certified in Bermuda. This professional's goal is to prevent, evaluate, diagnose, remediate and manage communication disorders in children and adults.

Where can we find Speech-Language Pathologists? They work in a variety of places -- hospitals, schools, clinics, private institutions and rehabilitation centres -- with a of educational, medical, social workers, public health and psychological personnel.

Who refers clients to the speech-language pathologist? Possible referral sources are: doctors, teachers, parents, psychologists and nurses.

What are speech and language disorders? Speech and language disorders affect the way people talk and understand. These disorders may range from simple sound substitutions to not being able to use speech and language at all.

What is a Speech Disorder? A speech disorder is characterised by difficulty with articulation, fluency or voice. Speech disorders may occur as an isolated problem, or in conjunction with either learning disabilities, cleft palate, cerebral palsy, stroke or a hearing loss.

There are three basic speech disorders: The first one -- articulation disorder -- involves difficulty with production and/or sequence of speech sounds. A speech sound production disorder is characterised by substituting one sound for another, i.e., thoup/soup, tat/cat, omitting a sound bo/boat and/or distorting a sound shlip/sip. A speech-sound sequencing disorder may not be apparent in single words but may appear as an articulation difficulty in spontaneous speech.

The second one -- fluency disorder -- involves difficulty in producing and/or maintaining normal speech flow or rhythm. Terms such as "stuttering'', "stammering'', "cluttering'' and "dysrhythmia'' are used to describe this problem. Fluency disorder may be associated with underlying neurological or language deficiencies.

The last one -- voice disorder -- is characterised by hoarseness, breathiness deviant nasality, abnormal volume or inappropriate pitch. Speech-language pathologists may initiate therapy for voice problems provided the client has been seen first by an ear, nose and throat specialist.

What is a language disorder? A language disorder is characterised by the inability to use words appropriately, construct meaningful sentences and express thoughts. Specific language disorders may be present from an early age in some children, or they may result from a head injury or stroke at any age. Language disorders may be receptive and/or expressive in nature.

Language disorders are a primary component of many learning disabilities and may be related to other handicaps. They may also occur in the mentally deficient, but the presence of a language disorder should not be misinterpreted as a sign of retardation. There are three types of disorders: The first is the receptive language disorder which includes problems in the following areas: understanding words and their meanings comprehending differences in sentence construction comprehending abstract words and multiple word meanings understanding spatial relationships and the use of prepositions following directions remembering verbal information understanding speech in the presence of distractions Individuals with receptive language disorders often have difficulty monitoring their own speech and language.

The second one: Expressive language disorder which may include problems in producing proper word order in sentences: deficits in grammar word retrieval problems deficits in use of descriptive words and limited vocabulary The last one is a combination of both receptive and expressive.

What are speech and language disorders' causes and effects? Hearing loss, cerebral palsy and other neuromuscular disorders, severe head injury, stroke, certain drugs, oral-facial anomalies (such as cleft lip and palate), birth difficulties and environmental factors may cause disorders.

The cause of some speech or language problems may not be really apparent and may be unrelated to any other problem. Therefore, it is important to obtain consultation from a qualified speech and language pathologist. Speech and language problems may affect an individual's ability to learn, to hold a job and to communicate important feelings and needs to other people. Also, a person with these disorders may find it difficult to deal comfortably with normal social situations and daily activities such as using the telephone.

For further information about a specific disorder, please call the Department of Health at 236-0224, Ext. 325. Yvonne West Speech-Language Pathologist Department of Health.