Communication disorders are a group of neurodevelopmental conditions that involve persistent problems related to language and speech. They most commonly occur in children but can persist into adulthood. It is estimated that nearly one in 10 American children has some type of communication disorder.
Language competence involves two main elements: production, or the ability to translate one's thoughts into words and phrases, and comprehension, or the ability to understand what others say Speech refers specifically to sound produced orally. Children and adults who struggle in language and/or speech may have a communication disorder.
In the DSM-5, communication disorders are broken into the following categories:
Communication disorders can affect language, speech, or auditory processing.
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 may 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 and developmental level. (To learn more about recognizing and treating language disorder, see our Diagnosis Dictionary.)
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. Someone with this disorder may also struggle to take turns in a conversation or stay on topic, which can make it difficult to make and keep friendships.
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. (To learn more about recognizing and treating childhood-onset fluency disorder, see our Diagnosis Dictionary.)
Articulation difficulties—problems forming and combining sounds, usually by omitting, distorting, or substituting them—are commonly found in people who have speech disorders. Children with difficulties in these areas may be diagnosed with what's known as a speech sound disorder. (To learn more about recognizing and treating these disorders, see our Diagnosis Dictionary.)
Voice disorders include difficulties with the quality, pitch, and loudness of one's 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.
According to the DSM-5, communication disorders include language disorder, speech sound disorder, childhood-onset fluency disorder (formerly known as stuttering), and social (pragmatic) communication disorder. Someone may also be diagnosed with an unspecified communication disorder when they present with persistent problems in language and speech but do not meet the criteria for any specific disorder. Auditory processing disorder is not included in the DSM-5 but is sometimes considered a communication disorder. Auditory processing disorder is included in the ICD-10, another widely used diagnostic manual.
According to the National Institute on Deafness and Other Communication Disorders, 5 percent of U.S. children between the ages of 3 and 17 had a speech disorder in 2016, while 3.3 percent of children had a language disorder. Approximately 1 percent of U.S children have childhood-onset fluency disorder specifically.
Autism is not currently considered a communication disorder. However, autism has many similarities to social (pragmatic) communication disorder, which was first added to the DSM in 2013; in the past, individuals who met the criteria for social communication disorder may have instead received an autism diagnosis. Someone with autism and someone with social communication disorder may both have trouble communicating with the people around them or making sense of social situations. The individual with autism, however, will also display autism-specific symptoms such as repetitive behavior or restricted interests.
Before diagnosing a communication disorder, a healthcare provider should first rule out hearing loss or other physical problems that could be interfering with the individual’s ability to communicate. After that, a careful assessment, usually conducted by a speech-language pathologist or a similarly qualified specialist, will determine whether a communication disorder is present. This assessment will typically include interviews with the individual and/or their parents, symptom questionnaires, and a family medical history, as communication disorders are thought to have a strong genetic component.
Behavior problems are not in themselves a symptom of communication disorders. However, individuals with communication disorders may at times feel frustrated by their inability to understand others or make themselves understood, and may act out or withdraw as a result. Communication disorders also frequently co-occur with other conditions, such as ADHD, that may present with behavioral challenges.
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 is unknown.
Communication disorders are thought to have a significant genetic component and frequently run in families. Some studies have found that as many as 70 percent of children with a language disorder, for example, have a family member who also has the disorder.
Individuals with a family history of communication disorders are thought to be at heightened risk. Sustaining a brain injury also increases the risk that someone will develop a communication disorder.
There is no known way to prevent communication disorders, other than taking steps to avoid brain injuries. However, early diagnosis and proactive treatment can help minimize the negative effects of the disorders and help children and adults learn to cope with their challenges.
The best way to approach treatment for a communication disorder is to focus on 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 are thought to be especially critical to the development of speech and language skills, as the brain is developing and maturing rapidly. 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.
Most treatment interventions for communication disorders have been primarily studied in children. However, some evidence suggests that adults with communication disorders can benefit from treatment as well, especially if that treatment primarily focuses on managing (rather than overcoming) symptoms. An adult who stutters, for example, can work with a speech-language pathologist to develop strategies for managing stuttering-related anxiety or prepare for situations where stuttering most frequently occurs. Adults with communication disorders may also benefit from support groups, where they can talk to others about how their communication disorder affects their life and what they’ve done to cope.