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DeThorne L.S., Hengst J.A., and Hamilton M.-B., Communication Disorders. In: Howard S. Friedman (Editor in
Chief), Encyclopedia of Mental Health, 2nd edition, Vol 1, Waltham, MA: Academic Press, 2016, pp. 324-329.

Copyright © 2016 Elsevier Inc. unless otherwise stated. All rights reserved.
 Author's personal copy

Communication Disorders
LS DeThorne, JA Hengst, and M-B Hamilton, University of Illinois, Champaign, IL, USA
r 2016 Elsevier Inc. All rights reserved.

Glossary Congenital communication disorders Communication

Adult-acquired communication disorders Communication disorders evident at birth.
disorders that disrupt communication after mature skills have Developmental communication disorders Communication
been established. disorders that emerge behaviorally during the course of
Communication differences Patterns of speech and childhood.
language use that are consistent with one‘s linguistic Hearing The sensory-perceptual process of
community yet differ from a perceived mainstream receiving sound.
standard. Language The cognitive-linguistic process of formulating
Communication disorders A presumed intrinsic and interpreting messages.
impairment, mild to severe, in an individual‘s speech, Speech The sensory-motor process of talking.
language, or hearing mechanisms relative to peers from
one’s own cultural-linguistic group.

Introduction functions (e.g., swallowing, balance, literacy, use of technol-

ogy, augmentative and alternative communication (AAC)),
Communication sciences and disorders (CSD) is a well- and continues to serve as a critical research base for the clinical
established area of research and clinical practice that emerged professions.
in the United States and Europe during the first half of the Within CSD, communication disorders are identified and
twentieth century. Broadly, CSD has sought to understand the differentiated by behavior profiles associated with perceived
character of communication disorders, to address the practical disruptions in an individual’s sensory, motor, or cognitive
goals of diagnosing and treating communication disorders in systems. Communication disorders are broadly identified by
children and adults, and to ultimately improve the quality of which of the three key physiological systems are presumed to
life of individuals with such disorders (International Associ- be involved: disorders of ‘hearing’ (due to impairment of the
ation of Logopedics and Phoniatrics, 2010). The International sensory-perceptual hearing mechanisms); disorders of ‘speech’
Association of Logopedics and Phoniatrics (IALP), one of the (due to impairment to the sensory-motor speech mech-
oldest professional organizations in the field, was established anisms); and disorders of ‘language’ (due to impairment in
in 1924 with the inaugural Congress of researchers and prac- higher cortical functions that control language use). Over the
titioners held at the Vienna Institute of Physiology. The IALP past century, research has differentiated multiple communi-
supports the exchange of science and services across 55 affili- cation disorders within each of these three physiological sys-
ated societies with 230 000 members from 35 countries. tems, which we will describe briefly in the sections below.
Speech, language, and hearing organizations exist globally, Across all communication diagnoses it is critical to note that
including in countries such as Canada (Canadian Association although they often correlate highly with specific medical
of Speech Language Pathologists and Audiologists), India diagnoses, or etiologies, communication diagnoses are based
(Indian Speech and Hearing Association), and Australia on behavioral profiles, not specific sites of physical damage.
(Speech Pathology Australia). The American Speech-Language- In addition to the physiological system presumed to be
Hearing Association (ASHA), which is the field’s professional, affected, communication disorders are often differentiated by
credentialing, and scientific organization in the United States, the age of the individual when the behavioral differences are
also traces its origins to the first half of the twentieth century observed. Broadly, the field distinguishes between communi-
and reports over 150 000 members. Shaped by both external cation disorders that occur in childhood versus those that
discoveries in other fields and internal needs of the clients with occur in adults. Of particular relevance is the time of onset in
communication disorders and their families, CSD has grown relation to the individual’s developing hearing, speech, and
considerably over the last century. Today, the field is recog- language abilities, which is reflected by the following labels:
nized in university departments around the world and certified ‘congenital communication disorders,’ which are evident at
practitioners specializing in disorders of hearing (i.e., audi- birth; ‘developmental communication disorders,’ which
ologists) and speech and language disorders (i.e., logopedists, emerge behaviorally during the course of childhood; and
speech-language therapists, or speech-language pathologists) ‘adult-acquired communication disorders,’ which disrupt
practice in diverse institutional settings such as hospitals, communication after mature skills have been established.
schools, rehabilitation centers, and private practices. Over the Another critical distinction in the field relates to differentiating
last century, research in the field has continued to expand our communication disorders from what is considered typical
understanding of the biological, cognitive-linguistic, and social cultural–linguistic variation. Informed largely by the field of
bases of communication; and has begun to focus on related sociolinguistics, the field of CSD has become increasingly

324 Encyclopedia of Mental Health, Volume 1 doi:10.1016/B978-0-12-397045-9.00060-4

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Communication Disorders 325

interested in ‘communication differences,’ speech-language ear or the nerve pathways from the inner ear to the brain.
patterns that are consistent with one’s linguistic community Common causes include aging, noise exposure, pre- or post-
and not attributable to learning difficulties. For example, natal infections, ototoxic drugs, and genetic variations. Mixed
consider differences in the production of the word [card] in the hearing loss includes both conductive and sensorineural
midwestern versus northeastern regions of the United States: components. Central hearing loss, also known as auditory
the [r] would be explicitly rhotacized in the former [card] but processing disorder, refers to difficulty processing sound, par-
not in the latter [caad]. Such variations that are consistent ticularly speech, at the level of the central nervous system.
within communities of speakers are considered dialect differ- Given that prominent symptoms include difficulty following
ences rather than indices of disorder. directions, particularly in noisy environments, the disorder
Finally, of critical interest for the field of CSD are the de- overlaps in categorization with language disorders.
velopmental course and social outcomes for individuals with In addition to type, hearing loss is also described in terms
communication disorders, including patterns of recovery and of degree and configuration. Degree refers to the severity of
responses to treatment. Such findings paired with broader loss, mild to profound, in comparison to expected hearing
society shifts are moving the focus of intervention away from sensitivity as measured in decibels (dB); ‘deafness’ is often a
targeting isolated speech, language, and hearing mechanisms term reserved for individuals with the most substantial degree
and towards developing robust and flexible communication of hearing loss, though the same term when capitalized is used
networks that include partners and everyday environments. to refer to a specific cultural-linguistic identity. The configur-
Said another way, intervention shifts from treating individuals ation of hearing loss refers to the frequencies, low to high, that
to supporting the relationships and communities individuals are affected. Other descriptors for hearing loss relate to whe-
are involved in. ther one or both ears are impacted (i.e., unilateral vs. bi-
The diagnosis and treatment of hearing and balance dis- lateral), whether the onset is sudden or progressive, and
orders across all ages fall under the scope of practice of audi- whether the loss is stable or fluctuates over time. ‘Presbycusis’
ologists, whereas the diagnosis and treatment of speech, is a progressive hearing loss found in older adults (50 þ years)
language, and swallowing disorders are the purview of speech- that often initially affects the high frequencies. The severity of
language pathologists (ASHA, 2004, 2007). Below, we will loss increases across time, and often includes central hearing
briefly describe the range of communication disorders diag- loss. Often associated with hearing loss, ‘tinnitus’ is a hearing
nosed by audiologists and speech-language pathologists, disorder defined by internal sound perception that is not
characterizing the diagnosis and prevalence, discussing com- attributable to an external sound source. Specifically, tinnitus
plications in assigning the diagnostic labels, and briefly de- presents as a ringing, hissing, roaring, or whooshing in the
scribing outcomes for individuals with communication ears.
disorders. United States census data reported by Bess and Humes
(2008) indicated that approximately 35 million (16%)
Americans indicated hearing loss, with the prevalence in-
creasing to nearly 40% in individuals over the age of 65.
Behavioral Profiles of Communication Disorders
Prevalence of hearing loss in young children was estimated to
be as high as 15%, with congenital hearing loss diagnosed in
In essence, a ‘communication disorder’ is defined as a be-
2–3 of every 1000 live births. Tinnitus reportedly impacts one
havioral profile linked to a presumed intrinsic impairment,
in five people (American Tinnitus Association, 2013).
mild to severe, in an individual’s speech, language, or hearing
mechanisms relative to same-age peers from one’s own cul-
tural-linguistic group. Clinicians base diagnoses on a com-
bination of formal and informal assessments, including Disorders of Speech
behavioral observations, detailed case histories, standardized
Foundational to the field, speech disorders refer to individual
tests, and electrophysiologic measures.
differences in the sensory-motor processes of talking that are
not consistent with one’s age and linguistic community. Such
differences are often categorized as impacting articulation,
Disorders of Hearing
voice, or fluency. An articulation disorder involves the sub-
Hearing disorders are the result of impairment in the auditory stitution, addition, omission, or distortion of speech sounds
system and often impact the development, comprehension, that may negatively impact message intelligibility, for ex-
production, and/or maintenance of communication skills. ample, producing the word [sun] as [tun]. The developmental
Specifically, hearing impairment is classified by type, degree, milestones for individual speech sound production ranges
and configuration (Bess and Humes, 2008; Canadian Academy from 2 to 8 years of age. If a child has not developed certain
of Audiology, 2013). Hearing loss type refers to which part of sounds within the expected time frame, an articulation im-
the auditory system is involved. Specifically, ‘conductive pairment may be present. Developmental expectations and
hearing loss’ refers to diminished sound conduction through related recommendations can be found on the ASHA website
the outer and middle ear. Common examples include a mis- (2013a). Whereas an articulation disorder is production-based
shapen outer ear, infection of the middle ear, and impacted and thought to be specific to individual sounds, a ‘phono-
earwax in the ear canal. Conductive hearing loss is often logical disorder’ is attributed to linguistically rule-governed
treated through medical intervention. In contrast, ‘sensor- differences in the production of multiple speech sounds with
ineural hearing loss’ is associated with impairment in the inner similar features (Bernthal et al., 2009). For example, if a child’s
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326 Communication Disorders

production of [sun] as [tun] was a pattern that impacted most common form of fluency disorder is stuttering, which
multiple sounds with continuous airflow such as [f] and [sh], can be acquired (also known as neurogenic) or develop-
it would be considered phonological in nature. Such patterns mental. Acquired stuttering may be due to injury, such as
are not considered indicative of disorder unless an individual stroke, illness, or certain medications. However, the majority
has surpassed the age at which such production patterns are of cases are developmental, emerging in early childhood
expected. Given their rule-based nature, phonological dis- around the period of rapid language growth.
orders are often classified under language disorders as well as The incidence of stuttering is reported to be as high as 5%
speech. with spontaneous recovery before the age of 6 years noted in
‘Motor speech disorders’ are associated with acquired or approximately 75% of the cases (Yairi and Ambrose, 1999). As
developmental neurologic impairments such as cerebral palsy, such, the prevalence of persistent stuttering in school-age
multiple sclerosis, and traumatic brain injury. ‘Dysarthria’ re- children and adulthood is reported around 1%, with the ratio
fers to a group of motor speech disorders marked by muscle of affected males to females being 4:1 (Bloodstein and Bern-
weakness, paralysis, and slowness and dyscoordination of the stein-Ratner, 2008).
muscles for speech production, including respiration, phon-
ation, velopharyngeal valving, articulation, and prosody
(Bernthal et al., 2009). Dysarthria can be caused by damage to
Disorders of Language
lower or upper motor neurons, with different sites of lesion
leading to different behavioral profiles (Duffy, 1995). In Language disorders refer to individual differences in the cog-
contrast, apraxia of speech, also known as verbal apraxia, can nitive-linguistic domains of semantics (words and meaning),
be caused by central or cortical damage that impacts speech morphosyntax (grammar), phonology (rule-governed use of
motor programing, thereby leading to highly variable speech speech sounds as covered previously), and pragmatics (social
production errors that cannot be accounted for by muscle rules and expectations) that are not consistent with one’s age
weakness. Unlike dysarthria, apraxia of speech more severely and linguistic community (American Speech-Language-Hear-
affects volitional movements, resulting in moments of strik- ing Association Ad Hoc Committee on Service Delivery in the
ingly less effortful production on highly automatic or over- Schools, 1993). Language disorders may be developmental or
learned speech. Developmental apraxia, or childhood apraxia acquired and are generally categorized as receptive (e.g., dif-
of speech, shares a similar behavioral profile to acquired ficulty with comprehension of what has been said), expressive
apraxia but with less clear etiology. (difficulty with message production), or mixed (difficulty with
Prevalence rates of developmental speech sound disorders both comprehension and production). Language disorders
range from 1% to 14% with prevalence rates higher for can manifest themselves in both the spoken and written
younger children (Law et al., 2000; McKinnon et al., 2007). modalities.
Motor speech disorders are less common, with prevalence of Diagnostic labels related to language disorder have been
childhood apraxia of speech estimated at less than 1% (The largely differentiated based on their developmental versus ac-
Childhood Apraxia of Speech Association of North America, quired nature. Developmental language disorders can be
2013). In adults, motor speech disorders in general represent isolated to linguistic skills, as in the case of ‘specific language
approximately one-third of adult-acquired communication impairment’ (cf. Leonard, 1998), or associated with other
disorders (Duffy, 1995). developmental domains. Leading theories suggest substantial
‘Voice disorders’ are typically acquired, as opposed to de- overlap between language and reading/writing disorders,
velopmental, and are caused by impairments in the structure which is likely mediated through difficulties in perceiving and
or function of the larynx, commonly known as the voice box segmenting speech sounds (i.e., phonological awareness). A
(Titze and Abbott, 2012). Voice disorders may be characterized school-age child who has difficulties with reading, writing, or
by atypical phonation including changes in vocal quality (e.g., spelling might be diagnosed with a ‘language-based learning
hoarseness and breathiness), reduced range and control of disability’ (ASHA, 2013b); however, when the primary diag-
pitch and loudness, vocal fatigue, aphonia, strained/struggling nosis involves difficulty specifically with reading, the diagnosis
voice production, vocal tremor, and pain or other physical of ‘dyslexia’ is often applied. ‘Autism spectrum disorder’ rep-
sensations (Colton and Casper, 1996). Drawing on medical resents a developmental disorder defined by difficulties with
classification systems, voice disorders associated with known communication/social interaction, and restricted/repetitive
vocal pathologies or impairments (e.g., paralyzed vocal fold) behavior. As with most communication disorders, the extent
are referred to as organic voice disorders, whereas those of individual differences varies widely; individuals with autism
without an identifiable pathology (e.g., overuse or misuse of range from being described as nonverbal to having typical
vocal mechanism) are referred to as functional voice disorders. language development.
Estimated prevalence rates for voice disorders range from Similar to developmental language disorders, the diagnoses
o1% to 15% of the general population (Roy et al., 2005). for adult-acquired language disorders differentiate between
‘Fluency disorders’ are characterized primarily by dis- those that are language specific and those that impair prag-
ruptions in the flow of speech manifested as blocked airflow, matics or language use. ‘Aphasia,’ which is caused by focal
prolonged sounds, or unusual repetition of individual sounds, damage to the dominant (usually left) hemisphere of the
syllables, words, or phrases (National Stuttering Association, brain, is an acquired language disorder that impairs com-
2013; Speech Pathology Australia, 2012a,b). Secondary char- prehension and production of language, both written and
acteristics may include tense and repetitive body movements spoken (Brookshire, 2003; Speech-Language & Audiology
and extreme articulatory tension during speech. By far the Canada, 2013). The severity and pattern of symptoms vary,
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Communication Disorders 327

and subtypes of aphasia correlate with specific sites of damage. of signed languages led to the instantiation of a Deaf cultural
For example, the Boston classification system differentiates community. In broad terms, the Deaf community views
non-fluent aphasias (Broca‘s, Transcortical Motor, Global) due ‘Deafness’ as a normal cultural-linguistic variation rather than
to anterior left hemisphere damage, from fluent aphasias a disorder. In a similar vein, the more recent Neurodiversity
(Wernicke, Transcortical Sensory, Conduction) due to pos- movement casts certain neurological conditions such as aut-
terior left hemisphere damage. A hallmark of aphasia is that ism as typical neurological variation rather than specific dis-
individuals often display strikingly well preserved social or orders. Such a shift in perspective suggests that the goal should
pragmatic skills in the face of even profound disruptions to be to accommodate, even celebrate such differences, rather
linguistic content and form. In contrast, individuals with than attempt to ‘cure’ them. The effectiveness of this approach
‘cognitive-communication disorders’ from diffuse damage or rests largely on an interaction between the extent and nature of
damage to the non-dominant hemisphere (e.g., right hemi- one’s individual differences and the nature and flexibility of
sphere disorder) have surprisingly preserved linguistic forms, one’s environment.
but poor pragmatic abilities, and poor verbal memory, prob- An additional nuance in the attempt to differentiate dif-
lem solving, and complex language use (Davis, 2007). ference from disorder is that sometimes individuals seek to
It is estimated that between 6 and 8 million people in the employ speech-language pathologists to bring about changes
United States have a form of language disorder (NIDCD, in their speech-language patterns even when they do not have
2010). Prevalence rates for kindergarten children identified communication disorders. For example, accent modification
with specific language impairment is 7.4%, with 8% preva- refers to services aimed at helping individuals attain languages
lence rates for boys and 6% for girls (Tomblin, 1997); the or dialects that they aspire toward. In addition, actors, polit-
reported prevalence rate for autism spectrum disorders has icians, or transgender individuals might seek the services of
been increasing, with recent estimates from the Center for speech-language pathologist in order to attain desired voice
Disease Control and Prevention (2014) at 1 in 68 children, qualities. Regardless of the somewhat murky distinction be-
with rates in boys reportedly as high as 1 in 42. Acquired tween difference and disorder, a common thread running
language disorders are less prevalent; in particular, aphasia through all examples is the key role that communication plays
affects more than 100 000 Americans per year with a total in forming community, solidifying personal identity, and ac-
prevalence rate of about 1 million people (or 1 in 250) in the cessing social capital.
United States (National Aphasia Association, 2011).

Etiologies
Communication Disorder versus Communication
Difference Despite the explicit focus on behavioral profiles, increasing ef-
forts have been made to understand the cognitive processes and
Informing and complicating diagnoses across all three areas of neurobiological bases of communication disorders (Bishop and
hearing, speech, and language disorders is the distinction be- Snowling, 2004), particularly in light of expanding advances in
tween impairment and cultural-linguistic difference (American neuroimaging. For example, attempts have been made to as-
Speech-Language-Hearing Association Ad Hoc Committee on sociate language impairments with differences in underlying
Service Delivery in the Schools, 1993; Speech Pathology Aus- cognitive processes, such as memory, auditory processing,
tralia, 2012a,b). Specifically, ‘dialect’ differences represent rule- symbolic understanding, and theory of mind. Likewise, speech-
governed variations in all aspects of a particular language (i.e., sound disorders have been associated with differences in sens-
vocabulary, grammar, speech sounds, and social use) that ory-motor learning. Accordingly then, such cognitive processes
emerge within specific communities of speakers based on are often linked to certain neurological substrates. In regard to
shared geography, gender, race/ethnicity, and socioeconomic neurobiological bases, speech and language impairments are
experience. In addition to the pronunciation of [r] noted in the most consistently linked with differences in certain dominant
introduction, dialect differences also impact vocabulary, as in hemisphere regions (e.g., Broca’s area, Wernicke’s arcuate fas-
the use of the words [stocking cap] versus [toque] in American ciculus). In the case of acquired adult neurogenic disorders,
versus Canadian English. As an example of a grammatical there is often overt damage to one or more of these areas with
difference, consider the plural [s] in the phrase [two chickens], damage lower in the nervous system associated with a clearer
which would be considered obligatory within mainstream one-to-one correspondence. Developmental disorders are more
American English dialect but not within African-American commonly associated with structural or functional differences
English dialect. To complicate matters further, the same lin- than overt neurological damage. For example, there is a general
guistic feature, such as how a sound is pronounced or whether tendency for individuals with developmental speech and lan-
a particular verb is inflected, can be due to impairment, a guage disorders to display greater bilateral activation during
dialect difference, or an interaction of both. Consequently, speech and language tasks. It is unclear whether such differences
knowledge of cultural-linguistic variation is critical to the in lateralization reflect the origin of the speech and language
process of differential diagnoses in CSD. disorders themselves or resulting compensatory strategies
As communities shift, so too do the boundaries between (Bishop, 2013).
difference and disorder. As an historical example, children In terms of underlying etiology, most disorders are attrib-
with substantial hearing loss were often cast as speech- uted to a complex interplay of environmental and genetic
impaired and even cognitively-disabled, but the development factors. Environmental influences are varied, including such
of schools for children with hearing loss and the proliferation factors as nutrition, illness, injury, and exposure to toxins.
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328 Communication Disorders

In the case of language development, the frequency and nature pressing need within and outside the field to develop richer
of social interactions is commonly cited in CSD literature as an understandings of how such behaviors integrate into the com-
important influence, although direct causal links between plex landscape of successful social interactions. Whether it is a
linguistic input and cases of language impairment are limited toddler asking her father for a cookie or a congresswoman
(cf. Conti-Ramsden, 1985). Despite the preponderance of drafting a complex piece of legislation, communicative success
proposed environmental effects, few communication disorders is by definition a social accomplishment. In contrast to re-
are free of genetic influence. In addition to identified genetic ductionist models that study isolated traits and behaviors, social
disorders, such as Down syndrome, primary communication approaches emphasize that communication for everyone is
impairments have also been directly linked to genetic effects multimodal, distributed across individuals, and situated within
(Rice et al., 2009; Wittke-Thompson et al., 2007), including activities (Gee, 2011). Such approaches highlight the need to
specific gene mutations (Lai et al., 2001). In the case of hearing study the complexity of social interactions directly.
loss, approximately 50% of auditory disorders are attributed to Outside of the field, the World Health Organization has
hereditary factors, and at least 20 types of genetic deafness are already recognized such complexity within its 2001 revision of
known to occur in relative isolation from other impairments the International Classification of Functioning, Health, and
(Bess and Humes, 2008). Despite the prevalence of genetic Disability (ICF; WHO, 2001). The revised ICF reflects a non-
influences, the effects of genetics on communication skills are linear biopsychosocial framework of health that includes
rarely straightforward. Complex behavioral traits, such as contextual components and highlights activity participation.
language, are likely governed by numerous quantitative trait The ICF argues that, although health and disability may be
loci, which individually are responsible for relatively small related to specific etiologies or diseases, identification of such
effects that are difficult to detect (Plomin, 2005); in addition, factors alone cannot predict or restore an individual’s func-
evidence of gene–environment correlations, interactions, and tional status. Moreover, patterns of functioning can be dis-
epigenetic effects continue to emerge (e.g., Cushing and rupted even in the absence of disease (Threats, n.d.).
Kramer, 2005; Plomin et al., 1977). Another external influence that has highlighted the complex
multimodal nature of all communicative interactions is the
emergence of computerized and digital technologies. In add-
Developmental Course and Social Outcomes ition to compact and powerful computer systems that are
able to serve as dedicated AAC devices for individuals with
As a consequence of the complex interplay of etiological influ- speech-language impairments, rapid asynchronous online
ences across one’s life span, the causal influences and behavioral communication systems (e.g., email, text messaging, and social
profiles of communication disorders are never static. Some ac- networking) and online gaming platforms are providing alter-
quired disorders, such as certain voice disorders, are associated nate means of supporting and experiencing social interaction at
with recovery. However, many acquired speech-language dis- large. Such technologies encourage us to redefine how we think
orders persist over time, requiring substantial neural reorganiza- about everyday communicative environments, underscoring the
tion and accommodation. In the case of certain developmental importance of resources that are visual, gestural, and embodied
speech-language disorders, such as stuttering and early language as well as linguistic. In accordance with such shifts, social
delay of unknown origin, spontaneous recovery by school age is approaches emphasize the need to move beyond changing
approximately 75% (Paul, 1996; Yairi and Ambrose, 1999). an individual’s isolated traits and toward creating robust
However, given the prominent role of communication in every- and flexible communication environments. In sum, social
day life, individuals with persistent communication disorders are approaches demand that speech-language pathologists and
often at risk for social, academic, and occupational challenges audiologists extend their established roles as diagnosticians
(Beitchman et al., 2001; Code and Muller, 2004; Yoshinaga- and coaches to embrace the role of communication partner,
Itano, 2003). For example, children with early developmental one who is expertly prepared to help navigate complex
speech-language disorders are at risk for social-emotional dif- social landscapes in order to foster better communicative and
ficulties and academic challenges, particularly with regard to life outcomes (e.g., Hengst and Duff, 2007; DeThorne et al.,
reading development (Bishop and Snowling, 2004; Redmond, 2013).
2004). More broadly, data on Americans with disabilities from
the US Census Bureau (2010) indicate that the employment rate
among individuals of age 21–64 years with was 34% for those See also: Aphasia, Alexia, and Agraphia. Autism Spectrum
with speech difficulty and 55.5% for those with hearing Disorder. Disability and Mental Health. Learning Disorders and
difficulty. Dyslexia. Mental Health in Developmental Disabilities. Nonverbal
Communication. Traumatic Brain Injury. Unemployment and Mental
Health
Future Directions

The difficulties faced by individuals with communication dis-

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