physical conditions make communication difficult. the use of electronic communication systems allow nonspeaking people and people with severe physical disabilities to engage in the give and take of shared thought. adaptability and limitations while some speech problems, such as certain voice problems, require medical interventions, many speech problems can be alleviated through effective behavioral interventions and practice. in these cases, instruction in speech techniques or speaking strategies, coupled with regular practice, can help the individual to overcome his/her speaking difficulties. in other, more severe cases, the individual with speech problems may compensate with aac devices. speech impairments can seriously limit the manner in which an individual interacts with others in work, school, social, and even home environments. inability to correctly form speech sounds might create stress, embarrassment, and frustration in both the speaker and the listener. over time, this could create aggressive responses on the part of the listener for being misunderstood, or out of embarrassment. alternatively, it could generate an avoidance of social situations that create these stressful situations. language impairments create similar difficulties in communicating with others, but may also include difficulties in understanding what others are trying to say (receptive language). because of the pervasive nature of language impairments, communicating, reading, writing, and academic success may all be compromised in these students. similar to individuals with speech impairments, individuals with language impairments may encounter long-term difficulties associated with work, school, social, and home environments. assistive technology augmentative and alternative communication (aac) includes all forms of communication other than oral communication that an individual might employ to make known his/her thoughts. aac work to compensate for impairments that an individual might have with expressive language abilities. each system works to maintain a natural and functional level of communication. there is no one best type of aac for all individuals; rather, the best type of aac will be determined by the strengths and weaknesses of a specific individual. while there are a large number of types of aac, there are fundamentally two categories: aided and unaided. unaided systems of communication are those that require both communication parties to be physically present in the same location. examples of unaided systems include gestures, body language, sign language, and communication boards. communication boards are devices upon which letters, words, or pictorial symbols might be displayed; the individual may interface with the communication board to express him/herself to the other individual. aided systems of communication do not require both individuals to be physically present in the same location, though they might be. aided systems are often electronic devices, and they may or may not provide some form of voice output. if a device does create a voice output, it is referred to as a speech generating device. while the message may take the form of speech output, it may also be printed as a visual display of speech. many of these devices can be connected to a computer, and in some cases, they may even be adapted to produce a variety of different languages. inclusion vs. exclusion students identified with a speech and language disability often qualify for an individualized education plan as well as particular services. these include one-on-one services with a speech and language pathologist. examples used in a session include reading vocabulary words, identifying particular vowel sounds and then changing the context, noting the difference. school districts in the united states often have speech and language pathologists within a special education staff to work with students. additionally, school districts can place students with speech and language disabilities in a resource room for individualized instruction. a combination of early intervention and individualized support has shown promise increasing long-term academic achievement with students with this disability. students might work individually with a specialist, or with a specialist in a group setting. in some cases, the services provided to these individuals may even be provided in the regular education classroom. regardless of where these services are provided, most of these students spend small amounts of time in therapy and the large majority of their time in the regular education classroom with their typically developing peers. therapy often occurs in small groups of three or four students with similar needs. meeting either in the office of the speech-language pathologist or in the classroom, sessions may take from 30 minutes to one hour. they may occur several times per week. after introductory conversations, the session is focused on a particular therapeutic activity, such as coordination and strengthening exercises of speech muscles or improving fluency through breathing techniques. these activities may take the form of games, songs, skits, and other activities that deliver the needed therapy. aids, such as mirrors, tape recorders, and tongue depressors may be utilized to help the children to become aware of their speech sounds and to work toward more natural speech production. prevalence in 2006, the u.s. department of education indicated that more than 1.4 million students were served in the public schools' special education programs under the speech or language impairment category of idea 2004. this estimate does not include children who have speech/language problems secondary to other conditions such as deafness; this means that if all cases of speech or language impairments were included in the estimates, this category of impairment would be the largest. another source has estimated that communication disorders—a larger category, which also includes hearing disorders—affect one of every 10 people in the united states. asha has cited that 24.1% of children in school in the fall of 2003 received services for speech or language disorders—this amounts to a total of 1,460,583 children between 3 –21 years of age. again, this estimate does not include children who have speech/language problems secondary to other conditions. additional asha prevalence figures have suggested the following: stuttering affects approximately 4% to 5% of children between the ages of 2 and 4. asha has indicated that in 2006: almost 69% of slps served individuals with fluency problems. almost 29% of slps served individuals with voice or resonance disorders. approximately 61% of speech-language pathologists in schools indicated that they served individuals with sli almost 91% of slps in schools indicated that they servedindividuals with phonological/articulation disorder estimates for language difficulty in preschool children range from 2% to 19%. specific language impairment (sli) is extremely common in children, and affects about 7% of the childhood population. discrimination while more common in childhood, speech impairments can result in a child being bullied. bullying is a harmful activity that often takes place at school, though may be present in adult life. bullying involves the consistent and intentional harassment of another individual, and may be physical or verbal in nature. speech impairments (e.g., stuttering) and language impairments (e.g., dyslexia, auditory processing disorder) may also result in discrimination in the workplace. for example, an employer would be discriminatory if he/she chose to not make reasonable accommodations for the affected individual, such as allowing the individual to miss work for medical appointments or not making onsite-accommodations needed because of the speech impairment. in addition to making such appropriate accommodations, the americans with disabilities act (1990) protects against discrimination in "job application procedures, hiring, advancement, discharge, compensation, job training, and other terms, conditions, and privileges of employment". terminology smith offers the following definitions of major terms that are important in the world of speech and language disorders. alternative and augmentative communication (aac): assistive technology that helps individuals to communicate; may be low-tech or high-tech articulation disorder: atypical generation of speech sounds cleft lip: upper lip is not connected, resulting in abnormal speech cleft palate: an opening in the roof of the mouth that allows too much air to pass through nasal cavity, resulting in abnormal speech communication: transfer of knowledge, ideas, opinions, and feelings communication board: low-tech aac device that displays pictures or words to which an individual points to communicate communication disorder: disorders in speech, language, hearing, or listening that create difficulties in effective communication disfluency: interruptions in the flow of an individual's speech expressive language: ability to express one's thoughts, feelings, or information language: rule-based method used for communication language delays: slowed development of language skills language disorder: difficulty/inability to comprehend/make use of the various rules of language loudness: a characteristic of voice; refers to intensity of sound morphology: rules that determine structure and form of words otitis media: middle ear infection that can interrupt normal language development pitch: a characteristic of voice; usually either high or low phonological awareness: understanding, identifying, and applying the relationships between sound and symbol phonology: rules of a language that determine how speech sounds work together to create words and sentences pragmatics: appropriate use of language in context receptive language: ability to comprehend information that is received semantics: system of language that determines content, intent, and meaning of language speech: vocal production of language speech impairment: abnormal speech is unintelligible, unpleasant, or creates an ineffective communication process speech/language pathologist: professionals who help individuals to maximize their communication skills. speech synthesizer: assistive technology that creates voice stuttering: hesitation or repetition contributes to dysfluent speech syntax: rules that determine word endings and word orders voice problem: abnormal oral speech, often including atypical pitch, loudness, or quality history in the mid 19th century, the scientific endeavors of such individuals as charles darwin gave rise to more systematic and scientific consideration of physical phenomenon, and the work of others, such as paul broca and carl wernicke, also lent scientific rigor to the study of speech and language disorders. the late 19th century saw an increase in "pre-professionals," those who offered speech and language services based upon personal experiences or insights. several trends were exhibited even in the 19th century, some have indicated the importance of elocution training in the early 19th century, through which individuals would seek out those with training to improve their vocal qualities. by 1925 in the usa interest in these trends lead to the forming of the organization that would become american speech-language-hearing association (asha) and the birth of speech-language pathology. the twentieth century has been proposed to be composed of four major periods: formative years, processing period, linguistic era, and pragmatics revolution. the formative years, which began around 1900 and ended around wwii, was a time during which the scientific rigor extended and professionalism entered the picture. during this period, the first school-based program began in the u.s. (1910). the processing period, from roughly 1945–1965, further developed the assessment and interventions available for general communication disorders; much of these focused on the internal, psychological transactions involved in the communication process. during the linguistic era, from about 1965–1975, professionals began to separate language deficits from speech deficits, which had major implications for diagnosis and treatment of these communication disorders. lastly, the pragmatics revolution has continued to shape the professional practice by considering major ecological factors, such as culture, in relation to speech and language impairments. it was during this period that idea was passed, and this allowed professionals to begin working with a greater scope and to increase the diversity of problems with which they concerned themselves.