Speech Pathologist or Tutor - Same or Different?
I’m often asked what the difference is between supports offered by a Speech Pathologist and those offered by a Tutor. While a Speech Pathologist should have a solid understanding of the principles of effective, research aligned whole class and small group intervention, their niche space is working with students who have co-occurring conditions or known ‘risk factors’ for increasing their likelihood of academic failure. While specialist tutors might work with students who have not responded to whole class and small group instruction, their focus is typically on students with Dyslexia who often have co-occurring conditions such as ADHD, Dysgraphia, Dyscalculia, or weakness in oral language skills resulting from the impact of reading difficulties.
A Speech Pathologist is often involved when there is an impact on language skills, such as students with DLD [Developmental Language Disorder], Hearing Loss, Autism, CAS [Childhood Apraxia of Speech] or Speech Sound Disorder [SSD]. There is also a population of students who have had complex medical history who may have mild-moderate injuries impacting language, learning and literacy. This might include a student with post-concussion syndrome, traumatic brain injury, brain tumor, those who have undergone chemotherapy treatments, epilepsy, extreme prematurity, and an emerging population of students with chronic heart conditions involving heart surgery at a young age. As a result of advances in medical treatments, there are many children who now survive illnesses of early childhood and attend mainstream school with their peers.
Speech Pathologists can make a valuable contribution to the language, learning and literacy skill development of students during the primary and high school years. For some students, difficulties with language, learning and literacy can appear in high school due to the increased complexity and abstractness of language and literacy demands. To support effective generalisation of skills, there is great value in Speech Pathologists embedding intervention in the curriculum to optimise student outcomes. One common concern voiced is that the line between Speech Pathologist, Tutor, Classroom Teacher, and Teacher Aid can become blurred meaning Speech Pathologists often lack clarity about their purpose and role working with school age students.
This issue has been comprehensively addressed in a well-known article by Barbara Ehren, 2000, key components of which are shared below. In NSW, where we don’t have Speech Pathologists employed in schools, the value that their role can make has been hidden, since traditionally public health services have prioritised students in the years before school or adults. It should also be noted that skills working with language-based learning difficulties are typically developed in the Speech Pathology profession after graduation, therefore it is worth having a discussion with your therapist regarding their completion of additional training in this area.
So, to put it simply, we speak our language [for example English] and we read and write in our language [for example, English] and therefore our language is the means through which we learn information across the curriculum. Ehren [200] describes this below:
‘With regard to curriculum, language is both an end and a means to an end [Hynds, 1994]. Students must learn to listen, speak, and write in order to participate in the typical communication events that are appropriate for their respective age and grade levels. Students also use spoken and written language skills and strategies to learn in other subject areas like math, social studies, and science [Bashir, Conte & Heerde, 1998]’ Ehren, 2000.
So, we have 3 different providers all providing a level of instruction and intervention on language skills, for a range of purposes. The two tables below provide some clarity around the differing roles of Instruction, Intervention and Therapy.
Classroom Teachers | Providers of instruction in Language Arts & English. |
Special Teachers | Providers of Intervention – ESL, Literacy Tutors, Special Education Teachers |
Speech Pathologists | Providers of Therapy with in-depth expertise in language and language disorders |
Ehren, 2000
Comparison of Instruction and Therapy
| Instruction | Therapy |
Purpose | Deals with learning new information and skills in the normal course of development | Deals with remediating of compensating for deficient skills that have not fully developed of that have been lost |
Knowledge Base | Requires a basic understanding of language and language processing | Necessitates an in-depth knowledge of language, language development and language disorders. |
Learner Engagement | Has a captive audience with varying degrees of active engagement at various times | Depends on the student’s ongoing active participation in the self-help process |
Sequence | Uses a teaching sequence based on external criteria, such as curriculum standards and progression | Requires that the sequence of activities be based on individual needs and individual degree of progress. |
Individualization | Oriented towards group goals | Oriented towards individual goals [diagnostic |prescriptive | clinical approach] |
Mastery | Moves forward even when the student has not achieved mastery and sets the pace based on the average student | Requires mastery of prerequisite skills; progresses with mastery of the building blocks |
Interaction | Involves the teaching of a planned lesson | Necessitates that the clinician’s actions be contingent on the actions or reactions of the student. |
However, ‘A Speech Pathologist should not simply ignore academic subject areas. Rather they need to be grounded in curriculum content without having to be as expert as teachers. Being familiar with the curriculum is necessary for the analysis of language underpinnings. Identifying the specific language skills and strategies required of students in the general education curriculum is the first step in targeting appropriate goals for curriculum relevant therapy and assisting classroom teachers in addressing any difficulties students may encounter.’
Given their knowledge of AAC, the Speech Pathologist is also ideally placed to support students to access learning using assistive technology in partnership with the classroom teacher and school-based learning support team. Where students have an acquired injury, they can utilise their training in adult rehabilitation during their university training to determine ways to support students, such as identifying how word finding difficulties are impacting literacy skills, using text as a visual support to support comprehension or explaining how language skills for an individual student might be affecting problem solving skills in mathematics [e.g. They struggle with synonyms for basic facts terminology used in story problems]
Examples of activities that allow the maintenance of a therapeutic focus & shared responsibility for student success when providing in-classroom services. [Ehren, 2000]
Activity Recommended | Activity NOT Recommended |
Take the maths worksheet and use the problems to teach a student on the caseload to interpret language and set up the problems to be solved [ie. Identify important information or decide on an operation]
Why it is a good idea -> Assuming that the student has difficulty with language comprehension, the difficulty with the math problem solving may be related to that problem. Therapy that deals specifically with content to be processed in solving maths problems is curriculum-relevant without being redundant and also facilitates academic success. | Take the math worksheet and help a student on the caseload complete the problems.
Why it is not a good idea: Solving the problem for the student is tutoring that can be done by anyone including an aid. Completing the worksheet with the student does not address therapy goas specifically.
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2. Teach vocabulary relevant to the curriculumto a student on the caseload by focusing on the words, metaphors, and idioms in a science textbook with which students with language disorders can be expected to have difficulty. Encourage the teacher to set up a learning station with a language master and provide language master cards for the students to review at specific times in the classroom.
Why it is a good idea: Students will have difficulty with the content of a lesson that the classroom teacher is teaching if they lack the basic vocabulary used in the explanation of content. This kind of vocabulary work is directly related to academic success. | 2. Pre-teach the science vocabulary of the next science lesson to a student on the caseload.
Why it is not a good idea: This teaching is what the science teacher should be doing. Implementing this step exonerates the teacher from responsibility to ensure that all students understand the vocabulary and concepts of a lesson or unit. |
3. Co-present a social studies lesson by guiding the students in the practice of the language strategies they have been learning in therapy. Give students cue cards to tape to their desks or use as bookmarks in their textbooks to remind them to use the strategies.
Why it is a good idea: This type of activity specifically addresses the generalization of strategies to classroom performance. |
3. Co-present a social studies lesson by taking turns teaching the lesson to all students without addressing the IEP goals of caseload students. Why it is not a good idea: Unless the speech-language pathologist is the primary instructor in a classroom program for students with severe language disorders, it is not the essential responsibility of the speech-language pathologist to teach social studies. Time can be used more effectively working on speech-language goals underlying the social studies curriculum. |
4. Go into a classroom while students are working in small groups or independently and gather the students on the caseload for a therapy session. The group may be joined by other students not on the caseload who can benefit from the specific activities of the day. Provide practice assignments to be done in the classroom when you are not there, using peer buddies to assist with feedback. Why it is a good idea: A therapy session can be conducted for caseload students. A bonus is that other students may benefit.
| 4. Go into a classroom while students are working in small groups or independently. Circulate primarily to help caseload students do their work.
Why it is not a good idea: This activity falls into the category of academic tutoring and does not deal directly with therapeutic targets. |
5. Go into a kindergarten class and do more intensive work in phonemic awareness with students on the caseload who have phonological disorders. This focus would be an addition to the teacher’s emphasis on phonemic awareness. Why it is a good idea: Students with phonological disorders may need more intensive work with phonemic awareness from an expert in phonological disorders. |
5. Go into a kindergarten class to teach phonemic awareness to the entire class. Why it is not a good idea: The classroom teacher should be offering phonemic awareness instruction in language arts. Taking responsibility for this aspect of general language development takes time away from the caseload. Instead, consider a few demonstration lessons, or conduct professional development activities with teachers in this area. |
As a Speech Pathologist with 25 years experience, who 20 years ago completed a Grad Dip. Ed [Primary] and Master of Teaching [Special Ed], I have had many years to develop my understanding of the K-12 curriculum and the language demands placed on students. In addition, my time with Outpatient Paediatric Rehabilitation and Paediatric Brain Injury teams has developed my ability to predict where students will experience difficulties as they progress throughout their school years, especially as they enter high school.
Knowledge and skills in this area are built up like we might paint a wall – one layer at a time. To support other Speech Pathologists [Specialist Tutors & Learning Support Teachers also welcome] who work in this space I’ve launched the Tier 3 Toolkit for Language, Learning and Literacy. It is an online membership with opportunities for professional development, access to recordings, resources, and professional support via an online community to allow you to develop your specialist skills, the way others have supported me. You’re welcome to join at any time whether you are completely new and want to develop skills or you’ve got great foundational skills and want to refine your ability to take a clinical-researcher, hypothesis-based approach to supporting students who fail to respond to whole class instruction and need individualisation and customisation according to their unique profiles. You can find out more and join at the link below.
Reference: Ehren, B.J. [2000]. Maintaining a Therapeutic Focus and Sharing Responsibility for Student Success: Keys to In-Classroom Speech-Language Services. LSHSS, 31, 219-229.
