Communication Disorders

Many children have speech or language disorders—including difficulty with word articulation, written language, and interacting with the social rules of verbal and nonverbal communication.  Early intervention is the key to successful treatment.

Definition

Communication disorders include problems related to speech, language, and communication. Speech refers to the production of sounds that allow individuals to express themselves, and includes articulation, fluency, voice, and resonance quality. Language refers to the use of a system of symbols, such as spoken words, sign language, written words, or pictures, that allow people to communicate in a rule-governed manner. Communication refers to any verbal or nonverbal behavior that influences the behavior, ideas, or attitudes of another person. 

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 communication. The communication disorders that have been outlined in the most recent version of the DSM include the following: language disorder, speech sound disorder, childhood-onset fluency disorder (stuttering), social (pragmatic) communication disorder, and other specified and unspecified communication disorders. 

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 lives with some type of communication disorder (including speech, language, and communication disorders). Nearly six million children under the age of 18 have a speech or language disorder.

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, five percent of children have noticeable speech disorders, the majority of which have no known cause.

One category of speech disorder is dysfluency.

Childhood-onset fluency disorder (formerly referred to as stuttering) is, perhaps, the most serious dysfluency. Childhood-onset fluency disorder 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 experience language dysfluency in the world. Most people first exhibit dysfluency at an early age, and this language disturbance occurs most frequently in children between the ages of 2 and 6, during language development. One child in 30 goes through a period of disturbance in fluency that can last six months or longer.

Articulation difficulties constitute the most numerous of all 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). People with voice disorders may have trouble with the way their voices sound. Listeners may have trouble understanding someone with this speech pathology.

Voice is generated by airflow from the lungs as the vocal folds in the larynx are brought close together and vibrate.  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 speechless 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 the articulation of words and aphasia, a problem with the brain's production of language.

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 six and eight 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 has not been 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.

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 problem 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.

APD is not universally recognized as a clinical condition, and it is not included in the most recent version of the DSM.

Symptoms

Language Disorder

  • Difficulties with learning and using language of various forms (i.e. spoken, written, or sign language)
  • Reduced vocabulary
  • Limited ability to put words and word endings together to form grammatically correct sentences
  • Impaired ability to have a conversation or use language to explain or describe a topic
  • Language abilities are significantly below those expected for the individual's age

Speech Sound Disorder

  • Difficulty with speech sound production
  • Trouble getting others to understand what they are trying to communicate
  • Persistent problems with articulation
  • Leaving out sounds where they should occur
  • Distorting sounds
  • Substituting an incorrect sound for a correct one

Childhood-Onset Fluency Disorder (Stuttering)

  • Repetition of syllables, sounds, or monosyllabic words (i.e. "I-I-I-I-I see them")
  • Prolonging the vocalization of consonants and vowels
  • Broken words (i.e. pauses within a word)
  • Filled or unfilled pauses in speech
  • Word substitution to avoid problematic words
  • Words produced with an excess of physical tension (head jerking, eye blinking)
  • Frustration with attempts to communicate
  • Embarrassment with speech

Social (Pragmatic) Communication Disorder

  • Persistent difficulties in the social use of verbal and nonverbal communication
  • Limited ability to communicate for social purposes, such as greeting others or sharing information
  • Limited ability to change communication style to match context—for example, speaking as loudly in a classroom as on a playground
  • Difficulties following rules for conversation, such as taking turns speaking
  • Difficulties understanding what is ambiguous or not explicitly stated, such as metaphors or ironic humor

Language disorders may also 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 events.
  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.

Auditory processing disorder: Children with APD typically have normal hearing and intelligence. Symptoms include:

  • Difficulty paying attention to and remembering information presented orally
  • Problems carrying out multistep directions
  • Poor listening skills
  • Needing more time to process information
  • Low academic performance
  • Behavior problems
  • Language difficulty (confusing syllable sequences and having trouble developing vocabulary and understanding language)
  • Problems with reading, comprehension, spelling, and vocabulary

Causes

There are many potential causes of communication impairment. These include:

  • Mental retardation
  • Hearing impairment
  • ADD
  • Learning disabilities
  • Autism
  • Schizophrenia
  • Cerebral palsy
  • Physical disability: cleft lip and palate or malformations of the mouth or nose
  • Significant behavioral 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's 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 six 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 their 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
  • With fluency disorder to cope with stuttering and increase speech fluency
  • With aphasia to relearn language and speech skills
  • To understand his or her 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

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

Last reviewed 04/19/2017