Health Library

Communication Disorders

Children with communication disorders may have trouble understanding language, using words, interacting with others (language disorders) and/or producing speech sounds (speech disorders).

Communication skills develop gradually and every child progresses in their own way. But some children face ongoing challenges that make communication harder than expected for their age. These communication challenges can affect learning, relationships and everyday activities. Early identification and treatment can help with later success.

How Do Communication Skills Develop?

Communication begins long before a child says their first word. Babies learn to understand and communicate through sounds, facial expressions, gestures and eye contact. As children grow and interact with others, they build vocabulary, develop speech sounds, and learn more complex skills. Early communication skills provide the foundation for learning, social relationships and emotional development.

Typical communication milestones include:

• Cooing, babbling and becoming more interactive during infancy (0–12 months)
• Producing first words around 12 months
• Combining words into short phrases by age 2
• Using increasingly complex sentences and conversation skills during the preschool years (3–5 years)
• Developing advanced language, reading and social communication skills throughout the school-age years

Children grow and develop at different rates. Delays or ongoing challenges may be a sign of a communication disorder.

What Are the Different Types of Communication Disorders?

Communication disorders can affect speech, language or social communication. Some children have challenges in just one area, while others may have difficulties in several areas.

Communication challenges may involve hearing loss or problems with attention, memory, problem-solving or organization. These skills can affect how children understand and share information.

Speech Disorders

Children with speech disorders have trouble making or organizing speech sounds, speaking fluently, or using their voices clearly. Their speech may be difficult for others to understand.

Types of speech disorders:

• Speech sound disorders happen when a child has difficulty producing specific sounds or groups of sounds. Types of speech sound disorders include:
• Articulation disorders happen when a child has a hard time making specific speech sounds.
• Phonological disorders happen when a child has trouble using speech sound patterns.
• Motor speech disorders happen when children either have trouble planning the movements for speech (childhood apraxia of speech) or executing the movements for speech (dysarthria).
• Fluency disorders happen when there are disruptions to the flow of speech. Stuttering is the most common fluency disorder.
• Resonance disorders happen when the quality of a child’s voice is impacted by the imbalance of nasal and oral sounds.
• Voice disorders happen when a child’s vocal folds do not vibrate well enough to produce a clear sound. A disordered voice may sound hoarse, breathy, strained, too loud or too soft.

Language Disorders

Language disorders affect how children understand language, use words and sentences, or both. Some children have trouble understanding what others say. Others may understand language but struggle to express their own thoughts and ideas.

Language disorders may include one or more of the following:

• Receptive language impairments happen when a child has difficulty understanding spoken, written or signed language.
• Expressive language impairments happen when a child has difficulty using words, sentences or other forms of communication to express thoughts, needs and ideas.
• Pragmatic language impairments happen when a child has difficulty with verbal and nonverbal communication in social situations. They may struggle with conversation, taking turns speaking, understanding social cues or adjusting communication for different situations.

Cognitive Communication Disorders

Cognitive communication disorders affect a child’s ability to communicate well because of difficulty with thinking. Thinking skills include attention, memory, learning, reasoning and problem-solving.

Cognitive communication disorders are usually associated with an underlying condition (like cerebral palsy, epilepsy or brain tumor) or an injury such as a concussion.

What Causes a Communication Disorder?

Communication disorders can have many causes. In some cases, the exact cause is unknown.

A child may be at greater risk if they have:

• Hearing loss or deafness
• Developmental delays
• Autism spectrum disorder
• Premature birth or birth complications
• Neurological conditions, such as cerebral palsy
• Brain injury
• Differences in the structure of the face, mouth or jaw such as cleft lip or cleft palate
• Problems with the muscles and movements needed for speech and swallowing, such as childhood apraxia of speech
• Voice or vocal fold problems
• A family history of speech or language difficulties

Having a risk factor does not mean a child will develop a communication disorder.

What Are the Signs of a Communication Disorder?

Signs can vary depending on a child's age and the type of communication disorder. Some children may:

• Speak later than expected
• Have a limited vocabulary for their age
• Struggle to form words or sentences
• Not respond consistently to sounds, voices or attempts at engagement
• Have difficulty understanding language, such as following directions
• Be difficult for others to understand when speaking
• Stop using skills they previously had
• Have a hoarse or atypical voice quality
• Avoid speaking situations
• Have trouble participating in conversation or making friends
• Become frustrated when trying to communicate
• Older children may have challenges with reading, writing, learning or social interactions because communication skills affect many areas of daily life.

How Are Communication Disorders Diagnosed?

Talk with your child’s pediatrician to determine if evaluation with a speech-language pathologist (SLP) would be helpful. An SLP can evaluate your child to determine if they have a communication disorder. The evaluation helps identify your child's strengths and challenges and guides treatment recommendations. During the evaluation, the SLP may:

• Review your child's medical and developmental history
• Discuss your concerns about your child’s communication
• Observe how your child communicates
• Test specific speech and language skills
• Use dynamic assessment to gauge your child’s response to instruction and learning potential with supports
• Screen for additional areas of need to see if other referrals are appropriate

Early evaluation can help identify communication challenges and decide if treatment or more support may be helpful. During the evaluation, the SLP may give you strategies to use at home and recommendations for therapy.

Because hearing plays an important role in communication development, the SLP often recommends your child complete a hearing test.

How are Communication Disorders Treated?

Treatment depends on the type of communication disorder and your child's individual needs.

Early intervention is important because communication skills develop rapidly during the first few years of life. Children often benefit most when treatment begins as early as possible.

Speech-language therapy may help children:

• Improve speech clarity
• Build vocabulary and language skills
• Improve understanding
• Strengthen social communication skills, such as taking turns in conversation and understanding social cues
• Improve fluency
• Develop healthy voice use
• Use augmentative and alternative communication (AAC) tools, such as picture boards, communication apps, or devices that speak words aloud, if needed

Your speech-language pathologist (SLP) will personalize the treatment plan to help your children reach their communication goals. Therapy may be provided individually, in a group setting, as a co-treat with another professional, or through a combination of approaches.

Family involvement is an important part of treatment. The SLP teaches parents and caregivers how to support communication skills at home. Some children may also benefit from school-based support services.

Supporting Communication at Home

Parents and caregivers play an important role in communication development. You can support your child by:

• Talking with your child throughout the day
• Reading books together regularly
• Singing songs and nursery rhymes
• Giving your child time to respond
• Encouraging conversation during daily activities
• Limiting distractions during communication
• Seeking out opportunities for your child to have peer interaction
• Following individualized recommendations from your child's speech-language pathologist

These everyday interactions help build communication skills in a natural and supportive way.

What Is the Outlook for Children with Communication Disorders?

Every child is different. Some children overcome communication challenges with treatment and support. Others may continue to need support as they grow. Several factors can influence long-term outcomes, including:

• The type of communication disorder
• Severity of symptoms
• Age when treatment begins
• Family involvement
• Presence of other developmental or medical conditions

A child can make significant improvements in their communication with early interventions and family support.

Frequently Asked Questions About Communication Disorders

What is the difference between a speech disorder and a language disorder?

A speech disorder affects how sounds are produced. A language disorder affects how a child understands or uses words and sentences.

What are the first signs of a communication disorder?

Early signs may include delayed milestones, difficulty understanding language, limited vocabulary, unclear speech or difficulty interacting with others.

When should my child see a speech-language pathologist?

Consider an evaluation if your child is not meeting communication milestones, has difficulty being understood, or struggles to understand language. Talk with your child’s pediatrician to see if your child would benefit from a speech and language evaluation.

Does my child need a hearing test?

Yes, it is important to be able to rule out or confirm hearing loss. Hearing is closely linked to speech and language development, so hearing evaluations are usually recommended.

How can I help my child communicate at home?

Talk, read, sing and play with your child every day. Give them opportunities to communicate. Talk with your child’s speech-language pathologist to determine individualized strategies to help your child improve communication skills.