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 DSM-5 include the following: language disorder, speech sound disorder, childhood-onset fluency disorder (stuttering), pragmatic language impairment (social communication disorder), and other specified and unspecified communication disorders. 

Symptoms

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, which is the disruption of the flow of speech by repeating sounds or words, prolonging sounds, or becoming silent. 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 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). People with voice disorders may have trouble with the way their voices sound. Listeners may have trouble understanding someone with this speech pathology.

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.

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 DSM-5.

Causes

Some causes of communication disorders 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. 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. Nearly six million children under the age of 18 have a speech or language disorder.

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 way to approach treatment for a communication disorder is to focus on prevention and early intervention.  Parents should be aware of the typical age their child should be reaching each developmental milestone. 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 rapidly developing and maturing. Language and communication skills appear to develop best in a world that is rich with sounds, sights, and consistent exposure to the speech and language of others.

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." 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 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. 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.

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 03/05/2018