COMMUNICATION

DISORDER

COMMUNICATION
DISORDER
LANGUAGE DISORDER
EXPRESSIVE & MIXED EXPRESSIVE-RECEPTIVE
LANGUAGE DISORDER

SPEECH DISORDER
PHOLOGICAL DISORDER & STUTTERING

Terminologies:

Communication- is the exchange of ideas ,

opinions and facts between people interacting
with each other.
Communicative competence- is the ability of
the child develops to use speech and language
to uncover how the world works.
Speech- is the systematic use of sounds and
sound combinations to produce meaningful
words, phrases and sentences.
Language- puts meaning into speech and is
used to express and receive meaning.

LANGUAGE
THE MAJOR COMPONENTS OF THE LANGUAGE
1. PHONOLOGY-is the sound system of language,
combinations of sounds are permissible I language to
form meaningful words.
2. GRAMAR- designates the organization of r words and the
rules for placing words in an order that makes the sense
in the language.
3. SYNTAX-is the rule system that governs the order and
combination of word to from phrases and sentences.
4. SEMANTICS- is the meaning of the language
5. PRAGMATICS- is the social aspect of language;
knowledge and understanding rules of turn taking,
starting and ending conversations.

Language have:
1. Form
2. Content
3. Function
---- AMERICAN SPEECH LANGUAGE-HEARING
ASSOCIATION, 1993----

EXPRESSIVE LANGUAGE
DISORDER

There are two types of expressive language disorder: the

developmental type and the acquired type

BELOW THE EXPECTED LEVELS OF:

vocabulary, use of correct tenses, production of complex
sentences, recall of words.

EPIDEMIOLOGY
Expressive language disorder is a relatively common childhood
disorder. Language delays occur in 1015% of children under
age three, and in 37% of school-age children.

Expressive language disorder is more common in boys that in

girls.

Studies suggest that developmental expressive language

disorder occurs two to five times more often in boys as girls.

The developmental form of the disorder is far more common

than the acquired type.

COMORBID
ADHD (19%)
ANXIETY DISORDER ( 10%)
OPPOSITIONAL DEFIANT DISORDER ( 7%)

Children with expressive language disorder

are also at higher risk for a speech disorder,
receptive difficulties and other learning
disorder.

ETIOLOGY
There is no known cause of developmental
expressive language disorder. Research is
ongoing to determine which biological or
environmental factors may be the cause.
Genetic factor
Left-handedness

DIAGNOSTIC CRITERIA
A. The scores obtained from a standardized
individually administered measures of expressive
language development are substantially below
those obtained from standardized measures of
both nonverbal intellectual capacity and
receptive language development the disturbance
maybe manifest clinically by symptoms that
include having a , making markedly limited
vocabulary making errors in tense, or having
difficulty recalling words or producing sentences
with developmentally appropriate length or
complexity.

B. The difficulties with expressive language

interfere with academic or occupational
achievement or with social communication
C. Criteria are not met for mixed receptiveexpressive language disorder or a PDD.
D. If a mental retardation, a speech motor or
sensory deficit or environmental deprivation is
present, the language difficulties are in excess
of those usually associated with these
problems.
CODING NOTE

PROGNOSIS
The developmental form of expressive language disorder
generally has a good prognosis. Most children develop
normal or nearly normal language skills by high school.
In some cases, minor problems with expressive language
may never resolve.
The acquired type of expressive language disorder has a
prognosis that depends on the nature and location of the
brain injury.
Some people get their language skills back over days or
months. For others it takes years, and some people
never fully recover expressive language function.

TREATMENT

There are two types of treatment used for expressive

language disorder. The first involves the child
working one-on-one with a speech therapist on a
regular schedule and practicing speech and
communication skills.
The second type of treatment involves the child's
parents and teachers working together to incorporate
spoken language that the child needs into everyday
activities and play. Both of these kinds of treatment
can be effective, and are often used together.
PSYCHOTHERAPY

MIXED RECEPTIVE-EXPRESSIVE
DISORDER
Mixed receptive-expressive language disorder
is diagnosed when a child has problems
expressing him-or herself using spoken
language, and also has problems
understanding what people say to him or
her.

CAUSES
There is no known cause of developmental
mixed receptive-expressive language
disorder. Researchers are conducting
ongoing studies to determine whether
biological or environmental factors may be
involved. The acquired form of the disorder
results from direct damage to the brain.

SYMPTOMS

signs and symptoms of mixed receptive-expressive language

disorder are for the most part the same as the symptoms of
expressive language disorder

not able to communicate thoughts, needs, or wants at the same

level or with the same complexity as his or her peers. In
addition, the child often has a smaller vocabulary than his or her
peers.

This lack of comprehension may result in inappropriate

responses or failure to follow directions. Some people think these
children are being deliberately stubborn or obnoxious, but this is
not the case.

EPIDEMIOLOGY
3% of school age children
Less common than the expressive disorder
Twice prevalent in boys than girls

COMORBIDITY
Additional speech and language disorders
Learning Disorder
Half children with this disorder have
pronunciation difficulties leading to
PHONOLOGICAL DISORDER
ADHD

DIAGNOSIS
The first criterion states that the child communicates using
speech and appears to understand spoken language at a level
that is lower than expected for the child's general level of
intelligence.
Second, the child's problems with self-expression and
comprehension must create difficulties for him or her in
everyday life or in achieving his or her academic goals. If the
child understands what is being said at a level that is normal
for his or her age or stage of development, then the diagnosis
would be expressive language disorder.
If the child is mentally retarded, hard of hearing, or has other
physical problems, the difficulties with speech must be greater
than generally occurs with the other handicaps the child may
have in order for the child to be diagnosed with this disorder.

The disorder is usually diagnosed in children because a

parent or teacher expresses concern about the child's
problems with spoken communication. The child's
pediatrician may give the child a physical examination
to rule out such medical problems as hearing loss.
Specific testing for mixed expressive-receptive
language disorder requires the examiner to
demonstrate that the child not only communicates less
well than expected, but also understands speech less
well. It can be hard, however, to determine what a
child understands.

most examiners will use non-verbal tests in

addition to tests that require spoken questions and
answers in order to assess the child's condition as
accurately as possible.

Children who speak a language other than English

(or the dominant language of their society) at home
should be tested in that language if possible

PROGNOSIS

The developmental form of mixed receptiveexpressive language disorder is less likely to resolve
well than the developmental form of expressive
language disorder. Most children with the disorder
continue to have problems with language skills. They
develop them at a much slower rate than their peers,
which puts them at a growing disadvantage
throughout their educational career. Some persons
diagnosed with the disorder as children have
significant problems with expressing themselves and
understanding others in adult life.

TREATMENT
mixed receptive-expressive language disorder should be
treated as soon as it is identified. Early intervention is the
key to a successful outcome. Treatment involves teachers,
siblings, parents, and anyone else who interacts regularly
with the child.
Regularly scheduled one-on-one treatment that focuses on
specific language skills can also be effective, especially
when combined with a more general approach involving
family members and caregiver
Teaching children with this disorder specific communication
skills so that they can interact with their peers is important

SPEECH DISORDER
PHONOLOGICAL DISORDER
Phonological disorder occurs when a child does not develop the
ability to produce some or all sounds necessary for speech that are
normally used at his or her age.

No known cause-developmental phonological disorder

neurological origin-dysarthria" slurred speech "dyspraxia-difficulty

in planning and executing speech

SPEECH DISORDER is characterized by any

impairment of vocal production, speech
sound production, fluency, or any
combination of these impairments
-AMERICAN SPEECH LANGUAGE
HEARING ASSOCIATION

SPEECH

Specific parts of the body coordinate to

produce sounds and modify the speech.

EPIDEMIOLOGY
Prevalence rate: 7-8% in children under 12
years.
2-3 times more common to boys
More common among first degree relatives

ETIOLOGY
MULTIPLE VARIABLES:
1. Perinatal problems
2. Genetic factors
3. Auditory processing problems
4. Hearing impairment
5. Abnormalities related to speech
6. Developmental lag
7. Neurological impairment : dysarthria &
apraxia
8. Environmental factors

DIAGNOSIS
Childs delay or failure to produce expected speech
sounds.
P pig 3
M man 3
N nose 3
W water 3
H hat 3
Bbag 4
D dog 4
K,c cat 4
G go4

F, ph
Ng
Sh
V
Wh

fun
long
shoes
voice
where

4
6
7
8
8

FEATURES
4 TYPES OF ERRORS IN PRODUCING SOUNDS
SUBSTITUTION-replacing one sound with
one another.
DISTORTION- Producing a sound in an
unfamiliar way.
OMISSION- omitting a sound in a word
ADDITION- inserting an extra sound in a
word.

DIAGNOSTIC CRITERIA
Failure to use developmentally expected speech
sounds that are appropriate age and dialect.
B. The difficulties in speech sound production
interfere with academic or occupational
achievement.
C. If a mental retardation, a speech motor or
sensory deficit or environmental deprivation is
present, the language difficulties are in excess
of those usually associated with these problems.
Coding note
A.

Course and Prognosis

Spontaneous recovery is rare after the age of
8 years.

Treatment

Speech therapy

STUTTERING
blockages, discoordination, or
fragmentations of the forward flow of
speech (fluency
These types of disfluencies include
repetitions of sounds and syllables,
prolongation of sounds, and blockages of
airflow. Individuals who stutter are often
aware of their stuttering and feel a loss of
control when they are disfluent

Causes and symptoms

First, there is a genetic predisposition to
stutter, as evidenced by studies of families
and twins
factor in the onset of stuttering is the
physiological makeup of people who stutter.
environmental issues have a significant
impact on the development of stuttering
behaviors. An environment that is overly
stressful or demanding, may cause children
to have difficulties developing fluent speech

Stuttering is a relatively low-prevalence

disorder. Across all cultures, roughly 1% of
people currently has a stuttering disorder

Research suggests that roughly 50-80% of all

children who begin to stutter will stop
stuttering. In addition, approximately three
times as many men stutter as women. This
ratio seems to be lower early in childhood,
with a similar number of girls and boys
stuttering

DIAGNOSTIC CRITERIA IN
STUTTERING
A.

1.
2.
3.
4.
5.
6.

7.

Disturbance in the normal fluency and time

patterning of speech characterized by frequent
occurrences of one or more of the following:
Sound and syllable repetitions
Sound prolongations
Interjections
Broken words
Circumlocutions
Words produced with an excess of physical
tension
Monosyllabic whole word repetitions

B. The disturbance in fluency interferes with

academic
C. If a speech motor sensory is present, the
speech difficulties are in excess of those
usually associated with these problems.
Coding Note

Treatment
Speech Therapy
Breathing exercises
Relaxation techniques

COMMUNCATION DISORDER NOT

OTHERWISE SPECIFIED
Disorder that do not meet diagnostic criteria
for any specific disorder fall into the
category of communication disorder not
otherwise specified.

Thank you!!