Purpose: Speech-language pathology (SLP) is inherently a humanistic and interpersonal profession, but clinicians often report uncertainty about their role in engaging clients and families in counseling. Although the American Speech-Language-Hearing Association (ASHA) explicitly includes counseling within the SLP scope of practice, the application and boundaries of that role remain elusive to many practicing clinicians, students, and educators. Method: This tutorial examines ASHA's SLP scope of practice and related policy documents to clarify the professional mandate for counseling in SLP and to clarify how counseling is defined, limited, and practiced within communication and swallowing disorders. Drawing on existing counseling literature, both in general and specific to SLP, we distinguish informational counseling from personal-adjustment counseling and propose a comprehensive, person-centered definition of counseling in SLP. To facilitate clinicians' integration of counseling into their clinical practice, we also introduce an adapted stepped-care model and a clinical decision tree that outline five levels of counseling involvement, including when to refer clients to other professionals. Conclusion: Together, these frameworks help clinicians, educators, and supervisors follow a clear structure for ethical, effective, and person-centered counseling practice, supporting both positive client outcomes and professional accountability in SLP practice.
Purpose: In this commentary, we respond to an article written by autism parent David Kaufer and entitled “WHY MESSAGE-PASSING IS INVALID: The Test Designed to Fail Nonspeaking Autistic People.” Method: We analyzed the claims made by Kaufer through a human rights lens and from the viewpoint of the authors having extensive disciplinary knowledge across linguistics, speech-language pathology, and educational psychology in the fields of autism, language, behavior, augmentative and alternative communication, and motor speech disorders. Three have provided expert testimony in several legal or educational cases involving authorship testing, and all have recently published guidance on authorship testing in support of human rights for minimally or nonspeaking individuals. Results: Kaufer offers no confirming or disconfirming evidence for his claims in opposition to authorship testing, and his article is erroneous and of concern in repeatedly mischaracterizing authorship tests. Authorship tests are not psychological tests and do not measure psychological states, cognition, language skills, or motor planning skills. Rather, authorship tests are a commonsense way to determine who the author of messages constructed using Facilitated Communication (FC), Spelling to Communicate, or other variants. Furthermore, a speech, limb, or body apraxia in an autistic person—even if present—would not prevent that person from being able to reliably point to answer questions in a message-passing test. Conclusions: The safeguarding of human rights of people who are minimally or nonspeaking is of the utmost importance. Considering the harms of facilitator control over messages produced using FC or its variants and associated human rights violations, access to authorship testing should be considered a human right and, as such, provided to every person subjected to these techniques.
Purpose: Speech-language pathologists (SLPs) worldwide face challenges in treating people who stutter, often citing inadequate knowledge and confidence, particularly in assessment and intervention. This study explored the strengths and areas of need among Ghanaian SLPs in treating stuttering. A secondary aim examined changes in SLPs' self-rated knowledge and confidence levels before and after a 6-week asynchronous online stuttering professional development (PD) program. Method: A secondary data set comprising 34 responses (28 from Phase I and six from Phase II) was analyzed. Phase I surveyed SLPs' needs, knowledge, and confidence levels, informing Phase II, which assessed self-rated knowledge and confidence pre- and post-PD. Descriptive statistics and inductive content analysis were employed. Results: SLPs' confidence was highest in parent counseling (25%), stuttering theory (17%), and teacher education (15%). SLPs' areas of least confidence were intervention (20%), assessment (19%), and goal setting (17%). The greatest support needs were in assessment (19%), intervention (17%), goal setting (17%), and accommodations (15%). Most SLPs reported increased knowledge of stuttering theory (40%), assessment (48%), and intervention (46%). SLPs demonstrated increases in self-reported knowledge and confidence across all 10 outcomes following the 6-week asynchronous PD program, with post-intervention scores exceeding pre-intervention scores. Conclusions: The findings provide preliminary evidence regarding the feasibility and value of asynchronous online PD for SLPs in Ghana. It further supports the need for expanded mentorship for SLPs in Ghana, particularly in stuttering management. Supplemental Material: https://doi.org/10.23641/asha.33311910
The 2025 Centers for Medicare & Medicaid Services (CMS) clarification, which initially excluded clinical fellows (CFs) from the definition of a qualified speech-language pathologist, revealed broader issues in how the clinical fellowship aligns with contemporary licensure and health care systems. Although CMS later clarified that provisionally licensed CFs could bill under state law, the rapid shift in guidance resulted in uncertainty, hiring delays, and care disruptions for older adults in Medicare-funded settings. The CF, once created to ensure competence in an era without licensure, accreditation, or standardized exams, may now duplicate existing systems that already verify readiness for independent practice. The incident underscored a misalignment between American Speech-Language-Hearing Association certification requirements and federal regulatory frameworks, exposing how the CF can contribute to workforce delays, inequities in pay and mobility, and inconsistent mentorship that varies widely across settings. Taken together, these issues suggest that the CF may no longer align optimally with contemporary speech-language pathology practice, as examined through a structure–process–outcome framework. A structured postlicensure mentorship model may better support workforce readiness and promote stable access to services for older adults.
Purpose: Speech and language therapy education has traditionally relied on Euro-American-centric theories of child development. This tutorial examines how child language acquisition curricula can be transformed through decolonization frameworks to better prepare practitioners for culturally responsive practice. Method: Drawing on critical conversations methodology and international collaborative experiences across the United Kingdom, New Zealand, and South Africa, we propose practical recommendations for curriculum transformation that center Indigenous knowledge systems, embrace multilingualism as normative, and develop critical consciousness among educators and students. The tutorial emphasizes shifting from individual deficit models toward community-based, culturally grounded approaches to understanding children's communication development. Case studies illustrate implementations of decolonized practices in university and community settings. Conclusion: This work addresses systemic inequities in speech-language therapy education and practice by providing practical guidance for curriculum transformation while acknowledging that decolonization represents an ongoing, experimental process rather than an outcome.
Purpose: This narrative review examines the role of artificial intelligence (AI) in enhancing the diagnosis and management of vestibular disorders, including benign paroxysmal positional vertigo, vestibular migraine, and Ménière's disease. These conditions are often misdiagnosed due to overlapping symptoms and limited access to specialized testing. Method: A literature search was conducted using PubMed, Scopus, IEEE Xplore, and Google Scholar for articles published between 2020 and 2025. Eligible studies focused on AI applications in vestibular diagnosis, monitoring, or therapy. Findings were organized thematically based on application domains and clinical relevance. Results: AI algorithms demonstrated improved diagnostic accuracy through analysis of clinical data, symptom patterns, and wearable sensor input. AI-enabled tools enhanced remote assessment and symptom tracking, while machine learning-guided rehabilitation improved adherence and outcomes. Despite these advances, challenges such as data quality, model transparency, and clinical adoption persist. Conclusions: AI holds significant promise for transforming vestibular care through improved diagnostics and personalized management. Future work should prioritize multimodal data integration, longitudinal validation, and explainable AI to support responsible and widespread clinical implementation.
Purpose: The purpose of this study was to assess the readability of patient-reported outcome measures (PROMs) related to dysphagia. Method: This descriptive cross-sectional analysis involved a systematic search to identify dysphagia-related PROMs. Readability was assessed using the Coleman-Liau Index (CLI), FORCAST, Gunning Fog Index (FOG), Simple Measure of Gobbledygook (SMOG), and Flesch Reading Ease (FRE) formulas. Results: All five PROMs exceeded the recommended fifth- to sixth-grade reading level across four of the five formulas. CLI scores ranged from 5.5 to 7.7, FORCAST from 9.6 to 10.8, FOG from 7.0 to 9.3, SMOG from 8.1 to 9.9, and FRE from 65 to 79. The average readability grade level ranged from 7.6 to 9.6. Quantitative features such as sentence length, syllable count, and multisyllabic word use further confirmed elevated reading complexity. Conclusions: Dysphagia-related PROMs are written at reading levels that may exceed the comprehension skills of many patients. Developers should incorporate readability assessments during instrument design and validation to enhance accessibility and ensure accurate, representative responses. Poor readability threatens the validity, reliability, and clinical applicability of PROMs, with potential implications for treatment planning and health outcomes. Clinicians must critically evaluate the reading demands of PROMs prior to administration.
Objective: This study aims to evaluate whether the Mimi Hearing Test application's two testing paradigms, pure-tone threshold (PTT) and masked threshold (MT) testing, can be used together to identify the presence of conductive hearing loss. Design: The Mimi Hearing Test application (app) was used to measure PTTs (PTT paradigm) and masked thresholds scores (MT paradigm) via air conduction in 25 adult listeners (two males, 25 females, age range: 18–37 years, M = 24, SD = 4.37) with normal hearing sensitivity as established by standard audiometry. The PTT module yields information about air-conduction hearing acuity, whereas the MT module reflects sharpness of auditory tuning. Both app-based and standard audiometry measurements were obtained in participants in unoccluded and occluded test conditions. In the occluded test condition, audiometry was completed with LYSIAN Ultra soft foam ear plugs (noise-reduction rating: 31 dB) situated in the ear canal to simulate a conductive hearing loss. Results: With the exception of the 2-kHz threshold in the left ear for one participant (30 dB HL), 100% of the app-based air-conduction PTTs occurred within 10 dB of normal hearing sensitivity (15 dB HL) in the unoccluded condition. Additionally, all participants returned excellent scores on the MT test in the unoccluded condition. In the occluded condition simulating conductive hearing loss, app-based air-conduction PTTs were elevated, while scores on the MT test generally remained excellent or good . Conclusions: While normal hearing sensitivity is associated with normal air-conduction thresholds and sharp frequency selectivity, conductive hearing loss is known to result in elevated air-conduction thresholds while retaining sharp frequency selectivity. Outcomes on the PTT and MT modules in the unoccluded and occluded conditions were consistent with this expectation, suggesting that the Mimi Hearing Test app has the potential to identify conductive hearing loss in an adult population.
Purpose: Graduate training in stuttering therapy is often limited, leaving many speech-language pathology students underprepared to work effectively with individuals who stutter. This study examined the impact of the Intensive Stuttering Clinic for Adolescents and Adults (ISCAA), a structured clinical training program, on graduate students' confidence, competence, and clinical perspectives. Method: A qualitative design was employed. Thematic analysis was conducted on reflection papers written by 40 graduate students following their participation in the ISCAA program, which emphasized supervised hands-on experience, use of a clinical manual, preclinic planning, and peer collaboration. Results: Five overarching themes emerged from the analysis: (a) evolving understandings of stuttering therapy, (b) increased clinical confidence and adaptability, (c) validation through client progress, (d) the importance of structure in learning, and (e) lasting professional impact. Students reported a notable shift from fluency-focused approaches to holistic, client-centered therapy that integrates emotional support and counseling. Conclusions: Structured experiential learning, such as that offered through ISCAA, significantly enhances student preparedness and fosters long-term professional development. Findings underscore the need to incorporate immersive stuttering training into graduate curricula to bridge the gap between theoretical knowledge and clinical practice.
Purpose: This study examined the differences between two language sample types, conversation and narrative, to determine whether there is an optimal type for assessing bilingual school-age children's syntactic complexity and lexical diversity with language sample analysis (LSA). Method: Conversation and narrative language samples were elicited from 24 typically developing school-age children divided into three groups: bilingual Spanish–English, bilingual Mam–English (Mam is an indigenous Mayan language), and monolingual English. Two measures of syntactic complexity (mean length of utterance in morphemes [MLUm] and clausal density [CD]) and two measures of lexical diversity (number of different words [NDW] and moving-average type–token ratio [MATTR]) were calculated to compare different language sample types. Results: All four LSA measures differed significantly between the two language sample types. The measures of syntactic complexity (MLUm and CD) were significantly greater in narratives compared to conversational samples, whereas the measures of lexical diversity (NDW and MATTR) were significantly greater in conversational samples compared to narratives. Group differences were found in both language sample types. Conclusions: The optimal language sample context for bilingual school-age children may best be determined by the suspected area of difficulty for each child. However, a clinician may choose to include both language sample types in their evaluation for a wide variety of evidence. Future research should examine other language sample types, such as play-based and expository samples.
Purpose: No studies have investigated comprehensive literacy instruction for children with cerebral palsy (CP). This study explored the use of a freely available comprehensive literacy web application (ABRACADABRA), supplemented by parent-led shared book reading (SBR), on the reading skills of one child with CP. Method: This single-case design study involved one 8-year-old girl with spastic quadriplegic CP. Reading outcomes were measured at three time points: baseline (T1), after a 6-week no-intervention control phase (T2), and following 6 weeks of intervention (T3). During the intervention phase, a speech-language pathologist delivered three 60-min sessions weekly via telepractice and parents completed two SBR activities. Results: No changes to reading skills were made over the control phase (between T1 and T2 assessments). At the final assessment (T3), the participant was able to correctly identify more letter-sound correspondences and read some words on standardized reading measures independent of the intervention. Engagement with the parent-led SBR program was high. Conclusions: Children with CP can make gains in their reading skills over a relatively short time when provided with intensive, high-quality, evidence-based comprehensive literacy instruction across multiple settings. Future research needs to explore comprehensive literacy instruction with a larger sample of children with CP with diverse abilities. Supplemental Material: https://doi.org/10.23641/asha.31915902
Purpose: Speech-language pathologists (SLPs) play a significant role in treating adults over 65 years, a population expected to increase significantly by 2030. Despite this trend, there is limited research on SLPs' academic preparation, attitudes, and knowledge regarding older adults. Prior studies suggest the presence of ageist beliefs among speech-language pathology students and professionals, which may negatively impact clinical care. The aim of this study was to examine the prevalence of ageism in speech-language pathology, with a focus on educational exposure, perceived preparedness, and attitudes toward the older adult population. Methods: A total of 190 SLPs across the United States completed an online survey via Qualtrics. The survey, distributed through American Speech-Language-Hearing Association listservs and speech-language pathology social media groups, included questions on demographics, knowledge and attitudes about aging, and academic exposure to ageism and gerontology. It included multiple-choice, open-ended, and sliding-scale items, some drawn from prior ageism research. Thematic analysis was also conducted to determine themes from two open-ended survey questions using NVivo coding software. Results: More than 90% of participants reported little to no education on ageism during graduate training. While greater academic exposure to gerontology correlated with increased preparedness, it did not improve attitudes toward aging. Regional differences were noted: the Western United States had more exposure to aging content, while the South reported more negative attitudes. Over half (51%) witnessed or experienced ageism in clinical settings. Six themes emerged: diagnosis, beliefs about aging, external support, treatment options, patient preferences, and setting limitations. Conclusion: These findings underscore the need for stronger education on aging and ageism within speech-language pathology graduate programs to better equip professionals and reduce bias in geriatric care. Supplemental Material: https://doi.org/10.23641/asha.31954863
Purpose: Radiation-associated dysphagia (RAD) due to head and neck cancer (HNC) and the associated silent aspiration is likely related, in part, to hypotussia , or downregulated cough. Although the negative impact of RAD may be exacerbated for HNC survivors with concomitant hypotussia , cough dysfunction remains an underemphasized area of clinical practice. Emerging evidence supports the need for improved assessment and management of cough in HNC survivors, particularly given the impact of cough dysfunction with uncompensated aspiration on respiratory compromise, feeding tube dependence, and quality of life in other clinical populations with dysphagia. The purpose of this tutorial was to increase knowledge on central and peripheral underpinnings of cough dysfunction, as it pertains to HNC patients and survivors, through a conceptual model. Conclusions: A conceptual model—iterative in nature—integrates both foundational and contemporary evidence on cough function and dysfunction in HNC patients and survivors for clinicians to leverage. By expanding the speech-language pathologists' clinical arsenal to include expertise in both swallow and cough dysfunction, HNC practitioners may be able to more effectively address the continuum of airway protective dysfunction for HNC survivors.
Purpose: This study used survey methodology to explore the attitudes about and knowledge of dyslexia among primary and secondary school educators (general education teachers, education specialists, and administrators). Method: The Dyslexia Belief Index survey was adapted and distributed by e-mail to 380 administrators and 5,173 other individuals employed within school districts in Eastern Idaho (Regions 4, 5, and 6), with 659 responses received. The questions fell within the broad categories of attitudes, behavior, cognition, language and literacy, and misconceptions related to dyslexia. Demographic data are reported, as well as associations between respondents' current job classification and self-reported attitudes about and knowledge of dyslexia. Results: Overall, attitudes toward dyslexia were positive across groups, agreeing that providing accommodations is appropriate and that individuals with dyslexia have the potential to succeed. General education teachers demonstrated less certainty in distinguishing whether statements about dyslexia were true or false than education specialists and administrators. Conclusions: Education specialists (special education teachers, counselors, school psychologists, speech-language pathologists, and social workers) demonstrated the most accurate knowledge of dyslexia. Misconceptions and gaps in knowledge were observed across job classifications. Implications, limitations, and future directions are discussed.
Purpose: Cultural responsiveness training and immersive international experiences were evaluated in students enrolled in the United States to South Africa Study Abroad Program. Method: A mixed-methods study design assessed students' ( n = 11) cultural awareness and competence in multiple program phases through a pretrip preparatory class, four administered surveys, and qualitative data from individual students' journals and a student group interview. Thematic analysis incorporated data from educator ( n = 4) interviews and reflexive program discussions. Educators provided clinical teaching in Phase 1 that supported students' clinical testing procedures in Phase 2. Results: Pretrip quantitative results on the Cultural Competence Checklist–Personal Reflection survey indicated high cultural awareness among students, and 91% identified as “near competent” on the Cultural Competence Self-Evaluation. The third pretrip survey (Diversity Awareness Profile) administered after the cultural competence class indicated that 45% of students were classified as “change agents.” These results were integrated with posttrip survey (Public Affairs Scale) mean scores of 4.2–4.5 per subscale and the qualitative thematic analysis results. Incorporating reflexive interpretation yielded four major themes, indicating that participants experienced cognitive and emotive learning, navigated tensions between the U.S. and local audiology standards, demonstrated enhanced learning through physical presence in context, and underwent phases of professional identity development. Overall findings reflected participants' development of cultural competence, ethical leadership, and community engagement. Conclusion: Structured cultural responsiveness training with immersive international experiences enhanced students' ability to provide culturally responsive care, emphasizing how critical reflection effectively prepared professionals for global health practices.
Purpose: While there is an increasing body of evidence demonstrating the impact of intercultural learning (ICL) activities in preprofessional programs through varied pedagogical approaches, there is limited information about long-term outcomes of these approaches. The purpose of this study is to evaluate longitudinal outcomes of undergraduate students enrolled in speech-language pathology and audiology courses that embed intentional and structured ICL activities in their syllabi. Method: Participants ( n = 50) were undergraduate students enrolled in at least two of four possible speech, language, and hearing sciences courses that embedded ICL activities. All courses had multiple ICL activities throughout the semester and required critical reflection papers after each ICL activity and a final reflection paper at the end of the semester. Using a mixed-methods approach, quantitative data using the Intercultural Development Inventory (IDI) and qualitative data from reflection papers were obtained from each participant. Results: Quantitative findings indicated that group IDI developmental orientation scores that increased after the first course with embedded ICL activities were maintained at the start of the final course incorporating ICL. Additionally, the group had another significant increase in developmental orientation scores after the final course. These quantitative findings were supported by themes that resulted from analysis of the qualitative reflections from students. Conclusions: The results of this study showed that structured ICL activities embedded throughout multiple courses facilitated lasting intercultural growth among undergraduate students. This study affirmed the value of intentional, longitudinal curricular design in order to prepare future clinicians and professionals to provide patient-centered care and to work effectively in diverse contexts.
Purpose: There is an increased interest among stutterers and clinicians in therapy approaches that focus on improved quality of life rather than increased fluency of speech. This interest is fueled by shifts in thinking about when and if stuttering is a problem, how society views differences, and what can and should be changed. Questions emerge: What are the desired outcomes and associated therapeutic goals? What are the basic principles of the therapy? What does therapy look like in practice? What assessments are congruent with stutter-affirming values? How can progress be measured? This clinical focus article includes the perspectives of six practicing clinicians shining light on a therapy case within the framework of Avoidance Reduction Therapy for Stuttering (ARTS). They demonstrate the alignment of therapy principles, outcomes, activities, and the measurement of change. Method: The cases highlight an aspect of the stuttering therapy journey across the lifespan, applying the ARTS framework with attention to (a) relevant background, (b) theoretical underpinnings, (c) the therapy process, and (d) key insights. The creativity, problem-solving, and counseling skills inherent in working within an ARTS framework are highlighted. The cases presented in this clinical focus article are fictionalized/composite examples created for illustrative purposes. They do not describe actual individuals, and therefore, informed consent was not required. Results: Cases reveal that, within a stutter-affirming therapy framework, (a) outcomes are less often measured by the frequency of stuttered moments (fluency) and more often by the stutterer's reported comfort and confidence in daily communication (impact); (b) goals shift from reducing stuttering-related behaviors and attitudes to reflecting the individual's priorities for speaking ease, self-representation, and socioemotional well-being; and (c) key ingredients for client change include clearly articulated rationales for therapy targets/goals, client-developed assignments, individualized counseling, and support from the stuttering community. Conclusions: Collectively, these cases underscore the importance of aligning therapeutic outcomes with the values and priorities of the stutterer. In doing so, they reframe therapeutic success beyond fluency to emphasize identity, participation, and well-being as meaningful indicators of progress. Further development of assessment measures and research grounded in stutter-affirming practice is needed to support and strengthen this framework for practice. Supplemental Material: https://doi.org/10.23641/asha.31448824
Purpose: This study aimed to investigate the current practice of prenatal consultations for parents expecting an infant with cleft lip and/or palate in the United States. Method: This study utilized a prospective survey and collected anonymous data. The survey was created and distributed using Qualtrics, which included 22 questions organized into four sections: (a) screening, (b) consent, (c) demographics, and (d) survey content. Data were analyzed using descriptive statistics and content analysis. A total of 59 surveys were included, and a range of professionals participated, such as speech-language pathologists, nurses, nurse practitioners, plastic surgeons, physician assistants, social workers, team coordinators, and genetics. Results: Feeding techniques and explanation of the cleft condition were found to be the most discussed topics across providers. Dr. Brown's Specialty Feeding System was the most frequently discussed and provided specialized feeding bottle, frequently accompanied by guidance on breastfeeding and bottle-feeding techniques. Unique findings include a two-visit prenatal consultation model and the underutilization of resources such as support groups and lactation consultants. Conclusions: While many providers discuss feeding, surgical planning, and emotional support, areas such as financial assistance and lactation are less frequently addressed. Incorporating providers such as lactation consultants and discussing topics such as Special Supplemental Nutrition Program for Women, Infants, and Children may help bridge these gaps. Additionally, establishing essential topics to be addressed during each prenatal consultation can ensure consistency across teams while allowing providers the discretion to tailor how this information is communicated.
Purpose: Aerodynamic assessments of voice are part of the American Speech-Language-Hearing Association–recommended, comprehensive approach for evaluating voice and voice disorders. However, one of the most widely used commercial multichannel systems for aerodynamic assessment, the Phonatory Aerodynamic System (PAS), is expensive and cumbersome, limiting widespread use. To address this clinical barrier, the aim of this proof-of-concept study was to assess the validity of pressure measurements using a commercially available, low-cost digital manometer (LDM). Method: This laboratory-based study used a motorized air pump and a simultaneous pressure testing study design to compare differences in pressure measurement between the PAS and the LDM. Concurrent validity was assessed using descriptive statistics, Lin's concordance correlation coefficient (ρ c ), Bland–Altman plots, and linear regression models. Concordance was interpreted as “poor” if ρ c < .90, “moderate” if ρ c = .90 to < .95, “substantial” if ρ c = .95 to < .999, and “excellent” if ρ c ≥ .999. Results: Substantial agreement was observed between the LDM and the PAS. Bland–Altman analysis revealed a consistent negative bias, with the LDM underestimating pressure by approximately 0.36 cmH 2 O. Regression modeling demonstrated excellent predictive accuracy ( R 2 = .999), with correction improving alignment between devices. Conclusions: The findings from this study demonstrate the potential for LDMs to enhance the clinical feasibility of obtaining intraoral pressure measurements that contribute to aerodynamic voice assessments, particularly in settings where access to comprehensive multichannel instrumentation is limited. Future research will compare aerodynamic measures of voice using LDM and PAS with human participants during phonatory tasks, expanding upon these proof-of-concept laboratory-based findings.
