Nathan Iskandar, 6, works with speech pathologist Beth Gapp at Wings on Words. On Friday they were using playing cards that showed characters doing various activities, and the students learned to put them in order, Gapp said. They were also asked to tell a story about the images on the cards. Nathan's mother says he has made great progress at the school.

A.E. Araiza / Arizona Daily Star

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Nathan Iskandar had some special challenges at a very young age.

Born slightly premature at 36 weeks, he had oral and motor delays as an infant, so his parents weren't surprised when the toddler started showing speech delays.

"At 3, his vocabulary was not even a third of what it should have been," recalled his mother, Sandy, a nurse and art teacher with two older children.

The family found Wings on Words, a preschool program that specializes in speech and language problems and has operated in Tucson for 10 years. A Far East Side resident, Sandy Iskandar at first was reluctant to make the crosstown trek to the school's Midtown location. But once Nathan started attending, she said, "I've told the teachers a million times that it is worth every minute being stuck in traffic and every extra tank of gas traveling back and forth."

She insists she's not exaggerating that his vocabulary quadrupled. One day, when he was 4, he picked up a baby bottle and exclaimed, "Look! It has graduated markings, just like a measuring cup!" She made him repeat it just to be sure she'd heard him correctly. She had.

He's come along so far, so quickly, in fact, that he may not even need speech therapy when he enters first grade in the fall.

"I think a lot of people are just not aware of how significant early intervention can be," said Iskandar, 42. "A lot of people just wait until they're in the school system, and they get referred by their primary teachers, but getting help early just sets a totally different tone for the rest of their lives. It's just one less obstacle for them to overcome."

Speech or language impairment or delays, experts say, affect about 50,000 public school students in Arizona, according to the state Department of Education. Demand has grown as more children have been diagnosed with communication impairments, partly driven from higher rates of autism. And yet the schools have only about 1,600 speech-language pathologists, who must have master's degrees and the appropriate clinical experience and a passing score on a national test.

A federal mandate requires school districts offer free screenings for developmental disabilities before the start of kindergarten and provide rehabilitation services if necessary.

The Tucson Unified School District, the area's largest district, served 700 students with special needs in preschool programs last year, up from 555 two years ago. More than 210 of them needed speech and language services. TUSD contracted with Wings on Words to provide services to about two dozen of those students but canceled the contract for the upcoming school year because of critical budget shortfalls.

The district in recent years has struggled to keep up with the demand for speech services. When Lorraine St. Germain, the director of exceptional education, took over the department in 2006, the district had a backlog of more than 1 million minutes it owed students whose educational plans required speech and language therapy.

Through the use of private outside contractors, which brought the number of speech pathologists providing services from 83 to 97, the district has whittled that number to about 300,000.

Shutting down the contract with Wings on Words will save the district $85,000, said St. Germain, adding she's confident that speech and language objectives can be met in-house.

"We just feel we have a lot of depth right here," she said.

Some parents who had been in the program are disappointed, though. Jennan Al-kadran, a 37-year-old nurse midwife student, remembered the pain of not being able to understand her son Ramy, who just turned 5. He would yell and get frustrated. And he became terribly shy around adults because of his communication problems.

Initially getting services directly from TUSD, it wasn't until he was sent to Wings on Words that she started seeing progress. Like other parents interviewed, Al-kadran said the inclusive nature of TUSD's programs, where students may have impairments ranging from autism to Down syndrome to attention deficit disorder, allowed less focus on her son's specific language needs.

After a year in the program, she said, he's "much, much better. He's not shy. He can talk. People understand him."

"The decision by TUSD really disappointed a lot of people."

Wings on Words works particularly well, Director Karen Zakerwski said, because students receive focused attention from speech-language therapists on staff and from the university's graduate students who have clinical rotations there.

Although the school enrolls students with more typical speech development so they can model for their peers, most students have some speech issues. Sometimes they have the vocabulary of much younger children. Some have trouble with certain sounds, so they may say "tat" when they mean "cat," or "weddy" instead of "ready." Sometimes they know what they want to say, but their brains don't send the right signals.

When Gretchen Wallace found out that TUSD would be canceling services with Wings on Words, she cried.

When her then-3-year-old daughter, Allison, came to the school, she only communicated through coos and gibberish. Now, she's using sentences.

"These were not small steps. These were leaps and bounds over mountains and hills and oceans," Wallace said. Raising three children on a single income means there's no room in the family budget to absorb the cost of the preschool, so she will use TUSD's in-house program.

"There's a lot less focus on language and a lot more on socialization, and I'm afraid once she's over there, all the progress she's made is going to stop."

TUSD, which offers retention and signing bonuses in an attempt to keep speech pathologists from jumping to the private market, is not alone in dealing with a critical shortage of them. Demand also is driven by adults who find they need therapy following accidents or strokes, for example.

Elena Plante, head of the University of Arizona's College of Speech, Language and Hearing Sciences, said the need is such that her graduates are being snapped up long before they leave school.

And the nature of all that competition means public schools often aren't able to keep up. "The students are going with whoever can put out the most attractive offer," Plante said. "And while the schools do offer some attractive features in terms of the variety of the caseload and the schedule, the private sector is making offers such as loan repayments and signing bonuses that school systems cannot match."

It's not unusual, she said, for parents to find themselves on waiting lists for services.

Still, she said, parents should do all they can to ensure their children get early intervention.

"We're trying to capitalize on the fact that the developing brain has a lot of potential," Plante said. "We want to help the brain wire up in a maximally functional way."