Communication disorders are conditions that impair a person’s ability to speak or understand language. Many of these disorders are diagnosed during childhood. Patients may struggle in academic settings and may have problems with social interaction. Many children with these disorders show dramatic improvement by adolescence. However, people with severe communication disorders may experience ongoing challenges to their ability to function as independent adults.
Communication disorders include:
- Expressive language disorder. Impaired ability to express oneself, including difficulty with vocabulary, complex sentences and recall of words.
- Mixed receptive-expressive language disorder. Impaired ability to express oneself and understand language.
- Phonological disorder. Inability to use appropriate sounds while speaking, given the patient’s age, developmental stage and dialect. Mild forms such as lisping are most common.
- Stuttering. Interruptions in a person’s ability to form the words and sentences necessary to verbally communicate with other people.
Additional disorders include aphasia (inability to speak or understand language), auditory processing disorder (inability to recognize subtle differences in sounds) and apraxia of speech (difficulty connecting sounds and syllables to form words in the correct way).
The cause of many communication disorders is unknown. Heredity appears to play a role. In some cases, an illness, accident or injury to the brain, or a physical or mental impairment can cause a communication disorder. Symptoms of communication disorders should be reported to a physician. Early diagnosis and treatment of these disorders is likely to yield the best possible outcome for patients.
Speech and language therapy is frequently recommended for patients who have communication disorders. Patients may also benefit from psychotherapy if emotional or behavioral problems are associated with the communication disorder.
About communication disorders
Communication disorders are conditions that impair a person’s ability to speak or to understand language. These conditions are typically diagnosed during childhood. In some cases, patients may experience relatively mild impairments, such as a tendency to make errors in sound when speaking (e.g., lisping) or an inability to comprehend certain parts of language. In other cases, patients may experience a total loss of their ability to communicate.
Communication disorders that affect speech, language or hearing affect one in every 10 people in the United States, according to the Academy for Educational Development. Patients with communication disorders find it difficult to use words or understand language. They may struggle in academic settings and may have problems with social interaction. In severe cases, patients may have difficulty functioning independently later in life.
Communication disorders identified by the American Psychiatric Association (APA) include:
- Expressive language disorder. Impaired ability to express oneself through language (e.g., verbal, sign language). This includes difficulty with vocabulary, production of complex sentences and recall of words. These difficulties may affect school or work performance and social relationships. The condition may result from developmental problems (which may be hereditary) or as a complication of medical conditions such as encephalitis (inflammation of the brain) or malnutrition.
Most commonly, the disorder is developmental in nature, and patients show substantial improvement by late adolescence. When caused by a medical complication, the prognosis depends on the severity of the condition that triggered the disorder. Between 10 and 15 percent of children younger than age 3 have some form of expressive language disorder, according to the APA. By the time children enter school, rates drop to between 3 and 7 percent.
- Mixed receptive-expressive language disorder. Similar to expressive language disorder, but also includes an impaired ability to understand language. It can be especially difficult to detect this impairment, which is usually only revealed through formal testing. Problems understanding speech usually begin by age 4. In mild cases, patients may have difficulty understanding certain words or statements. More severe cases can cause a complete inability to understand basic vocabulary or simple sentences. This disorder appears to be less common than expressive language disorder.
Although many children with mixed receptive-expressive disorder later develop normal language abilities, the prognosis is often less favorable than for children with expressive language disorder. Mixed receptive-expressive disorder due to developmental problems affects up to 5 percent of preschool children and 3 percent of school-age children, according to the APA. Acquisition of this disorder due to a medical complication is relatively uncommon.
- Phonological disorder (also known as developmental articulation disorder). Inability to use appropriate sounds while speaking, given the individual’s age, developmental stage and dialect. Some patients may experience little or no impairment of their speech, whereas others may be completely unintelligible. Misarticulated sounds tend to be those typically acquired later in development. These include the sounds “l,” “r,” “s,” “z,” “th” and “ch.” Lisping is especially common. The cause of phonological disorder is unknown, although heredity is believed to play a role.
Milder forms of phonological disorder (e.g., lisping) are most common and tend to resolve by about age 6. About 2 percent of 6- and 7-year-olds have moderate to severe forms of the disorder, according to the APA. Many of these cases resolve over time, with just 0.5 percent still affected at age 17.
- Stuttering. Interruptions of a person’s ability to speak fluently and form the words and sentences necessary for verbal communication. It is normal for children between the ages of 2 and 5 years to stutter. In most cases, the condition resolves over time, often by age 16. However, some people have stuttering problems that persist or worsen as they get older. Sometimes stuttering remains a lifelong problem.
According to the APA, 1 percent of children who have not yet reached puberty are affected by stuttering. This drops to just 0.8 percent in adolescence. Males are more likely to stutter than females.
Additional communication disorders include:
- Aphasia. Impaired ability to use and understand spoken and written language. Aphasia involves a loss of previously learned communication skills. Causes of aphasia include brain injury, stroke and Alzheimer’s disease.
- Auditory processing disorder. Impaired ability to recognize subtle differences in sounds and words. This disorder is not completely understood, although it is not caused by hearing problems or intellectual deficits. Also known as central auditory processing disorder, auditory perception problem, auditory comprehension deficit, central auditory dysfunction, central deafness or word deafness.
- Apraxia of speech. A speech disorder that may occur due to brain damage in adults or due to developmental problems in children. Children with apraxia often understand language spoken to them better than they can speak to others. Apraxia causes difficulty in connecting sounds and syllables to form words in the correct way. Its severity varies among patients. Apraxia of speech is also known as verbal apraxia or dyspraxia.
Risk factors/causes of communication disorders
The cause of many communication disorders is unknown.
In some cases, heredity appears to play a role. For example, as many as 60 percent of people who stutter have a family member who also stutters, according to the Stuttering Foundation of America. Research also indicates that there is a link between stuttering and and inability to control emotions and attention in children. Certain developmental disorders (e.g., autism) can also cause communication disorders.
In other cases, an illness, accident or injury to the brain or another body structure may trigger a communication disorder (e.g., aphasia, apraxia of speech). Anatomical conditions such as a cleft lip or palate (a birth defect characterized by a split in the lip or roof of the mouth), and cognitive problems such as mental retardation may also contribute to communication disorders. Malnutrition and vitamin deficiencies may also be a factor.
Communication disorders are typically diagnosed during childhood. In addition, those disorders identified by the American Psychiatric Association appear to be more common in males than in females. This includes expressive language disorder, mixed receptive-expressive language disorder, phonological disorder and stuttering.
Signs/symptoms of communication disorders
Symptoms of communication disorders can vary from patient to patient, and may depend on the cause of the disorder. Symptoms can range from mild to severe and may include:
- Below-average vocabulary skills
- Difficulty producing complex sentences
- Difficulty recalling early visual or auditory memories
- Impaired verbal expression (e.g., speaking, sign language)
- Impaired ability to understand language
- Improper use of tenses (e.g., past, present, future) in communication
- Inability to produce and use sound in an appropriate manner
- Omitting sounds, or substituting one sound for another
- Problems recalling words
- Inability to speak clearly (appropriate to patient’s age, developmental stage and dialect)
Diagnosis of communication disorders
Symptoms of communication disorders should be reported to a physician. Early diagnosis and treatment of these disorders is likely to yield the best possible outcome for patients.
A physician will perform a complete physical examination and compile a thorough medical history in diagnosing a communication disorder. In some cases, standardized testing may be performed to assess a patient’s communication skills.
In addition, the physician will examine the patient for other conditions. For example, a patient’s hearing will likely be tested because poor hearing is a frequent source of communication difficulties. The physician will also look for neurological conditions (e.g., cerebral palsy), cognitive problems (e.g., mental retardation) and anatomical problems (e.g., cleft palate) that may be causing the patient’s communication disorder. Finally, a physician may test patients for learning disabilities and other conditions that may be related to the communication disorder.
Treatment options for communication disorders
Speech and language therapy is frequently recommended for patients with most types of communication disorders. The outlook of such therapy may vary, depending on the cause and severity of a patient’s disorder. For example, patients with brain injuries or structural anatomical problems may have more difficulty making progress than others.
In addition to speech therapy, children and adolescents with communication disorders also can benefit from tutoring and appropriate school accommodation, which may help improve their academic achievement and social communication.
Patients may also benefit from psychotherapy if emotional or behavioral problems are associated with their communication disorder.
Questions for your doctor
Preparing questions in advance can help patients or their parents have more meaningful discussions with their physicians regarding their conditions. Patients or their parents may wish to ask their doctor the following questions related to communication disorders:
- How will I know if my child or I have a communication disorder?
- What type of communication disorder do you suspect?
- Could another condition be responsible for the symptoms?
- What tests will you need to perform to identify a communication disorder?
- How will the communication disorder impact learning and social relationships?
- Who should be informed about the disorder?
- What are the treatment options?
- What is the long-term prognosis?
- What can I do to overcome these communication difficulties?
- Do you know of any support groups in the area?