In speech therapy, what’s best for the bottom line might also be best for kids

Speech-language impairment affects millions of school-aged children in the U.S., not just limiting their ability to communicate, but posing a risk for their future achievement. Children with untreated speech-language issues go on to have more trouble with reading and math, as well as social and behavioral skills. Fortunately, access to treatment has become nearly universal, because the Individuals with Disabilities Act guarantees school-based services to any child whose educational performance is affected by a learning disability, including speech-language problems. About 40% of children receiving special education services at school have either a speech-specific diagnosis or a problem like autism that includes speech delays. But speech language pathologists (SLPs) report large caseloads and worry that could compromise the effectiveness of their services. Increasing the number of SLPs sounds like a logical remedy, but it might not be necessary, according to a review of research by Laura Justice, Jessica Logan, Mary Beth Schmitt, and Hui Jiang, in Policy Insights from the Behavioral Sciences. Research on how people process the skills they learn in speech therapy might allow SLPs to reduce the frequency or intensity of their services, the researchers write.

Typically, public school students receiving speech services see an SLP once or twice a week, for an average of about 36 minutes of treatment. But there is wide variation. One study found that the service amount ranged from 15 minutes a week to 120 minutes a week. Justice and her colleagues speculate that the variation could be due to differences in caseloads, with SLPs who have higher caseloads providing services with less intensity. But that isn’t necessarily a bad thing, because of a phenomenon known as the spacing effect.

“The spacing effect is the well-documented phenomenon by which human learning is enhanced when learning opportunities are spread apart in time,” the authors write. They hypothesize that the spacing effect might mean students actually learn more when there is some distance between their “learning opportunities.” Scientists believe the spacing effect has something to do with the way memory works. We tend to remember a new skill better when we learn it in multiple contexts or apply it to a new problem, and spreading out time between learning opportunities can provide more chances for us to use the skill in different settings. That may be particularly important for speech therapy, especially in a school setting where services are usually provided in an environment outside the regular daily context. The spacing effect might also be connected to the way we use cues to remember. We recall things more easily if we get a reminder of them, especially if it is provided at an optimal time that is “not too soon but not too distant” from the original learning situation. Counterintuitively, our recollections tend to be stronger the farther out we are from the original situation – that is, if it is soon enough that we can remember at all.

The spacing effect could mean that SLPs can provide services less frequently with more exercises during each session, or more often but with few exercises per session. One of the few studies that has looked at the intensity issue found that children benefitted equally from those two approaches. There are, of course, limits to the spacing effect; at some point the distance between learning opportunities becomes too great for the person to remember or maintain what she has learned. It’s not yet clear what the ideal spacing is for speech-language services, Justice and her colleagues write, but they warn that the study mentioned above found the low-dose, low-frequency combination to be less beneficial than the other schedules. There appears to be a threshold below which services are simply not enough to make a difference.

Justice and her colleagues acknowledge that there is little research on how often and how intensively school-based SLPs should provide services, but they think more study could help school leaders and SLPs address the caseload problem. They point out that, currently, SLPs in schools usually don’t have time to see children multiple times per week, so they advise that the best choice for now may be “seeing children about once per week, in highly productive sessions.” With more research, they hope to see a rare kind of solution: one that benefits the bottom line but is also best for kids.

Please find the full-text of the journal article here.