There are many types of speech therapy, typically referred to as areas of specialization. What you do as a speech-language pathologist (SLP) depends on your personal life journey and your passion for specific patient populations. Ultimately, your choice should align with your career goals and interests.

This blog examines different SLP specialties and the role of speech-language pathology across various work settings, helping a range of clinical populations from birth to geriatrics. Because the field is often organized by practice setting and patient population, an SLP’s work can look very different depending on where they practice.

For example, an SLP working in a medical setting, such as an outpatient hospital, may evaluate and treat both children and adults, while those in early intervention (0–3), schools or long‑term care typically focus on specific age groups or clinical needs.

What is an SLP?

According to the American Speech-Language-Hearing Association (ASHA), a speech-language pathologist is someone who “engages in professional practice in the areas of communication and swallowing across the lifespan.” In other words, SLPs assess, identify and treat language and swallowing disorders in patients from infants to the elderly to improve their quality of life.

For clarity, communication includes speech production and fluency, language, cognition, voice, resonance and hearing. Swallowing covers all aspects of swallowing, including related feeding behaviors.

What is the Scope of Practice for SLPs?

ASHA defines the SLP’s scope of practice in two areas: five domains of professional practice and eight domains of service delivery.

5 Professional Practice Domains	8 Service Delivery Domains
Advocacy and outreach	Collaboration
Supervision	Counseling
Education	Prevention and wellness
Administration/leadership	Screening
Research	Assessment
	Treatment
	Modalities, technology and instrumentation
	Population and systems

Within these practice and service delivery domains, SLPs assess, diagnose and treat communication and swallowing disorders in patients of all ages in these nine defined areas:

1. Speech Sound Disorders
2. Receptive and Expressive Language Disorders
3. Fluency Disorders
4. Voice and Resonance Disorders
5. Oral Communication Skills
6. Feeding and Swallowing Disorders
7. Cognitive Aspects of Communication
8. Social Aspects of Communication
9. Augmentative and Alternative Communication

Who Do Speech Pathologists Work With?

More than half (56%) of speech-language pathologists work with students in educational settings, from preschool through college. Others work in the healthcare field, including inpatient, outpatient, and rehabilitation centers, as well as in private practice, government agencies, the military and public health departments.

Let’s look at typical work settings in which SLPs practice and the role of speech-language pathology in treating some common disorders.

Early Intervention and School-Based Speech-Language Pathology

Educational SLPs collaborate with school staff and parents to facilitate students’ academic, communication and social skills in an educational environment.

SLPs practicing in this area can specialize in early intervention for young patients ages 0 to 3, or they may choose to focus on school-aged children ages 4 to 21.

Their role includes the study and treatment of communication difficulties, voice concerns and swallowing disorders, from the simple to the complex.

Additionally, some children and students need help with social communication, literacy and cognitive disorders such as those with autism spectrum disorder and other concerns, including:

• Articulation disorders
• Language delays or disorders
• Fluency and voice disorders
• Feeding and swallowing difficulties
• Auditory processing disorders

A day in the life of an SLP varies. They may work with students with mild impairments or severe, complex disorders. According to ASHA, SLPs routinely:

• Diagnostically screen and evaluate students
• Provide individual, small-group or whole-classroom services
• Provide listening, speaking, reading, writing and learning strategies
• Develop Individualized Family Service Plans (IFSPs) and Individualized Education Programs (IEPs) that provide a Free Appropriate Public Education (FAPE) for those with disabilities
• Provide family counseling and education
• Consult with other educators and related professionals

EDUCATIONAL SLP OVERVIEW
Specialty Focus	Those with language, speech, literacy, sound and fluency disorders, autism and other cognitive-communication challenges
Clinical Population	Early intervention, ages 0-3 K-12 and post-high school, ages 4-21
Research Opportunities	Early intervention, literacy intervention, Response to Intervention (RTI) models, leveraging AI technology, Augmentative and Alternative Communication (AAC), assessment practices, autism, swallowing disorders and the role of genetics
Practice Environments	Early childhood centers, K-12 schools, private and university clinics

Healthcare-Based Speech-Language Pathology

ASHA reports that 39% of SLPs are employed in healthcare settings – 13% work in hospitals, 16% in nonresidential healthcare facilities and 10% in residential healthcare settings.

Speech-language pathologists in the medical field provide diagnostic and treatment services to patients of all ages with impairments involving speech, voice, language, cognitive-communication and swallowing. They work as part of an interdisciplinary medical team across various practice environments, including hospitals, skilled nursing facilities (SNFs) and other clinical outpatient or private office settings.

While graduate practicum provides foundational clinical experience, medical SLPs typically develop specialized practice areas over the course of their careers through ongoing clinical work and continued professional development.

For example, this specialized knowledge may include advanced instrumental assessment, neurologic subspecialties, and setting-specific expertise, such as working with NICU or ICU patients, as well as the management of complex cases involving tracheostomies and ventilators.

Geriatric and Adult Neurogenic Disorders

SLPs in healthcare settings treat geriatric and adult neurogenic disorders, such as communication, language and swallowing impairments commonly seen in older adults, stemming from conditions such as a traumatic brain injury (TBI), stroke and Parkinson’s disease.

Speech-language pathologists’ focus in this area is to improve function and enhance their patients’ quality of life. Some areas of treatment include aphasia (language disorder), apraxia (motor speech disorder), dysarthria (muscle control), cognitive-communication deficits and dysphagia (swallowing).

Cognitive-Communication Disorders

Both verbal and nonverbal cognitive-communication disorders (CCDs) may affect executive function, memory, attention and problem-solving. CCDs can stem from brain injury, stroke, dementia or other diseases and developmental disabilities.

SLPs assess individuals and create personalized treatment plans to help their patients regain communication skills and improve cognitive functioning. Their role is to restore function and retrain using compensation strategies, therapeutic techniques, external aids and consistent routines.

Dysphagia and Feeding Disorders

From NICU infants to children to adults, individuals with a swallowing disorder (dysphagia) or feeding disorder may seek help from speech-language pathologists for assessment and treatment. SLPs evaluate at the bedside to assess oral motor skills and swallowing mechanics and observe how the patient eats and drinks.

In some cases, SLPs may recommend a Modified Barium Swallow Study (MBSS) to obtain a real-time view of all swallowing phases, or a Fiberoptic Endoscopic Evaluation of Swallowing (FEES) test to provide a more detailed view of swallowing mechanics.

Treatment of this disorder may include diet modifications, exercises, compensation strategies to make swallowing safer, behavioral techniques to improve mealtime habits and body positioning recommendations.

Voice and Resonance Disorders

Individuals with voice and resonance disorders have problems with vocal pitch, loudness and voice quality. Symptoms of voice disorders may include hoarseness or breathiness, vocal fatigue and limited vocal range. Resonance disorders may present as either too much nasal sound (hypernasality), stuffy or muffled sounds (hyponasality) or sound trapped in the throat (cul-de-sac resonance).

Causes of voice and resonance disorders can stem from structural issues (such as a cleft palate or vocal nodules), obstructive issues (such as enlarged tonsils and adenoids) and neurological disorders.

How SLPs treat individuals with voice and resonance disorders depends on the cause and type of disorder and may include speech therapy, prosthetics or, in some cases, surgery. SLPs practicing in this area may work in voice clinics, ENT practices and telepractice.

Speech-Language Pathologists Practicing in the Medical Field

The scope of practice in healthcare is broad. SLPs help patients find new ways to communicate, address tracheostomy and ventilator dependence, cognitive-communication impairment and challenges with dementia, to name a few. Patients in this field of speech-language pathology range from birth to the elderly and all ages in between.

Some SLPs in this arena earn additional credentials. For example, you may consider becoming a Board-Certified Specialist in Swallowing and Swallowing Disorders (BCS-S).

Others choose to receive specialized training in FEES or MBSS to help them assess swallowing function in their patients. To improve patients' quality of life, knowledge of ventilator management enables SLPs to explore new ways for patients to communicate and to treat swallowing issues.

HEALTHCARE SLP OVERVIEW
Specialty Focus	Acute care, medically complex cases Diagnosis and treatment for age- and illness-related communication and swallowing impairments
Clinical Population	Those with TBIs, neurodegenerative diseases such as Alzheimer’s and Parkinson’s, stroke survivors, tracheostomy/ventilator patients and some cancers
Research Opportunities	Clinical research to reduce limitations related to communication and swallowing disorders to improve patient outcomes, any study in the 9 areas of knowledge, cognitive-linguistic therapy and inter/multidisciplinary teamwork using instruments such as CT, MBS, FEES, etc.
Practice Environments	Hospitals, SNFs, rehab centers, outpatient clinics

Other Work Environments and SLP Specialties

Private Practice

One in five SLPs works in private practice either part-time or full-time. Some work alone, while others form large practices with staff, including other SLPs and other professionals. These entrepreneurial SLPs make their own decisions about their caseloads, populations and scheduling.

Corporate Speech-Language Pathology

Another pathway for SLPs involves providing services to a company or its customers as a consultant for assessment and training in many aspects of communication in the business world, including presentation skills, accent modification, interviewing skills and more.

Government Agencies

SLPs may be employed in administrative or clinical capacities in local, state and federal government agencies.

Public Health Departments

SLPs may provide consultative services or direct services to patients in public health departments at the local or state level.

Military Services

Clinical SLPs may provide services to active military and veterans, while SLPs involved with research may be employed by a branch of the military.

How Do I Become an SLP?

The first step is to earn a master’s degree in speech pathology or communication sciences and disorders from an accredited university. After you’ve passed the Praxis exam, a standardized test that assesses your knowledge and skills in the field, you can apply to ASHA for the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) and for licensure in your state.

Once you have completed your required clinical fellowship, you will be eligible for state licensure and to become certified by ASHA. (ASHA’s CCC-SLP certification is not legally mandatory to practice, but it meets most state licensing requirements and employer preferences.)

Working in schools may require additional licensure or certification, depending on the state in which you live. Some programs, such as Cleveland State University’s online Master of Arts in Communication Sciences and Disorders, include a specialized pathway for teacher certification.

In Summary

The role of speech-language pathology is broad and varied, but one thing all SLPs have in common is a desire to help people overcome or manage their difficulties and enjoy a better quality of life. A career as an SLP might be right for you if you want a rewarding, flexible and high-paying profession.

The national median salary for speech-language pathologists is $95,410 per year, and the job outlook is very positive. According to the Bureau of Labor Statistics, employment of SLPs is expected to grow by 15% through 2034, which is higher than the average 3% growth for all occupations.

Cleveland State University — Your Path to a Rewarding Career as an SLP

If any of these specializations interest you and you’re ready for a career as an SLP, earning a master’s degree is your first step.

Cleveland State University’s (CSU’s) online Master of Arts in Communication Sciences and Disorders (M.A. in CSD) program will prepare you for licensure while providing you with a high-quality, career-ready education.

CSU’s CAA-accredited program features 100% online coursework, one residency, clinical placement support, and a Teacher Licensure pathway.