Health Library

Communication Disorders

Many children will experience a temporary delay in speech and language development. Most will eventually catch up. Others will continue to have difficulty with communication development.

The following are common speech and language disorders found in children:

Speech Disorders

A speech disorder is characterized by difficulty with speech and sound production, voice, resonance, or fluency (the flow of speech). These are described below:

Speech Sound Disorders

A child with a speech sound disorder is unable to say all of the speech sounds in words. This can make the child’s speech hard to understand. People may not understand the child in everyday situations. For most children, the cause of the speech sound disorder is 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.

Reasons for Concern

• The child doesn't babble using consonant sounds (particularly b, d, m and n) by age 8 or 9 months.
• The child uses mostly vowel sounds or gestures to communicate after 18 months.
• The child's speech cannot be understood by many people at age 3.
• The child's speech is difficult to understand at age 4 or older

Voice Disorders

The voice is produced as air from the lungs moves up through and vibrates the vocal folds. This is called phonation. With voice disorders, the voice may be harsh, hoarse, raspy, cut in and out, or show sudden changes in pitch. Voice disorders can be due to vocal nodules, cysts, papillomas, paralysis or weakness of the vocal folds.

Reasons for Concern

• The voice is hoarse, harsh or breathy.
• The voice is always too loud or too soft.
• The pitch is inappropriate for the child’s age or gender.
• The voice often breaks or suddenly changes pitch.
• Frequent loss of voice

Resonance Disorders

Resonance is the overall quality of the voice. A resonance disorder is when the quality of the voice changes as it travels through the different-shaped spaces of the throat, nose and mouth. Resonance disorders include the following:

• Hyponasality (Denasality): This is when not enough sound comes through the nose, making the child sound “stopped up.” This might be caused by a 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 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.
• Cul-de-Sac Resonance: This is when there is a blockage of sound in the nose, mouth or throat. The voice sounds muffled or quiet as a result.

Reasons for Concern

• Speech sounds hyponasal or hypernasal
• Air is heard coming out of the nose during speech

Fluency Disorders (Stuttering)

Fluency is the natural “flow” or forward movement of speech. Stuttering is the most common type of fluency disorder. Stuttering happens when there are an abnormal number of repetitions, hesitations, prolongations, or blocks in this rhythm or flow of speech. Tension may also be seen in the face, neck, shoulders or fists. There are many theories about why children stutter. At present, the cause is most likely linked to underlying neurological differences in speech and language processing. Internal reactions from the person talking, and external reactions from other listeners, may impact stuttering, but they do not cause stuttering.

Reasons for Concern

• The parents are concerned about stuttering.
• The child has an abnormal number of repetitions, hesitations, prolongations or blocks in the natural flow of speech.
• The child exhibits tension during speech.
• The child avoids speaking due to a fear of stuttering.
• The child considers themself to be someone who stutters.

Language Disorders

A language disorder is characterized by difficulty conveying meaning using speech, writing or even gestures. There are two main types of language disorders: receptive and expressive. Causes of language disorders are unknown in many children. Known causes may include hearing loss, intellectual disabilities, emotional disturbance, a lack of environmental exposure to language, or brain injury.

Receptive Language Disorders

• Difficulty understanding words and/or sentences
• Difficulty attending to the speech of others
• Difficulty with following directions and learning

Expressive Language Disorder

• Difficulty using the right words when talking
• Difficulty combining words to make sentences
• Limited vocabulary
• Difficulty putting sentences together correctly

Reasons for Concern

• If the child does not use any words by 16-18 months.
• The child cannot follow simple instructions, such as "Give me your shoe" by 18 months.
• The child cannot point to body parts or common objects when asked by 18 months.
• The child has not started combining words by age 2.
• The child does not use complete sentences by age 3.
• The child imitates or “echoes” parts of questions or commands instead of responding appropriately by age 3. For example, when asked "What's your name?" the child says, "Your name".
• The child’s sentences are still short or jumbled by age 4.
• The child often uses words incorrectly by age 4. For example, a child may say "cut" for "scissors," or "dog" for "cow".

Causes of a Communication Disorder

A child may be at risk for a communication disorder if there is a history of the following:

• Cleft lip or cleft palate
• Craniofacial anomalies
• Velopharyngeal insufficiency
• Dental malocclusion
• Oral-motor dysfunction
• Neurological disease/dysfunction or brain injury
• Respirator dependency, respiratory compromise, or tracheostomy
• Vocal fold pathology
• Developmental delay
• Autism
• Prematurity or traumatic birth
• Hearing loss or deafness

Treatment for Communication Disorders

Early intervention is very important for children with communication disorders. Treatment is best started during the toddler or preschool years.  These years are a critical period of normal language learning. The early skills needed for normal speech and language development can be evaluated 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 usually starts between the ages of 2 and 4 years.

If you have concerns with your child’s communication skills, discuss them with your child’s doctor. The doctor will likely refer the child to a speech-language pathologist for evaluation and treatment. All children with speech and language disorders should also have their hearing tested.

Helping Your Child

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 their early years. They can help the child by giving lots of opportunities to listen and talk. This can be done by frequently pointing out and naming important people, places, and things. They can also read and talk to the child during the day, especially during daily routines, interactive play 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 are also great ways to build speech and language skills while having fun with your child.

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