COMMUNICATION DISORDER
Communication disorders refer to conditions that affect a person’s ability to
understand, produce, or use language effectively. These disorders can impact
speech, language, or both, and can arise at any stage of life. They may result from
neurological, developmental, physical, or psychological factors. Below are the main
types of communication disorders, including their characteristics, diagnostic criteria,
and examples.
Types of Communication Disorders
1. Speech Disorders
These disorders involve difficulty with producing sounds or speech patterns.
Articulation Disorders: Difficulty pronouncing words or sounds correctly.
o Example: A child may say “wabbit” instead of “rabbit” or have trouble
producing specific sounds like "r" or "s."
Fluency Disorders: Difficulty with the flow of speech, often characterized by
stuttering.
o Example: A person may repeat syllables (e.g., "I-I-I want") or
experience pauses in speech, making communication disjointed.
Voice Disorders: Problems with the pitch, volume, or quality of the voice.
o Example: Hoarseness, breathiness, or loss of voice can occur due to
vocal cord damage or misuse.
2. Language Disorders
Language disorders affect comprehension or production of language, which can
include both verbal and written forms.
Receptive Language Disorder: Difficulty understanding spoken or written
language.
o Example: A person may struggle to follow directions or comprehend
questions.
Expressive Language Disorder: Difficulty expressing oneself through
speech or writing.
o Example: A person may have trouble forming sentences, using
appropriate vocabulary, or conveying ideas clearly.
Mixed Receptive-Expressive Language Disorder: A combination of
problems understanding and using language.
o Example: A child may have trouble both understanding what others
say and expressing their thoughts clearly.
Syntactic and Semantic Deficits: Difficulty with sentence structure
(syntax) or word meanings (semantics).
o Example: Using incorrect grammar or struggling to understand
idiomatic phrases or abstract language.
3. Social (Pragmatic) Communication Disorder
This disorder involves challenges with using language in social contexts, such as
taking turns in conversation, interpreting nonverbal cues, or understanding social
norms.
Example: A child may speak inappropriately for a situation, struggle to make
eye contact, or have difficulty understanding sarcasm.
4. Hearing Disorders
Hearing impairments can affect communication, as hearing loss can result in
delayed language development or difficulty understanding speech.
Conductive Hearing Loss: Problems in the outer or middle ear that prevent
sound from being transmitted to the inner ear.
Sensorineural Hearing Loss: Damage to the inner ear or the auditory
nerve, affecting sound processing.
5. Cognitive-Communication Disorders
These disorders involve difficulties with memory, attention, problem-solving, and
executive functions, which impact communication.
Example: After a stroke or traumatic brain injury, a person may struggle with
word-finding, following complex conversations, or staying on topic.
Diagnostic Criteria for Communication Disorders (DSM-5 and ICD-11)
DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition)
The DSM-5 classifies communication disorders into several categories. Below are
the primary disorders and their diagnostic criteria:
1. Language Disorder (Expressive or Receptive)
o A. Difficulty acquiring and using language (spoken, written, or other
communication modes), characterized by limited vocabulary, sentence
structure, or grammatical errors.
o B. The language deficits interfere with communication, academic
performance, or social functioning.
o C. The disorder begins in the early developmental period, typically
before the age of 4.
2. Speech Sound Disorder (Articulation Disorder)
o A. Difficulty pronouncing sounds correctly (articulation errors), which
are not typical for the child’s age and development.
o B. The speech errors cause functional impairment, such as difficulty
being understood by others.
o C. The issue persists for a period of time, and typically begins early in
childhood.
3. Childhood-Onset Fluency Disorder (Stuttering)
o A. Frequent repetition of sounds, syllables, or words, long pauses, or
difficulty starting words.
o B. The fluency difficulties cause significant distress or impairment in
social, academic, or occupational functioning.
o C. Symptoms emerge in early childhood, often between 2-7 years of
age.
4. Social (Pragmatic) Communication Disorder
o A. Persistent difficulties in social use of verbal and nonverbal
communication, such as in greeting, taking turns in conversation, and
understanding nonliteral language (e.g., idioms, sarcasm).
o B. The difficulties impair social participation, relationships, academic
performance, or occupational functioning.
o C. Symptoms are evident early in development.
5. Voice Disorder
o While not explicitly categorized in DSM-5, voice disorders are
recognized as having an impact on social and academic functioning
and can be diagnosed under the category of "Other Specified
Communication Disorder."
ICD-11 (International Classification of Diseases, 11th edition)
The ICD-11 categorizes communication disorders in a similar manner, with a
broader focus on the medical and health-related aspects.
1. Speech Sound Disorders: These include difficulties in producing sounds or
organizing speech.
o This category includes articulation disorders, childhood apraxia of
speech, and phonological disorders.
2. Stuttering (Fluency Disorder)
o This diagnosis includes problems with speech fluency, such as
stuttering, where there is an abnormal flow of speech.
3. Language Disorders: Includes disorders like language delay, specific
language impairment (SLI), and mixed receptive-expressive language
disorders.
4. Social Communication Disorders
o ICD-11 specifically includes a category for social communication
deficits that affect a person's ability to function in social settings.
5. Hearing and Speech Disorders: The ICD-11 also recognizes the impact of
hearing loss or other auditory disorders on communication, and distinguishes
between conductive, sensorineural, and mixed hearing loss.
Causes and Risk Factors
Communication disorders can arise due to various factors:
Genetics: Family history of speech and language disorders increases risk.
Developmental Delays: Disorders like autism spectrum disorder (ASD) and
intellectual disabilities may involve communication challenges.
Brain Injury: Trauma or neurological conditions, such as strokes or brain
tumors, can impair speech and language.
Hearing Loss: Early or progressive hearing loss can delay language
development.
Environmental Factors: Lack of exposure to language or negative social
environments can contribute to delays or disorders in communication.
Treatment of Communication Disorders
Speech Therapy: The primary treatment for most speech and language
disorders, involving a speech-language pathologist (SLP) to help improve
speech, language, or social communication skills.
Behavioral Therapy: For conditions like social communication disorder,
therapy can focus on social skills training and pragmatic language use.
Hearing Aids/Assistive Devices: For those with hearing-related
communication disorders, hearing aids or cochlear implants may be
recommended.
Medication: In some cases, medications may be used to address underlying
neurological or psychological causes of communication disorders.
Treatment approaches are highly individualized, depending on the specific disorder,
its severity, and the age of the person affected.
