Communication Disorders

Many young children have difficulty with communication at some time in their lives. Most will eventually catch up. However, some will continue to have problems.

Communication disorders include speech disorders and language disorders. These disorders are discussed in this article. Some general guidelines are also given. This will help you decide if your child needs to be tested by a speech-language pathologist.

A child with a speech disorder may have difficulty with articulation, voice, fluency, or any combination of these.

Articulation is the physical production of speech sounds. A child with speech sound disorders has difficulty articulating certain speech sounds. This can make the child hard to understand.

Types of Errors

Omissions 

Sounds in words and sentences may be completely left out. For example: "I go a coo o the buh." (I go to school on the bus.); or "I ree a boo." (I read a book.)

Substitutions 

An incorrect (usually easier) sound is used instead of the correct one. For example: "I saw a wittle wamb;" "I tee de tun in the ty;" "I have a wed wadio;" "I'm a dood dirl."

Distortions 

The child tries to make the right sound, but cannot produce it clearly. For example, an /s/ sound may whistle, or the air comes out the sides of the mouth, making a "slushy" sound (a “lateral lisp”); or, the tongue may push between the teeth causing a “frontal lisp.”

Causes

For most children, the cause of the speech sound disorder in unknown.  Other speech sound disorders can be linked to things such as a cleft palate, problems with the teeth, hearing loss, or difficulty controlling the movements of the mouth. Neurological disorders that can affect articulation include cerebral palsy.

Oral Apraxia 

Difficulty making voluntary movements of the tongue and lips, or with combining movements to make speech sounds. As a result, speech may be difficult to produce or may have many inconsistent articulation errors.

Dysarthria 

Paralysis, weakness, or generally poor coordination of the muscles of the mouth. This can make speech slow, inaccurate, slurred, and/or hypernasal (when too much sound comes through the nose).

Reasons for Concern

  • If the child doesn't babble using consonant sounds (particularly b, d, m and n) by age 8 or 9 months
  • If the child does not produce one word other than mom or dad by 12 months
  • If the child uses mostly vowel sounds and gestures for communication after 18 months
  • If speech cannot be understood by strangers at the age of 3 
  • If the child often leaves out consonants from words at the age of 3
  • If speech is still difficult to understand at the age of 4
  • If, by 6, the child is still unable to produce many sounds
  • If the child is leaving out, substituting, or distorting sounds after the age of 7
  • If the child is embarrassed or worried about his speech at any age

The voice is produced as air from the lungs moves up through and vibrates the vocal cords. This is called phonation. The voice is then changed as it travels up through the different-shaped spaces of the throat, nose and mouth. This is called resonance. Voice disorders include both phonation and resonance disorders:

Phonation Disorders

The voice may be harsh, hoarse, raspy, cut in and out, or show sudden changes in pitch with phonation disorders. Voice disorders can be due to vocal nodules, papillomas, ulceration, a laryngeal web, paralysis or weakness of the vocal cords, or difficulty timing breathing for speech.

Resonance Disorders

These are caused by an imbalance in sound energy as the voice passes through the spaces of the throat, nose or mouth. When parents report that their child’s voice sounds “nasal,” they are usually hearing one of two different types of resonance disorder:

  • Hyponasality (or denasality): This is when not enough voice energy comes through the nose, making the child sound “stopped up.” This might be caused by some blockage in the nose, or by allergies.
  • Hypernasality: This happens when the movable, soft part of the palate (the velum) does not completely close off the nose from the back of the throat during speech. Because of this, too much sound energy escapes through the nose. This can be due to a history of cleft palate, a submucous cleft, a short palate, a wide nasopharynx, the removal of too much tissue during an adenoidectomy, or poor movement of the soft palate.

Reasons for Concern

  • If the voice is hoarse, harsh, breathy, or of poor quality
  • If the voice is always too loud or too soft
  • If the voice is too high or too low for the child's age or sex
  • If the voice often breaks or suddenly changes pitch
  • If the voice sounds hyponasal or hypernasal

Fluency is the natural “flow” or forward movement of speech. A fluency disorder, or stuttering, is when speech shows an abnormal number of repetitions, hesitations, prolongations, or disturbances in this rhythm or flow. Tension may also be seen in the face, neck, shoulders, or fists. There are many theories about why children stutter. Most experts agree that certain environmental reactions to normal disfluencies can result in stuttering.

Reasons for Concern

  • When the child’s speech seems to have many repetitions, hesitations, prolongations, blocks, or disruptions
  • If the child appears tense during speech
  • If the child avoids speaking due to a fear of stuttering
  • If the child considers himself to be someone who stutters

When a child has difficulty getting his meaning across using speech, writing, or even gestures, we may be seeing a language disorder. Some children have a language disorder even though they produce sounds well and have understandable speech. Difficulty expressing meaning to other people is called an expressive language disorder. Difficulty understanding other speakers is called a receptive language disorder. A child might have difficulties with both. This is what is called a mixed receptive-expressive language disorder.

Receptive Language Disorder

A child may have difficulty understanding the words or sentences used by others. Or the child may seem to show poor attention to speech. This may cause difficulty following spoken directions. It may also lead to problems with learning.

Expressive Language Disorder

A child may have difficulty coming up with the right words when talking. The child may be unable to join words correctly into sentences. As a result, the child may have a small vocabulary. Or the child may use words incorrectly. He or she may speak using short, "telegraphic" phrases, leaving out small but important words. Or the child may put sentences together incorrectly.

For both types of language disorder, the main problem may be with content (that is, words and their meanings), form (grammar or word order), or use (the ability to understand and use language appropriately).

Causes of language disorders are unknown in many children.  Other known causes may include hearing loss, cognitive delay, emotional disturbance, a lack of environmental exposure to language or brain damage.  

Reasons for Concern

  • If the child does not use any words by 12 months
  • If, by 18 months, the child cannot follow simple instructions such as, "Give me your shoe," or cannot point to body parts or common objects when asked
  • If the child has not started combining two words together (e.g., want cookie) by the age of 2
  • If the child does not use any complete sentences by the age of 3
  • If, at 3, the child imitates or “echoes” parts of questions or commands instead of responding properly. For example, if when asked, "What's your name?" the child says, "Your name!"
  • If sentences are still usually short or jumbled by the age of 4
    • If, by 4, the child often uses words incorrectly. Or if the child uses a related word instead of the one he or she meant. For example, a child may say "cut" for "scissors," or "dog" for "cow."

A child may be at risk for a communication disorder if there is a history of cleft lip or cleft palate; craniofacial anomalies; velopharyngeal insufficiency; dental malocclusion; macroglossia; oral-motor dysfunction; neurological disease or dysfunction; brain stem injury; respiratory dependency or respiratory compromise; tracheostomy; vocal fold pathology; paralysis or paresis of the vocal folds; developmental delay; psychosis; autism; prematurity or traumatic birth; hearing loss or deafness. Note: ankyloglossia (tongue-tie) rarely causes speech problems.

Early intervention is very important for children with communication disorders. Treatment is the most effective the earlier it is started, with preschool or earlier preferred. These years are a critical period of normal language learning, and strong speech habits have not yet been formed. The early skills needed for normal speech and language development can be tested even in infants. At that age, the speech-language pathologist works with the parents on stimulating speech and language development in the home. Active treatment in the form of individual therapy is usually begun between the ages of 2 and 4.

If there is a concern about the child’s communication skills at any age, this should first be discussed with the child’s doctor. The doctor will likely refer the child to a speech-language pathologist for evaluation and treatment.

Children learn speech and language skills by listening to the speech of others, and practicing as they talk to others. Parents are the most important teachers for their child in the early years. They can help the child by giving lots of opportunities to listen to speech and to talk. This can be done by frequently pointing out and naming important people, places and things. They can also read to the child and talk to the child throughout the day, especially during daily routines and favorite activities.

Parents can give the child models of words and sentences to repeat. Parents can also set up opportunities for the child to answer questions and talk. Listening to music, singing songs, and sharing nursery rhymes and finger play are also great ways to build speech and language while having fun with your child.

For more information, contact the Division of Speech Pathology, 513-636-4341.


Last Updated 04/2013