Communication Disorders

This article provides an overview of communication disorders, including the common types, general symptoms, the diagnostic process, and treatment strategies.

Key Takeaways

• Communication disorders arise in the early developmental period and affect nearly 10% of young children. This includes language disorder, speech sound disorder, childhood-onset fluency disorder (stuttering), and social (pragmatic) communication disorder

• These disorders cause difficulties with school, relationships, work, and well-being. Without treatment, they may persist into adulthood.

• Early treatment is essential and often effective. As treatment plans are individualized, most people can achieve meaningful improvement.

Understanding Communication Disorders

Communication disorders are conditions characterized by deficits in speech, language, and other aspects of communication, including verbal and non-verbal behaviors. These deficits can range from very mild, such as slight difficulty with pronunciation, to severe communication difficulties, such as a complete lack of language comprehension or speech ability.^[1]

Communication disorders can be characterized by the following features:^[1]

• Speech disorders: Deficits in articulation, verbal fluency, or voice production

• Language disorders: Difficulties with understanding and applying the form, function, meaning, and overall use of language for communication

While hearing and auditory processing disorders are sometimes considered communication disorders, they are not classified as such in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).^[2]

Types of Communication Disorders

The DSM-5 lists five types of communication disorders:^[2]

• Language disorder

• Speech sound disorder

• Childhood-onset fluency disorder (stuttering)

• Social (pragmatic) communication disorder

• Unspecified communication disorder

Language disorder involves deficits in language comprehension or production, whether through spoken, written, sign, or other means. Individuals with language disorder have a reduced vocabulary and a limited ability to produce sentences, which makes communication difficult.

Speech sound disorder refers to difficulty with producing speech sounds. This makes it difficult for others to understand the individual and negatively impacts general communication. These challenges may also cause anxiety and distress.

Childhood-onset fluency disorder (stuttering) is characterized by deficits in fluency and speech patterns that are inappropriate based on one’s age and general language skills. Individuals with this disorder often stutter and use broken sentences, which can impair communication and also lead to significant anxiety and distress.

Social (pragmatic) communication disorder refers to difficulty using verbal and non-verbal communication to engage in social interactions. People with this disorder struggle to understand and apply the social norms and cues that guide communication, which can negatively impact social participation and relationships.

Individuals who exhibit significant communication difficulties but do not meet the full criteria for any of the above conditions may be diagnosed with unspecified communication disorder.

Common Symptoms of Communication Disorders

The exact symptoms of communication disorders depend on the type of communication disorder present. Listed below are common symptoms for each of the communication disorders mentioned above:^[2]

• Language disorder:

• Reduced vocabulary

• Difficulty forming proper sentences

• Limited ability to use sentences or words

• Trouble explaining a topic or having a conversation

• Speech sound disorder:

• Difficulty pronouncing certain words or sounds

• Speech may be difficult for others to understand

• Slurred or slowed speech

• Childhood-onset fluency disorder (stuttering):

• Repeating sounds or syllables

• Prolonging sounds

• Using pauses within a word

• Using simpler words to replace those that are more difficult to articulate

• Excess tension or struggle when trying to say certain words

• Social (pragmatic) communication disorder:

• Difficulties with greetings or initiating conversation

• Trouble adjusting communication style to fit the specific context

• Struggle to maintain conversations

• Frequently interrupting (or not knowing when to speak)

• Unusual or inappropriate facial expressions, tone of voice, or gestures

• Difficulty making inferences and understanding non-literal language (e.g. metaphors, humor)

What age do symptoms typically present themselves?

Symptoms of communication disorders often first appear in the early developmental period, usually between age 2 to 7. Symptoms of social communication disorder and language disorder are typically the most noticeable at or after age 4. In contrast, childhood-onset fluency disorder and speech sound disorder often become apparent earlier, around age 2 or 3.^[2]

Causes of Communication Disorders

While the exact causes of communication disorders are not fully understood, research suggests a strong genetic component in many of these conditions.

For example:^[2]

• Individuals with language disorder often have a family history of language impairment

• Children with childhood-onset fluency disorder are more than three times as likely to have first-degree relatives that stutter compared to the general population

• Family history of autism spectrum disorder (ASD), communication disorders, or specific learning disorder increases the risk of social pragmatic communication disorder

• Specific genes have been identified with some of these disorders

In some cases, people experience communication difficulties as a result of underlying medical or neurological conditions, such as:

• Sensory deficits

• Deafness or hearing loss

• Cleft palate

• Traumatic brain injury

• Speech-motor deficits

• ASD and other developmental disorders

However, the DSM-5 explains that these factors can’t be the primary cause of symptoms in order to receive a communication disorder diagnosis. Nevertheless, it is essential they are identified and treated whenever they are present.^[2][3]

How common are communication disorders and who do they affect?

Overall, communication disorders affect around 10% of the population. Research in the U.S. shows that the rates of voice, speech, and language difficulties in children are 1.4%, 5%, and 3.3%, respectively. Regarding gender, these disorders are roughly 1.5 to 2 times more common in boys than in girls.^[4]

Communication disorders often arise in childhood during the developmental period. They are more common in children than adults, as many early speech and language difficulties may improve with age and intervention. However, these disorders can persist into adulthood as well.

In particular, social (pragmatic) communication disorder and language disorders often persist into adulthood to some degree. Stuttering and speech sound disorder can also continue into adulthood, although the majority (but not all) of children eventually overcome these deficits by adolescence or adulthood. Outcomes often depend on the severity of the disorder and the age at which it is diagnosed.^[2]

Diagnosing Communication Disorders

Diagnosing communication disorders requires a thorough, multi-step process. This helps to rule out other causes and ensures the most accurate diagnosis, which leads to the most effective treatment plan.

The first step is often meeting with a primary care physician. They will perform a comprehensive medical exam, especially to rule out physical causes, such as hearing loss, cleft palate, brain injury, or sensory deficits.

In addition to physical causes, clinicians must also rule out psychological causes too, such as ASD, intellectual disability, specific learning disorder, or attention-deficit hyperactivity disorder (ADHD).

If a communication disorder is still suspected, a speech-language pathologist or other qualified professional will conduct a comprehensive assessment. This typically involves direct observation, interviews with the individual and caregivers, and a review of family medical history.^[3]

Symptoms are then compared to the diagnostic criteria found in the DSM-5 for whichever specific communication disorder is being assessed. While specific symptoms vary depending on the disorder, a key shared feature of all communication disorders is that the symptoms cause clinically significant communication difficulties that negatively impact social participation, school achievement, or work performance.^[2]

Difficulties and Complications in Diagnosing

Diagnosing communication disorders is complex due to overlapping symptoms with various medical, neurological, psychological, and developmental conditions. In addition, communication disorders often have a high comorbidity with other disorders, such as ASD, intellectual disability, and ADHD, to name a few.^[2]

In addition, early communication abilities often develop earlier in girls than boys, making it essential to consider developmental differences when diagnosing young children.^[2]

Treatment Options for Communication Disorders

Treatment for communication disorders varies depending on the specific type of disorder, its severity, and the individual’s age. In most cases, treatment involves a speech-language pathologist, although other health professionals may be involved, especially if co-occurring mental disorders or medical conditions are present.

The speech-language pathologist works directly with the individual to address specific communication deficits, helping to develop or improve communication skills. For example, treatment may help address deficits with:^[2][5]

• Speech sounds

• Fluency

• Voice (e.g., vocal intensity or loudness)

• Understanding language

• Conversing (e.g., sharing thoughts and ideas)

• Vocabulary and grammar use

For severe communication disorders, treatment may also include the use of an augmentative or alternative communication system, such as a communication board or voice output communication aid.^[5]

Parents and teachers are often involved in the treatment process. They may be asked to implement some of the therapy techniques at home or at school to support their progress.

When to Seek Help

If you, your child, or someone you know is experiencing noticeable communication difficulties that interfere with school, work, relationships, and overall functioning, it’s important to seek help as soon as possible. Early treatment, especially for children, is linked to significantly better outcomes compared to delayed treatment.

It’s also important to note that adults can benefit from treatment too, regardless of age or how long symptoms have been present.

Living with a Communication Disorder

Communication disorders can make life challenging for both the individual and their loved ones. Fortunately, several strategies can help ease daily communication and improve quality of life.

In the case of children, early treatment has been shown to improve outcomes, and many may fully overcome the disorder or experience a notable reduction in symptoms. For individuals with difficulties that persist into adolescence or adulthood, it’s important to adopt strategies to reduce stress and promote better functioning, such as:

• Joining a support group

• Making sure teachers, employers, etc. are aware of your difficulties

• Using family and friends for support (these individuals may also act as communication mediators for more severe symptoms)

• Taking time for relaxing and enjoyable activities

These tips should always be used in conjunction with, and not apart from, professional treatment. When combined, professional treatment self-management strategies can improve overall outcomes for anyone living with a communication disorder.