The Big Nine Areas for SLP Exam Prep, Explained

The "Big Nine" refers to the nine disorder areas of speech-language pathology that students need to reason through for exam prep and clinical practice. Every practice question you take should map back to one of these areas.

The Big Nine show up across foundations and professional practice, assessment, and treatment, so the same disorder area can appear in multiple ways depending on whether a question is testing knowledge, evaluation, or intervention.

Here is each area with what it actually covers on the exam:

1. 01Speech sound production: articulation disorders, phonological processes, motor speech disorders (apraxia, dysarthria), and typical speech sound development.
2. 02Fluency: stuttering, cluttering, fluency assessment, and evidence-based treatment approaches (Lidcombe, Camperdown, stuttering modification).
3. 03Voice and resonance: vocal hygiene, nodules, polyps, spasmodic dysphonia, vocal fold paralysis, velopharyngeal insufficiency, and resonance disorders.
4. 04Receptive and expressive language: language delay, DLD, aphasia, specific language impairment, and language assessment across the lifespan.
5. 05Social aspects of communication (pragmatics): pragmatic language, autism spectrum disorder, right-hemisphere disorders, and social communication interventions.
6. 06Cognitive aspects of communication: TBI, dementia, attention and memory, executive function, and cognitive-communication treatment.
7. 07Augmentative and alternative communication (AAC): low-tech vs. high-tech systems, assessment, feature matching, and implementation.
8. 08Hearing: audiological basics, hearing loss impact on speech and language, aural rehabilitation, and working with the deaf and hard-of-hearing population.
9. 09Feeding and swallowing: dysphagia assessment (clinical and instrumental), normal swallow, pediatric feeding, and treatment approaches.

ETS publishes the three broad content categories, but it does not publish a question count for each Big Nine area. Treat all nine as testable and use your own practice results to decide where the next study block goes:

• Start with areas where you have little or no recent practice.
• Spend the next blocks on areas where repeated answers show a consistent gap.
• Keep rotating through all nine areas so a familiar topic does not crowd out a less familiar one.
• Use full-length timed forms to check category coverage and pacing, not to infer an unpublished Big Nine weighting.

From talking with SLP grad students over the last few years, the areas most commonly underprepared are:

Hearing. Most SLP programs only require one audiology course, and by the time you sit for a comprehensive exam, it has faded. Expect questions on audiogram interpretation, hearing loss types, and aural rehab basics.

Feeding and swallowing. If your externships were all pediatric language or early intervention, you have probably seen very little dysphagia. Study modified barium swallow studies, FEES, and IDDSI levels.

Cognition. TBI and dementia questions tend to show up in both assessment and treatment contexts. Know your cognitive-communication treatment approaches (e.g., spaced retrieval, errorless learning).

Instead of rereading textbooks, use the Big Nine as a checklist:

1. Take a diagnostic quiz that tags each question with a Big Nine area. 2. Rank your areas from weakest to strongest based on accuracy. 3. Spend 70% of your time on your bottom three areas. 4. Use full timed practice exams to check pacing and endurance, not to learn new content.

This approach beats passive rereading because it forces retrieval practice on the topics you actually need to improve.