Communication disorder

Communication disorder
Classification and external resources
Specialty	psychiatry
ICD-10	F80
ICD-9-CM	315.3
MeSH	D003147

A communication disorder is any disorder that affects an individual's ability to comprehend, detect, or apply language and speech to engage in discourse effectively with others.^[1] The delays and disorders can range from simple sound substitution to the inability to understand or use one's native language.^[2]

General definition

Disorders and tendencies included and excluded under the category of communication disorders may vary by source. For example, the definitions offered by the American Speech–Language–Hearing Association differ from that of the Diagnostic Statistical Manual 4th edition (DSM-IV).

Gleanson (2001) defines a communication disorder as a speech and language disorder which refers to problems in communication and in related areas such as oral motor function. The delays and disorders can range from simple sound substitution to the inability to understand or use their native language.^[2] In general, communications disorders commonly refer to problems in speech (comprehension and/or expression) that significantly interfere with an individual’s achievement and/or quality of life. Knowing the operational definition of the agency performing an assessment or giving a diagnosis may help.

Persons who speak more than one language or are considered to have an accent in their location of residence do not have speech disorders if they are speaking in a manner consistent with their home environment or a blending of their home and foreign environment.^[3]

DSM-IV-TR

According to the DSM-IV-TR, communication disorders are usually first diagnosed in childhood or adolescence though they are not limited as childhood disorders and may persist into adulthood.^[4] They may also occur with other disorders.

Diagnosis involves testing and evaluation during which it is determined if the scores/performance are "substantially below" developmental expectations and if they "significantly" interfere with academic achievement, social interactions and daily living. This assessment may also determine if the characteristic is deviant or delayed. Therefore, it may be possible for an individual to have communication challenges but not meet the criteria of being "substantially below" criteria of the DSM IV-TR.

It should also be noted that the DSM diagnoses do not comprise a complete list of all communication disorders, for example, auditory processing disorder is not classified under the DSM or ICD-10.^[5]

The following diagnoses are included in the communication disorders:

• Expressive language disorder – Characterized by difficulty expressing oneself beyond simple sentences and a limited vocabulary. An individual understands language better than their ability to use it; they may have a lot to say but have difficulties organizing and retrieving the words to get an idea across beyond what is expected for their developmental stage.^[6]
• Mixed receptive-expressive language disorder – problems comprehending the commands of others.
• Stuttering – a speech disorder characterized by a break in fluency, where sounds, syllables or words may be repeated or prolonged.^[7]
• Phonological disorder – a speech sound disorder characterized by problems in making patterns of sound errors, i.e. "dat" for "that".
• Communication disorder NOS (not otherwise specified) – the DSM-IV diagnosis in which disorders that do not meet the specific criteria for the disorder listed above may be classified.

Changes in DSM-5

The DSM-5 diagnoses for communication disorders completely rework the ones stated above. The diagnoses are made more general in order to capture the various aspects of communications disorders in a way that emphasizes their childhood onset and differentiate these communications disorders from those associated with other disorders (i.e. autism spectrum disorders)

• Language disorder – The important characteristics of language disorder are difficulties in learning and using language, which is caused by problems with vocabulary, with grammar, and with putting sentences together in a proper manner. Problems can both be receptive (understanding language) and expressive (producing language).^[8]
• Speech sound disorder – previously called phonological disorder, for those with problems with pronunciation and articulation of their native language.^[8][9]
• Childhood-Onset Fluency Disorder (Stuttering) - standard fluency and rhythm of speech is interrupted, often causing the repetition of whole words and syllables.^[10] May also include the prolongation of words and syllables; pauses within a word; and/or the avoidance of pronouncing difficult words and replacing them with easier words that the individual is better able to pronounce.^[11] This disorder causes many communication problems for the individual and may interfere with social communication and performance in work and/or school settings where communication is essential.^[11]
• Social (pragmatic) communication disorder – this diagnosis described difficulties in the social uses of verbal and nonverbal communication in naturalistic contexts, which affects the development of social relationships and discourse comprehension. The difference between this diagnosis and autism spectrum disorder is that in the latter there is also a restricted or repetitive pattern of behavior.^[8]
• Unspecified communication disorder – for those who have symptoms of a communication disorder but who do not meet all criteria, and whose symptoms cause distress or impairment.^[8]

Examples

Examples of disorders that may include or create challenges in language and communication and/or may co-occur with the above disorders:

• autism spectrum disorder - autistic disorder (also called "classic" autism), pervasive developmental disorder, and Asperger syndrome – developmental disorders that affect the brain's normal development of social and communication skills.^[12]
• expressive language disorder – affects speaking and understanding where there is no delay in non-verbal intelligence.
• mixed receptive-expressive language disorder – affects speaking, understanding, reading and writing where there is no delay in non-verbal intelligence.
• specific language impairment – a language disorder that delays the mastery of language skills in children who have no hearing loss or other developmental delays. SLI is also called developmental language disorder, language delay, or developmental dysphasia.^[13]

Sensory impairments

• Blindness – A link between communication skills and visual impairment with children who are blind is currently being investigated.^[14]
• Deafness/frequent ear infections – Trouble with hearing during language acquisition may lead to spoken language problems. Children who suffer from frequent ear infections may temporarily develop problems pronouncing words correctly. It should also be noted that some of the above communication disorders can occur with people who use sign language. The inability to hear is not in itself a communication disorder.

Aphasia

Aphasia is loss of the ability to produce or comprehend language. There are acute aphasias which result from stroke or brain injury, and primary progressive aphasias caused by progressive illnesses such as dementia.

• Acute aphasias
  • Expressive aphasia also known as Broca's aphasia, expressive aphasia is a non-fluent aphasia that is characterized by damage to the frontal lobe region of the brain. A person with expressive aphasia usually speaks in short sentences that make sense but take great effort to produce. Also, a person with expressive aphasia understands another person's speech but has trouble responding quickly.^[15]
  • Receptive aphasia also known as Wernicke's aphasia, receptive aphasia is a fluent aphasia that is categorized by damage to the temporal lobe region of the brain. A person with receptive aphasia usually speaks in long sentences that have no meaning or content. People with this type of aphasia often have trouble understanding other's speech and generally do not realize that they are not making any sense.^[15]
  • Conduction aphasia^[15]
  • Anomic aphasia^[15]
  • Global aphasia^[15]
• Primary progressive aphasias
  • Progressive nonfluent aphasia^[16]
  • Semantic dementia^[16]
  • Logopenic progressive aphasia^[16]

Learning disability

• Dyscalculia – a defect of the systems used in communicating numbers
• Dyslexia – a defect of the systems used in reading
• Dysgraphia – a defect in the systems used in writing

Speech disorders

• cluttering - a syndrome characterized by a speech delivery rate which is either abnormally fast, irregular, or both.^[17]
• dysarthria - a condition that occurs when problems with the muscles that helps a person to talk make it difficult to pronounce words.^[18]
• esophageal voice - involves the patient injecting or swallowing air into the esophagus. Usually learnt and used by patients who cannot use their larynges to speak. Once the patient has forced the air into their esophagus, the air vibrates a muscle and creates esophageal voice. Esophageal voice tends to be difficult to learn and patients are often only able to talk in short phrases with a quiet voice.
• lisp - a speech impediment that is also known as sigmatism.
• speech sound disorder - Speech-sound disorders (SSD) involve impairments in speech-sound production and range from mild articulation issues involving a limited number of speech sounds to more severe phonologic disorders involving multiple errors in speech-sound production and reduced intelligibility.^[19]
• stuttering - a speech disorder in which sounds, syllables, or words are repeated or last longer than normal. These problems cause a break in the flow of speech (called disfluency).

See also

• Compulsive talking
• Developmental verbal dyspraxia
• FOXP2
• Glossary of medical terms related to communications disorders
• Speech acquisition
• Speech-Language Pathology
• Voice disorders

References

1. Collins, John William. "The greenwood dictionary of education". Greenwood, 2011. page 86. ISBN 978-0-313-37930-7
2. Gleason, Jean Berko (2001). The development of language. Boston: Allyn and Bacon. ISBN 0-205-31636-0. OCLC 43694441.
3. "Speech sound disorders". Information for the Public. American Speech-Language-Hearing Association (ASHA).
4. DSM IV-TR, Rapoport DSM-IV Training Guide for Diagnosis of Childhood Disorders
5. Banai, K; Yifat, R (2010). JH Stone, M Blouin, eds. "Communication Disorders: Auditory Processing Disorders". International Encyclopedia of Rehabilitation. Center for International Rehabilitation Research Information and Exchange (CIRRIE).
6. Morales, Sarah. "Expressive Language Disorder - ICD 315.31". Children's Speech Care Center. Retrieved 8 December 2013.
7. "Stuttering". Children and stuttering; Speech disfluency; Stammering. U.S. National Library of Medicine - PubMed Health. 2012. Retrieved 8 December 2013.
8. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 41–49. ISBN 978-0-89042-555-8. OCLC 845233998.
9. Lee ASY, Gibbon FE. Non-speech oral motor treatment for children with developmental speech sound disorders. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD009383. DOI: 10.1002/14651858.CD009383.pub2.
10. Nolen-Hoeksema, Susan (2014). Abnormal Psychology (Sixth ed.). 2 Penn Plaza, New York, NY 10121: McGraw-Hill Education. p. 301. ISBN 978-0-07-803538-8.
11. American Psychiatric Association. "Diagnostic and Statistical Manual of Mental Disorders Fifth Edition". Page 46.
12. Kennison, Shelia M. (2013-07-30). Introduction to language development. Los Angeles: SAGE Publications. ISBN 978-1-4129-9606-8. OCLC 830837502.
13. "Specific Language Impairment". National Institute on Deafness and Other Communication Disorders (NIDCD).
14. James, D. M.; Stojanovik, V. (2007). "Communication skills in blind children: a preliminary investigation". Child: Care, Health and Development. 33 (1): 4–10. doi:10.1111/j.1365-2214.2006.00621.x.
15. Sinanović O, Mrkonjić Z, Zukić S, Vidović M, Imamović K; Mrkonjić; Zukić; Vidović; Imamović (March 2011). "Post-stroke language disorders". Acta Clin Croat. 50 (1): 79–94. PMID 22034787.
16. Harciarek M, Kertesz A; Kertesz (September 2011). "Primary progressive aphasias and their contribution to the contemporary knowledge about the brain-language relationship". Neuropsychol Rev. 21 (3): 271–87. doi:10.1007/s11065-011-9175-9. PMC 3158975. PMID 21809067.
17. Louis, Kenneth O.; Raphael, Lawrence J.; Myers, Florence L.; Bakker, Klaas (2013). "Cluttering Updated". ASHA Leader. American Speech-Language-Hearing Association (ASHA). Retrieved 8 December 2013.
18. "Dysarthria". Impairment of speech; Slurred speech; Speech disorders - dysarthria. U.S. National Library of Medicine - PubMed Health. 2012. Retrieved 8 December 2013.
19. Sices L, Taylor HG, Freebairn L, Hansen A, Lewis B; Taylor; Freebairn; Hansen; Lewis (December 2007). "Relationship between speech-sound disorders and early literacy skills in preschool-age children: impact of comorbid language impairment". J Dev Behav Pediatr. 28 (6): 438–47. doi:10.1097/DBP.0b013e31811ff8ca. PMC 2755217. PMID 18091088.

Further reading

• Cherney LR, Gardner P, Logemann JA, et al. (2010). "The role of speech-language pathology and audiology in the optimal management of the service member returning from Iraq or Afghanistan with a blast-related head injury: position of the Communication Sciences and Disorders Clinical Trials Research Group". J Head Trauma Rehabil. 25 (3): 219–24. doi:10.1097/HTR.0b013e3181dc82c1. PMID 20473095.
• Wong PC, Perrachione TK, Gunasekera G, Chandrasekaran B; Perrachione; Gunasekera; Chandrasekaran (August 2009). "Communication disorders in speakers of tone languages: etiological bases and clinical considerations". Semin Speech Lang. 30 (3): 162–73. doi:10.1055/s-0029-1225953. PMC 2805066. PMID 19711234.

External links

• Communication Disorders
• Aphasia - National Institute on Deafness and Other Communication Disorders (NIDCD)
• Dysgraphia - National Institute on Deafness and Other Communication Disorders
• Voice and Speech Disorder Online Community (VoiceMatters.net)
• List of communication disorder related links
• Child Language Disorders
• Talking Point Check the progress of your child's language development