Communication Disorders

Communication disorders involve persistent problems related to language and speech. It is estimated that nearly one in 10 American children has some type of communication disorder. 

Language competence involves two main elements, according to the book Speech and Language Disorders in Children—production, or "the ability to encode one's ideas into language forms and symbols," and comprehension, "the ability to understand the meanings that others have expressed using language." Speech refers specifically to sound produced orally.

The DSM-5 organizes communication disorders into the following categories:

Symptoms

Language

Language Disorder, as defined by the DSM-5, is marked by "persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign language, or other) due to deficits in comprehension or production." Such deficits include limited vocabulary, limited ability to form sentences, and limited capacity to use language to communicate relative to what is expected for one's age.

Social (Pragmatic) Communication Disorder involves "difficulties in the social use of verbal and nonverbal communication," such as a lack of ability to alter communication to fit particular contexts (e.g., a classroom), to grasp normal rules of conversation, or to understand nonliteral meanings of language.

Speech

One category of speech disorder is dysfluency. Childhood-onset fluency disorder (formerly referred to as stuttering) is characterized by a disruption in the flow of speech and includes repetitions of speech sounds, hesitations before and during speaking, and/or prolongations of speech sounds.

Articulation difficulties are commonly found in people who have speech disorders. The term refers to problems forming and combining sounds, usually by omitting, distorting, or substituting them.

Voice disorders include difficulties with the quality, pitch, and loudness of the voice (prosody). Individuals with voice disorders may have trouble with the way their voices sound, and listeners may have trouble understanding a person with this speech pathology.

Auditory Processing (Hearing)

Central auditory processing disorder, as described by the International Statistical Classification of Diseases and Related Health Problems (ICD), is "characterized by impairment of the auditory processing, resulting in deficiencies in the recognition and interpretation of sounds by the brain." This disorder is not included in the DSM-5.

Causes

Some causes of communication problems include hearing loss, neurological disorders, brain injury, vocal cord injury, autism, intellectual disability, drug abuse, physical impairments such as cleft lip or palate, emotional or psychiatric disorders, and developmental disorders. The DSM-5 generally separates distinct medical and neurological conditions from communication disorders. Frequently, the cause of a communication disorder unknown.

Treatment

The best way to approach treatment for a communication disorder is to focus on prevention and early intervention.

Parents should be aware of the typical age at which their child should be reaching each developmental milestone. "The first 3 years of life, when the brain is developing and maturing, is the most intensive period for acquiring speech and language skills," according to the National Institute on Deafness and Other Communication Disorders. By 4 to 6 months, a baby typically babbles in a manner that resembles speech, using a variety of sounds, and responds to changes in voice tone. After one year, it is normal for a child to, for example, understand some simple words for items, to communicate with physical gestures, and to use one or two words. From ages 1 to 2 and beyond, children regularly pick up new words and begin to use multiple words together.

If a parent has concerns about their child's speech or language development, they should talk to their family doctor, who may refer them to a speech-language pathologist trained to treat communication disorders. Treatment may involve interactive, communication-based activities for parent and child and, potentially, group or individual therapy.

References

  • American Psychiatric Association, Diagnostic and Statistical Manual, Fifth Edition
  • Speech and Communication Disorders, US National Library of Medicine, NIH
  • National Institute on Deafness and Other Communication Disorders
  • The American Speech-Language-Hearing Association
  • National Center for Health Statistics

Last reviewed 02/23/2019