Content corrections

Before: The scanning table merged two techniques into one row, directed (inverse) scanning, described as holding the switch to move the indicator and releasing on the target.

Now: The table gives them separate rows. Inverse scanning is hold to move and release to select. Directed scanning steers the indicator in a chosen direction with a joystick or several switches, and a pause or a separate switch selects.

Why: Directed and inverse scanning are different indirect selection techniques with different motor demands.

Guide: AAC Systems & Implementation

Before: The neuroanatomy guide placed the nuclei for cranial nerves IX, X, XI and XII in the medulla.

Now: The medulla holds the nuclei for IX, X and XII. The motor nucleus of XI sits mostly in the upper cervical spinal cord.

Why: The spinal accessory nucleus lies in the upper cervical cord, not the medulla. Checked against standard neuroanatomy references.

Guide: Neuroanatomy for SLPs

Before: The head and neck cancer guide called leakage through or around a voice prosthesis the one airway risk after total laryngectomy.

Now: It is the main swallow-related airway risk. Food still cannot be aspirated through a larynx that has been removed.

Why: Calling it the only airway risk overstated the claim. The corrected wording limits it to swallowing.

Guide: Head and Neck Cancer, Laryngectomy & Tracheostomy

Before: The gender-affirming voice guide said intake forms should not ask about other surgeries, such as genital surgery.

Now: It says such surgeries do not affect voice, so intake should ask only what bears on voice.

Why: The rule was stated as a flat prohibition about forms. The principle it rests on is to collect only history that bears on voice.

Guide: Gender-Affirming Voice & Communication

Before: Two guides gave the sex ratio among young children who stutter as 2 to 2.5 boys per girl.

Now: Roughly 1.5 to 2 boys per girl near onset, with studies reporting about 1.3 to 2.2, rising to about 4 or more to 1 in adults.

Why: Checked against a peer-reviewed review of stuttering epidemiology.

Guides: Stuttering: Causes, Theories & Epidemiology, Fluency Disorders & Treatment

Before: A question on what an SLPA may tell a classroom teacher treated giving the teacher session data as outside the assistant’s role.

Now: That answer choice now describes interpreting the data, showing it and saying the student is on track to exit, which is reserved for the supervising SLP. Sharing objective data when the SLP directs it is within the assistant’s role.

Why: Checked against the 2022 ASHA SLPA Scope of Practice.

Guide: Professional Practice & Service Delivery/Also changed: 1 question

Before: A question on Clinical Fellowship mentoring gave the requirement as at least 6 hours of direct and 6 hours of indirect supervision in each segment.

Now: It now gives at least six one-hour direct observations and six other monitoring activities in each of the three segments, 18 of each across the fellowship, and notes that fellowships started in 2023 or later need at least 3 of each segment’s direct observations in person. The guide’s fellowship row gives the same detail.

Why: The indirect requirement is counted in monitoring activities, not hours. Checked against the ASHA 2020 certification standards for SLP (Standard VII-B).

Guide: Professional Practice & Service Delivery/Also changed: 1 question

Draft: A draft set of phonology questions described a child of 4;2 and treated velar fronting as already past its expected age.

Published: The published set describes a child of 4;10, and the explanations say velar fronting usually resolves by about 3;6 to 4;0 and stopping of /f/ by about 3;0.

Why: Common elimination-age tables put velar fronting at about 4 years. Checked against the ASHA practice portal table of selected phonological processes.

Guide: Phonological Development/Also changed: 3 questions

Draft: A draft of the new head and neck cancer guide said a speaking valve is never placed on a laryngectomy stoma.

Published: The published guide says a tracheostomy one-way speaking valve must never go on a laryngectomy stoma, because it closes on exhalation and the person could not breathe out, and that the only valves worn there are hands-free valves made for voice-prosthesis speakers.

Why: The absolute statement contradicted the guide’s own section on hands-free valves. Checked against the ASHA practice portal page on communication after total laryngectomy.

Guide: Head and Neck Cancer, Laryngectomy & Tracheostomy

Draft: A draft source-filter question described a man with bilateral vocal fold paralysis who could only whisper.

Published: The published question describes a speaker on strict voice rest after vocal fold surgery.

Why: Bilateral paralysis usually leaves the folds near midline, so the voice can be fairly good while the airway is the main concern. Pairing it with whisper-only speech would have taught the wrong association. Checked against clinical references on vocal fold paralysis.

Guide: Speech Science & Phonetics/Also changed: 1 question

Before: The ethics guide followed the 2016 ASHA Code of Ethics.

Now: It now follows the 2023 Code: Principle I lists the protected characteristics as a closed list and holds the delegation and supervision rules; conflicts of interest are to be avoided, and disclosed and managed only when unavoidable; fraud in obtaining payment sits under Principle III; and the 60-day self-report rule is included. The common exam scenarios table maps each scenario to the right principle.

Why: The 2023 revision moved and reworded several rules. Checked rule by rule against the current ASHA Code of Ethics (effective March 2023).

Guide: ASHA Code of Ethics/Also changed: 12 questions and 4 flashcards

Before: Four questions had keyed answers that were not fully defensible.

Now: An ADA question is keyed on Title III public-accommodation duties: modifying policies and providing auxiliary aids for effective communication. A select-all item now asks what favors FEES over MBSS, and its explanation says both detect silent aspiration. A select-all item on AAC vocabulary keys only the features that favor a broad vocabulary. A select-all item asks what warrants laryngoscopy now rather than after waiting four weeks, keyed to a new neck mass and a breathy voice after thyroid surgery.

Why: Checked against the federal ADA regulations for public accommodations (28 CFR Part 36), the ASHA adult dysphagia and AAC practice portals and the clinical practice guideline on hoarseness.

Guides: Key Legislation, Dysphagia Assessment, AAC Systems & Implementation, Voice Disorders & Treatment/Also changed: 4 questions

Before: Content treated a bolus reaching the valleculae or pyriform sinuses before the swallow as proof of a delayed swallow, and used a fixed cutoff of under 1 second.

Now: Delayed onset is judged by timing: how long the bolus waits before onset, whether that repeats, and whether material enters the airway. The fixed cutoff was replaced with age- and bolus-matched norms.

Why: Healthy adults often start the swallow with the bolus low in the pharynx, so location alone does not show delay. Checked against peer-reviewed videofluoroscopic studies of healthy swallowing.

Guide: Swallowing Anatomy & Physiology/Also changed: 3 questions and 1 flashcard

Before: True vocal fold closure was called the most critical level of airway protection, and epiglottic deflection was listed before it.

Now: Closure is taught from the bottom up: the arytenoids carry the true folds to midline first, then the false folds close, the arytenoids tilt forward and the epiglottis deflects. Laryngeal vestibule closure is described as the primary defense. One question that had two defensible answers was rewritten.

Why: Swallow physiology research describes the order and roles differently from the old wording. Checked against peer-reviewed studies of laryngeal closure during the swallow.

Guide: Swallowing Anatomy & Physiology/Also changed: 1 question

Before: Two guides said compensatory articulation errors would not resolve until velopharyngeal inadequacy was treated, and that therapy works best after surgery.

Now: They now say these learned errors need speech therapy, that therapy can begin before physical management, and that it may need to continue afterward because the errors can persist after successful surgery.

Why: Checked against the ASHA practice portal on cleft lip and palate.

Guides: Cleft Palate & Craniofacial Anomalies, Genetic Syndromes Relevant to SLP

Before: The cleft guide gave palate repair at about 9 to 12 months.

Now: Palate repair is often done at 9 to 14 months and ideally by 18 months, and the timing of later surgery for velopharyngeal inadequacy follows the speech evaluation.

Why: Checked against the 2024 ACPA standards for cleft and craniofacial teams.

Guide: Cleft Palate & Craniofacial Anomalies

Before: A typical process that persisted past its usual suppression age was called a disorder.

Now: It is now called a delay; atypical processes, such as backing or initial consonant deletion, at any age suggest a disorder. Either can warrant treatment.

Why: Checked against published classification research on delayed and disordered phonological development.

Guide: Phonological Development/Also changed: 1 question

Before: Intelligibility was taught with the rule of thumb of 25, 50, 75 and 100 percent at ages 1 to 4.

Now: The guide leads with measured medians, about 56 percent at 3, 79 percent at 4 and 89 percent at 5, and labels the older rule as a parent-report estimate. Consonant acquisition keeps the early, middle and late 8 order with current mastery ages.

Why: Newer large normative studies of intelligibility and consonant acquisition replace the older parent-report rule. The Milestones lab uses the same figures.

Guides: Speech & Language Development Milestones, Phonological Development

Before: The milestones guide called absent canonical babbling at 10 months a red flag for hearing loss or a motor speech disorder, and placed responding to name at 4 to 6 months.

Now: Onset of canonical babbling after about 10 months is described as a risk marker: it is linked to hearing loss and predicts later speech and language delay. Responding to name sits at 7 to 9 months.

Why: Checked against ASHA and CDC milestone guidance and published studies of babbling onset.

Guide: Speech & Language Development Milestones

Before: The audiogram guide said a profound loss relies on visual communication, and its Type B tympanogram callout equated a flat tracing with effusion without covering an open tube or an occluded canal.

Now: A profound loss gives little access through hearing aids alone, and families choose sign, spoken language through a cochlear implant, or both. A Type B tympanogram with normal volume suggests effusion, with large volume a perforation or open tube, and with small volume an occluded canal.

Why: Checked against the ASHA hearing loss practice portal and standard tympanometry references.

Guide: Hearing & Audiogram Interpretation

Before: The descriptions of step and automatic scanning were reversed.

Now: Step scanning is described as having no timing demand but needing many activations, and automatic scanning as needing few activations with good timing and sustained attention. A hold-and-release scanning row was added, eye gaze is classed as direct selection, and aided language stimulation is described as an evidence-based strategy rather than the primary one.

Why: Checked against AAC textbooks, the ASHA AAC practice portal and a published meta-analysis of aided input.

Guides: AAC Systems & Implementation, AAC Implementation & Communication Partner Strategies

Before: The candidacy table gave infants from 9 months with other manufacturers at 12, a 70 dB HL cutoff for children and one set of adult cutoffs.

Now: It opens with an exam-level summary and then shows how labels differ: minimum infant ages of 7, 9 or 12 months by manufacturer, hearing-level and speech-recognition cutoffs that vary by label, single-sided deafness criteria, and the Medicare coverage threshold.

Why: Manufacturers’ FDA labels have changed since the table was written. Checked against FDA approval letters from 2020 to 2026 and the Medicare national coverage determination.

Guide: Cochlear Implants & Hearing Technology Candidacy/Also changed: 1 flashcard

Before: IDEA Part C read as birth to 2, transition planning was tied to age 16 without the IEP rule, school records were not clearly separated from HIPAA, and the 8-minute rule was presented as covering therapy billing in general.

Now: Part C covers birth through age 2 (until the third birthday). Transition services appear in the first IEP in effect when the student turns 16. School SLP records are FERPA education records, not HIPAA health information. The 8-minute rule applies only to timed codes; most SLP treatment and evaluation codes are untimed, and 92507 stays untimed through December 31, 2026 before new timed codes replace it on January 1, 2027.

Why: Checked against federal regulations (34 CFR Parts 300 and 303), the joint Department of Education and HHS guidance on FERPA and HIPAA, and ASHA coding guidance.

Guide: Key Legislation

Before: Cohort and case-control studies shared one level of the evidence hierarchy, and the p-value definition left out the at-least-as-extreme condition.

Now: They are separate levels, with cohort studies above case-control studies. The p-value is the probability of results at least as extreme as those observed if the null hypothesis is true, and not the probability that the null hypothesis is true.

Why: Checked against the Oxford Centre for Evidence-Based Medicine levels of evidence and the American Statistical Association statement on p-values.

Guide: Research Design & Evidence-Based Practice

Before: IDDSI Level 3 was described as not flowing through a straw, Level 4 as eaten only with a spoon, and chin tuck and head turn were given fixed effects.

Now: Level 3 can be drunk from a cup and sucked through a straw with moderate effort. Level 4 is usually eaten with a spoon. A posture’s effect is to be verified on an instrumental exam.

Why: Checked against the IDDSI detailed definitions and published studies of swallow postures.

Guide: Dysphagia Management/Also changed: 1 flashcard and the Swallow lab

Before: The clinical swallow evaluation was described as best used for screening, with an uncited sensitivity figure. The MBSS was said to cover all swallow phases and called the gold standard, Penetration-Aspiration Scale level 6 was misdefined, and the Swallow lab called PAS 1 the only normal score.

Now: The clinical evaluation identifies signs of dysphagia and decides whether an instrumental exam is needed. The MBSS covers the oral, pharyngeal and upper esophageal phases. PAS 6 is defined as in the published scale, and PAS 1 and 2 both occur in healthy adults. A screening section was added.

Why: Checked against the ASHA adult dysphagia practice portal, the published scale and its normative data, and screening validation studies.

Guide: Dysphagia Assessment/Also changed: the Swallow lab

Before: LSVT LOUD was credited with improving swallowing, nodules were always bilateral, the s/z ratio was treated as evidence of pathology, and the Vocal Function Exercises power step did not match the protocol.

Now: The swallowing benefit is described as reported in small studies only. Nodules are typically bilateral. The s/z ratio is a screening clue. The power step uses the published protocol, and advice against whispering is hedged.

Why: Checked against the ASHA voice disorders practice portal, the published exercise protocol and peer-reviewed studies.

Guide: Voice Disorders & Treatment/Also changed: 2 flashcards

Before: The thyroarytenoid was described as shortening and tensing the folds.

Now: It is described as adding medial compression, stiffening the body of the fold while slackening the cover, and lowering pitch when it acts alone.

Why: Checked against laryngeal physiology references.

Guide: Laryngeal Anatomy & Voice Production/Also changed: 1 flashcard

Before: The flaccid dysarthria row gave bulbar ALS as an example cause.

Now: It gives progressive bulbar palsy.

Why: Checked against motor speech disorder references.

Guide: Motor Speech Disorders

Before: Intact repetition was taught as pointing to a transcortical aphasia, and constraint-induced language therapy and Melodic Intonation Therapy candidacy were described too broadly.

Now: The decision path includes anomic aphasia and the full fluency, comprehension and repetition sequence. Constraint-induced language therapy is massed spoken practice adapted from limb therapy, with the benefit of the constraint itself noted as debated. Melodic Intonation Therapy candidacy is relatively preserved comprehension with poor repetition.

Why: Checked against the ASHA aphasia practice portal and the published classification and treatment literature.

Guides: Aphasia Classification, Named Treatment Approaches

Before: Primary progressive aphasia was called a language-predominant frontotemporal dementia, and the right hemisphere mnemonic had letters that did not name real features.

Now: PPA is a language-led decline whose semantic and nonfluent variants usually reflect frontotemporal lobar degeneration and whose logopenic variant most often reflects Alzheimer pathology. Each letter of the mnemonic now names a real feature.

Why: Checked against the international consensus criteria for PPA and the ASHA right hemisphere damage practice portal.

Guide: Dementia & Right Hemisphere Disorders

Before: Rancho Level V was described as following simple commands inconsistently, Level VI as carrying over new learning, and the ASHA FACS was listed as a standardized test.

Now: Level V follows simple commands fairly consistently with structure and cues, without learning new information. Level VI carries over relearned tasks, and new learning needs maximal assistance. The ASHA FACS is a functional measure.

Why: Checked against the revised Rancho Los Amigos scale and published descriptions of the ASHA FACS.

Guide: Traumatic Brain Injury & Cognitive-Communication/Also changed: 1 question

Before: All whole-word repetitions were counted as typical disfluency, natural recovery was given as 75 to 80 percent, concern was tied to more than 12 months since onset, and awareness and secondary behaviors were treated as required.

Now: Only multisyllabic whole-word and phrase repetitions count as typical; monosyllabic whole-word repetitions are stuttering-like. Natural recovery is about 88 to 91 percent. Concern rises after about 6 to 12 months or no improvement over several months. Awareness and secondary behaviors are not required for a stuttering diagnosis.

Why: Checked against the ASHA fluency practice portal and community cohort studies of stuttering onset and recovery.

Guides: Fluency Disorders & Treatment, Fluency Assessment Across the Life Span, Stuttering Assessment & Counseling/Also changed: 4 questions and 2 flashcards

Before: Camperdown Program items described its self-ratings as severity and naturalness scales, and the Lidcombe severity scale was given as 0 to 9.

Now: Camperdown items use the 2018 treatment guide’s 0 to 8 stuttering severity and fluency technique scales, and one question was rebuilt on them. The Lidcombe scale is 0 to 10, and the outline notes that the 2015 to 2021 guides used 0 to 9.

Why: Checked against the published Camperdown and Lidcombe treatment guides.

Guide: Fluency Disorders & Treatment/Also changed: 4 questions and 2 flashcards

Before: The Turner karyotype was written 45, X0, about 30 percent of people with fragile X were said to meet autism criteria, and Down syndrome language was described only as delayed beyond cognition.

Now: The karyotype is written 45,X. About half of males and about 1 in 5 females with fragile X meet autism criteria. Down syndrome language is more delayed than nonverbal cognition predicts, especially expressive language and syntax.

Why: Checked against MedlinePlus Genetics, registry data on fragile X and published studies of language in Down syndrome.

Guide: Genetic Syndromes Relevant to SLP

Before: Tongue deviation was taught as always toward the weak side, and bilateral recurrent laryngeal nerve paralysis was described as leaving the folds adducted at midline.

Now: The guide separates lower and upper motor neuron lesions for the tongue and face and gives the side of weakness for each. Bilateral recurrent laryngeal nerve paralysis leaves the folds near midline, with airway compromise and a voice that may be fairly good.

Why: Checked against neuroanatomy and motor speech references.

Guide: Cranial Nerves for Speech-Language Pathology

Before: A callout said errors in both languages mean a disorder and errors in one language mean a difference.

Now: Surface forms differ across languages; exposure, language loss, schooling and trauma all shape performance; and dynamic assessment helps separate a difference from a disorder.

Why: Checked against the ASHA multilingual service delivery practice portal.

Guide: Pediatric Assessment Essentials

Draft: A draft question on the Yale Swallow Protocol said a patient who fails the orientation and command items is not given the water challenge.

Published: The published question makes inability to stay alert the exclusion. A failed cognitive screen is recorded as a sign of higher aspiration risk, not a reason to skip the challenge.

Why: Checked against the published Yale Swallow Protocol and its validation research.

Guide: Dysphagia Assessment/Also changed: 1 question

Draft: A draft explanation said that in most states, telling a supervisor does not satisfy the duty to report suspected abuse.

Published: The published explanation says state laws differ: some let staff notify the person in charge, who must then report, and many keep the individual duty. The key rests on the case, in which no one will file.

Why: State survey counts do not support “most”. Checked against the federal Child Welfare Information Gateway summaries of state reporting laws.

Guide: ASHA Code of Ethics/Also changed: 1 question

Draft: A draft explanation said Down syndrome is not linked to recurrent infections from immune differences.

Published: The published explanation notes heart defects and more frequent infections in Down syndrome, and names the bifid uvula, velopharyngeal inadequacy after adenoidectomy and glottal-stop compensations as the cluster that points to 22q11.2 deletion.

Why: Checked against published immunology research and the AAP clinical report on Down syndrome.

Guide: Genetic Syndromes Relevant to SLP/Also changed: 1 question

Draft: A draft question labeled holding one switch to move the highlight and releasing it to select as directed scanning.

Published: The published answer choice calls that inverse scanning, where the release still has to be timed.

Why: Checked against AAC textbooks and the ASHA AAC practice portal.

Guide: AAC Systems & Implementation/Also changed: 1 question

Draft: A draft of the rewritten AAC guide filed tangible symbols under unaided systems.

Published: The published guide lists tangible symbols, real or partial objects, under low-tech aided systems, consistent with its own definition of unaided as using no external equipment.

Why: Checked against the ASHA AAC practice portal.

Guide: AAC Systems & Implementation

Draft: A draft of the rewritten swallowing guide dated the first rotary chewing to 24 to 36 months.

Published: The published feeding table shows diagonal rotary chewing emerging between 12 and 18 months, with first signs around 9 to 12 months, and the rotary pattern maturing by 24 to 36 months.

Why: Checked against ASHA feeding and swallowing milestones.

Guide: Swallowing Anatomy & Physiology