The Americans with Disabilities Act and Voice Disorders: Practical Guidelines for Voice Clinicians

OBJECTIVE: The Americans with Disabilities Act Amendments Act of 2008 (ADAAA) resulted in changes to the legal definition of disability and substantially affected how those with voice disorders may qualify for reasonable accommodations under the law. However, there has been little guidance and a lack of awareness about these changes within the voice literature. This article examines the Americans with Disabilities Act of 1990 (ADA), the changes made in 2008 (ADAAA), and how the law applies to individuals with voice disorders. STUDY DESIGN: This is a review article. METHODS: The ADA and ADAAA are summarized with a particular focus on individuals with voice disorders. Types of reasonable accommodations within the workplace are suggested, and online resources are provided which outline the disclosure and accommodation process. Practical examples are used to provide guidance for clinicians who may be involved in counseling this clinical population. RESULTS/CONCLUSIONS: Many individuals with voice disorders may not realize that their conditions can be classified as disabilities under the law, entitling them to workplace accommodations and time off to pursue medical treatment. However, disclosure laws such as the right to refrain from mentioning a disability during a job interview may not be protective of individuals with severe voice impairments, as symptoms are often difficult to conceal. Clinical implications and directions for future research are discussed

Employer Detection of Spasmodic Dysphonia Across Varying Severity Levels

Objective: To determine the ability of human resources personnel (HRP) with experience in phone interviews to detect the presence or absence of adductor spasmodic dysphonia (ADSD) in potential applicants via auditory stimuli alone. Methods/Design: Thirty HRP were exposed to a brief definition of ADSD. They subsequently performed an auditory-perceptual task in which they were asked to detect the presence of the voice disorder in 20 speakers with ADSD and 20 age- and gender-matched controls. ADSD samples were categorized a priori as perceptually within normal limits (WNL) to mild, moderate, or severe. Frequency counts and percentages were calculated for each speaker that was correctly and incorrectly identified as having ADSD. Mean accuracy ratings, and positive and negative likelihood ratios (LR+ and LR-) also were determined. Accuracy scores were grouped according to severity for ADSD speakers. Results:On average, listeners were 78.83% accurate in discriminating ADSD speakers, and 90.17% in discriminating controls. Based on group averages, 16 speakers with ADSD were correctly identified as having ADSD, and 4 were incorrectly identified as control speakers (sensitivity = 0.80 or 80%). Based on group averages, 20 out of 20 control speakers were correctly identified as not having a voice disorder(specificity = 1.0 or 100%).HRP were accurate at determining ADSD from 87%-100% of the time for perceptually severe ADSD speakers. In moderate cases, accuracy fell between 77%-100%, and dropped between 10% to 87% accurate for mild speakers. Differences related to severity were statistically significant. Conclusions: Results suggest that job applicants with more severe forms of ADSD may not be able to escape detection during phone interviews. However, those with mild symptoms may not be identified as having voice disorders

Inferring Speaker Attributes in Adductor Spasmodic Dysphonia: Ratings from Unfamiliar Listeners

PURPOSE: To determine whether unfamiliar listeners\u27 perceptions of speakers with adductor spasmodic dysphonia (ADSD) differ from control speakers on the parameters of relative age, confidence, tearfulness, and vocal effort and are related to speaker-rated vocal effort or voice-specific quality of life. METHOD: Twenty speakers with ADSD (including 6 speakers with ADSD plus tremor) and 20 age- and sex-matched controls provided speech recordings, completed a voice-specific quality-of-life instrument (Voice Handicap Index; Jacobson et al., 1997), and rated their own vocal effort. Twenty listeners evaluated speech samples for relative age, confidence, tearfulness, and vocal effort using rating scales. RESULTS: Listeners judged speakers with ADSD as sounding significantly older, less confident, more tearful, and more effortful than control speakers (p \u3c .01). Increased vocal effort was strongly associated with decreased speaker confidence (rs = .88-.89) and sounding more tearful (rs = .83-.85). Self-rated speaker effort was moderately related (rs = .45-.52) to listener impressions. Listeners\u27 perceptions of confidence and tearfulness were also moderately associated with higher Voice Handicap Index scores (rs = .65-.70). CONCLUSION: Unfamiliar listeners judge speakers with ADSD more negatively than control speakers, with judgments extending beyond typical clinical measures. The results have implications for counseling and understanding the psychosocial effects of ADSD

Do Listeners’ Perceptions of Confidence Relate to Self-Perceived Handicap in Spasmodic Dysphonia?

Adductor spasmodic dysphonia (ADSD) is a rare neurological disorder characterized by the involuntary spasm of the vocal folds, which results in an effortful, strained voice quality. This altered voice quality may result in negative reactions from speakers with ADSD as well as their communication partners. One qualitative study reported that some ADSD speakers expressed feeling inadequate, as though their “capabilities” were called into question, when conversing with others. In reality, the way in which individuals perceive a person with a communication disorder may reveal inherent biases that extend beyond voice quality. For example, when researchers manipulated the rate and pitch of a normal voice sample, listeners similarly altered their assessment of that speaker’s characteristics, such as intelligence. Literature also indicates that the more severe an individual’s voice quality, the more negatively that individual’s traits will be perceived. Additional studies have examined how listeners’ perceptions of voice quality relate to a speaker’s voice handicap; neither topic has been investigated in ADSD. Therefore, the objectives of this study are: 1) to determine whether there is a relationship between listeners’ perceptions of severity of ADSD speech with perceived speaker’s confidence; and, 2) to determine whether listeners’ ratings of speaker confidence relate to speakers’ self-rated voice handicap. Twenty speakers with ADSD were previously recorded and completed validated questionnaires (Voice Handicap Index; VHI). Twenty inexperienced listeners are enrolled in this study. These participants will listen to and judge ADSD speech samples on overall vocal effort and speaker confidence using 100 mm visual analog scales. It is hypothesized that speakers with more severely effortful voices will receive lower ratings of speaker confidence. It is also expected that more negative assessments of confidence will correlate with a speaker’s higher VHI score. Results of this study have implications for understanding the role of potential biases in ADSD outcomes

Do Listeners’ Perceptions of Confidence Relate to Self-Perceived Handicap in Spasmodic Dysphonia?

Adductor spasmodic dysphonia (ADSD) is a rare neurological disorder characterized by the involuntary spasm of the vocal folds, which results in an effortful, strained voice quality. This altered voice quality may result in negative reactions from speakers with ADSD as well as their communication partners. One qualitative study reported that some ADSD speakers expressed feeling inadequate, as though their “capabilities” were called into question, when conversing with others. In reality, the way in which individuals perceive a person with a communication disorder may reveal inherent biases that extend beyond voice quality. For example, when researchers manipulated the rate and pitch of a normal voice sample, listeners similarly altered their assessment of that speaker’s characteristics, such as intelligence. Literature also indicates that the more severe an individual’s voice quality, the more negatively that individual’s traits will be perceived. Additional studies have examined how listeners’ perceptions of voice quality relate to a speaker’s voice handicap; neither topic has been investigated in ADSD. Therefore, the objectives of this study are: 1) to determine whether there is a relationship between listeners’ perceptions of severity of ADSD speech with perceived speaker’s confidence; and, 2) to determine whether listeners’ ratings of speaker confidence relate to speakers’ self-rated voice handicap. Twenty speakers with ADSD were previously recorded and completed validated questionnaires (Voice Handicap Index; VHI). Twenty inexperienced listeners are enrolled in this study. These participants will listen to and judge ADSD speech samples on overall vocal effort and speaker confidence using 100 mm visual analog scales. It is hypothesized that speakers with more severely effortful voices will receive lower ratings of speaker confidence. It is also expected that more negative assessments of confidence will correlate with a speaker’s higher VHI score. Results of this study have implications for understanding the role of potential biases in ADSD outcomes