Criteria for determining disability in speech-language disorders.

Approximately 42 million people (1 in 6) in the United States have some type of communication disorder. Of these, 28 million have communication disorders associated with hearing loss, and 14 million have disorders of speech, voice, and/or language not associated with hearing loss. The personal and societal costs of these disorders are high. On a personal level, such disorders may affect nearly every aspect of daily life. Estimates of annual societal costs in the United States range from $30 billion to $154 billion in lost productivity, special education, and medical costs. Over the last several decades, researchers and clinicians have developed a vast array of assessment instruments for speech, voice, and language; one source reviewing commercially available assessment instruments includes more than 140 tools in its most recent edition. Important clinical decisions follow from the assessment of a person with a communication disorder. These clinical decisions affect an individual’s access to services and funding (e.g., eligibility for special education services, third-party payer coverage of treatment, and Social Security disability income). Thus, the quality of the evaluation procedures on which such decisions are based is an important issue for individuals with a communication disorder, the clinicians involved in their evaluation and treatment, and the policymakers with fiscal responsibilities for services to individuals with these disorders. This evidence report, prepared by staff of the Research Triangle Institute-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) is directed to audiences who must grapple with this set of issues.