National Academies Press: OpenBook
« Previous: Summary
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 15
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 16
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 17
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 18
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 19
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 20
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 21
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 22
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 23
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 24
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 25
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 26
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 27
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 28
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 29
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 30
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 31
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 32
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 33
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 34
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 35
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 36
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 37
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 38
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 39
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 40
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 41
Suggested Citation:"1 Introduction." National Academies of Sciences, Engineering, and Medicine. 2016. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington, DC: The National Academies Press. doi: 10.17226/21872.
×
Page 42

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

1 Introduction Speech and language are central to the human experience; they are the vital means by which people convey and receive knowledge, thoughts, feel- ings, and other internal experiences. Acquisition of communication skills begins early in childhood and is foundational to the ability to gain access to culturally transmitted knowledge, to organize and share thoughts and feelings, and to participate in social interactions and relationships. Speech and language skills allow a child to engage in exchanges that lead to the ac- quisition of knowledge in his or her community and the educational arena. Communication skills are crucial to the development of thinking ability, a sense of self, and full participation in society. Speech and language disorders—disruptions in communication development—can have wide-ranging and adverse impacts on the ability not only to communicate but also to acquire new knowledge and par- ticipate fully in society. Most children acquire speech and language by a seemingly automatic process that begins at birth and continues through adolescence. Typically, basic communication skills are developed (although not complete) by the time a child enters kindergarten, enabling the child to begin learning from teachers and interacting fluently with peers and caregivers (Oller et al., 2006). Severe disruptions in speech or language acquisition thus have both direct and indirect consequences for child and adolescent development, not only in communication but also in associated abilities such as reading and academic achievement that depend on speech and language skills. When combined with other developmental risks, such as poverty (Williams, 2013), severe speech and language disabilities can 15

16 SPEECH AND LANGUAGE DISORDERS IN CHILDREN become high-impact, adverse conditions with long-term cognitive, social, and academic sequelae and high social and economic costs. STUDY CONTEXT Like other entitlement programs, the Supplemental Security Income (SSI) program has generated considerable and recurring interest in its growth, effectiveness, accuracy, and sustainability. Questions have arisen in both the media and policy-making settings regarding the appropriateness of SSI benefits for children with speech and language disorders. As an example, the Boston Globe published a series of articles in December 2010 describing the experiences and challenges of families who either were currently receiving or had sought to become eligible to receive SSI benefits for their children. These articles focused on the growing number of children enrolled in SSI on the basis of speech and language disorders. In response to issues raised in these articles, members of Congress directed the U.S. Government Accountability Office (GAO) to conduct an assessment of the SSI program for children. This assessment was designed to examine decade-long trends in the rate of children receiving SSI benefits based on mental impairments;1 the role played by medical and nonmedical informa- tion, such as medication use and school records, in the initial eligibility determination; and steps taken by the Social Security Administration (SSA) to monitor children’s continued eligibility based on disability. The GAO assessment was conducted between February 2011 and June 2012. Midway through the assessment, on October 27, 2011, the Subcommittee on Human Resources of the House Ways and Means Committee convened a hearing on SSI for children, including an interim report by the GAO on its findings regarding the SSI program for children. In that report, the GAO found that between 2000 and 2011, the annual number of children applying for SSI benefits had increased from 187,052 to 315,832. Of these applications, 54 percent had been denied. The GAO also found that mental impairments constituted approxi- mately 65 percent of all child SSI allowances. The three most prevalent primary mental impairments2 for children found eligible were attention deficit hyperactivity disorder (ADHD), speech and language impairments,3 1  The SSI program categorizes “speech and language impairments” as mental disorders. 2  See the report Mental Disorders and Disabilities Among Low-Income Children for trends in prevalence for mental disorders (NASEM, 2015). 3  Impairment code 3153 was changed from “speech and language delays” to “speech and language impairments” in August 2015.

INTRODUCTION 17 and autism/developmental delays.4 From December 2000 to December 2011, the total number of children receiving SSI benefits for mental im- pairments had increased annually, from approximately 543,000 in 2000 to approximately 861,000 in 2011, an almost 60 percent increase. Secondary impairments were present for many of those found medically eligible. In ad- dition, the GAO estimated that in 2010, 55 percent of children with speech and language impairments who received SSI benefits had an accompanying secondary impairment recorded; 94 percent of those recorded secondary impairments were other mental disorders. In its final report, the GAO suggested that several factors may have contributed to the observed changes in the size of the SSI program for children, including • long-term receipt of assistance, with fewer children leaving the dis- ability program prior to age 18; • increased numbers of children living in poverty in the United States; • increased awareness and improved diagnosis of certain mental impairments; • a focus on identifying children with disabilities through public school special education services; and • increased health insurance coverage of previously uninsured children. The GAO found an increase between 2000 and 2010 in both applica- tions and allowances (applicants determined to meet the disability criteria) for children with speech and language impairments (GAO, 2012). During this period, the number of applications for speech and language impair- ments increased from 21,615 to 49,664, while the number of children found to meet the disability criteria increased from 11,565 to 29,147 (GAO, 2012). The cumulative number of allowances for children with speech and language impairments has continued to increase. In December 2014, 213,688 children were receiving benefits as the result of a primary speech or language impairment (16 percent of all children receiving SSI benefits) (SSA, 2015). The factors that contributed to these changes are a primary focus of this report and are discussed at length in Chapters 4, 5, and 6. Based on the GAO findings, the SSA determined that additional study was needed to understand the increases in the total number of children 4  “Autism/developmental delays” is language drawn directly from the GAO report. How- ever, autism spectrum disorder is a distinct neurodevelopmental disorder with distinct clinical characteristics. For further reading on autism spectrum disorder, see Mental Disorders and Disabilities Among Low-Income Children (NASEM, 2015).

18 SPEECH AND LANGUAGE DISORDERS IN CHILDREN receiving SSI benefits as a result of speech and language disorders. This study was requested to meet that need. STUDY CHARGE AND SCOPE In 2014, the SSA’s Office of Disability Policy requested that the Institute of Medicine (IOM) of the National Academies of Sciences, Engineering, and Medicine convene a consensus committee to (1) identify past and current trends in the prevalence and persistence of speech and language disorders among the general U.S. population under age 18 and compare those trends with trends among the SSI childhood disability population; and (2) provide an overview of the current status of the diagnosis and treatment of speech and language disorders and the levels of impairment due to these disorders in the U.S. population under age 18. (See Box 1-1 for the committee’s full statement of task.) This report addresses the charge defined in the committee’s statement of task. It should be noted that this report is not intended to provide a comprehensive discussion of speech and language disorders in children, but to provide the SSA with information directly related to the administration of the SSI program for children with these disorders. In addition, this com- mittee was not charged with providing an evaluation of the SSI program or addressing any other questions related to policy or rulemaking. Finally, it is important to note that this study was conducted at the same time that the Committee on the Evaluation of the Supplemental Security Income (SSI) Disability Program for Children with Mental Disorders study was under way. Although the two studies have related statements of task and were both sponsored by the SSA, the work was conducted by two distinct committees, which held separate meetings and underwent indepen- dent report review processes. The report Mental Disorders and Disabilities Among Low-Income Children was released in September 2015 (NASEM, 2015). A brief summary of that report’s key findings and conclusions is included in Appendix G. The following subsections describe how the committee used its state- ment of task to guide its review and analysis and to determine the inclusion or exclusion of related or noteworthy topics. Speech and Language Disorders and Corresponding Treatments Numerous childhood speech and language disorders and other condi- tions associated with these disorders are worthy of rigorous examination. Similarly, many approaches are used to treat childhood speech and language disorders. As noted above, however, this report does not provide an ex- haustive review of all such disorders or of their corresponding treatments.

INTRODUCTION 19 BOX 1-1 Statement of Task An ad hoc committee will conduct a study to address the following task order objectives: •  dentify past and current trends in the prevalence and persistence of I speech disorders and language disorders for the general U.S. population under age 18 and compare those trends to trends in the Supplemental Security Income (SSI) childhood disability population; and •  rovide an overview of the current status of the diagnosis and treatment P of speech disorders and language disorders, and the levels of impairment in the U.S. population under age 18. To accomplish this goal, the committee will: •  ompare the national trends in the number of children with speech C disorders and language disorders under age 18 with the trends in the number of children receiving SSI on the basis of speech disorders and language disorders; and describe the possible factors that may contribute to any differences between the two groups; and •  dentify current professional standards of pediatric and adolescent health I care for speech disorders and language disorders and identify the kinds of care documented or reported to be received by children in the SSI childhood disability population. To perform the above activities, the committee shall do the following with respect to the two child populations: •  dentify national trends in the prevalence of speech disorders and I language disorders in children and assess factors that influence these trends. •  dentify the causes of speech disorders and language disorders and I determine how often these disorders are the result of known causes. •  dentify the average age of onset and the gender distribution and assess I the levels of impairment within age groups. •  ssess how age, development, and gender may play a role in the A progression of some speech disorders and language disorders. •  dentify common comorbidities among pediatric speech disorders and I language disorders. •  dentify which speech disorders and language disorders are most ame- I nable to treatment and assess typical or average time required for im- provement in disorder to manifest following diagnosis and treatment. •  dentify professionally accepted standards of care (such as diagnos- I tic evaluation and assessment, treatment planning and protocols, and educational interventions) for children with speech disorders and with language disorders.

20 SPEECH AND LANGUAGE DISORDERS IN CHILDREN Rather, in accordance with the committee’s statement of task, this report describes primary categories of childhood speech and language disorders that occur most commonly in the population of children served by the SSI program and provides an overview of treatments for these disorders. Therefore, the exclusion of any conditions or treatments should not be viewed as an oversight, but as a necessary narrowing of the focus of this study to the issues of greatest relevance to the SSI program. Data and Data Sources The committee consulted a variety of data sources to identify trends in the prevalence and persistence of speech and language disorders (prevalence and trends in prevalence are discussed below). These sources included data from clinical samples (i.e., Pennington and Bishop, 2009), population- based studies (i.e., Law et al., 2000; Tomblin et al., 1997), nationally representative surveys (e.g., the National Survey of Children’s Health), and administrative or service-based data from federal programs (Medicaid Analytic eXtract [MAX] data, Individuals with Disabilities Education Act [IDEA] child count data, and the SSA’s program data). These sources differ substantially with respect to how they define and/or designate speech and language disorders in children, how they collect information (e.g., parental reporting, medical records, test results), which variables are examined (e.g., level of severity or duration of disorders, child and/or family demographic information), and the period(s) of time examined, among other factors. As a result, readers of this report will encounter numbers and estimates that appear quite different from chapter to chapter. Recognizing the challenge this variation presents to readers, the committee carefully describes the dif- ferent types of data and how estimates were derived throughout the report. (A full discussion of data limitations is included in Chapter 5.) In addition to the challenges that the committee encountered in using available data, the absence of other relevant data limited the committee’s ability to generate more precise population estimates, to compare changes over time, and to conduct further analyses. This absence of data included data sources and data collection efforts that do not currently exist, as well as data that were unavailable to the committee (or to the general public). For example, the committee’s efforts to determine prevalence estimates of children with speech and language disorders could have been improved by access to a national data source derived from health services or health insurance records. Similarly, the committee’s efforts to describe trends in childhood speech and language disorders could have been improved through an analysis of longitudinal data from programs (i.e., Medicaid and SSI) or national surveys. At this time, no such national-level data sources or longitudinal data collection efforts exist for these conditions.

INTRODUCTION 21 Furthermore, the committee’s efforts to document the persistence of speech and language disorders among children who receive SSI benefits and the types of treatment received by these children would have been improved by access to certain types of unpublished SSA administrative data, such as age-18 redeterminations and continuing disability reviews. However, these data were not available to the committee for the purpose of this study. Finally, the committee had access to an analysis of MAX data that included limited analyses related to speech and language disorders (see Chapter 5). Because these data are drawn from a study that was commissioned for another report (see NASEM, 2015), this committee was unable to conduct additional analyses, which would have allowed for comparisons between speech and language disorders and other health conditions. Severity of Speech and Language Disorders This report frequently refers to “severe” speech and language disorders in children. However, the word “severe” has different meanings depend- ing on the context in which it is used. In clinical research, severity may be measured according to how far below average children score on tests compared with children of the same age (i.e., in standard deviations from a norm-referenced score or quotient) or “percentage of delay” relative to chronological age. In the context of the SSI program, however, the word “severe” has a specific legal meaning that is related to the standard of dis- ability for children in the Social Security Act. Specifically, the regulations explain that “an impairment or combination of impairments must cause ‘marked and severe functional limitations’ in order to be found disabling.”5 Elsewhere, the regulations explain that “a child’s impairment or combina- tion of impairments is ‘of listing-level severity’ if it causes marked limitation in two areas of functioning or extreme limitation in one such area.”6 These areas of functioning include acquiring and using information, attending to and completing tasks, interacting and relating with others, moving about and manipulating objects, caring for himself or herself, and maintaining health and physical well-being. Chapter 4 includes an in-depth review of how children are evaluated for disability as part of the SSI eligibility deter- mination process. Readers of the report should therefore consider the word “severe” as a clinical expression of impairment level except when it is used in the context of the SSI program. 5  20 C.F.R. 416.902. 6  20 C.F.R. 416.925(b)(2).

22 SPEECH AND LANGUAGE DISORDERS IN CHILDREN Identifying Severe Speech and Language Disorders When prevalence estimates (for any condition) are based on a threshold or cutoff score imposed on a continuous normal distribution, the cutoff score will necessarily determine the percentage of individuals falling above and below it. The committee used cutoffs (two and three standard devia- tions below the mean) that are consistent both with conventional definitions of severe disorders in medicine, psychology, and other fields and with the quantitative standards used by the SSA for defining severe speech and lan- guage disorders (see Chapter 4). Many researchers and organizations have noted the need to consider additional sources of evidence, including subjec- tive judgments of functioning, in addition to norm-referenced cutoff scores. For example, the World Health Organization’s International Classification of Functioning, Disability and Health is one widely accepted approach to describing the severity of medical and developmental conditions (WHO, 2001). This, too, is consistent with the SSA’s approach, which requires qualitative evidence that is consistent with quantitative scores when the lat- ter are available. Unfortunately, high-quality data from large, representative populations that have been assessed with both quantitative and qualitative metrics are not available. Prevalence and Trends in Prevalence As part of its charge, the committee was asked to “identify past and current trends in the prevalence and persistence of speech disorders and language disorders for the general U.S. population (under age 18) and compare those trends to trends in the SSI childhood disability population.” Prevalence is defined as “the number or proportion of cases or events or attributes among a given population” (CDC, 2014). The term “prevalence” is often used to describe “point prevalence,” which refers to “the amount of a particular disease present in a population at a single point in time” (CDC, 2014). Given the lack of longitudinal data on speech and language disorders in SSI administrative data and the paucity of similar data for the general population, the committee determined that the best way to identify trends in prevalence using available data sources would be to examine trends in point prevalence—that is, the number of children with speech and lan- guage disorders at a given time and over time both for the general U.S. population (under age 18) and in the SSI childhood disability population. To identify trends in prevalence in these groups, the committee reviewed multiple estimates of point prevalence over time from a variety of sources, including studies using clinical samples, nationally representative surveys, and administrative or service data from federal programs (see Chapter 5).

INTRODUCTION 23 When these estimates are arranged in chronological order, they produce a trend line—or a trend in prevalence. However, comparing trends in prevalence between these two popula- tions posed a number of challenges beyond a lack of longitudinal data. These challenges, described in Chapters 4 and 5, include inherent differ- ences in the sample populations (e.g., socioeconomic status, levels of sever- ity) and differences in how children with speech and language disorders are identified and categorized. In addition, many of the estimates of prevalence and trends in prevalence presented in this report lack statements of preci- sion, such as confidence intervals or error bars. Recognizing this limitation, the committee provides detailed information regarding sample sizes and methods used to calculate estimates. These can be found in Chapters 2 and 5 and Appendixes C and D. Despite the numerous challenges and limita- tions, the committee used the available data to describe changes in both groups7 over time, in accordance with its charge. Poverty Because financial need is a basic condition of eligibility for SSI, the first step in determining eligibility is assessment of family financial status. As a result, the majority of children who receive SSI benefits are from families with a household income less than 200 percent of the federal poverty level (FPL). The number of families with incomes less than 200 percent of the FPL changes over time. That is, as economic conditions deteriorate, more families join the ranks of those with incomes at or below a defined poverty level. This most recently occurred following the 2008-2009 recession in the United States. Table 1-1 presents the absolute number of children under age 18 living in poverty and the percentage of children who were below the FPL annually from 2004 to 2013. The pattern shows that the percentage of children in poverty increased after 2006, peaked in 2010, and declined afterward, although by 2013 it was well above the 2006 level (NASEM, 2015). This pattern suggests that more children would have met the financial eligibility criteria for SSI benefits during the period that followed the 2008- 2009 recession in the United States. Thus, an increase in the number of children with speech and language disorders receiving SSI may not reflect an increase in these disorders, but instead may arise from an increased number of children with these disorders who meet the poverty threshold for SSI eligibility (NASEM, 2015). However, there are no reliable estimates of the 7  In accordance with the committee’s charge, this includes children with speech and language disorders of any level of severity in the general population and children with these disorders in the SSI population, whose impairments are inherently severe.

24 SPEECH AND LANGUAGE DISORDERS IN CHILDREN TABLE 1-1  U.S. Children Living in Poverty (below 100 percent of the federal poverty level), 2004-2013 (numbers in thousands) Below the Federal Poverty Level Total Number of Children in Number of Year General U.S. Population Children Percent of Total 2004 73,241 13,041 17.8 2005 73,285 12,896 17.6 2006 73,727 12,827 17.4 2007 73,996 13,324 18.0 2008 74,068 14,068 19.0 2009 74,579 15,451 20.7 2010 73,873 16,286 22.0 2011 73,737 16,134 21.9 2012 73,719 16,073 21.8 2013 73,625 14,659 19.9 SOURCE: DeNavas-Walt et al., 2014. number of children living in poverty who also have speech and language disorders. Therefore, this report examines the interaction of poverty and dis- ability as well as changes in childhood poverty rates and the changes observed in the SSI program for children with speech and language disor- ders. Additional data provided in this report allow for comparisons and analyses of SSI determinations, allowances, and total child SSI recipients as a proportion of low-income populations within the United States. This discussion can be found in Chapters 4 and 5. Limitation of Review of the SSI Program to Children Under Age 18 As noted in the committee’s statement of task, this review was limited to children under age 18, the age range served by the SSI childhood pro- gram. Therefore, data on redetermination at age 18 are not included in this report, although at age 18, SSI recipients must be reevaluated for eligibility to continue receiving SSI disability benefits as adults. One notable exception is that the committee includes program data on children and youth with disabilities served under IDEA Parts B and C; these data, which could not be disaggregated, include children and youth aged 0-21. Data related to topics beyond the scope of this review, such as continuing disability reviews and age-18 redeterminations, were not made available to the committee by the SSA.

INTRODUCTION 25 Age of Onset As part of its task, the committee was asked to identify the average age of onset of speech and language disorders. The onset of a disorder and its chronicity may have important implications related to the burden placed by the disorder on an individual and his or her family, as well as the types and duration of supports an individual will require. Chapter 3 reviews the evi- dence on persistence of speech and language disorders in children. However, the committee found that in most cases, a simplistic concept of onset does not apply to speech and language or other developmental disorders. The notion of onset of a condition implies that prior to the onset, affected individuals had these functions but then experienced a decline or loss of function. In general, developmental disorders are identified when expected functional skills in children fail to emerge. These expectations usually are based on ages when children typically begin to show these skills. The crite- ria for determining that a child is presenting severe and long-lasting devel- opmental problems often allow for a period of uncertainty. The underlying factors that contribute to developmental disorders are likely to have been present well before the signs are manifest in the child’s development. For example, the babbling of infants who later display severe speech disorders often lacks the consonant-like sounds (closants) seen in typically developing children (Oller et al., 1999). However, there is considerable variability in typical development, so that babbling features alone cannot be used as an accurate diagnostic test for speech disorder. A major effort in clinical research on developmental disorders has been to identify early risk factors and subclinical signs, so as to support earlier identification and treatment. This research also supports the general assumption that for most developmental disorders, identification is likely to occur during very early stages of development. Therefore, this report re- views what is known about the age of identification of speech and language disorders as it relates to expected developmental milestones. It is generally more accurate to describe the “age of identification” of a speech or lan- guage disorder than to focus on the “age of onset.” It is worth noting that the age at which a speech or language disorder is identified may be further influenced by a number of factors, including access to care, socioeconomic status, and other demographic factors. Gender The committee was charged with identifying the “gender distribu- tion” of speech and language disorders in children and with assessing “how gender may play a role in the progression” of these disorders. This report highlights findings on gender distribution from clinical research and

26 SPEECH AND LANGUAGE DISORDERS IN CHILDREN national survey data. However, the evidence base on the effects of gender on the efficacy of treatment and the progression or persistence of speech and language disorders is limited. In its review of the literature, the committee found that few studies examined differential effects of treatment on males and females or included longitudinal data that demonstrated gender differ- ences in the persistence or progression of speech and language disorders. State-to-State Variation in the SSI Program Determinations of eligibility for the SSI program are managed at the state level. Through its examination of the evidence, the committee became aware that states vary considerably in the number and rate of applica- tions leading to determinations and in the rate of allowances. This report includes some state-level data to provide an overall perspective, but it does not explore the potential factors contributing to state-to-state variation in the rates of SSI disability, which was beyond the scope of this study. Readers can refer to a recent research brief by the Office of the Assistant Secretary for Planning and Evaluation, The Child SSI Program and the Changing Safety Net (Wittenburg et al., 2015), or to Mental Disorders and Disabilities Among Low-Income Children (NASEM, 2015) for further information on geographic variation in child SSI program growth and participation. Exclusion of Recommendations Finally, the committee was not asked to provide the SSA with recom- mendations on the SSI program for children. Doing so would be beyond not only the scope of this study as laid out in the statement of task but also the expertise of this committee. Rather, the committee was tasked with gathering information and reporting on the current state of knowledge on the diagnosis, prognosis, and treatment of speech and language disorders in children, as well as trends in the prevalence of these disorders in children. The information presented in this report (and in the recent Academies report on trends in low-income children with mental disorders in the SSI program [NASEM, 2015]) provides a solid evidentiary basis that can in- form the SSA’s programs and policies, as well as the work of an array of related stakeholders. STUDY APPROACH The study committee included 13 members with expertise in speech- language pathology, auditory pathology, pediatrics, developmental-behavioral pediatrics, epidemiology, biostatistics, neurology, neurodevelopmental

INTRODUCTION 27 disabilities, adolescent health, health policy, and special education. (See Appendix H for biographies of the committee members.) A variety of sources informed the committee’s work. The committee met in person five times: two of those meetings included public work- shops to provide the committee with input from a broad range of experts and stakeholders, including parents and professional organizations; federal agencies (e.g., the Centers for Disease Control and Prevention, the SSA, and the National Institute of Deafness and Other Communication Disorders); and researchers from a range of relevant disciplines, including speech and language pathology and epidemiology. In addition, the committee con- ducted a review of the literature to identify the most current research on the etiology, epidemiology, and treatment of pediatric speech and language disorders. The committee made every effort to include the most up-to- date research in peer-reviewed publications. However, strong evidence was sometimes found in older studies that had not been replicated in recent years. In these instances, the older studies are cited. The committee also reviewed findings from a supplemental study using Medicaid data to create an approximate national comparison group for the SSI child population.8 (See Chapter 5 for additional information about this supplemental study.) Finally, the committee reviewed data collected from SSI case files of children who were eligible for SSI benefits under the category of “speech and lan- guage impairment.” (See Chapter 4 and Appendix C for more information about this review.) DEFINITIONS OF KEY TERMS Language has long been described as a verbal or written code for conveying information to others, and speech refers to oral communication (Bloomfield, 1926). All languages include words (vocabulary), word end- ings (morphology), and sentence structure (syntax), and speech includes the pronunciation of the sounds (phonemes) of the language. Language devel- opment also encompasses acquisition of the social rules for communicating and conversing in society (pragmatics). These rules include participating appropriately in conversations, as well as using and comprehending appro- priate gestures and facial expressions during social interaction (Gallagher and Prutting, 1983). The communication and social aspects of speech and language must be coordinated rapidly and fluently when one is speaking. Given the complex nature of speech and language development, mul- tiple factors can contribute to deficits in their acquisition and use (e.g., motor impairments, processing deficits, cognitive impairments). Disruptions 8  This supplemental study was commissioned by the Committee on the Evaluation of the Supplemental Security Income Disability Program for Children with Mental Disorders.

28 SPEECH AND LANGUAGE DISORDERS IN CHILDREN in communication development are broadly classified as speech disorders and language disorders. Speech disorder is defined as disruption in the production of the pho- netic aspects of words, phrases, and sentences so that communication is partially or, in severe cases, completely unintelligible to listeners. Stuttering is a form of speech disorder that involves disruptions in the rate and/or fluency of speaking due to hesitations and repetitions of speech sounds, words, and/or phrases. Language disorder is defined as impairment of expression and compre- hension because of a disruption in the acquisition of vocabulary (words), word endings, and sentence structure. In severe cases of language disorder, a child experiences extreme difficulty using correct words and proper gram- mar and may also have difficulty comprehending what others are saying. Box 1-2 presents the clinical definitions of speech and language disorders. BOX 1-2 Clinical Definitions of Speech and Language Disorders Speech: the production (pronunciation) of meaningful sounds from the complex coordinated movements of the oral mechanism Speech disorders: deficits that may cause speech to sound abnormal or prevent it altogether Examples of disordered speech: M  ild to moderate—speaking with a lisp, substituting or deleting sounds in words (e.g., saying “twee” for “three,” saying “jo” for “joke”) Severe—making multiple pronunciation errors so that speech is largely or even totally unintelligible Language: the code or system of symbols for representing ideas in various modalities, including understanding (comprehending) and speaking, reading, and writing Language disorders: conditions that interfere with the ability to understand the code, to produce the code, or both Examples of disordered language: Mild to moderate—omitting word endings, using an incorrect pronoun Severe—very low vocabulary, inability to comprehend, grossly inaccurate word order

INTRODUCTION 29 BOX 1-3 Primary Versus Secondary Speech and Language Disorders Primary speech and language disorders: no other etiology or “cause” is evident Examples of primary speech and language disorders: • Speech sound disorders • Voice disorders • Stuttering • Expressive language disorder • Receptive language disorder • Combined receptive and expressive language disorder • Social communication disorder Secondary speech and language disorders: can be attributed to another condition Examples of contributors to secondary speech and language disorders: • Hard of hearing or deaf • Intellectual disability • Autism spectrum disorder • Cleft palate • Cerebral palsy Furthermore, speech and language disorders can be categorized as primary, meaning the disorder does not arise from an underlying medical condition (e.g., cerebral palsy, Down syndrome, hearing impairment), or secondary, meaning the disorder can be attributed to another condition (see Box 1-3). This report discusses both primary and secondary speech and language disorders, but it focuses mainly on speech and language dis- orders that are identified as the primary condition. This corresponds with the categories of speech and language disorders in the SSI program that the report examines. SIGNIFICANCE AND IMPACT OF SEVERE SPEECH AND LANGUAGE DISORDERS Speech and language disorders can have a significant adverse impact on a child’s ability to have meaningful conversations and engage in age- appropriate social interaction. These disorders are serious disabilities with long-term ramifications for cognitive and social-emotional development and for literacy and academic achievement and have lifelong economic and social impacts, and these disruptions are evidenced in increased risk for

30 SPEECH AND LANGUAGE DISORDERS IN CHILDREN learning disabilities, behavior disorders, and related psychiatric conditions. The following sections describe the variety of ways in which speech and language disorders can impact children and their families. Impact on Social-Emotional and Cognitive Development Child development is best viewed in the context of a dynamic interac- tion between social-emotional and cognitive development (Karmiloff-Smith et al., 2014). A seminal paper by Sameroff (1975) brought attention to the critical role of parent–child interactions and social-communicative exchanges in children’s social and emotional development. In this communicative- interactive model, social development is the direct product of parent–child (or caregiver–child) interaction (Sameroff, 2009). Specifically, parent–child communication interactions, including speech and language skills, are foundational to emotional attachment, social learning, and cognitive de- velopment in addition to communication development. Communication interactions—social “back and forth” exchanges—are a natural part of parent-child communication, with more than 1 million of these parent– child exchanges occurring in the first 5 years of a child’s life (Hart and Risley, 1995). Figure 1-1 illustrates how social interaction between parent and child leads to the development of speech. FIGURE 1-1 Example of communication-interaction for speech development.

INTRODUCTION 31 In the decades since Sameroff’s (1975) original article, the communi- cation-interaction model has been applied to multiple aspects of develop- ment, including speech (Camarata, 1993), language (Nelson, 1989), the development of self (Damon and Hart, 1982), and cognitive development (Karmiloff-Smith et al., 2012). Karmiloff-Smith (2011) adapted the com- munication-interaction perspective as a means of mapping developmental processes across multiple domains of genetics and neuroimaging, as well as cognitive and linguistic abilities. In essence, she argues that dynamic communication interactions between parent and child serve not only as learning opportunities but also as the core of the genetically mediated neu- ral phenomena occurring for childhood brain development, often referred to as neural plasticity and remodeling. Viewed in this way, communicative interchanges are fundamental to the developmental experiences that shape a child’s neural architecture and, more important, brain function. Severe speech and language disorders can derail this typical cascade of develop- ment and have profound and wide-ranging adverse impacts (Clegg et al., 2005). Impacts on Literacy and Academic Achievement Figure 1-2 illustrates the importance of language development for the development of literacy skills and the relationship of both to academic achievement across a range of subject areas. Considerable data suggest that severe speech and language disorders are associated with reading disabili- ties and general disruptions in literacy (Fletcher-Campbell et al., 2009). In FIGURE 1-2 The relationship among language development, literacy skills, and academic achievement.

32 SPEECH AND LANGUAGE DISORDERS IN CHILDREN essence, reading involves mapping visual symbols (letters) onto linguistic forms (words). When the acquisition and mastery of oral vocabulary are impaired, it is not surprising that the mapping of symbols such as letters onto words is also disrupted. In addition, broader language and speech disorders can make processing the visual symbols much less efficient and disrupt their mapping onto meaning. Even after vocabulary has been ac- quired, cognitive problems with translating text to language can continue (Briscoe et al., 2001). In languages such as English that use phonetic text, severe speech disorders also can disrupt the phonological processing asso- ciated with reading (Pennington and Bishop, 2009). In sum, severe speech and language disorders often have direct or indirect adverse impacts on the development of literacy and fluid reading. In addition to their direct impact on literacy, severe speech and lan- guage disorders can have a deleterious cascading effect on other aspects of academic achievement. To illustrate, in a 15-year follow-up study of chil- dren with speech and language disorders, a high percentage (52 percent) of the children initially identified with such disorders had residual learning dis- abilities and poor academic achievement later in life (King, 1982). Similarly, Hall and Tomblin (1978) report poor overall long-term achievement in language-impaired children. More recently, a study of preterm infants with language disorders indicated multiple disruptions in subsequent achieve- ment (Wolke et al., 2008). And Stoeckel and colleagues (2013) found a strong correlation between early language problems and later diagnosis of written-language disorders. Because so much of academic achievement is predicated on acquiring information through reading and listening com- prehension, early severe speech and language disorders often are associated with poor achievement beyond reading problems. As illustrated in Figure 1-3, the most recent data from the Institute of Education Sciences of the U.S. Department of Education indicate that 21 percent of all special education eligibility in the United States is for speech and language impairments—three times greater than eligibility for autism or intellectual disability. Speech and language disorders are among the highest-incidence conditions among children in special education. Moreover, these data may underestimate the prevalence of speech and language disorders because the highest-incidence condition—specific learn- ing disability—includes many students who were previously categorized as having a speech or language impairment (Aram and Nation, 1980; Catts et al., 2002). Although mild speech and language impairments in preschool will sometimes be transient, severe forms of the disorders have a high prob- ability of being long-term disabilities (Beitchman et al., 1994; Bishop and Edmundson, 1987), with that probability rising with the disorder’s severity.

INTRODUCTION 33 Specific Learning DisabiliƟes 36 Speech or Language Impairments 21 Other Health Impairments 12 AuƟsm 7 Disability Type Intellectual Disability 7 Developmental Delay 6 EmoƟonal Disturbance 6 MulƟple DisabiliƟes 2 Hearing Impairments 1 Orthopedic Impairments 1 0 5 10 15 20 25 30 35 40 Percent FIGURE 1-3  Percentage distribution of children aged 3-21 served under the Indi- viduals with Disabilities Education Act (IDEA) Part B, by disability type: school year 2011-2012. SOURCE: Kena et al., 2014. Economic and Family Impacts In a review of the economic impact of communication disorders on so- ciety, Ruben (2000, p. 241) estimates that “communication disorders may cost the United States from $154 billion to $186 billion per year.” Severe speech and language disorders elevate risk for a wide variety of adverse eco- nomic and social outcomes, such as lifelong social isolation and psychiatric disorders, learning disabilities, behavior disorders, academic failure, and chronic underemployment (Aram and Nation, 1980; Baker and Cantwell, 1987; Beitchman et al., 1996; Johnson et al., 1999; Stothard et al., 1998; Sundheim and Voeller, 2004). Following a cohort of individuals with severe language disorders in childhood longitudinally through school age and adolescence and into early adulthood, Clegg and colleagues (2005, p. 128) found that “in their mid-30s, those who had language disorders as children had significantly worse social adaptation with prolonged unemployment and a paucity of close friendships and love relationships.” Research shows that children living in poverty are at greater risk for a disability relative to their wealthier counterparts, and that childhood dis- ability increases the risk of a family living in poverty (Emerson and Hatton, 2005; Farran, 2000; Fujiura and Yamaki, 2000; Lustig and Strauser, 2007; Msall et al., 2006; NASEM, 2015; Parish and Cloud, 2006). For example,

34 SPEECH AND LANGUAGE DISORDERS IN CHILDREN data from the U.S. Census 2010 showed that families raising children with a disability experienced poverty at higher rates than families raising children without a disability (21.8 and 12.6 percent, respectively) (Wang, 2005). At the same time, childhood poverty and the accompanying deprivations have significant adverse implications for children with disabilities and their fami- lies. Families with children with disabilities are also more likely to incur increased out-of-pocket expenses; for example, for child care or for trans- portation to locations with specialized medical care (Kuhlthau et al., 2005; Newacheck and Kim, 2005). Data from the National Survey of Children with Special Health Care Needs help illustrate the impact on families of caring for children with communication disorders. For example, the survey asked whether family members cut back on or stopped working because of their child’s health needs. Fifty-two percent of the survey respondents whose children had “a lot of difficulty speaking, communicating, or being understood” responded affirmatively to this question (Wells, 2015). In sum, given the complex multidimensional nature of language ac- quisition and the integral role of speech and language across multiple domains of early child development, speech and language disorders occur at relatively high rates (Kena et al., 2014). In 2011-2012, 21  percent of children served under IDEA Part B had speech or language impairments (Kena et al., 2014). These disorders also are associated with a wide range of other conditions (Beitchman et al., 1996), such as intellectual disabilities (Georgieva, 1996), autism spectrum disorder (Geurts and Embrechts, 2008; Sturm et al., 2004), hearing loss (Yoshinaga-Itano et al., 1998), learning disabilities (Pennington and Bishop, 2009; Schuele, 2004), ADHD (Cohen et al., 2000), and severe motor conditions such as cerebral palsy (Pirila et al., 2007). NOTABLE PAST WORK As noted earlier, in the period between 2000 and 2011, speech and language impairments were among the three most prevalent impairments in children in the SSI disability program (preceded by ADHD and followed by autism spectrum disorder) (GAO, 2012). In an effort to understand these trends in comparison with trends in the general population, the SSA requested that the IOM conduct two studies: the previously mentioned study on childhood mental disorders (including ADHD and autism spec- trum disorder)9 and this study on childhood speech and language disor- ders. While these impairments frequently co-occur and may have similar 9  Information on the Committee on the Evaluation of the Supplemental Security Income Disability Program for Children with Mental Disorders can be found online at http://iom. nationalacademies.org/activities/mentalhealth/ssidisabilityprograms.aspx.

INTRODUCTION 35 diagnostic characteristics, the separate studies allowed two independent committees to examine distinct literatures and data sources and to review different standards of care and treatment protocols. The study on children with mental health disorders was conducted from January 2014 through August 2015; the final report of that study was released in September 2015 (NASEM, 2015). While this report is the first examination of the SSI disability pro- gram for children with speech and language disorders conducted by the Academies, the IOM, and the National Research Council (NRC) have a long history of studying issues related to disability in children and adults and the SSA’s disability determination process. In addition to the recently released Mental Disorders and Disabilities Among Low-Income Children (NASEM, 2015), earlier reports by the IOM and the NRC that informed this committee’s work include The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs (IOM and NRC, 2002), The Future of Disability in America (IOM, 2007b), Improving the Social Security Disability Decision Process (IOM, 2007a), HIV and Disability: Updating the Social Security Listings (IOM, 2010b), Cardiovascular Disability: Updating the Social Security Listings (IOM, 2010a), and Psychological Testing in the Service of Disability Determination (IOM, 2015). Along with this earlier work of the Academies, the committee drew important lessons from the body of data and research aimed at identifying trends in the prevalence and persistence of speech and language disorders, as well as addressing diagnosis and treatment of and levels of impairment associated with these disorders. FINDINGS AND CONCLUSIONS Findings 1-1. Developmental disorders are identified when expected functional skills in children fail to emerge. 1-2. Underlying factors that contribute to developmental disorders are likely to have been present well before the signs are manifest in the child’s development. 1-3. In a 15-year follow-up study of children with speech and language disorders, 52 percent of the children initially identified with such disorders had residual learning disabilities and poor academic achievement later in life. 1-4. Twenty-one percent of all special education eligibility in the United States is for speech and language impairments—three times greater than eligibility for autism or intellectual disability.

36 SPEECH AND LANGUAGE DISORDERS IN CHILDREN Conclusions 1-1. It is generally more accurate to describe the “age of identifica- tion” of a speech or language disorder than to focus on the “age of onset.” 1-2. Mild speech and language impairments in preschool will some- times be transient; severe forms of these disorders have a high probability of being long-term disabilities. ORGANIZATION OF THE REPORT This report consists of six chapters. It is organized to provide readers with important background information on speech and language disorders in children in the general population before describing the subset of chil- dren with severe speech and language disorders who receive SSI benefits. To take readers through this progression, the report describes the SSI program in some detail. This description is intended to orient readers to the determi- nation process that shapes the population served by the program: children with severe speech and language disorders who are also from low-income, resource-limited families. The report then compares changes over time in the prevalence of speech and language disorders in the general and SSI child populations, based on the best evidence available. The report culminates with a summary of the committee’s overall findings and conclusions. The contents of each chapter are as follows: • Chapter 2 provides an overview of childhood speech and language disorders in the general U.S. population. The chapter begins with an overview of speech and language development in children. It then examines the diagnosis of speech and language disorders in children, causes and risk factors, and prevalence. The chapter also includes evidence related to common comorbidities of childhood speech and language disorders. • Chapter 3 reviews what is known about the treatment and per- sistence of speech and language disorders in children. This review includes current standards of care for these disorders, an overview of treatment approaches for different speech and language disor- ders, and expected responses to treatment. • Chapter 4 provides an overview of the SSI program for children, how it has changed over time, and how those changes have shaped the population of children receiving SSI benefits. It describes the eli- gibility determination process and the speech and language-related criteria that are used to evaluate children. Finally, the chapter in- cludes case examples and a review of a random sample of case files

INTRODUCTION 37 of children who receive SSI benefits based on speech and language disorders. This information offers insight into the characteristics of children with speech and language disorders who apply for SSI and helps demonstrate the evidence considered by the SSA when making a disability determination for a case. • Chapter 5 compares trends in speech and language disorders among children (under age 18) in the general population with trends in these disorders among participants in the SSI childhood disability program. The chapter reviews the data sources used by the com- mittee to describe the epidemiology of speech and language disor- ders in children in both populations. It also identifies gaps in the evidence that impede more precise estimates of trends in prevalence for speech and language disorders and comorbid conditions. • Finally, Chapter 6 provides a summary of the committee’s over- all findings and conclusions and their implications in the follow- ing three areas: speech and language disorders in children in the general population, speech and language disorders among chil- dren who receive SSI benefits, and comparisons between these two groups. The report includes several appendixes. Appendix A provides a glossary of terms used throughout the report, while Appendix B includes summaries of data sources that informed the committee’s work. Appendix C includes administrative/service data that the committee used to examine changes in program participation over time and national survey data that the commit- tee used to estimate changes in prevalence over time. Appendix D provides the methods that the committee used to calculate trends in the national survey data. Appendix E includes a description of the methods used to review case files, and Appendix F lists the agendas and speakers for the committee’s public workshops. A brief summary of Mental Disorders and Disabilities Among Low-Income Children, the report of the Committee on the Evaluation of the Supplemental Security Income Disability Programs for Children with Mental Disorders, is included in Appendix G. Finally, Appendix H contains biographical sketches of the committee members. REFERENCES Aram, D. M., and J. E. Nation. 1980. Preschool language disorders and subsequent language and academic difficulties. Journal of Communication Disorders 13(2):159-170. Baker, L., and D. P. Cantwell. 1987. A prospective psychiatric follow-up of children with speech/language disorders. Journal of the American Academy of Child & Adolescent Psychiatry 26(4):546-553.

38 SPEECH AND LANGUAGE DISORDERS IN CHILDREN Beitchman, J. H., E. Brownlie, A. Inglis, J. Wild, R. Mathews, D. Schachter, R. Kroll, S. Martin, B. Ferguson, and W. Lancee. 1994. Seven-year follow-up of speech/language- impaired and control children: Speech/language stability and outcome. Journal of the American Academy of Child & Adolescent Psychiatry 33(9):1322-1330. Beitchman, J. H., B. Wilson, E. Brownlie, H. Walters, and W. Lancee. 1996. Long-term con- sistency in speech/language profiles: I. Developmental and academic outcomes. Journal of the American Academy of Child & Adolescent Psychiatry 35(6):804-814. Bishop, D. V. M., and A. Edmundson. 1987. Language-impaired 4-year-olds: Distinguishing transient from persistent impairment. Journal of Speech and Hearing Disorders 52(2): 156-173. Bloomfield, L. 1926. A set of postulates for the science of language. Indianapolis, IN: Bobbs-Merrill. Briscoe, J., D. V. M. Bishop, and C. F. Norbury. 2001. Phonological processing, language, and literacy: A comparison of children with mild-to-moderate sensorineural hearing loss and those with specific language impairment. Journal of Child Psychology and Psychiatry 42(3):329-340. Camarata, S. 1993. The application of naturalistic conversation training to speech production in children with speech disabilities. Journal of Applied Behavior Analysis 26(2):173-182. Catts, H. W., M. E. Fey, J. B. Tomblin, and X. Zhang. 2002. A longitudinal investigation of reading outcomes in children with language impairments. Journal of Speech Language and Hearing Research 45(6):1142-1157. CDC (Centers for Disease Control and Prevention). 2014. Principles of epidemiology glossary. http://www.cdc.gov/ophss/csels/dsepd/SS1978/Glossary.html (accessed August 11, 2015). Clegg, J., C. Hollis, L. Mawhood, and M. Rutter. 2005. Developmental language disorders—a follow-up in later adult life. Cognitive, language and psychosocial outcomes. Journal of Child Psychology and Psychiatry 46(2):128-149. Cohen, N. J., D. D. Vallance, M. Barwick, N. Im, R. Menna, N. B. Horodezky, and L. Isaacson. 2000. The interface between ADHD and language impairment: An examina- tion of language, achievement, and cognitive processing. Journal of Child Psychology and Psychiatry 41(3):353-362. Damon, W., and D. Hart. 1982. The development of self-understanding from infancy through adolescence. Child Development 53(4):841-864. DeNavas-Walt, C., B. D. Proctor, and J. C. Smith. 2014. Income and poverty in the United States: 2013. Washington, DC: U.S. Census Bureau. Emerson, E., and C. Hatton. 2005. The socio-economic circumstances of families with dis- abled children. Disability and Society 22(6):563-580. Farran, D. 2000. Another decade of intervention for children who are low-income or disabled: What do we know now? In Handbook of early childhood intervention (2nd ed.), edited by J. P. Shonkoff and S. J. Meisels. Cambridge, England: Cambridge University Press. Pp. 510-548. Fletcher-Campbell, F., J. Soler, and G. Reid. 2009. Approaching difficulties in literacy develop- ment assessments, pedagogy and programmes. Thousand Oaks, CA: Sage Publications. Fujiura, G. T., and K. Yamaki. 2000. Trends in demography of childhood poverty and dis- ability. Exceptional Children 66(2):187-199. Gallagher, T. M., and C. A. Prutting. 1983. Pragmatic assessment and intervention issues in language. San Diego, CA: College-Hill Press. GAO (U.S. Government Accountability Office). 2012. Supplemental security income: Better management oversight needed for children’s benefits: Report to congressional requesters. http://purl.fdlp.gov/GPO/gpo25551 (accessed June 12, 2015). Georgieva, D. 1996. Speech and language disorders in children with intellectual disability [microform], edited by M. Cholakova. Washington, DC: ERIC Clearinghouse.

INTRODUCTION 39 Geurts, H. M., and M. Embrechts. 2008. Language profiles in ASD, SLI, and ADHD. Journal of Autism and Developmental Disorders 38(10):1931-1943. Hall, P. K., and J. B. Tomblin. 1978. A follow-up study of children with articulation and language disorders. Journal of Speech and Hearing Disorders 43(2):227-241. Hart, B., and T. R. Risley. 1995. Meaningful differences in the everyday experience of young American children. Baltimore, MD: Paul H. Brookes Publishing Co. IOM (Institute of Medicine). 2007a. Improving the social security disability decision process, edited by J. D. Stobo, M. McGeary, and D. K. Barnes. Washington, DC: The National Academies Press. IOM. 2007b. The future of disability in America, edited by M. J. Field and A. M. Jette. Washington, DC: The National Academies Press. IOM. 2010a. Cardiovascular disability: Updating the social security listings. Washington, DC: The National Academies Press. IOM. 2010b. HIV and disability: Updating the social security listings. Washington, DC: The National Academies Press. IOM. 2015. Psychological testing in the service of disability determination. Washington, DC: The National Academies Press. IOM and NRC (National Research Council). 2002. The dynamics of disability: Measuring and monitoring disability for social security programs, edited by G. S. Wunderlich, D. P. Rice, and N. L. Amado. Washington, DC: National Academy Press. Johnson, C. J., J. H. Beitchman, A. Young, M. Escobar, L. Atkinson, B. Wilson, E. B. Brownlie, L. Douglas, N. Taback, I. Lam, and M. Wang. 1999. Fourteen-year follow-up of children with and without speech/language impairments. Journal of Speech Language and Hearing Research 42(3):744. Karmiloff-Smith, A. 2011. Static snapshots versus dynamic approaches to genes, brain, cogni- tion, and behavior in neurodevelopmental disabilities. In Early development in neuroge- netic disorders, Vol. 40, edited by D. J. Fidler. London, UK: Elsevier. Pp. 1-15. Karmiloff-Smith, A., D. D’Souza, T. M. Dekker, J. Van Herwegen, F. Xu, M. Rodic, and D. Ansari. 2012. Genetic and environmental vulnerabilities in children with neurode- velopmental disorders. Proceedings of the National Academy of Sciences of the United States of America 109:17261-17265. Karmiloff-Smith, A., B. J. Casey, E. Massand, P. Tomalski, and M. S. C. Thomas. 2014. Environmental and genetic influences on neurocognitive development: The importance of multiple methodologies and time-dependent intervention. Clinical Psychological Science 2(5):628-637. Kena, G., S. Aud, F. Johnson, X. Wang, J. Zhang, A. Rathbun, S. Wilkinson-Flicker, and P. Kristapovich. 2014. The condition of education 2014. NCES 2014-083. Washington, DC: U.S. Department of Education, National Center for Education Statistics. King, R. R. 1982. In retrospect: A fifteen-year follow-up report of speech-language-disordered children. Language, Speech, and Hearing Services in Schools 13(1):24-32. Kuhlthau, K., K. Hill, R. Yucel, and J. Perrin. 2005. Financial burden for families of children with special health care needs. Maternal and Child Health Journal 9(2):207-218. Law, J., J. Boyle, F. Harris, A. Harkness, and C. Nye. 2000. Prevalence and natural history of primary speech and language delay: Findings from a systematic review of the literature. International Journal of Language & Communication Disorders/Royal College of Speech & Language Therapists 35(2):165-188. Lustig, D. C., and D. R. Strauser. 2007. Causal relationships between poverty and disability. Rehabilitation Counseling Bulletin 50(4):194-202. Msall, M. E., F. Bobis, and S. Field. 2006. Children with disabilities and supplemental security income: Guidelines for appropriate access in early childhood. Infants & Young Children 19(1):2-15.

40 SPEECH AND LANGUAGE DISORDERS IN CHILDREN NASEM (National Academies of Sciences, Engineering, and Medicine). 2015. Mental disorders and disabilities among low-income children. Washington, DC: The National Academies Press. Nelson, K. E. 1989. Strategies for first language teaching. In The teachability of language, edited by M. Rice and R. L. Schiefelbusch. Baltimore, MD: Paul H. Brookes Publishing Co. Pp. 263-310. Newacheck, P. W., and S. E. Kim. 2005. A national profile of health care utilization and expen- ditures for children with special health care needs. Archives of Pediatric and Adolescent Medicine 159(1):10-17. Oller, D. K., R. E. Eilers, A. R. Neal, and H. K. Schwartz. 1999. Precursors to speech in infancy: The prediction of speech and language disorders. Journal of Communication Disorders 32(4):223-245. Oller, J. W., S. D. Oller, and L. C. Badon. 2006. Milestones: Normal speech and language development across the life span. San Diego, CA: Plural Publishing. Parish, S. L., and J. M. Cloud. 2006. Financial well-being of young children with disabilities and their families. Social Work 51(3):223-232. Pennington, B. F., and D. V. Bishop. 2009. Relations among speech, language, and reading disorders. Annual Review of Psychology 60:283-306. Pirila, S., J. van der Meere, T. Pentikainen, P. Ruusu-Niemi, R. Korpela, J. Kilpinen, and P. Nieminen. 2007. Language and motor speech skills in children with cerebral palsy. Journal of Communication Disorders 40(2):116-128. Ruben, R. J. 2000. Redefining the survival of the fittest: Communication disorders in the 21st century. The Laryngoscope 110(2):241-245. Sameroff, A. 1975. Transactional models in early social relations. Human Development 18(1-2):65-79. Sameroff, A. 2009. The transactional model. Washington, DC: American Psychological Association. Schuele, C. M. 2004. The impact of developmental speech and language impairments on the acquisition of literacy skills. Mental Retardation and Developmental Disabilities Research Reviews 10(3):176-183. SSA (Social Security Administration). 2015. SSI monthly statistics, December 2014. http:// www.ssa.gov/policy/docs/statcomps/ssi_monthly/2014/index.html (accessed February 18, 2015). Stoeckel, R. E., R. C. Colligan, W. J. Barbaresi, A. L. Weaver, J. M. Killian, and S. K. Katusic. 2013. Early speech-language impairment and risk for written language disorder: A population-based study. Journal of Developmental and Behavioral Pediatrics 34(1):38. Stothard, S. E., M. J. Snowling, D. Bishop, B. B. Chipchase, and C. A. Kaplan. 1998. Language- impaired preschoolers: A follow-up into adolescence. Journal of Speech, Language, and Hearing Research 41(2):407-418. Sturm, H., E. Fernell, and C. Gillberg. 2004. Autism spectrum disorders in children with nor- mal intellectual levels: Associated impairments and subgroups. Developmental Medicine & Child Neurology 46(7):444-447. Sundheim, S. T., and K. K. Voeller. 2004. Psychiatric implications of language disorders and learning disabilities: Risks and management. Journal of Child Neurology 19(10):814-826. Tomblin, J. B., N. L. Records, P. Buckwalter, X. Xhang, E. Smith, and M. O’Brien. 1997. Prevalence of specific language impairment in kindergarten children. Journal of Speech, Language, and Hearing Research 40:1245-1260. Wang, Q. 2005. Disability and American families: 2000. Bulletin 62(4):21-30.

INTRODUCTION 41 Wells, N. 2015. Families of Children/Youth with Special Health Care Needs. Workshop presentation to the Committee on the Evaluation of the Supplemental Security Income (SSI) Disability Program for Children with Speech Disorders and Language Disorders on March 9, Washington, DC. WHO (World Health Organization). 2001. International classification of functioning, dis- ability and health. Geneva, Switzerland: WHO. Williams, F. 2013. Language and poverty: Perspectives on a theme. Philadelphia, PA: Elsevier. Wittenburg, D., J. Tambornino, E. Brown, G. Rowe, M. DeCamillis, and G. Crouse. 2015. The Child SSI Program and the changing safety net. Washington, DC: Mathematica Policy Research. Wolke, D., M. Samara, M. Bracewell, N. Marlow, and E. S. Group. 2008. Specific language difficulties and school achievement in children born at 25 weeks of gestation or less. The Journal of Pediatrics 152(2):256-262. Yoshinaga-Itano, C., A. L. Sedey, D. K. Coulter, and A. L. Mehl. 1998. Language of early- and later-identified children with hearing loss. Pediatrics 102(5):1161-1171.

Next: 2 Childhood Speech and Language Disorders in the General U.S. Population »
Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program Get This Book
×
Buy Paperback | $79.00 Buy Ebook | $64.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Speech and language are central to the human experience; they are the vital means by which people convey and receive knowledge, thoughts, feelings, and other internal experiences. Acquisition of communication skills begins early in childhood and is foundational to the ability to gain access to culturally transmitted knowledge, organize and share thoughts and feelings, and participate in social interactions and relationships. Thus, speech disorders and language disorders—disruptions in communication development—can have wide-ranging and adverse impacts on the ability to communicate and also to acquire new knowledge and fully participate in society. Severe disruptions in speech or language acquisition have both direct and indirect consequences for child and adolescent development, not only in communication, but also in associated abilities such as reading and academic achievement that depend on speech and language skills.

The Supplemental Security Income (SSI) program for children provides financial assistance to children from low-income, resource-limited families who are determined to have conditions that meet the disability standard required under law. Between 2000 and 2010, there was an unprecedented rise in the number of applications and the number of children found to meet the disability criteria. The factors that contribute to these changes are a primary focus of this report.

Speech and Language Disorders in Children provides an overview of the current status of the diagnosis and treatment of speech and language disorders and levels of impairment in the U.S. population under age 18. This study identifies past and current trends in the prevalence and persistence of speech disorders and language disorders for the general U.S. population under age 18 and compares those trends to trends in the SSI childhood disability population.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  6. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  7. ×

    View our suggested citation for this chapter.

    « Back Next »
  8. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!