Low-Incidence Speech and Swallowing Disorders | Job Description and Certification

Speech-language pathologists are trained to deal with any type of disorder or disability that may affect speech, language acquisition, or feeding and swallowing functions. But the truth is that some of these disabilities are more common than others. When it comes to practical experience, most SLPs accumulate the bulk of their knowledge and expertise dealing with only a few, very common conditions.

In almost every practice area, SLPs are likely to see many cases of autism, aphasia, and hearing impairment through the course of their career. But there are other disorders that are far less common, and most SLPs might deal with only a handful even in the course a decades-long career…

• Stuttering
• Deafblind
• Medically fragile (patients with ongoing illness or chronic conditions)
• Severe cognitive disabilities
• Craniofacial disorders

In these instances, care is usually referred to a specialist. These low-incidence disorder specialists may serve as consultants to other SLPs or as specialized care providers working with a limited caseload of patients within their practice area.

Being a specialist requires having specialized knowledge, but with low-incidence disorders it can be hard to acquire. The fact that there are relatively fewer cases with such disorders makes it harder to gain the experience required to treat them successfully.

Where Do Low-Incidence Disorder SLPs Work?

Frequently, SLPs in dedicated medical settings such as hospitals have the most opportunities to work with such patients. Patients recovering from traumatic brain injury (TBI) or other traumatic injuries often experience low-incidence issues that require the attention of SLPs.

Large school systems may also employ SLPs who they designate as specialists in working with low-incidence disorders. This involves traveling between multiple schools, typically, working with cases that require treatment outside of what a generalist SLP can offer. SLPs in education who specialize in certain low-incidence conditions might also be expected to provide treatment plans and supervise treatment offered by other SLPs and to provide training to other SLPs and district staff.

The demand in education is particularly strong. Between 1989 and 2001, diagnoses of students with disabilities increased by 151 percent. In 2002, the U.S. Department of Education noted that the single highest category of students identified for special education services were those with Other Health Impairment… a catch-all category including many low-incidence conditions not otherwise given their own rating.

What Certifications Are Available for Low-Incidence Disorder SLPs?

There are few certifications that are applicable in most low-incidence disorder specialties. A CCC-SLP Specialty Certification might cover some of the disorders you want to specialize in. These are available for:

• Child language and language disorders (Board Certified Specialist in Child Language – BCS-CL)
• Fluency and fluency disorders (Board Certified Specialist in Fluency – BCS-F)
• Swallowing and swallowing disorders (Board Certified Specialist in Swallowing – BCS-S)

Acquiring these certifications occurs outside of the process for acquiring and maintaining the CCC-SLP itself, and each of them is overseen by a separate board with its own individual requirements:

• American Board of Child Language and Language Disorders
• American Board of Fluency and Fluency Disorders
• American Board of Swallowing and Swallowing Disorders

These requirements generally involve both additional educational credits specific to the specialty and certain minimum hours of practice with the target population or disorders. A test or interview is also frequently part of the certification process.

Maintaining the credentials, just as with the CCC-SLP, requires continuing education credits in those areas and renewals registered with the board at specified intervals, usually every year or two.

Simply because there are specialty certifications in these areas do not make them low-incidence issues in and of themselves, nor do certified specialists necessarily specialize in low-incidence disorders. There are many common swallowing conditions, for example.

But there are low-incidence disorders within those categories that may benefit from the specialist knowledge that comes with certification. Stuttering, for example, is considered a fluency disorder, and BCS-Fs are among the best qualified SLPs to treat that low-incidence condition.

Other Resources For SLPs Treating Low-Incidence Disorders

For some low-incidence disorders, there are support groups and national organizations that provide resources for clinicians and therapists. For example, for deafblind patients, the National Center on Deaf-Blindness offers training and conferences that may be of interest to SLPs.

Other SLPs are also an excellent resource for practicing in low-incidence disorders and ASHA hosts nearly 20 special interest groups covering various topics that some SLPs focus on. A number of these cover low-incidence disorders, including:

• SIG 2, Neurogenic Communication Disorders
• SIG 4, Fluency and Fluency Disorders
• SIG 5, Craniofacial and Velopharyngeal Disorders

A career working with low-incidence disorders will ensure you get some of the hard cases that other SLPs may not be able to handle. That puts additional pressure on you but it’s also a great source of satisfaction and offers a sense of accomplishment if your personality is up for it.