A child with a communication disorder has trouble communicating with others. A speech-language pathologist often treats a communication disorder in a child. Communication disorders include problems related to speech, language, and communication. Speech refers to the production of sounds that allow individuals to. Speech is how we say sounds and words. Language is the words we use to share ideas and get what we want.
This chapter begins by providing an overview of speech and language development and disorders.
Introduction - Speech and Language Disorders in Children - NCBI Bookshelf
It then addresses the following topics within the committee's charge: Language refers to the code, or symbol system, for transforming unobservable mental events, such as thoughts and memories, into events that can be perceived by other people.
Being a competent language user requires two essential capabilities. One, known as expressive language or language production, is the ability to encode one's ideas into language forms and symbols. The other, known as receptive language or language comprehension, is the ability to understand the meanings that others have expressed using language.
People commonly express themselves by speaking and understand others' meanings by listening. However, language also can be expressed and understood in other ways—for example, by reading, writing, and signing Crystal, Speech has a narrower meaning than language because it refers specifically to sounds produced by the oral mechanism, including the lips, tongue, vocal cords, and related structures Caruso and Strand, Speech is the most common way to transmit language and, unlike language, can be observed directly.
Speech disorders are sometimes mistakenly equated with language disorders, and conversely, normal speech is sometimes assumed to reflect normal language. In fact, speech disorders and language disorders can occur separately or together.
For example, a child might have a speech disorder, such as extremely poor articulation, yet have intact language skills. Another child might have a language disorder, such as extremely poor comprehension, yet be able to produce speech sounds normally.
Finally, some children have both language disorders and speech disorders.
In young children who are producing little if any speech, it can be difficult to determine whether a speech disorder, a language disorder, or both are present. As noted in Chapter 3 on treatment, early intervention for such children generally is designed to facilitate both language and speech skills.
When children reach an age that allows each area to be assessed separately, it becomes possible to narrow the focus of treatment according to whether deficits are found only in speech, only in language, or in both. Overview of Speech and Language Development and Disorders The foundations for the development of speech and language begin in utero, with the growth of the anatomical structures and physiological processes that will eventually support sensory, motor, attention, memory, and learning skills.
Before the end of the prenatal period, fetuses are able to hear, albeit imperfectly, speech and other environmental sounds, and within a few minutes after birth they show special attention to human faces and voices.
This early interest in other people appears to set the stage for forming relationships with caregivers, who scaffold the child's growing ability to anticipate, initiate, and participate in social routines e. The social experiences and skills that occur during the infant's first months of life are important precursors to pragmatic language skills: In the first few months of life, infants show improvement in their ability to recognize increasingly detailed patterns of speech, a precursor to linking spoken words with their meanings.
Also in the first months of life, infants begin to use their oral mechanisms to produce nonspeech sounds, such as cooing and squealing, as they develop control of their muscles and movements.
Thus, they are able to produce increasingly consistent combinations of speech-like sounds and syllables babblinga precursor to articulating recognizable words e. Evidence from neurophysiological habituation, neuroimaging, and preferential looking studies shows that children begin to recognize speech patterns that recur in their environments early in the first year of life Friedrich et al, ; Pelucchi et al. When tested using behavioral measures, most to month-old children show that they can understand at least a few words in the absence of gestural or other cues to their meaning e.
They also can produce at least a few intelligible words during this period e. Their speech skills progress in a systematic fashion over the next few years, as they learn first to say relatively simpler consonants e.
Receptive language, expressive language, and speech all develop at a rapid pace through the preschool period as children learn to understand and say thousands of individual words, as well as learn the grammatical or morpho-syntactic rules that enable them to understand and produce increasingly lengthy, sophisticated, intelligible, and socially acceptable combinations of words in phrases and sentences e.
These speech and language skills enable children to achieve communication goals as diverse as understanding a simple story, taking a turn in a game, expressing an emotion, sharing a personal experience, and asking for help e.
By the end of the preschool period, children's ability to understand the language spoken by others and to speak well enough for others to understand them provides the scaffolding for their growing independence. The end of the preschool period is also when most children show signs that they can think consciously about sounds and words, an ability known as metalinguistic awareness Kim et al.
Awareness of the phonological sound characteristics of words, for example, enables children to identify words that rhyme or words that begin or end with the same speech sound. Such phonological awareness skills have been linked to children's ability to learn that speech sounds can be represented by printed letters—one of the skills necessary for learning to read words Troia, Reading requires more than recognizing individual words, however.
Competent readers also must understand how words combine to express meanings in connected text, such as phrases, sentences, and paragraphs. Strong evidence shows that children's receptive language skills—such as their knowledge of vocabulary and grammar—are important contributors as well to this aspect of reading comprehension Catts and Kamhi, ; Duke et al.
In short, by the time children enter elementary school, the speech and language skills they have acquired through listening and speaking provide the foundation for reading and writing. These new literacy skills are critical for learning and social development through the school years and beyond. At the same time, ongoing growth in spoken language skills contributes to building personal and professional relationships and participating independently in society.
It is worth noting that children's speech and language experiences may vary substantially depending on the values and expectations of their culture, community, and family. This point is most obvious for children being raised in multilingual environments, who acquire more than one language. Although the majority of people in the world speak two languages, bilingualism currently is not the norm in the United States, and bilingualism has sometimes been assumed to increase the risk of speech and language disorders.
However, there is no evidence that speech or language disorders are more prevalent in bilingual than in monolingual children with similar biological and sociodemographic profiles Gillam et al. Similarly, some investigators have reported differences in the amounts and kinds of language experienced by children according to their socioeconomic circumstances, and some of these differences have been associated with scores on later tests that emphasize language skills, including tests of vocabulary and verbal intelligence Hart and Risley, ; Hurtado et al.
The language spoken to children certainly influences their language skills, and some aspects of language have been linked to parents' socioeconomic and educational backgrounds e. However, the range of language variations observed to date has not been found to increase the risk of speech or language disorders independent of other factors associated with low socioeconomic status, including inadequate or poor-quality health care, hunger, reduced educational and social resources, and increased exposure to environmental hazards Harrison and McLeod, ; Parish et al.
Speech Disorders As described above, speech refers to the production of meaningful sounds words and phrases from the complex coordinated movements of the oral mechanism.
Speech requires coordinating breathing respiration with movements that produce voice phonation and sounds articulation. Respiration yields a stream of breath, which is set into vibration by laryngeal mechanisms voice box, vocal cords to yield audible phonation or voicing. Exquisitely timed and coordinated movements by the articulatory mechanisms, including the jaw, lips, tongue, soft palate, teeth, and upper airway pharynxthen modify this voiced stream to yield the speech sounds, or phonemes, of the speaker's native language Caruso and Strand, Speech disorders are deficits that may prevent speech from being produced at all, or result in speech that cannot be understood or is abnormal in some other way.
This broad category includes three main subtypes: Speech sound disorders can be further classified into articulation disorders, dysarthria, and childhood apraxia of speech. The speech variations produced by speakers of different dialects and non-native speakers of English are not defined as speech disorders unless they significantly impede communication or educational achievement. Speech sound disorders, often termed articulation or phonological disorders, are deficits in the production of individual speech sounds, or sequences of speech sounds, caused by inadequate planning, control, or coordination of the structures of the oral mechanism.
Dysarthria is a speech sound disorder caused by medical conditions that impair the muscles or nerves that activate the oral mechanism Caruso and Strand, Dysarthric speech may be difficult to understand as a result of speech movements that are weak, imprecise, or produced at abnormally slow or rapid rates Morgan and Vogel, ; Pennington et al.
Neuromuscular conditions, including stroke, infections e. Another rare speech sound disorder, childhood apraxia of speech, is caused by difficulty with planning and programming speech movements ASHA, Children with this disorder may be delayed in learning the speech sounds expected for their age, or they may be physically capable of producing speech sounds but fail to produce the same sounds correctly when attempting to use them in words, phrases, or sentences.
Voice disorders also known as dysphonias occur when the laryngeal structures, including the vocal cords, do not function correctly Carding et al. For example, a voice that sounds hoarse or breathy may be due to growths on the vocal cords, allergies, paralysis, infection, or excessive vocal abuse when speaking.
A complete inability to produce any sound, called aphonia, may be caused by inflammation, infection, or injury to the vocal cords. Stuttering also known as fluency disorder or dysfluency is a speech disorder that disrupts the ability to speak as smoothly as desired.
Language Disorders As described above, language refers to the code, or system of symbols, for representing ideas in various modalities, including hearing and speaking, reading, and writing. Language may also refer to the ability to interpret and produce manual communication, such as American Sign Language.
Language disorders interfere with a child's ability to understand the code, to produce the code, or both American Psychiatric Association, ; WHO, Children with expressive language disorders have difficulty in formulating their ideas and messages using language. Children with receptive language disorders have difficulty understanding messages encoded in language. Children with expressive-receptive language disorders have difficulty both understanding and producing messages coded in language.
Language disorders may also be classified according to whether they affect pragmatics, semantics, or grammar. Pragmatic language disorders may be seen in children who generally lack social reciprocity, a contributor to the dynamic turn-taking exchanges that typify the earliest communicative interactions e.
A child with a receptive pragmatic language disorder may have difficulty understanding messages that involve abstract ideas, such as idioms, metaphors, and irony. A child with an expressive pragmatic disorder may have difficulty producing messages that are socially appropriate for a given listener or context.
A child with a receptive semantic disorder may not understand as many vocabulary words as expected for his or her age, while a child with an expressive semantic disorder may find it difficult to produce the right word to convey the intended meaning accurately. A child with a receptive grammatical deficit may not understand the differences between word endings that indicate concepts such as past walked or present walkingor may not understand complex sentences e. Similarly, a child with an expressive grammatical disorder may produce short, incomplete sentences that lack the grammatical endings or structures necessary to express ideas clearly or completely.
Language disorders can interfere with any of these subsystems, singly or in combination. For example, children with severe pragmatic deficits may appear uninterested in communicating with others. Other children may try to communicate, but suffer from semantic disorders that prevent them from acquiring the words they need to express their messages.
Still other children have normal pragmatic skills and vocabularies, but produce grammatical errors when they attempt to combine words into phrases and sentences. Finally, children with phonological disorders may be delayed in learning which sounds belong in words. As mentioned earlier, language disorders first identified in the preschool period have been linked to learning disabilities when children enter school Sun and Wallach, For this reason, children with a history of language disorders as preschoolers are monitored closely when they enter elementary school, so that services can be provided to those whose language disorders adversely affect literacy, learning, and academic achievement.
Box summarizes the major types of speech and language disorders in children. Types of Speech and Language Disorders in Children. Co-occurring Speech and Language Disorders Speech and language disorders may co-occur in children, and in children with severe disorders it is plausible that less obvious deficits in other aspects of development, such as cognitive and sensorimotor processing, may also be implicated.
In the first few years of life it may be particularly difficult to determine whether a child's failure to speak is the result of a speech disorder, of a language disorder, or of both. For one thing, many speech and language abilities emerge during the early years of development, and disorders cannot be identified until children have reached the ages at which various speech and language abilities are expected. This difficulty is compounded by the fact that children under the age of approximately 30 months are often difficult to evaluate because they may be reluctant or unable to engage in formal standardized tests of their speech and language skills.
Fortunately, effective treatments for very young nonspeaking children exist that do not depend on differentiating speech from language disorders, and a child's rate of progress in treatment may provide important evidence on the nature and severity of the disorders.
In addition, studies of children with primary speech and language disorders often reveal that they have abnormalities in other areas of development. For example, studies by Brumbach and Goffman suggest that children with primary language impairment show general deficits in gross and fine motor performance, and such children also show deficits in working memory and procedural learning Lum et al.
The causes of stuttering are mostly a mystery. There is a correlation with family history indicating a genetic link. Another theory is that a stutter is a form of involuntary or semi-voluntary tic. Most studies of stuttering agree there are many factors involved. Because the causes of stuttering are largely unknown the treatments are mostly behavioral.
Triggers often precede a stuttering episode, and SLPs can help people recognize and cope with these triggers ahead of time. Dysarthria Dysarthria is a symptom of nerve or muscle damage.
It manifests itself as slurred speech, slowed speech, limited tongue, jaw, or lip movement, abnormal rhythm and pitch when speaking, changes in voice quality, difficulty articulating, labored speech, and other related symptoms.
It is caused by muscle damage, or nerve damage to the muscles involved in the process of speaking such as the diaphragm, lips, tongue, and vocal chords.
This can start during development in the womb or shortly after birth as a result of conditions like muscular dystrophy and cerebral palsy.
In adults some of the most common causes of dysarthria are stroke, tumors, and MS. Lisping A lay term, lisping can be recognized by anyone and is very common. Speech language pathologists provide an extra level of expertise and can make sure that a lisp is not being confused with another type of disorder such as apraxia, aphasia, impaired development of expressive language, or a speech impediment caused by hearing loss.
SLPs are also important in distinguishing between the five different types of lisps. It is caused by the tongue reaching past or touching the front teeth. Because lisps are functional speech disorders, SLPs can play a huge role in correcting these with results often being a complete elimination of the lisp.
Treatment is particularly effective when implemented early, although adults can also benefit. SLP intervention is recommended as soon as possible for all other types of lisps. Treatment includes pronunciation and annunciation coaching, re-teaching how a sound or word is supposed to be pronounced, practice in front of a mirror, and speech-muscle strengthening that can be as simple as drinking out of a straw. Lisps usually develop during childhood, and children will often outgrow an interdental or dentalised lisp on their own.
It is characterized by a spasming of the vocal chords when a person attempts to speak and results in a voice that can be described as shaky, hoarse, groaning, tight, or jittery. It can cause the emphasis of speech to vary considerably. SLPs will most often encounter this disorder in adults, with the first symptoms usually occurring between the ages of 30 and It can be caused by a range of things mostly related to aging, such as nervous system changes and muscle tone disorders.
After diagnosis SLPs can have a role helping with coaching to optimize voice production, and can be particularly effective in mild cases of SD.
This especially includes working on breathing control techniques to maintain a stead flow of air from the lungs. You might have heard a similar lay diagnosis for cluttering. This is an indication of how common this disorder is as well as how crucial SLPs are in making a proper diagnosis.
The first symptoms of this disorder appear in childhood. Like other fluency disorders, SLPs can have a huge impact on improving or eliminating cluttering.
This report highlights findings on gender distribution from clinical research and national survey data. However, the evidence base on the effects of gender on the efficacy of treatment and the progression or persistence of speech and language disorders is limited. In its review of the literature, the committee found that few studies examined differential effects of treatment on males and females or included longitudinal data that demonstrated gender differences in the persistence or progression of speech and language disorders.
Through its examination of the evidence, the committee became aware that states vary considerably in the number and rate of applications leading to determinations and in the rate of allowances. This report includes some state-level data to provide an overall perspective, but it does not explore the potential factors contributing to state-to-state variation in the rates of SSI disability, which was beyond the scope of this study.
Doing so would be beyond not only the scope of this study as laid out in the statement of task but also the expertise of this committee. Rather, the committee was tasked with gathering information and reporting on the current state of knowledge on the diagnosis, prognosis, and treatment of speech and language disorders in children, as well as trends in the prevalence of these disorders in children.
The information presented in this report and in the recent Academies report on trends in low-income children with mental disorders in the SSI program [ NASEM, ] provides a solid evidentiary basis that can inform the SSA's programs and policies, as well as the work of an array of related stakeholders. STUDY APPROACH The study committee included 13 members with expertise in speech-language pathology, auditory pathology, pediatrics, developmental-behavioral pediatrics, epidemiology, biostatistics, neurology, neurodevelopmental disabilities, adolescent health, health policy, and special education.
See Appendix H for biographies of the committee members. A variety of sources informed the committee's work. The committee met in person five times: In addition, the committee conducted a review of the literature to identify the most current research on the etiology, epidemiology, and treatment of pediatric speech and language disorders.
The committee made every effort to include the most up-to-date research in peer-reviewed publications. However, strong evidence was sometimes found in older studies that had not been replicated in recent years.
In these instances, the older studies are cited. The committee also reviewed findings from a supplemental study using Medicaid data to create an approximate national comparison group for the SSI child population. All languages include words vocabularyword endings morphologyand sentence structure syntaxand speech includes the pronunciation of the sounds phonemes of the language.
Language development also encompasses acquisition of the social rules for communicating and conversing in society pragmatics. These rules include participating appropriately in conversations, as well as using and comprehending appropriate gestures and facial expressions during social interaction Gallagher and Prutting, The communication and social aspects of speech and language must be coordinated rapidly and fluently when one is speaking.
Given the complex nature of speech and language development, multiple factors can contribute to deficits in their acquisition and use e.
Disruptions in communication development are broadly classified as speech disorders and language disorders. Speech disorder is defined as disruption in the production of the phonetic aspects of words, phrases, and sentences so that communication is partially or, in severe cases, completely unintelligible to listeners.
Language disorder is defined as impairment of expression and comprehension because of a disruption in the acquisition of vocabulary wordsword endings, and sentence structure. In severe cases of language disorder, a child experiences extreme difficulty using correct words and proper grammar and may also have difficulty comprehending what others are saying.
Box presents the clinical definitions of speech and language disorders. Furthermore, speech and language disorders can be categorized as primary, meaning the disorder does not arise from an underlying medical condition e. This report discusses both primary and secondary speech and language disorders, but it focuses mainly on speech and language disorders that are identified as the primary condition. This corresponds with the categories of speech and language disorders in the SSI program that the report examines.
These disorders are serious disabilities with long-term ramifications for cognitive and social-emotional development and for literacy and academic achievement and have lifelong economic and social impacts, and these disruptions are evidenced in increased risk for learning disabilities, behavior disorders, and related psychiatric conditions. The following sections describe the variety of ways in which speech and language disorders can impact children and their families. Impact on Social-Emotional and Cognitive Development Child development is best viewed in the context of a dynamic interaction between social-emotional and cognitive development Karmiloff-Smith et al.
A seminal paper by Sameroff brought attention to the critical role of parent—child interactions and social-communicative exchanges in children's social and emotional development.
In this communicative-interactive model, social development is the direct product of parent—child or caregiver—child interaction Sameroff, Specifically, parent—child communication interactions, including speech and language skills, are foundational to emotional attachment, social learning, and cognitive development in addition to communication development.
Figure illustrates how social interaction between parent and child leads to the development of speech. In the decades since Sameroff's original article, the communication-interaction model has been applied to multiple aspects of development, including speech Camarata,language Nelson,the development of self Damon and Hart,and cognitive development Karmiloff-Smith et al.
Karmiloff-Smith adapted the communication-interaction perspective as a means of mapping developmental processes across multiple domains of genetics and neuroimaging, as well as cognitive and linguistic abilities. In essence, she argues that dynamic communication interactions between parent and child serve not only as learning opportunities but also as the core of the genetically mediated neural phenomena occurring for childhood brain development, often referred to as neural plasticity and remodeling.
Viewed in this way, communicative interchanges are fundamental to the developmental experiences that shape a child's neural architecture and, more important, brain function. Severe speech and language disorders can derail this typical cascade of development and have profound and wide-ranging adverse impacts Clegg et al.
Impacts on Literacy and Academic Achievement Figure illustrates the importance of language development for the development of literacy skills and the relationship of both to academic achievement across a range of subject areas.
Considerable data suggest that severe speech and language disorders are associated with reading disabilities and general disruptions in literacy Fletcher-Campbell et al. In essence, reading involves mapping visual symbols letters onto linguistic forms words. When the acquisition and mastery of oral vocabulary are impaired, it is not surprising that the mapping of symbols such as letters onto words is also disrupted.
In addition, broader language and speech disorders can make processing the visual symbols much less efficient and disrupt their mapping onto meaning. Even after vocabulary has been acquired, cognitive problems with translating text to language can continue Briscoe et al.
In languages such as English that use phonetic text, severe speech disorders also can disrupt the phonological processing associated with reading Pennington and Bishop, In sum, severe speech and language disorders often have direct or indirect adverse impacts on the development of literacy and fluid reading.
10 Most Common Speech-Language Disorders
In addition to their direct impact on literacy, severe speech and language disorders can have a deleterious cascading effect on other aspects of academic achievement. To illustrate, in a year follow-up study of children with speech and language disorders, a high percentage 52 percent of the children initially identified with such disorders had residual learning disabilities and poor academic achievement later in life King, Similarly, Hall and Tomblin report poor overall long-term achievement in language-impaired children.
More recently, a study of preterm infants with language disorders indicated multiple disruptions in subsequent achievement Wolke et al. And Stoeckel and colleagues found a strong correlation between early language problems and later diagnosis of written-language disorders.
Because so much of academic achievement is predicated on acquiring information through reading and listening comprehension, early severe speech and language disorders often are associated with poor achievement beyond reading problems.
As illustrated in Figurethe most recent data from the Institute of Education Sciences of the U. Department of Education indicate that 21 percent of all special education eligibility in the United States is for speech and language impairments—three times greater than eligibility for autism or intellectual disability. Speech and language disorders are among the highest-incidence conditions among children in special education. Moreover, these data may underestimate the prevalence of speech and language disorders because the highest-incidence condition—specific learning disability—includes many students who were previously categorized as having a speech or language impairment Aram and Nation, ; Catts et al.
Although mild speech and language impairments in preschool will sometimes be transient, severe forms of the disorders have a high probability of being long-term disabilities Beitchman et al. Economic and Family Impacts In a review of the economic impact of communication disorders on society, Rubenp. Following a cohort of individuals with severe language disorders in childhood longitudinally through school age and adolescence and into early adulthood, Clegg and colleaguesp.
For example, data from the U. Census showed that families raising children with a disability experienced poverty at higher rates than families raising children without a disability At the same time, childhood poverty and the accompanying deprivations have significant adverse implications for children with disabilities and their families.
Families with children with disabilities are also more likely to incur increased out-of-pocket expenses; for example, for child care or for transportation to locations with specialized medical care Kuhlthau et al. Data from the National Survey of Children with Special Health Care Needs help illustrate the impact on families of caring for children with communication disorders. For example, the survey asked whether family members cut back on or stopped working because of their child's health needs.
In sum, given the complex multidimensional nature of language acquisition and the integral role of speech and language across multiple domains of early child development, speech and language disorders occur at relatively high rates Kena et al. These disorders also are associated with a wide range of other conditions Beitchman et al. In an effort to understand these trends in comparison with trends in the general population, the SSA requested that the IOM conduct two studies: While these impairments frequently co-occur and may have similar diagnostic characteristics, the separate studies allowed two independent committees to examine distinct literatures and data sources and to review different standards of care and treatment protocols.
The study on children with mental health disorders was conducted from January through August ; the final report of that study was released in September NASEM, While this report is the first examination of the SSI disability program for children with speech and language disorders conducted by the Academies, the IOM, and the National Research Council NRC have a long history of studying issues related to disability in children and adults and the SSA's disability determination process.
Along with this earlier work of the Academies, the committee drew important lessons from the body of data and research aimed at identifying trends in the prevalence and persistence of speech and language disorders, as well as addressing diagnosis and treatment of and levels of impairment associated with these disorders.
Developmental disorders are identified when expected functional skills in children fail to emerge. Underlying factors that contribute to developmental disorders are likely to have been present well before the signs are manifest in the child's development. In a year follow-up study of children with speech and language disorders, 52 percent of the children initially identified with such disorders had residual learning disabilities and poor academic achievement later in life.
Twenty-one percent of all special education eligibility in the United States is for speech and language impairments—three times greater than eligibility for autism or intellectual disability. Mild speech and language impairments in preschool will sometimes be transient; severe forms of these disorders have a high probability of being long-term disabilities. It is organized to provide readers with important background information on speech and language disorders in children in the general population before describing the subset of children with severe speech and language disorders who receive SSI benefits.
To take readers through this progression, the report describes the SSI program in some detail. This description is intended to orient readers to the determination process that shapes the population served by the program: The report then compares changes over time in the prevalence of speech and language disorders in the general and SSI child populations, based on the best evidence available.
The report culminates with a summary of the committee's overall findings and conclusions. The contents of each chapter are as follows: Chapter 2 provides an overview of childhood speech and language disorders in the general U.
The chapter begins with an overview of speech and language development in children. It then examines the diagnosis of speech and language disorders in children, causes and risk factors, and prevalence. The chapter also includes evidence related to common comorbidities of childhood speech and language disorders. Chapter 3 reviews what is known about the treatment and persistence of speech and language disorders in children.
This review includes current standards of care for these disorders, an overview of treatment approaches for different speech and language disorders, and expected responses to treatment. Chapter 4 provides an overview of the SSI program for children, how it has changed over time, and how those changes have shaped the population of children receiving SSI benefits.
It describes the eligibility determination process and the speech and language-related criteria that are used to evaluate children. Finally, the chapter includes case examples and a review of a random sample of case files of children who receive SSI benefits based on speech and language disorders.