What do autism, stuttering, cleft lip and palate, and voice disorders have in common? They all can lead to childhood communication difficulties that speech pathologists have been trained to treat. And the list doesn't stop there. The trained therapists can help children who are late talkers, primary school children who want to quit school because of learning problems, children born with cerebral palsy, and many others.
They also deal largely with adults who have a range of difficulties, from teachers or singers whose vocal folds are damaged from overuse, to elderly people with poor hearing, and those who have suffered a stroke (see stories next page). In addition, their expertise extends to treating children and adults with swallowing problems.
One in seven Australians has some form of communication disability, which may be the result of problems with speech, voice, fluency, hearing, using and understanding language, or reading and writing.
About 8.5 per cent of three-year-olds and 12 per cent of four-year-olds - amounting to about 10 per cent of pre-primary children - have some form of communication delay or difficulty, including stuttering.
Dr Erin Godecke, postdoctoral research fellow in speech pathology at Edith Cowan University, said boys were four times more likely than girls to have a speech disorder.
There was a genetic component in about 75 per cent of disorders such as stuttering.
Despite the prevalence of communication difficulties, there was an enormous gap in services for children and the waiting lists were extensive.
"The children who come through clinics are the ones who have failed to develop normally, or are doing so at a slower rate and so they may be experiencing communication problems," she said. "This can include literacy, speech delay or speech disorders."
Then there were children who stuttered or had voice disorders, which included vocal nodules and vocal abuse, usually resulting from shouting or over-talking.
Problems could also result when children had autism, cerebral palsy, brain injury, specific learning disorders, a stroke or other conditions. Hearing impairment could affect speech production.
Another condition treated by speech pathologists was developmental dyspraxia, a motor programming disorder. "The children are unable to select the right sound to go in the right sequence at the right time so they are unable to put words together to make the right sounds in sentences," Dr Godecke said. "It is particularly disabling for them."
Other problems included specific language impairment, in which a child had a normal IQ, but their verbal language production was well below expectation for their age range, and developmental delay, in which children were slower in reaching developmental milestones.
Diagnosis usually occurred by the time children were starting to talk. "At 18-24 months, the flags will start to go up if kids are not hitting their milestones," Dr Godecke said.
For lisps, the child needed to be at least six or seven years of age before starting treatment. "It is really an articulatory disorder that is easily remediated," Dr Godecke said.
Some problems, such as a lisp, could be addressed within 4-8 weeks but dyspraxia could take 5-8 years and children with autism might need ongoing treatment and support.
Dr Godecke said there was still a stigma attached to communication difficulty, including stuttering and developmental delay. "It is unspoken but it is certainly there," she said.
"Children sometimes get teased or bullied at school, and may be more at risk of failing in the education system, and even finding themselves restricted socially if they have ongoing language and literacy problems. So there are many negative side-effects to not having communication within normal developing limits, including underdeveloped relationships with family and friends."
Treatment involved additional practice. "Often it is home practice around the communication skills they are taught in the session," Dr Godecke said. A family member was usually asked to help by monitoring and helping to generalise those skills.
Speech pathologists also treated a lot of feeding and swallowing problems in children, including premature babies who might not have developed a strong sucking reflex.
Dr Godecke said there was a high success rate for treatment of developmental disorders and feeding difficulties and most children with developmental speech delay caught up with their peers.
She said there was a shortage of speech pathologists in Australia but it was becoming an increasingly sought- after career.
"Taking someone from being non-verbal through into a conversation where they can have a chat with their partner again or family is hugely rewarding," she said.
"And watching people who think they literally are unable to get words out and they have a go and reach success is really a gift, it is special."