Communication Disorders

Many children have speech or language disorders—including stuttering, inability to articulate certain words, and auditory processing problems. Early intervention is the key to successful treatment.

Definition

Communication disorders include problems related to speech, language and auditory processing. Communication disorders may range from simple sound repetitions such as stuttering to occasional misarticulation of words to complete inability to use speech and language for communications (aphasia).

Some causes of communication disorders include hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical impairments such as cleft lip or palate, emotional or psychiatric disorders, and developmental disorders. Frequently, however, the cause is unknown. It is estimated that one in every 10 Americans, across all ages, races and genders, has experienced or lived with some type of communication disorder (including speech, language and hearing disorders). Nearly 6 million children under the age of 18 have a speech or language disorder.

About Speech

Speech is produced by precise, coordinated muscle actions in the head, neck, chest, and abdomen. Speech development is a gradual process that requires years of practice. During speech development, one learns how to regulate these muscles to produce intelligible speech. It is estimated that by the first grade, 5 percent of children have noticeable speech disorders, the majority of which have no known cause.

One category of speech disorder is dysfluency.

Stuttering is, perhaps, the most serious dysfluency. Stuttering is characterized by a disruption in the flow of speech. It includes repetitions of speech sounds, hesitations before and during speaking and, or, prolongations of speech sounds. There are over 15 million individuals who stutter in the world. Most stutterers first exhibit dysfluency at an early age, and stuttering occurs most frequently in children between the ages of 2 and 6, during language development. One child in 30 goes through a period of stuttering that can last six months or longer.

Articulation difficulties constitute the most numerous of all speech disorders. The term refers to difficulties with the way sounds are formed and strung together ("wabbit" for "rabbit"), omitting a sound ("han" for "hand"), or distorting a sound ("sip for ship")

Voice disorders, another type of speech disorder, relate to difficulties with the quality, pitch and loudness of the voice (prosody). People with voice disorders may have trouble with the way their voices sound. Listeners may have trouble understanding someone with a speech pathology.

Voice is generated by airflow from the lungs as the vocal folds are brought close together. The vocal folds vibrate when air is pushed past them with sufficient pressure. Without normal vibration of the vocal folds in the larynx (voice box), the sound of speech is absent. To produce a whisper, the vocal folds need to be partially separated. It is estimated that 7.5 million people in the United States have difficulties using their voices. Many people who have acquired normal speaking skills become communicatively impaired when their vocal apparatus fails. This can occur if the nerves controlling the functions of the larynx are impaired as a result of an accident, a surgical procedure or a viral infection.

It is important to distinguish between a difficulty in articulation of words and aphasia (a problem with the production of language).

About Language

Language is the expression of human communication through which knowledge, beliefs and behavior can be experienced, explained and shared. A language disorder is the impairment or deviant development of expression and, or, comprehension of words in context. The disorder may involve the form of language, the content of language and, or, the function of language as a communication tool. It is estimated that between 6 and 8 million individuals in the United States have some form of language impairment. Disorders of language affect children and adults differently. For children who do not use language normally from birth, or who acquire the impairment in childhood, the disorder occurs in the context of a language system that is not fully developed or acquired. Many adults acquire disorders of language because of stroke, head injury, dementia or brain tumors. Language disorders are also found in adults who failed to develop normal language because of childhood autism, hearing impairment or other congenital or acquired disorders of brain development.

About Auditory Processing (Hearing)

Auditory processing is the term used to describe what happens in your brain when it recognizes and interprets the sounds around you. Humans hear energy, which we recognize as sound when it travels through the ear and is changed into electrical impulses that can be interpreted by the brain. The "disorder" part of auditory processing disorder (APD) means that something is adversely affecting the processing or interpretation of information.

Children with APD often do not recognize subtle differences between sounds in words, even though the sounds themselves are loud and clear. For example, the request "Tell me how a couch and a chair are alike" may sound to a child with APD like "Tell me how a cow and a chair are alike." It can even be understood by the child as "Tell me how a cow and a hair are alike." These kinds of problems are more likely to occur when a person with APD is in a noisy environment or when he or she is listening to complex information.

APD goes by many other names. Sometimes it is referred to as central auditory processing disorder (CAPD). Other common names are auditory perception problem, auditory comprehension deficit, central auditory dysfunction, central deafness and so-called "word deafness."

Children with APD typically have normal hearing and intelligence.

Symptoms

Dysfluency:

  • Repetition of sounds, words or phrases after age 4
  • Frustration with attempts to communicate
  • Head jerking while talking
  • Eye blinking while talking
  • Embarrassment with speech

Articulation Deficiency:

  • Unintelligible speech by age 3
  • Leaving out consonants at the beginnings of words by age 3
  • Leaving out consonants at the ends of words by age 4
  • Persistent problems with articulation after age 7
  • Leaving out sounds where they should occur
  • The distortion of sounds
  • Substituting an incorrect sound for a correct one (saying, "see" when the individual means "ski")

Voice disorders:

  • Pitch deviations
  • Deviations in loudness of the voice
  • Quality deviations

Language disorders may include:

Aphasia the loss of previously learned communication skills that results from damage to portions of the brain responsible for language. Aphasia usually occurs suddenly, most commonly as the result of a stroke or head injury, but it may also develop slowly, as in the case of a brain tumor.

There are four main types of aphasia:

  1. Expressive aphasia: you know what you want to say, but you have trouble saying or writing what you mean.
  2. Receptive aphasia: you hear the voice or see the print, but you can't make sense of the words.
  3. Anomic aphasia: you have trouble using the correct words for objects, places or event.
  4. Global aphasia: you can't speak, understand speech, read or write.

Delayed language: characterized by a marked slowness in the development of language skills necessary for expressing and understanding thoughts and ideas.

Other symptoms may include:

  • Improper use of words and their meanings
  • Inability to express ideas
  • Inappropriate grammatical patterns
  • Reduced vocabulary
  • Inability to follow directions
  • Unable to understand the meaning of a word seen or heard
  • May have trouble getting others to understand what they are trying to communicate

Children with APD typically have normal hearing and intelligence. Symptoms of APD:

  • Have trouble paying attention to and remembering information presented orally
  • Have problems carrying out multistep directions
  • Have poor listening skills
  • Need more time to process information
  • Have low academic performance
  • Have behavior problems
  • Have language difficulty (they confuse syllable sequences and have problems developing vocabulary and understanding language)
  • Have difficulty with reading, comprehension, spelling and vocabulary

Causes

There are many potential causes of communication impairment; the most common is mental retardation. Other causes include:

  • Hearing impairment
  • ADD
  • Learning disabilities
  • Autism
  • Schizophrenia
  • Cerebral palsy
  • Physical disability: cleft lip and palate, or malformations of the mouth or nose
  • Significant behavior or emotional problems, including deficits in social skills
  • Vocal cord injury
  • Cri-du-chat syndrome
  • Gilles de la Tourette syndrome
  • Ill-fitting dentures
  • Alcohol intoxication
  • Neurological disorders and diseases
  • Head trauma
  • Alzheimer's disease
  • Stroke
  • Transient ischemic attack (TIA)

Call your health care provider if impairment or loss of communication comes on suddenly or there is any unexplained impairment of speech or written language.

Treatments

The best treatment is prevention and early intervention.

Parents should be aware of developmental milestones. The most intensive period of speech and language development for humans is during the first three years of life, a period when the brain is developing and maturing. These skills appear to develop best in a world that is rich with sounds, sights and consistent exposure to the speech and language of others.

There is increasing evidence suggesting that there are "critical periods" for speech and language development in infants and young children. This means that the developing brain is best able to absorb a language, any language, during this period. Learning a language will be more difficult, and perhaps less efficient or successful, if these critical periods are allowed to pass without early exposure to a language. Communication begins during the first days of life when an infant learns that a cry will bring food, comfort and companionship. The newborn also begins to recognize important sounds in his or her environment. The sound of a parent or another's voice can be one important sound. As they grow, infants begin to sort out the speech sounds (phonemes), or building blocks, that compose the words of their language. Research has shown that by 6 months of age, most children recognize the basic sounds of their native language.

As the speech mechanism (jaw, lips and tongue) and voice mature, an infant is able to make controlled sounds. This begins in the first few months of life with cooing—a quiet, pleasant, repetitive vocalization. By 6 months, an infant usually babbles or produces repetitive syllables such as "ba, ba, ba" or "da, da, da." Babbling soon turns into a type of nonsense speech (jargon) that often has the tone and cadence of human speech but does not contain real words. By the end of their first year, most children have mastered the ability to say a few simple words. Children are most likely unaware of the meaning of their first words, but soon learn the power of those words as others respond to them.

By 18 months of age, most children can say eight to ten words. By age 2, most are putting words together in crude sentences such as "more milk." During this period, children rapidly learn that words symbolize or represent objects, actions, and thoughts. At this age, they also engage in representational or pretend play. At ages 3, 4, and 5, a child's vocabulary rapidly increases, and she or he begins to master the rules of language.

If you have concerns about your child's speech or language development, you should talk to your family doctor. Your doctor may refer you to a speech-language pathologist, a health professional trained to evaluate and treat people who have speech, language, voice, hearing or swallowing disorders that affect the ability to communicate. The speech-language pathologist will talk to you about your child's communication and general development. She will also evaluate your child with special speech and language tests. A hearing test is often included in the evaluation because a hearing problem can affect speech and language development.

Depending on the test results, the speech-language pathologist may suggest at-home activities to stimulate speech and language development. These activities may include reading to your child regularly; speaking in short sentences, and using simple words so that your child can successfully imitate you; or repeating what your child says, using correct grammar or pronunciation. For example, if your child says, "Ball baybo" you can respond with, "Yes, the ball is under the table." This allows you to demonstrate more accurate speech and language without actually "correcting" your child, which can eventually make speaking unpleasant for him or her.

The speech-language pathologist may also recommend group or individual therapy, or suggest further evaluation by other health professionals such as an audiologist or a developmental psychologist.

Speech training is an involved and time-consuming endeavor that can have profound results with consistent treatment. Speech training by a speech pathologist may include helping an individual:

  • With an articulation disorder to learn proper production of speech sounds
  • With a voice disorder to develop proper control of the vocal and respiratory systems for correct voice production
  • Who stutters to cope with the disorder, and to increase the amount of fluent speech
  • With aphasia to relearn language and speech skills
  • To understand their disorder and achieve more fluent communication in educational, social, and vocational settings

Speech and language pathologists typically provide professional services in:

  • Public and private schools
  • Hospitals
  • Rehabilitation centers
  • Nursing care facilities
  • Community clinics
  • Colleges and universities
  • Private practice
  • State and local health departments
  • State and federal government agencies
  • Centers for the developmentally disabled
  • Research laboratories

Sources

  • Journal of Communication Disorders
  • Speech and Communication Disorders, US National Library of Medicine, NIH
  • Speech and Language Impairment Fact Sheet 11
  • National Institute on Deafness and Other Communication Disorders
  • The American Speech-Language-Hearing Association
Last reviewed 02/17/2015