Prevention of Communication Disorders

Committee on Prevention of Speech, Language and Hearing Disorders

The American Speech-Language-Hearing Association (ASHA) has long accepted the prevention of communication disorders as one of the profession's primary responsibilities. Article II of the ASHA Bylaws states that one of the “…purposes of this organization shall be to…promote investigation and prevention of disorders of human communication….” ASHA has addressed this responsibility by initiating action in a number of ways, including committee activities and educational programs. In 1973, the ASHA Legislative Council approved a policy statement entitled “Prevention of Communication Problems in Children.” Since the acceptance of that statement, ideas concerning prevention, especially as it relates to all age groups, have changed. There has been a national emphasis on disease prevention and health promotion, and speech-language pathologists and audiologists have broadened their view of prevention of communication disorders. This revised position statement is designed to reflect these changes.

Prevention of communication disorders requires some adjustment in the traditional focus of professional practice in speech-language pathology and audiology. In the past, the principal focus of the profession has been on identification and treatment of existing communication disorders. While treatment is still an important function for speech-language pathologists and audiologists, professional roles can be expanded to include the different focus of attention and energy demanded by prevention. Prevention requires increased efforts to eliminate the onset of communication disorders and their causes and to promote the development and maintenance of optimal communication. Alternative professional roles and strategies must be developed, and the information and skills to promote and practice them must be acquired.

It is the position of the American Speech-Language-Hearing Association that speech-language pathologists and audiologists should:

1. Utilize consistent terminology related to prevention.

   This terminology includes:

   • Primary Prevention—the elimination or inhibition of the onset and development of a communication disorder by altering susceptibility or reducing exposure for susceptible persons.

   • Secondary Prevention—the early detection and treatment of communication disorders. Early detection and treatment may lead to the elimination of the disorder or the retardation of the disorder's progress, thereby preventing further complications.

   • Tertiary Prevention—the reduction of a disability by attempting to restore effective functioning. The major approach is rehabilitation of the disabled individual who has realized some residual problem as a result of the disorder.

   • At Risk—the potential to develop a disorder based on specific biological, environmental, or behavioral factors. This term may apply to an asymptomatic population.

   • Incidence—the rate of new occurrences of a condition in a population free of the disorder within a specified time period.

   • Prevalence—the total rate or proportion of cases in a population at, or during, a specified period of time.

   • Epidemiology—an observational science which investigates distribution and determinants of diseases and disorders in populations.

   • Wellness—the development and maintenance of an optimal level of competence appropriate to any given stage of the life cycle.

2. Play a significant role in the development and application of prevention strategies.

   In order to be competent in prevention, speech-language pathologists and audiologists should demonstrate the ability to:

   1. use prevention terminology appropriately.

   2. understand conditions that place individuals at risk for various communication disorders.

   3. understand conditions which promote development and maintenance of optimal communication abilities (wellness).

   4. interpret the existing prevention literature in order to apply the information appropriately.

   5. present primary prevention information to groups known to be at risk for communication disorders and other appropriate groups.

   6. provide individual, family and community focused primary prevention information and services.

   7. provide early identification and early intervention services for communication disorders occurring at any time during the life span.

   8. make appropriate referrals for prevention-related services not provided by speech-language pathologists and audiologists.

   9. disseminate prevention information to various public sectors including health care professionals, social service professionals and extended families.

   10. understand methods of influencing public policy related to prevention of communication disorders. Undergraduate, graduate and continuing education efforts should include information on prevention of communication disorders which will help professionals to gain these competencies.

3. Expand research into the causes of communication disorders and variables which influence the development and maintenance of communication abilities.

   Prevention depends on knowledge of causes of communication disorders and of positive influences on communicative abilities. It is recommended that epidemiological, clinical, and basic research efforts to increase this knowledge be intensified. In order to support efforts in primary prevention, it is recommended that epidemiologic methods be used to study (1) the epidemiologies of specific communication disorders and (2) the distribution and determinants of conditions to which communication disorders are secondary. In addition, prevention research might include studies of: the validity of causal models; the efficacy of early intervention models; the appropriateness of prevention education materials; and family variables that affect susceptibility to communication disorders.

4. Educate colleagues and the general public relative to personal wellness strategies as they relate to the prevention of communication disorders.

   Prevention has two emphases: (1) identifying and eliminating causal factors of disorders, and (2) wellness which refers to increasing resistance to a disorder and promoting optimal functioning. It is an accepted principle of leadership that, wherever possible, the best leaders practice what they expect their followers to do. Speech-language pathologists and audiologists should adopt personal wellness practices which help them maintain their own best levels of communication performance. They should also engage in efforts to promote these wellness practices among members of the general public.

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