Language Association. She holds a PhD from the University of Memphis. Her research interests include assessment and intervention of language and literacy impairments, multicultural populations, and processes involved in text comprehension. Sandi was the PI on a Goal II IES grant to develop narrative intervention procedures, and is currently Co‐PI on a Goal III grant to conduct a randomized controlled trial of the narrative program.
Katarina L. Haley, PhD, CCC‐SLP, is Professor in the Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina School of Medicine. She holds PhD and MS degrees from Vanderbilt University in Nashville, Tennessee, and a BS from Karolinska Institutet in Stockholm, Sweden. She teaches courses on neurological communication disorders, particularly aphasia. She specializes in assessment and treatment of adults with left hemisphere brain lesions. Her research focuses on speech production, apraxia of speech, development of quantitative speech assessment procedures, and client‐centered treatment.
Archie B. Harmon is an Assistant Professor of Otolaryngology at Washington University School of Medicine in St Louis. Dr Harmon is a fellowship‐trained speech pathologist with clinical expertise in voice therapeutic outcomes, the aging larynx, and paradoxical vocal fold motion. His research interests include voice treatment adherence and voice therapy outcomes.
Ingo Hertrich is Professor at the University of Tübingen, Germany, working as lecturer in phonetics and phonology at the Linguistics Department, and researcher
in Neurobiology of Language at the Department of Neurology and Stroke and the Hertie Institute for Clinical Brain Research. He holds a PhD from the University of Munich in physical anthropology. He has published in the fields of acoustic phonetics, kinematic analysis of speech articulation, voice analysis, magnetoencephalography, functional magnetic resonance imaging, and transcranial magnetic stimulation. These studies considered various clinical aspects, but also included experimental work with healthy subjects in order to contribute to a functional‐anatomic model of speech and language processing in the brain.
Sarai Holbrook is an assistant professor in the School of Communication Sciences and Disorders in the College of Professional Studies at the University of Wisconsin‐Stevens Point. She holds the Certificate of Clinical Competence in speech‐language pathology from the American Speech‐Language‐Hearing Association. Her research interests include assessment and intervention for social communication in children with autism spectrum disorder, language intervention for children with developmental language disorder, and the scholarship of teaching and learning.
Katherine C. Hustad, PhD, CCC‐SLP, is Professor of Communication Sciences and Disorders at the University of Wisconsin – Madison. She is also an investigator at the Waisman Center. Professor Hustad’s research focuses on characterizing and enhancing speech, language, and communication development and outcomes in children with cerebral palsy. She also studies variables that influence speech intelligibility, with a special emphasis on augmentative/alternative communication interventions. A primary objective of her work is to generate a theoretically driven, data‐based longitudinal model of speech and language development in cerebral palsy that can be used to predict outcomes, develop and test interventions, and guide treatment decisions. Professor Hustad has a strong interest in bridging research with clinical practice. Her work has been funded by the National Institutes of Health, National Institute on Deafness and other Communication Disorders (USA) since 2003. She is a fellow of the American Speech, Language, and Hearing Association.
Adam Jacks, PhD, CCC‐SLP, is Associate Professor in the Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina School of Medicine. He holds PhD and MA degrees from the University of Texas at Austin and a BA from Duke University in Durham, North Carolina. He teaches courses on speech science and motor speech disorders. His research focuses on understanding the link between neuropathology and behavioral manifestations of neurological speech disorders, investigating novel interventions for people with aphasia and apraxia of speech, and identifying factors associated with improved quality of life with aphasia.
Alan G. Kamhi is a Professor of Communication Sciences and Disorders at UNC‐Greensboro Department of Communication Sciences and Disorders at the University of North Carolina‐Greensboro. His early research focused on linguistic and cognitive abilities of children with specific language impairments (SLI) and
mental handicaps. Later research focused on language‐learning disabilities, culminating in a book co‐edited with Hugh Catts, on language and reading disabilities. The third edition of this book was published in 2012. Recent articles have considered how to balance certainty and uncertainty in clinical practice, what SLPs need to know about auditory processing disorders, how to improve clinical practices for children with language and learning disorders, and how to assess and treat reading comprehension problems.
Natalie Kippin is a certified practicing speech‐language pathologist and is currently completing a PhD with Telethon Kids Institute and Curtin University in Perth, Western Australia. She is a Member of Speech Pathology Australia and the Public Health Association of Australia. Natalie’s clinical and research areas include the oral and written communication skills of adolescents who are involved with youth justice, including those who have been exposed to alcohol prenatally. Natalie is the inaugural Chair of the justice‐related child health research interest group at Telethon Kids Institute. She also has a background in health promotion and has worked as a youth custodial officer in an Australian youth detention centre.
Karen Lê is a speech‐language pathologist in the VA Connecticut Healthcare System where she developed the cognitive‐communication rehabilitation program, and serves on the interdisciplinary Polytrauma Support Clinic Team. She is a member of the Student Veteran Community of Practice Workgroup within the VA. Her research interests include the study of discourse following traumatic brain injury, the development of sensitive and reliable discourse measures for clinical use, discourse intervention, and the impact of mental health and neurologic comorbidities on discourse ability. She holds a PhD from the Department of Speech, Language, and Hearing Sciences at the University of Connecticut.
Suze Leitão is an Associate Professor of Speech Pathology at Curtin University, Western Australia, Director of Graduate Research, and a clinical speech pathologist. She is a Life Member and Fellow of Speech Pathology Australia, recently completing nine years as the Chair of the National Ethics Board of SPA. She is on the Board of the International Journal of Speech‐Language Pathology and Child Language Teaching and Therapy. Her research interests encompass theory, assessment, and intervention for children and young people with language disorder and developmental language disorder. She has published extensively in these areas with her research group: Language and Literacy in Young People. She grew up in Europe, trained and lived in the UK, and currently lives in Fremantle, Western Australia.
Zaneta Mok is a lecturer in speech pathology at Australian Catholic University. She also works in a quality and research capacity at a major Australian hospital service. Her research interests include aphasia and dementia, and speech pathology in culturally and linguistically diverse communities. She is especially interested in topics related to social interaction and functional discourse. Her recent publications include papers on outcome measures for communication partner training, and repair mechanisms in conversations involving people with dementia.
David Jackson Morris is an Associate Professor at the Department of Nordic Studies and Linguistics, University of Copenhagen, Denmark. He is originally from Australia and is a graduate of Griffith University and the University of Queensland. He holds a PhD from the University of Copenhagen and has also held positions at Lund University, Sweden. Prior to postgraduate studies in Scandinavia, David worked in the diagnostic instrument and hearing aid industries. With a diverse network of collaborators he investigates receptive communication, particularly electrophysiological measures of speech perception, cochlear implant listening, phonemic restoration, and clinical issues involved in resolving functional hearing loss. As an educator David lectures in a combined Speech Pathology and Audiology degree program and convenes a graduate course in electroencephalography methods.
Richard J. Morris, PhD, is a Professor in the School of Communication Science and Disorders at Florida State University. Dr Morris is the director of the Special Summer Program in Communication Disorders at the FSU London Centre. He has taught courses on the anatomy and physiology of speech and hearing, the acoustics of speech, critical thinking and communication disorders, voice disorders, ethical research practice, and acoustics of the singing voice. His main research interests are acoustic and physiological phonetics, and the assessment and teaching of critical thinking skills. He has presented and published papers on age‐related changes in speech and voice, speech acoustics, the effects of neuromuscular electrical stimulation on voice, the acoustics and physiology of the classically trained singing voice, acoustics of choral singing, the assessment of thinking skills, and the teaching of thinking skills.
Jennifer Mozeiko is a licensed speech‐language pathologist, Assistant Professor, and researcher directing the Aphasia Rehab Lab at the University of Connecticut. After earning her BA, she worked at the Harvard School of Public Health, spent a year teaching English in Hong Kong, and then returned to Boston where she worked in e‐commerce for several years before pursuing her interest in language disorders following brain injury. She received her MA and PhD at the University of Connecticut where she is now a faculty member. Her research is focused on improving treatment and the quality of life of people with acquired brain injury.
Nicole Müller is Professor and Head of the Department of Speech and Hearing Sciences, University College Cork, Ireland and Visiting Professor at Linköping University, Sweden. She has previously held professorships in the United States and Sweden. Her research interests include multilingualism and neurogenic and neurodegenerative conditions leading to cognitive‐communicative impairments. She is co‐editor of the journal Clinical Linguistics and Phonetics (Taylor & Francis) and of the book series Communication Disorders Across Languages (Multilingual Matters). She has published widely in journal and book form and was awarded a Fulbright scholarship in 2014 to study bilingual Irish–English communication in a retirement home in the west of Ireland. Among her recent publications are co‐edited collections on sonority and on cross‐linguistic language acquisition.
Ryan Nelson, PhD, CCC‐SLP, holds the rank of associate professor and Head of the Department of Communicative Disorders at the University of Louisiana at Lafayette. Prior to joining the faculty at UL Lafayette, Dr Nelson held the rank of assistant professor at the University of Texas at El Paso. He has worked as a speech‐language pathologist in public school settings and in private practice. His work embodies collaboration with mentors, former students, and colleagues from many disciplines. Dr Nelson has published and presented nationally and internationally in the areas of language impairment, literacy, counseling in communicative disorders, qualitative research, eye‐tracking, and autism.
Valerie Pereira is Senior Lecturer at the Chinese University of Hong Kong, Department of Otorhinolaryngology, Head & Neck Surgery. She is a major academic teaching staff member for the Master of Science in Speech‐Language Pathology, and is the Programme Leader of the Professional Diploma in Communication Disorders and Sciences. She is also an Honorary Assistant Professor with the University of Hong Kong, Department of Oral Maxillofacial Surgery, as the Speech Therapist for the Joint Cleft & Nasendoscopy Clinics. She obtained her PhD from UCL Institute of Child Health, London, UK, with a dissertation titled The effect of maxillary osteotomy on speech, nasality and velopharyngeal function, and was previously with the North Thames Regional Cleft Service and the Supraregional Craniofacial Service, both based at Great Ormond Street Hospital for Children NHS Foundation Trust in London. She is the current Chair of the Cleft Palate and Craniofacial Committee of the International Association of Communication Sciences and Disorders.
Patricia A. Prelock, PhD, is Provost and Senior Vice‐President, University of Vermont. She is a Professor of Communication Sciences & Disorders in the College of Nursing and Health Sciences, and Professor of Pediatrics in the College of Medicine at the University of Vermont. She received her PhD from the University of Pittsburgh. Dr Prelock is an Associate Editor for the Journal of Autism and Developmental Disorders. She was named an ASHA Fellow in 2000 and a University of Vermont Scholar in 2003. In 2015 Dr Prelock was named a Distinguished Alumna of the University of Pittsburgh. In 2016, she received the ASHA Honors of the Association. She is a Board‐Certified Specialist in Child Language and was named a Fellow in the National Academies of Practice (NAP) in speech‐language pathology in 2018. She was the 2013 President for the American Speech‐Language‐Hearing Association.
Susan Rvachew, PhD, S‐LP(C), ASHA Fellow, is a Professor at McGill University and Director of the School of Communication Sciences and Disorders. Her research is concerned with the normal development of speech and phonology, the treatment of speech sound disorders in children, and the relationship between phonological disorders and delays in the acquisition of literacy skills. Dr Rvachew has published over 90 articles, chapters and encyclopedia entries as well as two books. She has also developed three phonology assessments for French‐speaking children, and three English‐language software tools for assessment and intervention.
Jane Russell is now retired from clinical and academic work. For many years she was Lead Specialist Speech & Language Therapist working with children and adults with orofacial anomalies and velopharyngeal dysfunction at the West Midlands Centre for Cleft Palate based in Birmingham, UK. She specialized in this field from 1978, and in 1991 completed her PhD with a dissertation entitled Speech development in children with cleft lip and palate. She is a Fellow of the Royal College of Speech and Language Therapists. Following retirement from clinical work, Jane continued to contribute to research in various ways including speech analysis. Unfortunately, she could no longer continue with this, after a change in personal circumstances in 2017.
Brittany Falcon Rutland, MCD, CCC‐SLP is a doctoral candidate at the University of Louisiana at Lafayette where she is specializing in fluency disorders. She is a person who stutters and has nine years of experience working in a private practice with children and adults who stutter. She has presented at local, national, and international conferences.
Kathleen Scaler Scott is a practicing speech‐language pathologist, Board Certified Fluency Specialist, and Associate Professor of Speech‐Language Pathology at Monmouth University, New Jersey, USA. Her research interests are largely in cluttering, atypical disfluency, and clinician training and treatment effectiveness. She is the co‐editor of Cluttering: A Handbook of Research, Intervention, and Education (Psychology Press, 2011), co‐author of Managing Cluttering: A Comprehensive Guidebook of Activities (Pro‐Ed, Inc., 2013), and author of the newly released book Fluency Plus: Managing Fluency Disorders in Individuals with Multiple Diagnoses (SLACK, Inc.). Dr Scaler Scott has spoken nationally and internationally on the topics of fluency and social pragmatic disorders. She was the first Coordinator of the International Cluttering Association, and is the recipient of the 2018 Deso Weiss Award for Excellence in the Field of Cluttering, and the 2018 Professional of the Year award from the National Stuttering Association.
Debbie Sell, PhD, OBE, is a Senior Research Fellow at Great Ormond Street Hospital NHS Foundation Trust (GOSH), London, UK, previously having been Head of Speech and Language Therapy (SLT) Services and Lead Therapist in the North Thames Regional Cleft Service there. Debbie now focuses on research, mentoring, supervision, teaching, and independent clinical practice. Her PhD study in Sri Lanka (speech in patients with unoperated and late operated cleft palate) led to that country’s only SLT training course. Debbie has led on developing and testing speech outcome tools in cleft palate/VPI, setting standards for measuring speech outcomes and has participated in several multicenter national and international studies of speech outcome. Debbie’s current interests focus on parents undertaking articulation therapy in children with cleft palate, supported by therapists and technology, and is a co‐Founder, together with Dr Triona Sweeney, of Speech at Home (www.speech@home.org). Debbie is a Fellow of the Royal College of Speech and Language Therapists, has co-edited two text books and has more than 90 peer reviewed publications.
Elizabeth C. Serpentine, PhD, CCC‐SLP, is a speech‐language pathologist with almost 20 years of experience in the public school system. She currently works in the Lower Merion School District and also teaches as an adjunct instructor in the Department of Special Education at Saint Joseph’s University, and in the Department of Communication Sciences and Disorders at Baylor University. She also holds a Supervisor of Special Education Certificate in the state of Pennsylvania. Her areas of clinical and research expertise include the use of evidence‐based practice, social competence, and transition/employment issues for individuals with autism spectrum disorder.
Pamela Snow is Professor of Cognitive Psychology in the School of Education at La Trobe University, Bendigo, Australia. She is a speech‐ language pathologist and a registered psychologist. Her research spans various aspects of risk in childhood and adolescence, particularly as these pertain to the emergence of oral language skills and the transition to literacy in the school years. Accordingly, she has researched children and adolescents in state care, adolescents in the youth justice system and also those in flexible education settings, and early years reading instruction practice in mainstream schools. She is a Life Member of Speech Pathology Australia, and in 2017 co‐authored Making Sense of Interventions for Children with Developmental Disorders with Dr Caroline Bowen, AM. Pamela is on the Editorial Board of First Language and is an Associate Editor of The Reading League Journal.
Vesna Stojanovik is a Professor of Clinical Linguistics at the School of Psychology and Clinical Language Sciences at the University of Reading. She holds a BA in English Language and Literature and French Language and Literature from the University of Ss Cyril and Methodius, Skopje, North Macedonia; an MA in Linguistics and English Language Teaching from the University of Leeds, and a PhD in Human Communication Sciences from the University of Sheffield. Her main research interests include speech, language, and communication disorders in atypical populations, particularly children affected by genetic syndromes such as Williams and Down syndrome, as well as early intervention for children with Down syndrome. Vesna is currently the vice‐president of the International Clinical Phonetics and Linguistics Association.
John A. Tetnowski is the Jeanette Sias Endowed Chair in Communication Sciences and Disorders at Oklahoma State University. He has over 80 publications in the areas of fluency disorders, research methodologies, and clinical interventions. He is a board‐certified fluency specialist and holds the Certificate of Clinical Competence from the American Speech‐Language‐Hearing Association. He has mentored 15 doctoral students to completion and has presented his work on five continents. He is a fellow of the American Speech‐Language‐Hearing Association. Previously, he was the Ben Blanco Endowed Professor of Communicative Disorders at the University of Louisiana‐Lafayette.
Daan van de Velde is lecturer and researcher at Leiden University Centre for Linguistics (LUCL) in the Netherlands, where he completed studies in General Linguistics and French Language and Culture. He holds a PhD from Leiden University on the topic of speech perception and production by cochlear implant users. He lectures and performs research in the field of (clinical) phonetics, applied linguistics, and psycholinguistics, including topics such as the comparison of language and music, and perception and production of prosody. Other areas of interest are language and speech technology and language change. Daan is co‐developer of a software application allowing Dutch university students to autonomously practice their pronunciation of French.
Silvana M. R. Watson is a professor of special education at Old Dominion University, Norfolk, VA. She earned her doctoral and master’s degrees in special education at the University of New Mexico, Albuquerque. She has published and presented nationally and internationally on attention deficit disorders, executive functions, intervention for students with learning disabilities, and on issues of multilingual learners. She received a Fulbright Scholar award and conducted research in Portugal. She currently is the principal investigator of a professional development grant to prepare in‐service and pre‐service teachers to assess and instruct English learners with and without disabilities. Dr Watson is a co‐principal investigator of a National Science Foundation grant to study the effects of pair programming on undergraduate students with learning disabilities. She is a past president of the Council for Learning Disabilities.
Carol Westby is a consultant for Bilingual Multicultural Services in Albuquerque, New Mexico, and holds an affiliated appointment in Communication Disorders at Brigham Young University in Provo, UT. She has published and presented nationally and internationally on play, theory of mind, language‐literacy relationships, ADHD, narrative/expository development and facilitation, screen time, understanding and working with children and families who have experienced trauma, and issues in assessment and intervention with culturally/linguistically diverse populations She is a fellow of the American‐Speech‐Language‐Hearing Association (ASHA), has received the Honors of ASHA, and is Board Certified in Child Language. Dr Westby has received the Distinguished Alumnus Award from Geneva College and the University of Iowa’s Department of Speech Pathology and Audiology, and the ASHA Award for Contributions to Multicultural Affairs.
Yvonne Wren is Director of Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, and Senior Research Fellow at the University of Bristol. She is Chair of the Child Speech Committee of the International Association of Communication Sciences and Disorders, and founded the UK and Ireland Child Speech Disorder Research Network. She is Chief Investigator of the Cleft Collective Speech and Language Study, a national clinical cohort study of children born with cleft lip and palate in the UK. She is on the Research Council for the charity The Scar Free Foundation, and a trustee for ICAN, the charity serving the needs of
Notes on Contributors xxi
children with communication impairments. She was Associate Editor of Folia Phoniatrica et Logopedica from 2016–2019 and co‐edited the book Creating Practice Based Evidence: A Guide for SLTs (JR Press), now in its second edition.
Wolfram Ziegler is Professor of Neurophonetics and head of the Clinical Neuropsychology Research Group (EKN) at the Institute of Phonetics and Speech Processing, University of Munich. He has a diploma and PhD in Mathematics from the Technical University of Munich and spent 10 years as a research assistant at the Max Planck Institute for Psychiatry. From 1995 to 2015 he headed the EKN at the Clinic for Neuropsychology, City Hospital Bogenhausen in Munich, and since 2015 at the LMU Munich. His research focus is on speech and language disorders in neurologic populations.
Introduction
JACK S. DAMICO1, NICOLE MÜLLER2, AND MARTIN J. BALL3
1 University of Colorado, Boulder, CO, USA
2 University College Cork, Ireland, and Linköping University, Sweden
3 Bangor University, Wales
It is now just under a decade since the first edition of this Handbook appeared, and in that time the field of communication disorders has progressed on many fronts. Certain areas have come to prominence that were not previously the focus of research. Among these areas are the speech and language consequences for children who have received cochlear implants, genetic syndromes other than Down syndrome, and literacy problems (especially the role of writing as well as reading).
In this second edition, and to reflect these and other recent developments in the field, we recruited internationally renowned experts as new chapter authors. The chapters on hearing impairment, literacy, and genetic syndromes have been radically refocused, while all other chapters present updated material. Further, the chapter on language delay (apart from having a new author) encompasses patterns of typical as well as disordered language development. The chapter on specific language impairment was retitled to reflect the now‐accepted label of this disorder: developmental language disorder.
We have retained the four‐part structure of the Handbook as we feel it is a useful way to present the main topics within language and speech disorders. In Part I the chapters address foundational issues. Thus, the first chapter by Jack Damico, Nicole Müller and Martin Ball examines labeling. By this term the authors mean the tendency of people to label others as deviating from a norm—a common practice with communication disorders. The chapter discusses the social background to labeling and points to ways in which communication specialists can become aware of labeling and avoid its negative consequences.
In Chapter 2, Elena Babatsouli discusses diversity issues in communication disorders, dealing with a range of topics including diversity in terms of language, gender, ethnicity, socioeconomic status, and others. As well as describing a variety of diversity concerns. the author also addresses the application of this information to clinical situations.
The Handbook of Language and Speech Disorders, Second Edition. Edited by Jack S. Damico, Nicole Müller, and Martin J. Ball.
The Handbook is primarily concerned with language and speech disorders and does not aim to cover hearing impairment in detail. Nevertheless, hearing loss and rehabilitation (through, for example, cochlear implantation) do impact speech and language abilities. Chapter 3 by David Morris and Daan van de Velde discusses this area. Recent developments in cochlear implants are examined in detail and the authors also describe auditory brainstem implants for those for whom cochlear implants are not suitable. Intelligibility impairment can be found in a wide range of language and speech deficits from child speech disorders, through aphasic language disorders, to adult acquired motor speech disorders. In Chapter 4, Katherine Hustad and Stephanie Borrie first define intelligibility (a not uncontroversial task!) and then describe ways of measuring it and developmental aspects of intelligibility.
Chapter 5 presents a range of genetic syndromes that can affect language and speech. Vesna Stojanovik covers Williams syndrome and Down syndrome in detail, dealing with communication problems encountered by these speakers. She also points forward to the need for neurocognitive investigations of typical development to better understand the impairments found in genetic syndromes.
The final chapter in Part I of the book also applies across the field of language and speech disorders. Bonnie Brinton, Martin Fujiki, and Robert Brinton Fujiki discuss the related areas of assessment and intervention in speech‐language pathology. They stress the importance of the social context of communication and the need to bear this in mind in both assessment and intervention. The chapter provides step‐by‐step advice on how to undertake these two aspects of the speech‐language pathologist’s practice, whatever communication problem is involved.
Part II of the Handbook contains eight chapters dealing with different language disorders. In disordered language, various linguistic features can be disturbed, ranging from lexical items (e.g., word‐finding difficulties), through morphology and syntax (missing or incorrect affixes, sentence ordering difficulties) to semantics and pragmatics (inaccurate assigning of meaning to words, inappropriate use of language for a specific context). The chapters in this part of the book highlight which of these features are most important in the specific disorder under discussion, but they are not limited to this. For example, Patricia Prelock, in her chapter on autism, describes the linguistic markers of this disorder, but also discusses at length the recent changes to the classification of autism and highlights the importance of appropriate assessment and intervention. Paul Fletcher in Chapter 8 outlines the typical trajectories of language acquisition, highlighting the wide variation in this process between individuals encompassing both vocabulary and grammar. He also points to good practice in assessment upon which to base appropriate intervention for children with various patterns of delay in language acquisition. Sandi Gillam, Sarai Holbrook, and Alan Kamhi in Chapter 9 focus on the language disorder formerly termed “specific language impairment” and recently renamed “developmental language disorder.” The authors discuss the attempts to characterize the disorder and to discover the underlying causes, but also point to successful therapeutic strategies and the need for early intervention. In Chapter 10 Louise Cummings addresses the pragmatics of language use. She illustrates many types of pragmatic impairments from a variety of speakers and discusses ways of assessing pragmatic impairment and intervention strategies.
In Chapter 11, Christine Brennan examines learning disabilities and their impact on the development of communication. In particular, she points to the different outcomes in adulthood between treated and untreated learning difficulties. The following chapter by Holly Damico, Jack Damico, and Ryan Nelson deals with literacy impairments. A development in this second edition has been to look more closely at writing rather than concentrating mainly on reading. The chapter stresses the importance of a meaning‐based approach to literacy teaching and intervention. Pamela Snow, Suze Leitão, and Natalie Kippin in Chapter 13 describe communication outcomes in children who have suffered early life adversity. They note that such children may not only demonstrate less‐developed language skills, but will also have trouble in moving from speaking and listening to reading and writing. The last chapter of Part II deals with aphasia, a multifaceted disorder affecting both the production and perception of communication. Chris Code provides a detailed description of the many types of aphasia, and then concentrates on effective intervention strategies and the need to reintegrate people with aphasia into the community.
Part III of the Handbook also contains eight chapters, this time dealing with speech disorders. Speech disorders can range from impairments to the speech production mechanisms to problems with the organization of speech sounds in the linguistic system. Causes can range from delays to normal developmental pathways to acquired neurological damage due to stroke or other injury via genetic or surgical damage to vocal organs. The first three chapters deal with what are often considered the core areas of speech disorders. Thus, Chapter 15 by Susan Rvachew describes child speech disorders; Ingo Hertrich, Hermann Ackermann, and Wolfram Ziegler deal with dysarthria in Chapter 16; and in Chapter 17, Adam Jacks and Katarina L. Haley cover apraxia of speech. The focus of Chapter 15 is the heterogeneity of child speech disorders and the need to tailor intervention to the four main subtypes identified in the chapter. Hertrich and colleagues address the wide range of dysarthria subtypes and how they relate to specific neurological conditions. They include assessment and treatment methods, and how to measure the efficacy of therapy. As well as presenting the characteristics of apraxia of speech, Jacks and Haley argue for a common set of speech characteristics to be used in the diagnosis of apraxia of speech in both children and adults. They also discuss treatment approaches and describe those approaches that so far seem most efficacious.
Chapter 18 by Kathryn Drager, Erinn Finke, and Elizabeth Serpentine deals with augmentative and alternative communication (AAC) for those with minimal or no speech abilities. The authors describe the range of AAC approaches and stress the need for individually tailored solutions to the communication needs of a highly variable clinical population.
The next two chapters cover two specialized areas of speech impairment: fluency disorders and voice disorders. In Chapter 19, John Tetnowski, Kathy Scaler Scott, and Brittany Rutland describe normal and disordered fluency. In particular they point to major advances in both understanding the underlying causes of stuttering and in assessment and treatment, since their chapter in the first edition
of this Handbook. Richard Morris and Archie Harmon also present an updated chapter on voice and voice disorders. They too bring updated information to their description of voice disorders, their prevalence, and assessment and treatment issues.
The final two chapters of Part III deal with speech disorders derived from genetic and medical factors. Debbie Sell, Valerie Pereira, Yvonne Wren, and Jane Russell have updated Russell’s chapter from the first edition of the Handbook with details of the most recent research in cleft palate and velopharyngeal impairments. They stress the importance of the role of the speech‐language professional in the team treating children with cleft palate, especially in terms of timing of surgical intervention and of speech therapy. Tim Bressmann, in Chapter 22, describes the various speech outcomes encountered in cases of laryngectomy, glossectomy, and disorders related to head and neck cancer. The author deals also with the surgical procedures undertaken with the various disorders, and describes the different rehabilitation options available to ameliorate the resultant impairments to speech production.
The final part of the Handbook contains four chapters dealing with communication disorders linked to cognitive and intellectual impairments. Chapter 23, authored by Carol Westby and Silvana Watson, covers attention deficit hyperactivity disorder (ADHD) and its impact on communication. The authors point to the increasing incidence of ADHD in children, and the need for research‐based interventions with this population. Margaret Lehman Blake, in Chapter 24, examines the range of communication problems encountered with right hemisphere brain damage. She describes difficulties this population may encounter with comprehension, and with managing conversation, and the need to develop treatment approaches based on the wide literature concerning this disorder.
Chapter 25, by Karen Lê and Jennifer Mozeiko, deals with traumatic brain injury (TBI). A major focus of the chapter is the complex and dynamic nature of discourse, and how TBI disrupts discourse in its many facets. The authors suggest that the impairments seen in TBI may be ascribed to disruptions in cognitive systems, or they may be viewed as manifestations of underlying pragmatic impairments. The potential causes are not only of theoretical importance but have clinical implications as well.
The final chapter, by Nicole Müller and Zaneta Mok, covers the wide area of dementia and its impact on communication. The authors describe the more common dementia types, risk factors for dementia, and diagnosis, assessment, and intervention. They go on to consider bilingualism and dementia, and conclude with a section on interactional approaches.
This Handbook presents current research and thinking across the wide range of topics falling under the heading of language and speech disorders. It will prove invaluable to those working with communication impairments and those just entering the field alike. In this second edition we have taken the opportunity to update the chapters and, in some cases, to redirect the main emphasis in a topic. We are confident that the current collection reflects the current status of this important field of investigation.
Foundations Part I
Labeling as a Sociocultural Process in Communicative Disorders
JACK S. DAMICO1, NICOLE MÜLLER2, AND MARTIN J. BALL3
1 University of Colorado, Boulder, CO, USA
2 University College Cork, Ireland, and Linköping University, Sweden
3 Bangor University, Wales
1.1 Introduction
As a discipline oriented to communication, learning and social action, speechlanguage pathologists are increasingly cognizant of the fact that our discipline stands with several other disciplines as firmly located within the social sciences. While we must acknowledge our debts to psychology, education, and medicine, our theoretical orientation over the past 30 years has been influenced by linguistics, sociology, and anthropology. In parallel with the other social sciences, our research methodologies and our clinical practices are progressively increasing our focus on naturalistic inquiry, authentic social contexts, interpretive and interactional perspectives, and the qualitative research paradigm (Duchan, 2010; Goodwin, 2014). This increased turn to the social sciences holds many advantages for our discipline. One of these advantages is how we can adopt aspects of social action theory to understand the complex process of labeling.
The term labeling within the human and social sciences refers to the tendency of providing an appraisal and/or a descriptor of others based upon any deviation from the perceived norm that is sufficient to garner attention (Matsueda, 2014); the typical outcome of labeling is some sort of categorization that creates differentiation. Social scientists have recognized that this process is ubiquitous in society. We are constantly observing and appraising others from our normative and interpretive
The Handbook of Language and Speech Disorders, Second Edition. Edited by Jack S. Damico, Nicole Müller, and Martin J. Ball.
perspectives. We note features of an individual’s appearance and behavior, and if even a subtle deviation from the perceived norm is identified, we have a propensity to create and use a label as mental shorthand. For example, if someone is observed as experiencing a brief unintelligibility while they are conversing, they may be labeled as exhibiting a communication deficit. Whether this label is accurate or appropriate is beside the point; it is sufficient to recognize that based upon some perceived deviation, there is a tendency to assign a label.
While this tendency toward labeling is common across all social actors, as professionals we formalize this tendency and treat it as a specialized circumstance referred to as “diagnosis” and, as sociologist Howard Becker (1963) has suggested, in such circumstances the label has power to create positive and negative consequences. As a result, care must be taken when assigning labels to others, whether we are in commonplace circumstances or within our professional venues (Conrad, 2007). To understand the impact of labeling and how it functions, this chapter will briefly discuss the social theory behind labeling; describe the role of labeling within the formalized diagnostic process, including some of the mechanisms employed to help establish the practice of assigning diagnostic labels for various perceived deviations; and detail some of the consequences of labeling via diagnostic categories in speech-language pathology.
1.2 Labeling Theory
To understand the impact of labeling in specialized circumstances, it is helpful to review the theoretical foundation underlying labeling as a social process. Based upon the work of several early sociologists, but especially George Herbert Mead and Charles Horton Cooley, Herbert Blumer (1969) coined the term symbolic interactionism to describe how social interaction is used to create shared meanings within society using common language or symbols. He stated that individuals interpret significant symbols (language) reciprocally and then jointly construct a common interpretation within a context or situation which then calls for a specific meaningful social action. In effect, as Berger and Luckmann suggested in The Social Construction of Reality (1967), our systematic and comprehensible social world is constructed by our mutually agreed-upon interpretations. An important consequence of this process is that the outcome of any social action is not only the objective behaviors exhibited, but also how the situation and behaviors are defined and interpreted by the interactants. This is a primary reason that society or social reality is an ever-changing social process, rather than a static structure that consists of unchanging functional positions or stances. Each of us as social actors not only adapt to societal constraints but we also (and continually) contribute to the creation and re-creation of these constraints (Matsueda, 2014; Shotter, 1993).
Blumer’s work had a significant impact on labeling theory. This idea of constructed societal reality via social interaction and meaning negotiation between individuals was applied to definitions of deviancy, and it was argued that regardless of whether a person is objectively deviant in their appearance or actions,
if others defined that person or those actions as deviant, then consequences inherent in the concept of one being “set apart” accrued. Symbolic interactionism implied that the labeling/appraisal of individuals by social groups affects one’s self-identity; the self is a construction based on appraisals made by significant others (Matsueda, 1992).
The next step for labeling theory was to employ Blumer’s ideas but also to make several facets of the interpretive process inherent in symbolic interactionism more salient. The first question concerning saliency was that if significant others appraise, judge, and create the concept of who or what is deviant, and if this has an impact on the various social actions, including one’s self-identity, who are these significant others? Research and theory defined these significant others as members of primary groups, such as families and peers, and they were referred to as reference groups since it was understood that they provide an individual with a point of perspective and a comparison group (Matsueda, 1992). By extension, in specific situations or contexts, those individuals with various kinds of societal designations or roles (e.g., speech-language pathologists in a diagnostic clinic, teachers in a classroom, police officers on a beat) became the reference groups who made decisions on the labeling of deviancies. The second question revolved around the idea of how deviancy was typically formulated. Erikson (1966) discovered that the labeling of deviancy entails a very explicit process of selection. He found that, although even the most deviant social actors engage frequently in conventional routine behaviors, they tend to exhibit moments of deviation as a measure of the kind of persons they really are. In his research, Erikson demonstrated via an examination of the Salem witchcraft trials that this very selective labeling serves a societal purpose of helping a community define its social and moral boundaries so that they could develop a sense of group identity. That is, labeling some individuals via interpretations of their behaviors or appearances as outliers served to define the rest of the group as a community.
The third question regarding the interpretation of deviancy through labeling involved the reasons or process of deciding whether a behavior or appearance was sufficiently different to warrant the label of deviant. Edwin Lemert (1967) established the concepts of primary and secondary deviance to address this question. Primary deviance refers to initial acts of deviance that arise from original causes like social or cultural factors or psychological and physiological limitations. He believed that these were often situational, transient, and idiosyncratic, and therefore they could be dismissed by others. In these situations, these individuals experienced only minor consequences that impacted their persons and their status, social relationships, and future behaviors. Secondary deviance, however, was more severe. Lemert defined this level of deviancy as occurring when society’s negative response to a person’s initial deviance (e.g., stigmatizing, punishing, segregating the offender) caused fundamental changes in the person’s status, self-identity, or personality. In these cases, there is an explicit response involving societal reactions to the deviant behavior or appearance; this results in the “secondary deviant’s life and identity (being) organized around the facts of deviance” (Lemert, 1967, p. 41). Tied into the distinction between primary and secondary deviancy was the fact
that the most important societal reaction, the one that often triggered secondary deviancy, was the response of social institutions of control—the criminal justice system, special education regulations, mental health institutions—that are legitimated by the state (Goffman, 1964; Lemert, 1967).
Given this theoretical orientation and the work of others, Howard Becker investigated labeling as a theoretical social construct in his 1963 book Outsiders: Studies in the Sociology of Deviance. In this book, Becker was especially interested in the construct of deviancy in society—why some acts are thought to be deviant and who has the power to label individuals and/or their behavior as deviant. Becker examined the impact of such labeling on society and the individual. Based upon his work, he believed that labeling is a sociopolitical act, since his research indicated that once a label has been assigned, how we respond to the label (and the underlying acts that characterize it) depends on whether the label and its underlying actions have become sanctioned within the society. He believed that it is not the label or the actions of the individual so labeled that are deviant, but rather, the responses of society that defines it as such. Importantly, Becker believed that the responses of the powerful in the society (e.g., judges, legislators, physicians, diagnosticians) often determine how we are expected to view such labels and the actions that are characteristic of the labels.
Becker, led by symbolic interactionism, made two primary contributions to labeling theory, and his work, though somewhat controversial, is the primary current standard for labeling theory. The two major contributions were, first, that he offered an explicit labeling definition of deviance: “. . .deviance is not a quality of the act the person commits, but rather, a consequence of the application by others of rules and sanctions to an offender” (1963, p. 9). His second contribution was that he expanded the scope of societal reactions to encompass the creation and enforcement of social rules. Basically, this meant that the creation of deviancy begins not at the point when a person violates some rule, but earlier when social groups first create those rules. Becker also contrasted the positions he staked out for labeling theory with conventional theories of deviance. This enabled a greater constructivist orientation.
Based upon this work in sociology, labeling theory has become an important mechanism for understanding how and why the labeling of individuals as deviant or the assigning of a diagnostic label (in the case of speech-language pathologists) may result in unintended consequences. Erikson summed up labeling theory succinctly when he argued that “Deviance (as a basis of labeling) is not a property inherent in certain forms of behavior; it is a property conferred upon those forms by the audiences which directly or indirectly witness them” (1962, p. 311).
1.3
Labeling within a Diagnostic Process
Based upon labeling theory, it is clear that this social process is active in the diagnostic process within which speech-language pathologists are frequently engaged; labeling as a specialized circumstance is most evident in the educational and clinical
