Management of speech impairment in children: The journey so far and the road ahead

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Abstract
The management of speech impairment of unknown origin in children requires speech-language pathologists (SLPs) to make a number of important clinical decisions. These decisions resolve around assessment, analysis, diagnosis and intervention. Ideally, clinicians should be guided in their clinical decision making by the best available published evidence. Over 30 years ago, this was a relatively straightforward task. Most children's speech problems were assessed and analysed from an articulation perspective, and children were provided with articulation-based intervention. Since the paradigm shift from articulation to phonology, it could be argued that clinical decision making has become challenging. This challenge is not due to a limitation of options for children with unintelligible speech, but due to a plethora of knowledge and approaches for assessment, analysis, diagnosis and intervention. This paper summarizes the current state of knowledge in the management of speech impairment in children. The benefits as well as the difficulties associated with having such a plethora of knowledge are explored, followed by a discussion of possible pathways for both clinicians and researchers. It is proposed that more comparative research is needed to make sense of the increasing diversity in the field.