COMMUNICATION

DISORDERS
 COMMUNICATION
DISORDERS
Disorders of communication include deficits in language, speech, and communication. Speech is the expressive
production of sounds and includes an individual’s articulation, fluency, voice, and resonance quality. Language
includes the form, function, and use of a conventional system of symbols (i.e., spoken words, sign language,
written words, pictures) in a 47 rule-governed manner for communication. Communication includes any verbal
or nonverbal behavior (whether intentional or unintentional) that has the potential to influence the behavior,
ideas, or attitudes of another individual.
LANGUAGE
DISORDER
 DIAGNOSTIC CRITERIA

A B C D

Persistent difficulties in the acquisition and use of Language abilities are substantially and Onset of symptoms is in the early developmental The difficulties are not attributable to hearing or
language across modalities (i.e., spoken, written, quantifiably below those expected for age, period. other sensory impairment, motor dysfunction, or
sign language, or other) due to deficits in resulting in functional limitations in effective another medical or neurological condition and
comprehension or production that include the communication, social participation, academic are not better explained by intellectual
following: achievement, or occupational performance, developmental disorder (intellectual disability)
individually or in any combination. or global developmental delay.
• Reduced vocabulary (word knowledge and
use).
• Limited sentence structure (ability to put
words and word endings together to form
sentences based on the rules of grammar
and morphology).
• Impairments in discourse (ability to use
vocabulary and connect sentences to explain
or describe a topic or series of events or
have a conversation).
 FEATURES
Language disorder is characterized by difficulties in acquiring and using
language, affecting vocabulary, grammar, sentence structure, and
CORE LANGUAGE DEFICITS discourse. Both expressive (production) and receptive (comprehension)
language skills are impacted, often with differences in severity between
the two modalities.

Children with language disorder typically exhibit delayed onset of first

DELAYED MILESTONES words and phrases. Their vocabulary is smaller and less varied, and
sentences are shorter with grammatical errors, particularly in past tense.
These deficits limit their capacity for effective communication.

Deficits in language comprehension are common and may be

underestimated. Word-finding difficulties, poor verbal definitions, and
COMPREHENSION CHALLENGES challenges with understanding synonyms, multiple meanings, or word
play are observed. Remembering new words and sentences is
problematic, affecting tasks like following instructions or recalling
information.

Difficulties with discourse include a reduced ability to provide sufficient

DISCOURSE IMPAIRMENTS information about key events and to narrate a coherent story. These
challenges impact the individual's overall communication skills,
affecting both academic and social aspects of life.
 PREVALENCE

It occurs in 10 to 15 percent of those under the age of 3 years old,

according to the University of Mississippi Medical Center. By age 4,
language ability is generally more stable and can be measured more
accurately to determine whether or not a deficit exists.
 CAUSES/ETIOLOGY

GENETIC FACTORS NEUROBIOLOGICAL FACTORS HEARING IMPAIRMENTS

Genetic predisposition or family history of Abnormalities or disruptions in brain Hearing deficits, whether congenital or
language disorders can contribute to their structure or function, such as in areas acquired, can significantly impact
development. responsible for language processing, may language acquisition and development.
be a contributing factor.

ENVIRONMENTAL FACTORS EMOTIONAL DISTURBANCE PERINATAL FACTORS

Lack of exposure to language-rich Emotional factors can influence language Complications during pregnancy, birth, or
environments, inadequate stimulation, or development, with disturbances potentially the neonatal period, such as prematurity or
socio-economic factors can impact impacting communication skills. low birth weight, can increase the risk of
language development. language disorders.
 • Language therapy:
The common treatment for language
disorder is speech and language therapy.
MANAGEMENT Treatment will depend on the age of your
child and the cause and extent of the
condition. For example, your child may
participate in one-on-one treatment
sessions with a speech-language
therapist or attend group sessions. The
speech-language therapist will diagnose
and treat your child according to their
deficits.
• Psychotherapy and Cognitive
Behaviour Therapy:
Language disorder might well be
accompanied by emotional and
behavioural problems, which could be
treated by way of Psychotherapy and
Cognitive Behaviour Therapy.
Psychotherapy helps to find out where
the problem lies, get to the root of the
problem and by making a person
expresses his or her problems through
careful questioning, can help them get
rid of the problems.
SPEECH SOUND
DISORDER
 DIAGNOSTIC CRITERIA
A B
Persistent difficulty with speech sound production that The disturbance causes limitations in
interferes with speech intelligibility or prevents verbal effective communication that interfere with
communication of messages. social participation, academic achievement,
or occupational performance, individually or
in any combination.
C D
Onset of symptoms is in the early The difficulties are not attributable to
developmental period. congenital or acquired conditions, such as
cerebral palsy, cleft palate, deafness or hearing
loss, traumatic brain injury, or other medical or
neurological conditions.
 • Speech sound production describes the clear articulation of the phonemes
ASSOCIATED Features (i.e., individual sounds) that in combination make up spoken words.

• Speech sound production requires both the phonological knowledge of

speech sounds and the ability to coordinate the movements of the
articulators (i.e., the jaw, tongue, and lips,) with breathing and vocalizing
for speech.

• Children with speech production difficulties may experience difficulty with

phonological knowledge of speech sounds or the ability to coordinate
movements for speech in varying degrees.

• A speech sound disorder is diagnosed when speech sound production is not

what would be expected based on the child’s age and developmental stage
and when the deficits are not the result of a physical, structural,
neurological, or hearing impairment.

• Among typically developing children at age 3 years, overall speech should

be intelligible, whereas at age 2 years, only 50% may be understandable.

• Boys are more likely (range of 1.5–1.8 to 1.0) to have a speech sound
disorder than girls.
 PREVALENCE
Prevalence of speech sound disorder can vary, but it's estimated to affect around 2-10% of children. 8- 9% in young
children.
 CAUSES/ETIOLOGY

FAMILY HISTORY PRE- AND PERINATAL PROBLEMS

Factors such as maternal stress or infections during

Children who have family members (parents or
pregnancy, complications during delivery, preterm
siblings) with speech and/or language
delivery, and low birthweight were found to be
difficulties were more likely to have a speech
associated with delay in speech sound acquisition and
disorder.
with speech sound disorders.

GENDER PERSISTENT OTITIS MEDIA

The incidence of speech sound disorders is Persistent otitis media with effusion (often associated
higher in males than in females with hearing loss) has been associated with impaired
speech development.
 • Speech therapy:
Targeted sessions with a speech language
pathologist to address specific speed
sound errors.
MANAGEMENT • Articulation exercises:
Participating specific sounds through
various exercises to improve articulation
e.g. syllable repetition, reading aloud etc.
• Auditory discrimination:
Activities that enhance the ability to
distinguish between different sounds like
Animal Sounds, who said it?, Where Is
the Sound? Etc.
• Phonological awareness:
Developing awareness of the sound
structure of the words, including
rhyming and segmenting sounds.
• Oral exercises:
Non-speech oral exercises such as
blowing, oral massages and brushing,
cheek puffing, whistleblowing, etc.
• Parent education:
Providing parents with information and
techniques to support their child's speech
development at home.
CHILDHOOD-ONSET
FLUENCY DISORDER
(STUTTERING)
 DIAGNOSTIC CRITERIA

A B C D

Disturbances in the normal fluency and time patterning of
speech that are inappropriate for the individual’s age and
language skills, persist over time, and are characterized by
frequent and marked occurrences of one (or more) of the
following:
. The disturbance causes anxiety about speaking
or limitations in effective communication, social
participation, or academic or occupational
performance, individually or in any
combination.
The onset of symptoms is in the early
developmental period. (Note: Later-onset cases
are diagnosed as F98.5 adult-onset fluency
disorder.)
The disturbance is not attributable to a speech-
motor or sensory deficit, dysfluency associated
with neurological insult (e.g., stroke, tumor,
trauma), or another medical condition and is not
better explained by another mental disorder.

• Sound and syllable repetitions.

• Sound prolongations of consonants as well as
vowels.
• Broken words (e.g., pauses within a word).
• Audible or silent blocking (filled or unfilled
pauses in speech).
• Circumlocutions (word substitutions to avoid
problematic words).
• Words produced with an excess of physical
tension.
• Monosyllabic whole-word repetitions (e.g., “I-I-I-I
see him”).
 • The speaker may attempt to avoid dysfluencies by linguistic
ASSOCIATED FEATURES mechanisms (e.g., altering the rate of speech, avoiding certain words
or sounds) or by avoiding certain speech situations, such as
telephoning or public speaking.

• In addition to being features of the condition, stress and anxiety

have been shown to exacerbate dysfluency.

• Childhood-onset fluency disorder may also be accompanied by

motor movements (e.g., eye blinks, tics, tremors of the lips or face,
jerking of the head, breathing movements, fist clenching).

• Males are more likely to stutter than females.

• Causes of stuttering are multifactorial, including certain genetic and

neurophysiological factors.
 The prevalence of childhood stuttering is
estimated to be around 5% in the general
population.

PREVALENCE Stuttering is more common in boys than

girls, and its onset often occurs between the
ages of 2 and 5.
 CAUSES/ETIOLOGY
GENETIC AND PHYSIOLOGICAL
The risk of stuttering among first-degree biological
relatives of individuals with childhood-onset fluency
disorder is more than three times the risk in the general
population. To date, mutations of four genes that underlie
some cases of stuttering have been identified.

ENVIRONMENTAL FACTORS
Certain environmental factors may contribute to the
development or exacerbation of stuttering. These can
include high levels of stress, pressure to communicate
quickly, or exposure to a fast-paced speaking environment.
 Speech Therapy:
• Early Intervention: Speech therapists
can work with individuals who
stutter, providing strategies to
MANAGEMENT improve fluency and minimize
disruptions in speech.
Counseling and Emotional Support:
• Supportive Environment: Creating a
supportive and understanding
environment is essential. It's
important for parents, teachers, and
peers to be patient, avoid putting
pressure on the individual, and
provide emotional support.
Education and Awareness:
• Education for Parents and Teachers:
Educating parents, teachers, and
peers about stuttering helps foster
understanding and support. This can
reduce feelings of frustration or
embarrassment for the individual
who stutters.
Speech Modification Techniques:
• Fluency-Shaping Techniques:
Speech therapists may teach
fluency-shaping techniques, which
focus on modifying speech patterns
to enhance fluency. These
techniques include slow and
deliberate speech, gentle onset of
sounds, and relaxed breathing
 SOCIAL
(PRAGMATIC)
COMMUNICATION
DISORDER
 DIAGNOSTIC CRITERIA

A B C D E

Persistent difficulties in the social Deficits in using Impairments in the ability to change Difficulties following rules for Difficulties understanding what
use of verbal and nonverbal communication for social communication to match the context conversation and storytelling. is not explicitly stated and
communication. purposes. or needs of the listener. nonliteral or ambiguous
meanings of language.
 • Difficulty initiating and maintaining conversations.
ASSOCIATED Features
• Inappropriate or limited use of communication for social purposes.

• Difficulty understanding and following social rules of conversation.

• Literal interpretation of language and difficulty understanding

nonliteral or ambiguous meanings.
 It is estimated that some form of pragmatic
language impairment can affect up to 7.5% of
children.

PREVALENCE Males are typically affected more than

females, by a ratio of 2:1.
 CAUSES/ETIOLOGY

GENETIC FACTORS: NEUROLOGICAL FACTORS:

Some individuals may have a genetic predisposition Differences in brain structure and function may
to social (pragmatic) communication disorder. contribute to the development of social (pragmatic)
communication disorder.

ENVIRONMENTAL FACTORS
Adverse early life experiences, such as neglect or
trauma, may increase the risk of social (pragmatic)
communication disorder.
 Individualized Therapy
• Therapy sessions tailored to the
MANAGEMENT specific needs of the individual with
social (pragmatic) communication
disorder.
Collaboration with Caregivers and
Educators
• Working closely with parents,
caregivers, and educators to develop
strategies and supports for the
individual's communication needs.
Social Skills Training
• Teaching and practicing social skills
such as turn-taking, active listening,
and nonverbal communication.
Environmental Modifications
• Making changes to the individual's
environment to support their
communication, such as visual
supports, structured routines, and
clear expectations.
 UNSPECIFIED
COMMUNICATION
DISORDER
This category applies to presentations in which symptoms characteristic of
communication disorder that cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for communication disorder
or for any of the disorders in the neurodevelopmental disorders diagnostic
class. The unspecified communication disorder category is used in
situations in which the clinician chooses not to specify the reason that the
criteria are not met for communication disorder or for a specific
neurodevelopmental disorder, and includes presentations in which there is
insufficient information to make a more specific diagnosis.
 CASE STUDY
CASE 1
Sarah, a 6-year-old girl, was referred to a speech-language
pathologist (SLP) by her school due to persistent fluency
difficulties. Her parents noted that Sarah had been
experiencing stuttering since the age of 3, and despite prior
interventions, her fluency challenges showed little
improvement. There was no reported family history of
stuttering. Sarah's stuttering was characterized by repetitions
of sounds, syllables, and words, with occasional speech blocks.
The severity and frequency of her stuttering heightened in
stressful situations, such as oral presentations or when
conversing with unfamiliar individuals. Sarah actively avoided
participating in class discussions, impacting her overall
engagement and participation in various subjects, as observed
by her teachers.
CASE 2
Arjuna El Sharif Uwaish, a 3-year-old boy facing challenges
in speech and communication. Through diaries and
observations, they documented 22 phonetic sounds, 85
morphemes, and a limited ability to construct sentences over
the course of 12 months. Arjuna's linguistic journey revealed
struggles in vocalizing thoughts despite understanding
others, emphasizing the intricate nature of language
acquisition. The study advocated for medical intervention
and specialized support, leaving the reader to speculate on
the specific challenges Arjuna might be facing in his
linguistic development.
THANK YOU!