People with disability in Australia 2022 - Statistics about communication disability

IMPORTANT DATA FROM:
 

Australian Institute of Health and Welfare (2022) People with disability in Australia 2022, catalogue number DIS 72, AIHW, Australian Government.

https://www.aihw.gov.au/getmedia/3bf8f692-dbe7-4c98-94e0-03c6ada72749/aihw-dis-72-people-with-disability-in-australia-2022.pdf.aspx?inline=true

Australian Bureau of Statistics’ (ABS) 2018 Survey of Disability, Ageing and Carers (SDAC).

"Nearly one-third (32%) of people with disability – about 1.4 million or 5.7% of the Australian population – have severe or profound disability. This means sometimes or always needing help with daily self-care, mobility or communication activities, having difficulty understanding or being understood by family or friends, or communicating more easily using sign language or other non-spoken forms of communication (ABS 2019a)." (p. 26)

Of people with disability living in households who need help with at least one activity: • the need for help with cognitive or emotional tasks decreases with age (79% or 362,000 of those aged under 25, 45% or 422,000 of those aged 25–64, and 19% or 208,000 of those aged 65 and over) • those aged under 25 are more likely (41% or 187,000) to need help with oral communication than those aged 25–64 (5.9% or 55,000) or 65 and over (5.8% or 64,000) (p. 36)

Of the selected chronic conditions, stroke is associated with a high level of core activity limitation: • 42% (or 37,000) of people with stroke as their main condition have severe or profound core activity limitation • 17% (or 15,000) have mild or moderate core activity limitation • 39% (or 33,000) have no core activity limitations, but may still have disability not related to core activities. Of the selected chronic conditions, asthma is associated with the lowest level of core activity limitation: • 1.5% (or 13,000) of people with asthma as their main condition have severe or profound core activity limitation • 4.6% (or 38,000) have mild or moderate core activity limitation • 94% (782,000) have no core activity limitation, but may still have disability not related to core activities (Figure CHRONIC.3). (p. 96)

Not everyone with disability receives all the help they need from formal services. Common activities for which the need for formal assistance was unmet include: • cognitive or emotional tasks (40% or 286,000 people with disability, aged 64 and under, living in households who need formal assistance with that activity) • communication (38% or 86,000) • property maintenance (31% or 139,000) • household chores (31% or 124,000) • mobility (20% or 98,000) (ABS 2019). The reasons given for not receiving any or more help from an organised service with at least one activity include: • service costs too much (38% or 199,000 people with disability, aged 64 and under, with an unmet need for formal assistance) • did not know of service (18% or 95,000) • not eligible for service (16% or 84,000) • service does not provide sufficient hours (14% or 73,000) • unable to arrange service (14% or 72,000) • no service available (13% or 68,000) (ABS 2019). Reasons for not receiving any or more help from an organised service with at least one activity differ by remoteness. Among people with disability aged 64 and under, with an unmet need for formal assistance: • people living in Outer regional and remote areas are more likely (24% or 15,000) not to receive help due to no service being available than those living in Major cities (9% or 31,000) • people living in Inner regional areas are more likely (23% or 26,000) not to receive help due to not being eligible for service than those living in Major cities (14% or 49,000) and Outer regional and remote areas (15% or 9,000) • people living in Major cities are more likely (40% or 140,000) not to receive help due to service costing too much than those living in Outer regional and remote areas (27% or 16,000) (ABS 2019). (p. 133)

Household, Income and Labour Dynamics in Australia (HILDA) Survey

Difficulties experienced. Some people with disability experience difficulties at their school or educational institution, such as learning, fitting in socially and communicating. 

School students (primary and secondary). Not all school students (aged 5–18) with disability have difficulty at their school – more than one-third (36% or 135,000) do not. Some who have no difficulty have a schooling restriction (16% of school students with disability, or 61,000) while others do not (20% of school students with disability, or 76,000). This varies by disability group and remoteness: • More than 4 in 5 (81% or 122,000) students with psychosocial disability have difficulty at school compared with 3 in 5 (59% or 54,000) of those with physical disability. • More than two-thirds (69% or 59,000) of students living in Inner regional areas have difficulty compared with 3 in 5 (59% or 23,000) of those living in Outer regional and remote areas (ABS 2019). 

Of those who have difficulty at school, the most common experienced are: 

• learning difficulties (68% or 165,000) 

• fitting in socially (56% or 137,000) 

• communication difficulties (44% or 107,000) 

• intellectual difficulties (22% or 54,000) 

• sports participation (17% or 42,000) 

• difficulty sitting (15% or 37,000) (ABS 2019). (pp. 298-299)

Non-school students Not all non-school students with disability have difficulty at their educational institution – almost three-quarters (74% or 137,000) do not. Some with no difficulty have a nonschool educational restriction (19% of non-school students with disability, or 35,000) while others do not (53% of non-school students with disability, or 99,000). Of those who have difficulty, the most common experienced are: • learning difficulties (32% or 17,000) • fitting in socially (25% or 13,000) • communication difficulties (20% or 11,000) (ABS 2019).

References

ABS (Australian Bureau of Statistics) (2019) Microdata: disability, ageing and carers, Australia, 2018, ABS cat. no. 4430.0.30.002, ABS, AIHW analysis of TableBuilder data, accessed 14 October 2021. https://www.abs.gov.au/statistics/microdatatablebuilder/available-microdata-tablebuilder/disability-ageing-and-carers-australia

DSS (Department of Social Services) and MIAESR (Melbourne Institute of Applied Economic Social Research) (2019) The Household, Income and Labour Dynamics in Australia (HILDA) Survey, general release 18 (wave 17), doi:10.26193/IYBXHM, ADA Dataverse, AIHW analysis of unit record data, accessed 15 December 2021.

Anniek's PhD is going well

Tonight we discussed the next draft of one of Anniek Van Doornik's PhD papers. I really enjoy collaborating with her supervisory team in The Netherlands: Prof Ellen Gerrits, Hayo Terband and Marlies Welbie.

ICF Illustration Library

WOW! Tonight at my meeting with Dr Sandra Neumann I learned about the ICF Illustration Library: http://www.icfillustration.com/top_e.html

It can be searched in English, Spanish and Japanese.

We may be able to use these images for the child version of the ICS.

 

ICF Australia Interest Group Meeting

This afternoon I attended the ICF Australia Interest Group Meeting. Topics discussed included: 

• Updates from annual WHO-FIC meeting October 2020 (Richard Madden and Catherine Sykes). They discussed the moves to bring together ICD-11, ICF and ICHI onto a common platform (ICAT) and provided a 

• National Disability Data Asset and disability definition (Louise York, AIHW). 
• NSW is running a pilot on early childhood education (one of five national case studies)
  
• ICF and outcome measures in rehabilitation trials (Prof Cathie Sherrington) 
• Updates from ICF Australia Interest Group Members (including NDIS Independent Assessment Framework and its use of ICF by Ros Madden)

Here is a new paper about the bringing together of the WHO classifications: 

• Tu SW, Nyulas CI, Tudorache T, Musen MA, Martinuzzi A, van Gool C, della Mea V, Chute, CG, Frattura L, Hardiker N, ten Napel H, Madden RC, Almborg A-H, Ginige JA, Sykes CR, Celik C, Jakob R. (2020) Toward a Harmonized WHO Family of International Classifications Content Model. In L.B. Pape-Haugaard et al. (Eds.) Digital Personalized Health and Medicine. European Federation for Medical Informatics (EFMI) and IOS Press. p1409-1410. doi:10.3233/SHTI200466. http://ebooks.iospress.nl/publication/54468

Health and Wellbeing in Childhood - Third Edition

My copy of Health and Wellbeing in Childhood - Third Edition has just arrived in the mail. It is so new it is not even on the Cambridge University Press website yet.

Here are the chapters I have co-authored with Jane McCormack:

• McCormack, J. & McLeod, S. (2020). Classifying health and wellbeing: Applying the International Classification of Functioning, Disability and Health to early years learners. In S. Garvis & D. Pendergast (Eds). Health and wellbeing in childhood (3rd ed.) (pp. 20-34). Melbourne, Australia: Cambridge University Press. 
• McCormack, J. & McLeod, S. (2020). Communication development. In S. Garvis & D. Pendergast (Eds). Health and wellbeing in childhood (3rd ed.) (pp. 132-153). Melbourne, Australia: Cambridge University Press. 

They have been substantially updated since the second edition - and the chapter on communication development includes case studies based around children's drawings.

Providing feedback to the World Health Organization

Today I submitted feedback about proposals to the International Classification of Functioning, Disability and Health (ICF) to the World Health Organization on behalf of 24 speech-language pathologists from across the world (UK, US, Fiji, The Netherlands, Iceland, Australia, etc.).  We plan to provide more feedback when new proposals are welcomed.

ICF-Australia Interest Group

Today I attended the ICF-Australia Interest Group online meeting chaired by Richard Madden from the University of Sydney and attended by people across Australia, in the US and Greece.
The topics included:

• Merging ICF and ICF-CY into ICF2020 that will be uploaded into a new electronic format
• Request for comments about recommended changes to ICF (including recommendations to Chapter 3 - Communication) (Catherine Sykes)
• Mapping SDGs onto ICF is underway (Brooke MacPherson)
• ICHI for medical and surgical interventions will be finalised in 2020. ICHI for functioning will be the next focus, followed by public health.

In the section about news from the Interest Group, I was able to mention the following publications:

1. Cronin, A., McLeod, S., & Verdon, S. (2020, in press May). Holistic communication assessment for young children with cleft palate using the ICF-CY. Language, Speech, and Hearing Services in Schools. 
2. Cronin, A., McLeod, S., & Verdon, S. (2020, in press February). Applying the ICF-CY to specialist SLPs’ practice with toddlers with cleft palate speech. The Cleft Palate-Craniofacial Journal. Advance online publication https://doi.org/10.1177/1055665620918799 
3. Blake, H. L., & McLeod, S. (2019). Speech-language pathologists’ support for multilingual speakers’ English intelligibility and participation informed by the ICF. Journal of Communication Disorders, 77, 56-70. doi:10.1016/j.jcomdis.2018.12.003

I was also able to make a number of suggestions regarding recommended changes to the ICF and will followup on this in the next week.

Here are some resources recommended during the meeting:

• ICF Australia website https://www.sydney.edu.au/medicine-health/our-research/research-centres/who-collaborating-centre-for-strengthening-rehabilitation-capacity-in-health-systems/classifications-and-terminologies.html 
• ICF Australia Education resources: https://cloudstor.aarnet.edu.au/plus/s/MOdUMYinBvueonD (Imelda) 

Catherine Sykes demonstrating how to use the ICF Update Platform

Dr. Rune Simeonsson

Invited book chapter about the ICF and how to use participation to guide assessment and intervention

This morning I had a videoconference with Dr Karla Washington from the University of Cincinnati, OH. We have been invited to write a book chapter titled "School-age children with communication disorders" in a new book provisionally entitled "ICF and Communication Disorders in Child-Onset Disability" edited by Mary Jo Cooley Hidecker and Travis Threats. Their book uses the framework from the World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) through the lifespan. Our chapter will be in section 3: How to use participation to guide assessment and intervention of communication disorders across the lifespan.

Presentation at the World Health Organization symposium on ICF-CY

Today (25th June 2019) Associate Professor Jane McCormack and I had the honour of presenting a paper titled "The application of ICF-CY to inclusion of children and young people with primary communication disability" at the symposium titled "Applications of the ICF and Lessons Learned", held at The University of Sydney.

The following international speakers, influential in the development of the ICF-CY, also presented:

• Rune Simeonsson: ICF/CY and children: Accomplishments and next steps. 
• Mats Granlund: Conceptualizing change with the help of ICF-CY – is it possible? 
• Eva Björck-Akesson: ICF-CY as a basis for collaborative problem solving in early childhood intervention - a focus on inclusion 

Here is the outline of the event:

This symposium is an opportunity for researchers, practitioners and policy makers to hear about diverse applications of the International Classification of Functioning, Disability and Health (ICF) and to discuss, network, and share information. The Symposium includes four sessions, the first three involving 3-4 short presentations followed by a forum discussion. Two brainstorm sessions will also enliven the day. The final session will draw together common themes of the day, and there will be a group discussion of lessons learned and future directions for ICF application – whether for research, education, statistical, clinical or service use. The symposium has been organised to take advantage of three international speakers attending the International Society on Early Intervention Conference. There will be a major (but not exclusive) focus on the ICF and children’s functioning and disability, with a range of speakers from universities, research groups and organisations in Australia and overseas.

A/Prof Jane McCormack, Helen Blake, Rune Simeonsson ("Father of the ICF-CY"),
Prof Sharynne McLeod, A/Prof Bronwyn Hemsley

Presenters and participants at the WHO-ICF-CY symposium

Professor Sharynne McLeod presenting at the symposium

The SAGE encyclopedia of human communication sciences and disorders

The SAGE encyclopedia of human communication sciences and disorders has just been published. The 4-volume encyclopedia was edited by Jack Damico and Martin Ball. The website states "The editors have recruited top researchers and clinicians across multiple fields to contribute to approximately 640 signed entries across four volumes"  Members of our SLM team have written seven of these entries:

1. Blake, H. L. & McLeod, S. Intelligibility enhancement. 
2. Cronin, A. & McLeod, S. Cleft lip and palate: Speech effects. 
3. Cronin, A. & McLeod, S. Craniofacial anomalies.
4. McLeod, S. International Classification of Functioning, Disability and Health. 
5. McLeod, S. Prevalence of communication disorders.
6. McLeod, S. & Verdon, S. Multilingualism and speech sound disorders. 
7. Phạm, B. & McLeod, S.  Tone languages and communication disorders.

Anna Cronin with volume 1 (of 4) of the encyclopedia

Framing our work (and lives) around the International Classification of Functioning, Disability and Health

Our Speech-Language-Multilingualism team use the International Classification of Functioning, Disability and Health (ICF, World Health Organization, 2001) and the children and youth version (ICF-CY, WHO, 2007) as the framework for most of our work. It enables us to think  holistically about the lives of the children, families, and professionals we work with. It also enables us to enjoy and participate in all aspects of our own lives (not just work).

Recently, Anna Cronin has been using the ICF-CY as the framework for her PhD study undertaking a comprehensive content analysis of the transcripts of conversations with experts who work with young children with cleft lip and palate. She visited these experts around the world as part of her Churchill Fellowship. There have been some surprising insights using the ICF-CY. For example, e210 Physical geography and e2151 Population density were frequently discussed as a in relation to the impact of access to specialist services for these children.

Anna Cronin

Exploring multilingual speakers’ perspectives on their intelligibility in English

The following manuscript has been accepted for publication. It forms part of Helen Blake's PhD research:
Blake, H. L., Verdon, S. & McLeod, S. (2019, in press February). Exploring multilingual speakers’ perspectives on their intelligibility in English. Speech, Language and Hearing.
50 free copies are available from this link: https://www.tandfonline.com/eprint/eJF8jisEZg7UkRtFFBIM/full?target=10.1080/2050571X.2019.1585681
Here is the abstract:

Multilingual speakers’ ability to communicate effectively and intelligibly in the language of their country of residence is crucial to their participation. This study explored multilingual speakers’ motivations for improving their intelligibility in English and their perceptions of potential barriers and facilitators to enhancing intelligibility. Participants were multilingual students and staff at 14 Australian universities. Extended response data from 137 survey responses were combined with seven semi-structured interviews, thematically analysed using the World Health Organization’s International Classification of Functioning, Disability and Health as a conceptual framework, and coded using NVivo software. Three overarching themes were: motivations, barriers, and facilitators. Themes that emerged under motivations were meeting their own and others’ expectations and career aspirations. Themes that emerged under barriers to intelligibility were lack of self-awareness of reduced English intelligibility, use of ineffective strategies (e.g., fast speech rate to disguise pronunciation difficulties), language differences, lack of opportunity to practise English, participants’ perceptions of others’ negative attitudes to their English skills, and challenging conversational partners. Facilitators to intelligibility were emotional support from others, beneficial strategies (e.g., confirming listener understanding), and opportunities to practice. The results highlight the importance of supporting multilingual speakers’ efforts to improve their English intelligibility. An environment with barriers such as lack of opportunity to practise English may restrict an individuals’ performance and participation, while facilitators such as support from others may increase participation. This study will inform the understanding of speech-language pathologists engaged in Intelligibility Enhancement, as well as SLPs working with multilingual speakers in any context.

Speech-language pathologists’ support for multilingual speakers’ English intelligibility and participation informed by the ICF

Congratulations to Helen Blake who just had the following paper accepted for publication from her PhD:
Blake, H. L. & McLeod, S. (in press). Speech-language pathologists’ support for multilingual speakers’ English intelligibility and participation informed by the ICF. Journal of Communication Disorders.

Purpose: To use the ICF to classify characteristics and aspirations of multilingual university students and faculty who seek speech-language pathologists’ support for intelligibility in English and to identify activities, facilitators, and barriers that impact participation in society.
Method: A retrospective record review was conducted on files of 175 clients attending a university clinic for intelligibility enhancement (accent modification). Participants came from 35 countries and spoke 28 different home languages.
Results: Assessment and intervention for intelligibility enhancement involved consideration of ICF components of Body Functions and Structures (e.g., articulating phonemes, rate, prosody), Environmental Factors (e.g., support), and Personal Factors (e.g., motivation). Consonant substitutions and deletions were common, although participants were often unaware of these. For example, only 25.6% of participants reported English dental fricatives (/θ/ and /ð/) were difficult to pronounce; however, 94.9% substituted them with other phonemes such as [t] and [d]. The combination of substitutions/deletions, fast speech rate, low speaking volume, and differences in word stress exacerbated poor intelligibility. More time conversing in English was associated with greater confidence and less difficulty communicating in English, although more time knowing English was not. Difficult communication situations were reported to be conversing over the phone, talking to strangers, and communicating in English on professional fieldwork placements. Participants were motivated to seek intelligibility enhancement for academic, employment, and social reasons.
Conclusions: To ensure multilingual speakers are able to participate fully in society, intelligibility enhancement requires a multi-pronged approach where speech and environmental characteristics interweave.

The ICF framework: Considering individuals from a perspective of health and wellness

The following article has been accepted for publication.

Blake, H. L. & McLeod, S. (2018, in press June). The ICF framework: Considering individuals from a perspective of health and wellness. Perspectives of the ASHA Special Interest Groups (SIG17: Global issues in Communication Sciences and Related Disorders).

It will be published in a special issue on the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), and forms part of Helen's PhD.
Here is the abstract:

This paper describes the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) and its application to speech, language, and hearing. The ICF framework was developed to present a holistic person-centered approach for people of all ages, across all nations, health care disciplines, services, and time from a perspective of health and wellness. Therefore, it is an appropriate framework for the professions of speech-language pathology and audiology for use with people in relation to their communication and/or hearing. This paper describes the ICF, its purpose, development, contents, and coding. It also discusses how the framework is being used by speech-language pathologists and audiologists in clinical practice and research to investigate body structures and their functions and any restrictions these may place on an individual’s ability to participate in activities. The acceptance of the ICF as a biopsychosocial framework for practice and research marks a transition in thinking from the professions’ previous focus on handicap to a focus instead that considers individuals and society from a perspective of health and wellness.

30th World Congress of the International Association of Logopedics and Phoniatrics (IALP)

This week over 1000 participants from 53 countries met in Dublin for the 30th World Congress of IALP.  The congress opened with a fantastic session including a presentation from Declan Murphy, a lecturer at NUI Galway who has Down Syndrome. He explained “speech is my Everest” and stated that “I believe that communication is a human right”. His speech was inspiring and received a standing ovation. Declan’s speech was followed by Move4 Parkinson’s, a choir made up of people with Parkinson’s disease, their friends and family. Their rendition of Roar again had people cheering on their feet.

Declan Murphy presenting his inspiring opening address

There has been an emphasis on the World Health Organization’s initiatives, and I was invited to present the first of eight 30 minute papers on the International Classification of Functioning, Disability and Health.

Presenters in the WHO sessions on the ICF sponsored by the American Speech-Language-Hearing Association

Over the week, my students, colleagues and I have presented the following papers:

McLeod, S. - Description of the ICF Framework. Invited presentation.

McLeod, S., Verdon, S., & International Expert Panel on Multilingual Children’s Speech -  Recommendations for the assessment of multilingual children’s speech.

McLeod, S., Baker, E., McCormack, J., Wren, Y., Roulstone, S., Crowe, K. & Masso, S. - Sound Start Study: A community-based randomized controlled trial of Phoneme Factory Sound Sorter.

Crowe, K., Cumming, T., McCormack, J., McLeod, S., Masso, S., Baker, E., Wren, Y., Roulstone, S. - Sound Start Study: Early childhood educators' experiences of implementing Phoneme Factory Sound Sorter.

Verdon, S., McLeod, S. & Wong, S. - Six Principles of Culturally Competent Practice: Enhancing families’ engagement in speech and language therapy.

Wylie , K., Hopf, S. C., McAllister, L., Marshall, J., Davidson, B., McLeod, S., McDonagh, S., Amponsah, C., & Ohenewa Bampoe, J. - An exploration of the diversity of self‐ help and help‐seeking practices for communication disability in Ghana and Fiji.

Sound Start Study team members, Yvonne Wren, Jane McCormack and Sharynne with Debbie Sell (UK)

Application of the ICF to communication

Last year I was invited to be a member of the American Speech-Language-Hearing Association ad hoc committee on the application of the International Classification of Functioning, Disability and Health to communication. ASHA has subsequently developed a website that includes resources we developed on creating person-centered goals:
ICF and speech sound disorders
ICF and specific language impairment

Working near Washington DC at the ASHA headquarters

I am an international representative on the American Speech-Language-Hearing Association Ad Hoc Committee on the International Classification of Functioning, Disability and Health. This week I have been working with the committee at the ASHA headquarters that are located near Washington DC.  The meeting has been very collegial and enthusiastic, generating many plans for resources, presentations, and publications to facilitate ASHA's membership's use of the ICF within speech-language pathology and audiology practice. The day before the meeting I was able to visit the famous places in Washington DC.

ASHA ICF committee: Backrow L-R: Sharynne, Holly Wise (PT), Tammy Hopper, Mary Hildebrand (OT), Lemmietta McNeilly, Pam, Bob Burkard, Sandi Gillam. Front row: Candace Vickers, Janet Brown, Donna Smiley, Jean-Pierre Gagne

Sharynne at ASHA in Rockville

The White House from the Washington Monument

ASHA headquarters: The White House for American speech-language pathologists and audiologists

Ad Hoc Committee on the ICF

This morning I participated in a conference call for the American Speech-Language-Hearing Association's Ad Hoc Committee on the ICF. We meet face-to-face next month in Washington DC.

The contribution of the ICF-CY to working with children with SSD

The following book chapter has been published:

McLeod, S. (2015). The contribution of the ICF-CY to working with children with SSD. In C. Bowen Children’s speech sound disorders (2^nd ed.) (pp. 5-7). Oxford: Wiley-Blackwell. 

Information about the book is here.
The impressive list of contributors within this book is here.

Applying the World Report on Disability to children’s communication

The following manuscript has just been published online

McLeod, S., McAllister, L., McCormack, J., & Harrison, L. J. (2013, in press). Applying the World Report on Disability to children’s communication. Disability and Rehabilitation, doi:10.3109/09638288.2013.833305

Here is the abstract:

Purpose: The World Report on Disability is an important milestone in the recognition of people with disabilities; however, the Report acknowledges that people with communication difficulties may be underrepresented in estimates of disability. Consequently, this article applies the nine recommendations from the World Report on Disability to supporting children’s communication skills. Method: Australia is similar to most Minority World countries since it places high regard on articulate and literate communication. Recent large-scale Australian studies of children with speech, language and communication needs were reviewed to determine prevalence, impact and associated environmental and personal factors. Studies of met and unmet need were reviewed and discussed in relation to legislation and policies. Results: Recent years have seen improvements in the collection of and access to disability data about children’s communication, including the involvement of children in research about the impact of communication difficulties on their lives. The prevalence of speech and language impairment in children is high and is associated with poorer educational and social outcomes at school-age. Significant unmet need for services was noted, and there were differences in health, education and disability policies regarding access to services. Conclusions: Updated legislation, policies and practices are needed to more effectively support access to services to support children’s communication across health, education and disability sectors.

Implications for Rehabilitation

• There is a high prevalence of speech and language impairment in Australian children.
• Childhood speech and language impairment (and associated communication disability) can impact educational, social, behavioural and occupational outcomes throughout life.
• Many Australian children do not have sufficient access to targeted services (including speech-language pathology) to ameliorate the impact of their communication disability.
• Formulation of a national strategy to support children children’s communication is required.

Keywords: Communication, disability, ICF, ICF-CY, language, speech, World Health Organization, World Report on Disability

Figure 1. Drawings created by 4- to 5-year-old children with speech impairment in response to being asked to draw themselves talking to someone. These examples are of drawings that accentuated the listener’s ears, and many of these examples also demonstrate the listener or speaker leaning towards the other, possibly to facilitate understanding of the spoken message. Copyright 2012 by S. McLeod, L. McAllister, J. McCormack and L. J. Harrison. Reprinted with permission.