From John J. O’Neill, In Oyer, Herbert J. Administration Of Programs In Speech-Language Pathology And Audiology, Published by Allyn and Bacon, Boston, MA. Copyright © 1987 by Pearson Education. Reproduced by permission of the author and the publisher. Further reporduction is prohibited without written permission of the publisher.
The Development of Speech-Language Pathology and Audiology in the United States
John J. O’Neill
The roots of the development of what was to become the speech and hearing profession in the United States are to be found in Europe during the nineteenth century. Rockey indicates that it was during that period that problems of communication were being differentiated and individuals were starting to join together to work in the area. Concern seemed to center on the management of speech and hearing disorders rather than on diagnosis or research, with the greatest interest directed towards the deaf. Geographical location was a crucial factor at this stage. Practitioners working on the Continent had medical backgrounds, whereas practitioners in Great Britain had backgrounds mainly in elocution.
In this review, four areas will be under consideration, those which appeared to be of interest at that time. All of the events described occurred well before any thought had been given to the development of a profession to deal with speech and hearing disorders.
The deaf. The first organized effort at managing a disorder of communication involved the deaf. In France a manual system was in vogue, while in Germany an oral approach was advocated. Itard, in the early l800s, reported on what appeared to be the first effort to use auditory training. Other individuals such as Blanchet and Deleau carried on the work after Itard's death. It involved training with changes in the intensity of bells and individual speech sounds. In the late l800s Urbantschitsch in Germany reported on the use of auditory training with a deaf boy, and in 1895 he published a text on auditory training. There was a definite division between the manual and oral methods. The early work of del'Epee, which utilized the manual approach, was carried forth in France by Abbé Sicard, who developed a dictionary of signs, and by C. Deschamps and Ernaud. The oral method, the product of S. Heinicke, was initiated in Germany. The sites that demonstrated the two schools of thought were frequently visited by individuals from around the world, including several from the United States. In the British Isles Thomas Braidwood, a Scottish grammar school teacher, developed his own approach to teaching the deaf. Some individuals have indicated that the classifying of sounds by educators of the day in their efforts to develop remedial approaches led to the start of a new profession of speech correction.
Audiology. Major interest was in diseases of the ear rather than in the educational aspects of dealing with the hard of hearing. Most of the work in the area was being done by physicians who had received some specialized training in diseases of the ear. Two of these early physicians have been given the title "Father of Audiology" by several authors. These physicians were V. Urbanschitsch and F. Bezold. Both stressed the value of auditory training, but Bezold placed emphasis upon the significance of units of speech, as opposed to the individual sounds approach of Urbanschitsch. Tuning fork tests were developed to assist in the clinical diagnosis of hearing impairment. The Weber test developed in 1834 was one of the first of the qualitative hearing tests. It was followed by the Rinne test in 1885 which provided for a comparative evaluation of air conduction and bone conduction hearing. Very little was reported in regard to the development or use of the electric audiometer until two European investigators, A. Hartmann and D. E. Hughes, applied electric current to hearing tests. A. Politzer, one of the leading otologists in Europe at that time was quite optimistic about the possible use of such an instrument. In 1885 L. Jacobson added a second induction coil to the electric audiometer to control the intensity as well as the frequency of the tone. Also, several of the audio- meters allowed for presentation of the tone by means of a hand-held telephone earphone.
However, the usual approach to hearing testing, if not with tuning forks, made use of such devices as the Galton-Edelman whistle or the monochord. Both of these devices presented tones that range in frequency from 4000 to 25,000 Hz. Individual sound amplification was accomplished through the use of the "ear trumpet" or speaking tube. These resonators were made of thin metal, brass, or vulcanite. The speaking tube allowed individuals to speak into a funnel at the end of the tube and the listener would insert the other end of the tube into the ear. Toynbee in 1862 was the first to conduct a histological investigation on ears with hearing damage.
Speech and voice disorders. In 1801 J. Thelwall in Great Britain indicated that he thought speech correction was a science as well as an art and the following were treating it as such. Dieffenbach, on the continent, was suggesting surgery of the tongue for stuttering and Broca and Wernicke were presenting their material on aphasias. Another continental practitioner, J. Muller, was in 1837 discussing the movement of the vocal folds, while M. Garcia developed the laryngeal mirror in 1854. H. Gutzman, Sr. and Albert Gutzman, his son, established the Berlin School for Speech and Voice Therapy and published numerous articles and books, while in Vienna R. Coen was recognized for his work with speech disorders. Charvin in France and Bell in Scotland were also considered to be experts in voice. Also in Great Britain, Hunt, in 1863, published a text on stammering and stuttering, and in 1894 a text on speech disorders was written by J. Wyllie. During the period from 1839 to 1894 there was in fact a veritable avalanche of textbooks dealing with stuttering and stammering. One of the problems of determining the significance of this work, especially in Great Britain, was the lack of scientific reports. Letters from eminent men served as a testimonial for the clinician, or patients rewarded the therapist with a portrait of themselves, and in one instance actually presented the therapist with a bust. During this period the concept of a profession was being developed, along with the determination of the problems with which it could deal. The point is made by Rockey that the battle over who should deal with stutterers assisted in determining that the area of speech correction should not become another medical specialty, and this gave further emphasis to. the development of the independence of the profession.
Experimental phonetics or speech science. The first text to carry the title Experimental Phonetics was written by K. Rousselet in 1910. Even though research was quite limited some individuals were offering theories to explain certain speech phonemena. In 1830 W. Willis formulated what may have been the first scientific theory of vowel production. Several mechanical pieces of equipment were developed specifically for the study of the physical aspects of speech, including the spirometer developed by Hutchinson (1849), and the belt penumograph (1855) by H. Gutzman, Sr. The first stroboscopic observation of the larynx in 1878 was per- formed by M. J. Oertel and the first photographs of the larynx were produced by T. French in 1884. Most of the equipment made use of the pneumatic-mechanical principle which utilized levers, capsules and rubber tubes. This state existed until the principles of electricity were applied to the equipment.
Several other mechanical aids were being used during this period, including a tongue bridle or retractor, wooden plates shaped to the lower jaw, and the glossonochon tongue lever, which was a thin plate fastened to a lower tooth. H. von Helmholtz developed the resonators that carry his name to analyze tones (1913).
THE NINETEENTH CENTURY AND THE FIRST HALF OF THE TWENTIETH CENTURY IN THE UNITED STATES
The European interest in speech and hearing provided a body of knowledge along with an orientation to the management of communication disorders that was carried to the United States. The education of the deaf attracted the earliest attention through the dedication of individuals who wanted to help deaf offspring or relatives. The only other area that attracted early attention was stuttering, which was discussed in medical texts or texts dedicated to training of the deaf. Simon suggests that in the twentieth century audiology and speech correction emerged as new professions to serve as an educational response to the developing public consciousness of the handicapped in the United States.
The early years. Representatives of what was still an undeveloped profession included Alexander Graham Bell, Thomas Gallaudet, E. W. Scripture and Walter Swift. Most of these individuals had visited experts or clinics in Europe where they either observed or received training in the methods espoused by specific individuals. In these early years there were no formal training programs, few clinics, and a fair amount of representation in the public schools. The early proponents had been trained as elocution teachers, physicians, and teachers of the deaf, while others were self-trained entrepreneurs.
The first recorded textbook on speech defects published in the United States has been attributed to S. C. L Potter, who had practiced in Great Britain. Published in 1802, it carried the title Speech and Its Defects. In 1825 one of the first accounts of a private practice was attributed to a Mrs. E. Leigh. She utilized a method referred to as the Leigh Method, aimed at curing stuttering. Some authorities report that the method had been developed by a Dr. Yates who did not wish to have his name associated with it, so he used the name of his daughter's tutor. One account claims that Mrs. Leigh cured 150 people between the period 1828-1830. The early years were typified by the dogged use of "the method" associated with a particular master, but these methods were so closely guarded that there is not much information available in regard to them.
The speech disorder receiving the greatest attention was stuttering. Several physicians were using the surgical procedure developed by Dr. Diffenbach in Germany, which involved operations on the tongue of the stutterer. This was also the period of mechanical aids. For example, the aforementioned Mrs. Leigh suggested placing rolls of linen beneath the tongue during the hours of sleeping. This allowed the tongue to be in the "correct position" for speech with the tongue tip raised to the palate. Another approach involved the placing of a cork between the teeth.
The greatest service activity took place in the schools. Reports of such activity were made concerning the Grand Rapids schools (107 children in the period between 1916-1917) and the Chicago, Detroit, Minneapolis and New York school systems. In 1922 a survey undertaken in Wisconsin indicated that some nineteen hundred children, or 5 to 7 percent of the students surveyed, needed speech help. Another survey in St. Louis indicated that 5.7 percent of the children in the public and parochial schools required speech assistance. Of some interest is the title of an article that appeared in a 1917 issue of a medical journal, "The Economic Value of Speech Correction." The concept of cost effectiveness is not so new! The article further indicated that speech defects should. be treated as soon as the child entered school. Some four years later Smiley Blanton reported on a psychoneurotic type of speech disorder which was related to a wartime experience. Also, at about the same time the first commercially available manual for the correction of speech defects appeared from a medical book publisher. The White House conference of 1930 estimated that among children between the ages of five and eighteen there were one million requiring remedial speech treatment. Also, it was recommended that every school system should have school programs in speech correction.
The Martin Institute for Speech Correction was in operation in Ithaca, New York in 1926, while the Boston Stammerers Institute had been in operation in Boston since 1867. Speech clinics were in operation from 1916 at the University of Wisconsin, from 1928 at Northwestern University, at the New York University medical school in 1925 and Washington University in 1926. In 1936 the first issue of the Journal of Speech Disorders appeared and in 1931 one of the first textbooks in the field, Speech Pathology by L Travis, appeared. Ten years before, the first meeting of the National Society for the Study and Correction of Speech Disorders was held. In New York the National Hospital for Speech Disorders was established by members of the so-called Viennese School, including such individuals as Froeschels and Weiss. The first formal laboratory for research in speech science, the Flo Brown Memorial Laboratory, was established at the University of Wichita in 1935. Other laboratories associated with academic training programs were developed in the 1920s and 1930s at the University of Iowa and Ohio State University. A thesis dealing with the experimental analysis of causes of stuttering was submitted in 1921 at the University of Wisconsin and in 1924 there was a listing of two theses in speech pathology at the University of Iowa. The first reported effort at speech correction at the college level appeared in 1923 in the Quarterly Journal of Speech and was written by Sara Stinchfield in regard to the student population at Mt. Holyoke College. She reported that 17 percent of the student population required some corrective work. Classes in speech improvement were initiated at Smith College in 1922 and administered by the Spoken English Department. Of some historical interest was the following reported faculty additions in 1936: Charles Van Riper joined the staff at Western State Teachers College at Kalamazoo and John W. Black became the head of Speech at Kenyon College. In 1934 Raymond Carhart completed a thesis that dealt with the study of the relation between cushion pipes and subglottic resonators.
Audiology. The pure tone audiometer came into its own in the United States. The first vacuum tube audiometer was developed in 1921, and the first commercial model was the Western Electric 1A, the brainchild of Dr. Edmund Fowler, an otologist. It was a nonportable unit and its cost ($1,500) was viewed as excessive. Other audiometers were introduced by other manufacturers. Included were the Sonotone unit developed by Jones and Knudsen and a unit developed by Kranz. These units tested 1he frequency range from 32 to 16, 384 d.v. (Hz in present language) and higher. The difficulty with these models was that none of them used a universally accepted reference level and the intensity units were labeled as sensation units rather than decibels. The Council on Physical Therapy of the American Medical Association, in conjunction with the American Standards Association, in 1937-1939 established standards for audiometers in terms of frequency and intensity ranges, including five decibel steps. In 1937 the Maico D-5 audiometer was introduced. This was the first audiometer with a zero reference level that was adjusted automatically for each frequency. The first articles that dealt with the design of soundproofed rooms appeared in the professional literature in 1938. One of the greatest breakthroughs in terms of diagnostic audiology occurred when the two-channel audiometer was developed. This development allowed the audiologist to have separate control over the intensity of the stimulus for each channel.
Hearing aids. The electric hearing aid came about through the development of the telephone by Alexander Graham Bell. The first such hearing aid was of the carbon variety, in which the movement of electrically charged carbon granules made it possible to transfer sound to electrical charges which varied with changes in the frequency and intensity of the speech. Berger writes that the first carbon hearing aid was developed by M. R Hutchinson in 1899. The carbon aid proved to be impractical because of its size and the distortion and noise in the microphone, but nevertheless it was the instrument of choice until the late 1930s. After World War II, with the advent of the vacuum tube, it became possible to have more reliable and accurate amplification of sound. With the advent of the printed circuit and the development of the transistor it became possible to make the hearing aid smaller. Along with this reduction in the size of the instrument came a decrease in battery size.
Auditory training units. The first electrical, group auditory training unit, named the Electrophone, appeared in 1921. Another unit, the Acuovox, was developed about the same time. It enabled students to hear their own voices and the voices of the other students and the teacher as well. The first group auditory training unit was developed by Currier and consisted of multiple conversation tubes so that five students could be trained at one time. In the same reference Goldstein also described the CID multiple tube unit, which enabled larger groups of youngsters to receive auditory stimulation at one time. From 1930 to 1935 individual as well as multiple non wearable vacuum tube group auditory training units were being placed in leagues for the hard of hearing, churches, and schools for the deaf. Several of the major hearing aid manufacturers, especially Maico, started to develop commercially available auditory training units in the 1950s. The development of such units can be attributed to the tremendous reception given to the organized auditory programs developed at the Deshon and Hoff general army hospitals as part of the armed services aural rehabilitation programs. The majority of the amplification equipment used in the army-sponsored AR programs were specially constructed for use in the programs. The early commercial units incorporated these electronic developments into the units that were being presented for sale. Shortly after the beginning of the 1950s some seven to eight companies were selling commercial auditory training units. Three of these companies (Maico, Warren and Grason Stadler) were still manufacturing units at the end of the 1970s. In the 1960s loop units and, later, radio frequency units were developed. These developments enabled teachers to avoid the hard wire features which had restricted the mobility of teacher and pupils.
Speech reading. The development of speech reading in the United States took three directions: the importing of a method developed in Europe, the development of a new method, and the expansion of the newly developed method. The Mueller-Walle approach was brought to Boston by Martha Bruhn, a hard-of-hearing individual who had taken a six-week course from J. Mueller-Walle in Germany. She translated the method into English and opened a school of lipreading in Boston. Another method that was brought to this country was the Jena method. This method, developed by Brauckmann, used a motor as well as visual approach to the teaching of lipreading. It was translated and expanded by several individuals at the University of Michigan, the best known of the group being Anna Bunger of Eastern Michigan University. Her name became associated with this approach.
One of the first individuals to develop her own method in this country was Lillie Warren, who dealt with an analytic system that assigned numbers to sixteen "visible" sounds. She established the first speech reading classes in the United States. One of her students, Edward Nitchie, in 1903 wrote a book on self-instruction in lipreading which Warren claimed was plagiarized from her method. Over the next twenty years Nitchie's approach became a more synthetic one and he and his wife published some four or five texts in the area, the basic approach involving drills with syllables. The Kinzie sisters, Cora and Rose, developed their own school of speech reading in Philadelphia in 1917. Their method was a combination of elements from the Mueller-Walle methods and the Nitchie approach. Another method developed during this early period was that of Louise M. Morgenstern, and consisted of a series of lessons utilizing sounds as well as conversational materials. These materials were used in evening classes in the public schools in New York. In 1915 the Cincinnati Board of Education authorized evening lipreading classes. An article in a 1914 issue of the Laryngoscope described a program which involved two or three lipreading lessons a day and indicated that the students learned lipreading in a period of two months. Also, during this same period an article entitled Ear and Aviation appeared in, of all places, the Archives of Neurology and Psychiatry. In 1926 the first school screening program was undertaken in New York with the 4A audiometer. The investigators indicated that through screening in the schools cases would appear other than those present at the physician's office. In 1935 Robert West pushed the idea of developing hearing aids which would have the effect upon hearing that corrective lenses had upon vision. Also, he indicated that the aids should be light in weight, compact, inconspicuous and dependable. He further indicated that he felt deafness was a problem of lack of range as well as a lack of acuity. West had developed a test for the evaluation of hearing aids that made use of words that carried specific frequency characteristics. In this early period an individual who was later to be heavily identified with speech disorders was providing some of the most innovative ideas about hearing aids.
At the end of the 1940s the profession was receiving attention for its service activities. Along with the development of sophisticated instrumentation, this resulted in the development of speech and hearing clinics, which in turn necessitated the assignment of administrative responsibilities. Thus the early members of the profession were beginning to obtain exposure to administrative roles.
POST WORLD WAR II PERIOD
In the discussion that follows the events that occurred during the profession's most formative years are described. When one views the situation immediately after the conclusion of World War II, the speech-language pathology and audiology profession was shaped by seven factors. These factors were: change in professionals outlook and orientation; increases in federal funding; growth of the national professional organization; development of academic autonomy; national and state legislation; expansion of service activities; and increases in training programs.
Change in professional outlook and orientation. The period immediately after the war was typified by a tremendous increase in funds for higher education through the GI Bill of Rights, with a resulting increase in the availability of post- secondary education. Also, some individuals gained experience during the war working in the newly developed rehabilitation centers, plus a sense of idealism, and thus had an orientation toward the treatment of handicaps, including severe communication difficulties. One small group of individuals in particular, who had gained extensive and intensive experience working in interprofessional environments, had witnessed the successful results of short-term, intensive therapy as well as the efficacy of treating the "whole man."
Increases in federal funding. Along with such changes in orientation at the professional level came increases in funding at the federal level. In 1943 the United States Congress had indicated that the Veterans Administration should be the agency in charge of all service-connected rehabilitation programs. Between 1943 and 1948 there was a pronounced increase in the number of speech and hearing rehabilitation programs being conducted both in Veterans Administration hospitals and through contracts with college or university speech and hearing clinics. Some funding had been available since 1949, when the Children's Bureau provided funds for service programs and traineeships at Johns Hopkins University. In 1950 similar funding was provided at the University of Iowa. Also, financial assistance for services was provided through two of the subunits of the agency, the Maternal and Child Health and Services for Crippled Children units.
The first federal agency to provide extensive funding for speech and hearing training programs was the Vocational Rehabilitation Administration, located in the U.S. Department of Health, Education and Welfare. The agency had received authorization for such training activities, as well as for research and demonstration activities, through the Vocational Rehabilitation Act Amendments of 1954 (Public Law 565, 83rd Congress.) Then, between 1963 and 1974, the time was very ripe for the development of the profession, as Flower indicates, in that the federal government had made a unique commitment to the development of human services through the passage of certain items of legislation. In 1966, as part of the "Great Society" activities of the Lyndon Johnson administration, the Bureau of Education for the Handicapped was formed, resulting from an amendment to the Elementary and Secondary Education Act of 1965 (Public Law 89-10). These various funding activities allowed for the growth of master's level training in speech and hearing. In 1965 at perhaps the peak of such activity, the VRA funds were allocated to some sixty six training programs. This support probably provided the greatest impetus for the growth of the profession, through the increase in opportunities for training it offered. The Office of Education provided $1,229,300 for training, as contrasted to the $8,500,000 provided by VRA.
While doctoral training programs received some funding from the previously mentioned two sources, the greatest support for this level of training came from the National Institutes of Neurological Disease and Stroke, with some additional assistance from the National Institute of Dental Research. Since the mid-1960s sufficient training funds were available to encourage more individuals to select the discipline for graduate study. With the beginning of the 1970s, however, there was a decrease in funding for training. This decrease has continued until the present day, with approximately twenty-five to thirty graduate programs having federal funding. Also, the NIH institutes dropped funding for predoctoral training in speech pathology and audiology.
Growth of national organization. The growth in funding described above can be attributed in part to the tenor of the times, but it can also be attributed to the establishment of a national office of the American Speech and Hearing Association in Washington, D.C. and later in Bethesda, Maryland. This organization began assembling and disseminating statistics about the operations of the professions as well as serving as an advocate at the United States Congress. In the fall of 1959 the association introduced the journal Asha, which served as its house organ and became the source for much of the data about the profession, with the presentation of the results of surveys, position papers, proposals for changes in organization, certification, federal legislation, and professional events.
The findings of the first survey published in the journal is of interest. The results included the following: Twenty-five institutions had OVR (Office of Vocational Rehabilitation-the original name of the Rehabilitation Services Administration) grants and there were forty training programs at the masters level and thirty at the doctoral-masters level. In the same year (1959) Kenneth Johnson, executive secretary of the organization, indicated that there were several major issues facing the profession. Two of the more important dealt with the need for developing independence, along with the need to develop a professional identity. Beginning in 1965 ASHA started to accredit training programs in speech pathology and audiology as a result of negotiations with the National Council on Accreditation, the American Medical Association, and the American Dental Association. The accreditation program had been initiated in 1961 with the formation of the American Boards of Examiners in Speech Pathology and Audiology, under whose direction two boards were in operation. These were the Education and Training Board and the Professional Services Board, with the latter being responsible for the accreditation of service or clinic programs. Over the past twenty years there has been a continuing argument as to whether clinics associated with training programs should be accredited. There have been surges of pro and con activities, and as of 1983 there were 258 clinical facilities accredited by the Professional Services Board with forty-four of them being university speech and hearing clinics.
The national organization continues to be quite active as, for example, the accrediting agency for master's degree programs in speech pathology and audiology; as an advocacy and public information unit for the profession; serving in a lobbying role; developing a standards program; and providing services to state associations and individual members.
Development of academic autonomy. As was indicated earlier, the discipline did not show signs of gaining departmental status until the 1950s. Before then the operation of training programs was usually under the direction of the individual who was serving as head of the speech department. In the early 1900s the discipline of speech was a part of English departments under the rhetoric section. Around 1915 the first of the speech units left English and developed departments of rhetoric or speech. As of 1915 there were some fourteen state universities with separate departments of speech, with six being in the Midwest. There were few courses to be taught in the area of speech and hearing disorders in the early years, and the only function that could bring an individual some status or academic identification was serving as head of a speech and/or hearing clinic-if the individual's institution condoned remedial services. Once such a clinic was available and services were being provided it became obvious that additional trained individuals were needed to work with disorders of communication. Simon writes that the pattern of the university clinic serving as a training center had been very well established in some areas before World War I, but it did not appear that very many such clinics were in operation until after World War II. As funding for training increased and as national certification came into full bloom, along with an increase in the funds for service, a faculty member trained in the speech pathology and audiology area was probably directing a clinic, teaching courses, obtaining training funds, doing some clinical supervision, and acting as head of a section within a speech department. Also, because of the need for clinic and laboratory space, a physical separation may have developed from colleagues in the speech department and attention was turned to possible affiliation with medicine, special education or in some instances psychology.
The eventual move toward departmental status can be attributed to several causes. The first involved the "follow-the-leader" syndrome. As the programs in the major universities started to establish departmental status others scrambled to follow their example. Also, ASHA started to stress certification requirements that called for speech and hearing personnel in academic settings to have greater freedom to establish academic requirements. It is difficult to establish a date when departmental status occurred for the majority of the profession. Some of the delay in establishing departments could be attributed to academic inertia, to campus politics and in some instances to philosophical disagreements.
In 1959 Carhart proposed that speech pathology and audiology should be considered as an independent educational field dealing with the social and educational aspects of communicative breakdowns. Four years later, Peterson and Fair- banks authored an article that included among its several viewpoints a conclusion that the profession had the necessary academic material for a separate discipline, which they thought should be called speech and hearing science. Cluff reported that the majority of his respondents in a national survey indicated that departmental status allowed them to obtain professional recognition, and facilitated growth. In the large university or college setting the speech and hearing department is usually viewed as a small to medium unit. In the smaller colleges or universities the department may be viewed as one of the larger but also as one of the stronger departments. From the results of a 1984 survey undertaken by the National Council of Graduate Programs in Speech-Language Pathology and Audiology it appears that 45 percent of the responding departments were located in Arts and Sciences settings, 22 percent in Education settings, and 16 percent in Health and Medicine settings. As heads of departments, members of the profession served on the usual university committees, were actively involved in college matters, and obviously did not disgrace their lineage. In fact, some did such an excellent job that they were appointed deans. In the past few years at least six have served as deans of graduate schools, several more as deans of colleges of Applied or Affiliated Health and Humanities, Social Sciences and Education, and Communication Arts and Sciences. At least three have become university presidents. If individuals serve as a head of a department they may have to wear another hat as director of a speech and hearing clinic. In any event they find there is a need to satisfy a variety of masters.
What roles do members of these relatively new departments play? Muma et al. reported that a high percentage of such faculty members carried large clinical loads and were not very involved in research or community service. Also, senior clinical staff members viewed administration as the least demanding of their activities, under training, clinical service, and research, in that order.
and state legislation. One of the major reasons for the growth of a profession is
its acceptance by the professional community. This acceptance is usually
evidenced by certification or licensure laws. Of key importance to the
profession was the acceptance by accreditation agencies of the certification
pattern developed by ASHA. Because the public schools utilized a large number
of members of the profession, the initial battle began with state
certification. The national organization representing the profession operated
from the desire to develop its own standards for certification rather than have
standards forced upon it. The resulting difficulties could be attributed in
part to the fact that the profession was attempting to interfere with other
professions that had not developed the type of certification standards that we
had through ASHA.
A second area involved federal legislation which provided funding for training. With regard to the Vocational Rehabilitation Administration, the funding was for graduate training towards a masters degree. Other professional disciplines involved in such training included rehabilitation counseling, social work, and public health. Thus the pattern of training, and the resulting certification requirements for persons working in rehabilitation settings, was greatly influenced by this federal funding. One other item of federal funding that provided for the setting of minimal requirements was the legislation known as the Social Security Act, especially titles XVIII and XIX, which developed the plans for Medicare and Medicaid. Amendments to the act provided funding for speech pathology services. Also, the requirements indicated that the minimal level of training required for persons to be reimbursed for services were basically those specified in the ASHA certification requirements. These pieces of legislation, along with the requirements of Public law 94-142, which extended public education down to age three years, not only brought the significance of services in speech-language and hearing to the attention of the public, but also provided funding which in turn expanded the job market. In the private sector the spinoff from the federal legislation resulted in many insurance companies authorizing payment for speech pathology services and some audiology services.
With the increase in funding came pressures for licensures. The ASHA certification system was not viewed by governmental or service groups as sufficient to cover the legal difficulties that went along with such funding. The first state licensure law was approved in 1969 in Florida. As of 1986 thirty-six states have licensure in speech pathology and audiology. In all but one or two states the licensure requirements are equivalent to the ASHA certification requirements. Thus, it is possible to obtain reciprocity among the majority of the states. There is some developing skepticism about the value of licensure. This is due to the confusion over the possible licensure of speech and hearing personnel in the schools.
Academic training. While speech correction was in operation in the public schools in the early 1900s, no official training programs came into operation until the 1930s. The early professionals either received their training in Europe, were trained in the general area of speech, or were dedicated classroom teachers serving in a specialized capacity. In 1916 the newly developed department of speech at the University of Illinois included a section on speech science that offered courses such as phonology, phonetics, psychology of audition, physics of sound, and physiology of the voice. In 1916 an article that appeared in the Journal of Educational Psychology indicated that the University of Wisconsin was training teachers for speech correction work in the schools. In the same article there was a statement to the effect that teachers should know the anatomy and physiology of the speech mechanism and they should learn to detect speech defects, especially in the lower grades. In a 1933 report in the Quarterly Journal of Speech there was an indication that 27.6 percent of the colleges in the United States offered facilities for a major in speech correction and that 28.9 percent had a clinic. In 1923 the University of Wisconsin catalogue contained the listing of a course in the correction of speech disorders. A later report indicated that in 1936 four universities offered courses in speech and hearing therapy. In the mid-1930s a survey of the first twenty years of the Quarterly Journal of Speech revealed that 7 percent of the publications were in the area of speech correction and that authors from four schools in the Midwest were the most prolific publishers. The schools were the universities of Illinois, Iowa, Michigan and Wisconsin. In a speech before the National Association of Teachers of Speech in 1933 J. M. O'Neill, the past president of the group, said that there were signs of disintegration in the group because of the desires for separation by staff members in the areas of speech correction and theatre. The late 1930s and early 1940s saw what Paden described as the beginning of the growth of a profession concerned with disorders of communication. In 1925 the American Academy of Speech Correction was founded. That group went through several name changes and in 1947 adopted the name American Speech Correction Association. It was now possible for an academic program to represent a nationally recognized discipline. The period from 1950 through 1960 saw the period of greatest growth, as was described under the section dealing with funding.
As a sign of its growing maturity, members of the profession held a conference on graduate education in 1963 with the intent of defining long-term goals of the profession as well as providing suggestions for a curriculum in graduate education. Several key points emerged from the many resolutions adopted at the conference. They were to serve as guiding beacons for the next ten to fifteen years. There was a strong emphasis upon the need for training programs to be located in a liberal arts and science setting. Also, the training program should have a core of training that centered around such areas as basic communicative processes, human growth and development, phonetics, and speech and hearing science. In 1983 a second national conference on graduate education was held. The concern of the conference was broadened to include consideration of undergraduate and continuing education. Many of the recommendations that resulted from that conference echoed those of the 1963 meeting. Several additional resolutions dealt with such areas as specialty training, the need to strengthen the theoretical and scientific bases of graduate education, as well as to strengthen the role of research. As Rees indicated in her summary of the conference, the key points were the support of the concept of a discipline, and the reaffirmation of the master's degree as the minimal preparation level. In 1976 the training programs in the "big ten" held a conference to discuss the professional doctorate, with the net result that little support existed for such a degree. In 1978 the directors of graduate training programs formed a national group, the Council on Graduate Programs in Speech-Language Pathology and Audiology. This group has held five annual conferences to deal with topics of immediate interest. It has changed its name to the National Council of Graduate Programs in Communication Disorders and Sciences. This change reflects the group's efforts to develop a common title for the profession.
Service activities. Clinical services in
both speech pathology and audiology had been fairly well established prior to
1945 both as independent clinical settings and as ancillary services in various
types of medical settings. Speech pathology had been well established in some
public schools since 1917. Because of the development of certification
requirements in most states after 1950, speech pathology services became
established more extensively in public schools. Audiology, however, except in
Indiana and Utah, had not up to this date developed a certification requirement
that allowed it to be involved in activities in the schools. Relationships
between audiologists and educators of the deaf were still strained despite the
fact that a national conference was held in Tucson in 1964 followed by nine
regional conferences for the purpose of developing better relationships. As a
result of the aforementioned difficulties in the schools situation, audiology
was more likely to be involved in medical settings and community clinics.
According to an ASHA survey published in 1965, 84 percent of the members were
involved in providing clinical or educational services, with 56 percent
involved in services in the schools.
In the 1960s there was a developing interest in language disorders, early work in the diagnosis of such disorders being reported by W. Hardy, H. Myklebust and S. Kastein. This early interest, along with contacts with linguists and the growth of the Chomsky "wave," lead more and more training and service programs to include course work and services in the area of language. In 1980 there was a move to develop special certification for a language clinician. This move led in turn to a review of the concept of single certification, and there was considerable discussion over the role members of the profession could play in the area of language learning difficulties, auditory processing difficulties, and learning disabilities. In some states speech and language clinicians were doing clinical work with children with learning difficulties, while in other states learning disabilities specialists were working with children with speech and language difficulties. Several members of the profession, including J. Eisenson, B. Porch, H. Schuell and J. Wepman, had been interested for many years in the language disorders of adults, as typified by aphasia. This interest had carried over from programs for brain-damaged veterans of World War II, and several of the most popular tests of aphasia had been developed by W. Halstead, J. Wepman, J. Eisenson and H. Schuell. Also, early research with language disorders associated with mental retardation had been undertaken in a large-scale project at Parsons Hospital and the University of Kansas by R Schiefulbusch and his colleagues. Several of the individuals trained as part of the project assumed leadership positions in the area of language disorders.
Many of the textbooks published during the 1970s concentrated on the areas of language development, language disorders, and language evaluation. With this increased interest in language the service market received another stimulus. Then, with the development of service possibilities in audiology, came the development of certain types of instrumentation. In the 1950s the galvanic skin testing unit was popular because of Veteran's Administration testing requirements. Later on in the late 1950s and the early 1960s Bekesy audiometry became the test of choice for more sophisticated evaluation. This was assisted by the issuance of the Jerger typology for Bekesy tracings. The next stage of equipment development involved impedence testing, electronystagmography, and evoked response. With each improvement in equipment, audiology became more sophisticated in terms of its testing capabilities.
Speech pathology, on the other hand, was not quite as involved with the development of new equipment. There were certain pieces of equipment that proved to be valuable for assistance in diagnostic testing in certain areas: cineradiographic testing for cleft palate patients, pneumotachography for air flow measures, and strain gauges to measure lip and jaw movements. In essence speech pathology was more involved in the development of therapy techniques and clinical materials than with diagnostic activities.
The period between 1937 and 1948 witnessed tremendous progress in hearing aid development. The distortion in hearing aids was reduced, the frequency range was extended and the overall output of the aid was improved. The continuing argument over selective fitting was somewhat alleviated by the issuance of the often mentioned Harvard report in 1945. This report indicated that a high frequency emphasis on the order of 3 to 6 decibels would accommodate most hearing losses. Then the eyeglass hearing aid appeared and in the early 1960s the CROS and BICROS aids were introduced and in 1964 behind-the-ear hearing aids were first introduced.
During the 1950s audiology became quite active in terms of evaluation of individuals with suspected otosclerosis. The results of pure tone, speech reception, and discrimination tests were used in selecting candidates who would be successful candidates for surgery. One of the better known audiological characteristics developed during this period was the Carhart notch.
The concept of electrical activity in the brain was first reported in 1875, and in this country P. Davis in 1939 was the first investigator to report on the evoked response, as Brazier writes. In the later part of 1950 several individuals became involved with evoked response testing, and Clark in 1958 at MIT developed the average response computer.
Also, during the period of the late1950s came the building of individual clinic units, which set a pattern for future units. They were developed at Gallaudet College, the Bill Wilkerson Center in Nashville, and the Cleveland Hearing and Speech Center.
The area of private practice has not developed to the extent some individuals might have liked. In 1961 ASHA devoted one issue of the journal Asha to the discussion of private practice. The report had been prepared by the ASHA committee on private practice. At about the same time the American Academy of Private Practice in Speech Pathology and Audiology was formed. In 1981 A. Feldman in his presidential address stressed the need for professional autonomy and the need for expansion of the profession into the private sector.
Present status and
present status of the profession can be detailed, to some degree, by glancing
at the topics under consideration at annual conferences and by studying the
resolutions that arise from those conferences. In general, it would appear that
the items of concern for the 1 980s reflect the problems of the time. In the
academic area the concern is, as always, with the recruitment of quality students,
and also with the nature of a "core" curriculum, supervision of
clinical practicum, the academic status of the supervisor, and the need for a
continuing scientific approach to the concerns of the profession. In the
service area, concerns are for the effects of decreased funding upon human
services; the role of the speech-pathologist and audiologist (since it appears
they serve as supporting professionals within both educational and medical
settings, rather than as independent decision makers); the need for growth in
the area of private practice; and the continuing distance between clinical
problems and research interests.
Members of the profession as well as the national organization have become quite active in regard to federal legislation. At the state level, committees or individuals have been assigned the task of staying current with and influencing ongoing legislative activities that may have an Impact on the profession.
The profession has exhibited considerable growth in just over fifty years. It still appears to be growing and to be facing clinical and academic problems. Appropriate solutions may enable it to enjoy further growth.
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