characteristics of a speech and language impairment

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Speech and Language Impairments

The Individuals with Disabilities Education Act, or IDEA, defines the term “speech or language impairment” as follows:

“(11) Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.” [34 CFR §300.8(c)(11]

(Parent Information and Resources Center, 2015)

Table of Contents

What is a Speech and Language Impairment?

Characteristics of speech or language impairments, interventions and strategies, related service provider-slp.

A Day in the Life of an SLP

Assistive Technology

Speech and language impairment are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency.

A speech impairment is characterized by difficulty in articulation of words. Examples include stuttering or problems producing particular sounds. Articulation refers to the sounds, syllables, and phonology produced by the individual. Voice, however, may refer to the characteristics of the sounds produced—specifically, the pitch, quality, and intensity of the sound. Often, fluency will also be considered a category under speech, encompassing the characteristics of rhythm, rate, and emphasis of the sound produced.

A language impairment is a specific impairment in understanding and sharing thoughts and ideas, i.e. a disorder that involves the processing of linguistic information. Problems that may be experienced can involve the form of language, including grammar, morphology, syntax; and the functional aspects of language, including semantics and pragmatics.

(Wikipedia, n.d./ Speech and Language Impairment)

*It’s important to realize that a language delay isn’t the same thing as a speech or language impairment. Language delay is a very common developmental problem—in fact, the most common, affecting 5-10% of children in preschool. With language delay, children’s language is developing in the expected sequence, only at a slower rate. In contrast, speech and language disorder refers to abnormal language development. Distinguishing between the two is most reliably done by a certified speech-language pathologist. (CPIR, 2015)

The characteristics of speech or language impairments will vary depending upon the type of impairment involved. There may also be a combination of several problems.

When a child has an articulation disorder , he or she has difficulty making certain sounds. These sounds may be left off, added, changed, or distorted, which makes it hard for people to understand the child.

Leaving out or changing certain sounds is common when young children are learning to talk, of course. A good example of this is saying “wabbit” for “rabbit.” The incorrect articulation isn’t necessarily a cause for concern unless it continues past the age where children are expected to produce such sounds correctly

Fluency refers to the flow of speech. A fluency disorder means that something is disrupting the rhythmic and forward flow of speech—usually, a stutter. As a result, the child’s speech contains an “abnormal number of repetitions, hesitations, prolongations, or disturbances. Tension may also be seen in the face, neck, shoulders, or fists.”

Voice is the sound that’s produced when air from the lungs pushes through the voice box in the throat (also called the larnyx), making the vocal folds within vibrate. From there, the sound generated travels up through the spaces of the throat, nose, and mouth, and emerges as our “voice.”

A voice disorder involves problems with the pitch, loudness, resonance, or quality of the voice. The voice may be hoarse, raspy, or harsh. For some, it may sound quite nasal; others might seem as if they are “stuffed up.” People with voice problems often notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use.

Language has to do with meanings, rather than sounds. A language disorder refers to an impaired ability to understand and/or use words in context. A child may have an expressive language disorder (difficulty in expressing ideas or needs), a receptive language disorder (difficulty in understanding what others are saying), or a mixed language disorder (which involves both).

Some characteristics of language disorders include:

improper use of words and their meanings,
inability to express ideas,
inappropriate grammatical patterns,
reduced vocabulary, and
inability to follow directions.

Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate. These symptoms can easily be mistaken for other disabilities such as autism or learning disabilities, so it’s very important to ensure that the child receives a thorough evaluation by a certified speech-language pathologist.

(CPIR, 2015)

Use the (Cash, Wilson, and DeLaCruz, n.d) reading and/or the [ESU 8 Wednesday Webinar] to develop this section of the summary.

Cash, A, Wilson, R. and De LaCruz, E.(n,d.) Practical Recommendations for Teachers: Language Disorders. https://www.education.udel.edu/wp-content/uploads/2013/01/LanguageDisorders.pdf

[ESU 8 Wednesday Webinar] Speech Language Strategies for Classroom Teachers.- video below

Video: Speech Language Strategies for Classroom Teachers (15:51 minutes)’

[ESU 8 Wednesday Webinars]. (2015, Nov. 19) . Speech Language Strategies for Classroom Teachers. [Video FIle]. From https://youtu.be/Un2eeM7DVK8

Most, if not all, students with a speech or language impairment will need speech-language pathology services . This related service is defined by IDEA as follows:

(15) Speech-language pathology services include—

(i) Identification of children with speech or language impairments;

(ii) Diagnosis and appraisal of specific speech or language impairments;

(iii) Referral for medical or other professional attention necessary for the habilitation of speech or language impairments;

(iv) Provision of speech and language services for the habilitation or prevention of communicative impairments; and

(v) Counseling and guidance of parents, children, and teachers regarding speech and language impairments. [34 CFR §300.34(c)(15)]

Thus, in addition to diagnosing the nature of a child’s speech-language difficulties, speech-language pathologists also provide:

individual therapy for the child;
consult with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; and
work closely with the family to develop goals and techniques for effective therapy in class and at home.

Speech and/or language therapy may continue throughout a student’s school years either in the form of direct therapy or on a consultant basis.

A Day in the Life of an SLP

Christina is a speech-language pathologist. She works with children and adults who have impairments in their speech, voice, or language skills. These impairments can take many forms, as her schedule today shows.

First comes Robbie. He’s a cutie pie in the first grade and has recently been diagnosed with childhood apraxia of speech—or CAS. CAS is a speech disorder marked by choppy speech. Robbie also talks in a monotone, making odd pauses as he tries to form words. Sometimes she can see him struggle. It’s not that the muscles of his tongue, lips, and jaw are weak. The difficulty lies in the brain and how it communicates to the muscles involved in producing speech. The muscles need to move in precise ways for speech to be intelligible. And that’s what she and Robbie are working on.

Next, Christina goes down the hall and meets with Pearl in her third grade classroom. While the other students are reading in small groups, she works with Pearl one on one, using the same storybook. Pearl has a speech disorder, too, but hers is called dysarthria. It causes Pearl’s speech to be slurred, very soft, breathy, and slow. Here, the cause is weak muscles of the tongue, lips, palate, and jaw. So that’s what Christina and Pearl work on—strengthening the muscles used to form sounds, words, and sentences, and improving Pearl’s articulation.

One more student to see—4th grader Mario , who has a stutter. She’s helping Mario learn to slow down his speech and control his breathing as he talks. Christina already sees improvement in his fluency.

Tomorrow she’ll go to a different school, and meet with different students. But for today, her day is…Robbie, Pearl, and Mario.

Assistive technology (AT) can also be very helpful to students, especially those whose physical conditions make communication difficult. Each student’s IEP team will need to consider if the student would benefit from AT such as an electronic communication system or other device. AT is often the key that helps students engage in the give and take of shared thought, complete school work, and demonstrate their learning. (CPIR, 2015)

Project IDEAL , suggests two major categories of AT computer software packages to develop the child’s speech and language skills and augmentative or alternative communication (AAC).

Augmentative and alternative communication ( AAC ) encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. Augmentative and alternative communication may used by individuals to compensate for severe speech-language impairments in the expression or comprehension of spoken or written language. AAC can be a permanent addition to a person’s communication or a temporary aid.

(Wikipedia, (n.d. /Augmentative and alternative communication)

Center for Parent Information and Resources (CPIR) (2015), Speech and Language Impairments, Newark, NJ, Author, Retrieved 4.1.19 from https://www.parentcenterhub.org/speechlanguage/

Wikipedia (n.d.) Augmentative and alternative communication. From https://en.wikipedia.org/wiki/Augmentative_and_alternative_communication

Wikipedia, (n.d.) Speech and Language Impairment. From https://en.wikipedia.org/wiki/Speech_and_language_impairment

Updated 8.8.23

Understanding and Supporting Learners with Disabilities Copyright © 2019 by Paula Lombardi is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Speech and Language Impairments

A young girl with a colorful hat on. Una joven con sombrero de muchos colores.

En español | In Spanish
See fact sheets on other disabilities

Table of Contents

A Day in the Life of an SLP

Tomorrow she’ll go to a different school, and meet with different students. But for today, her day is…Robbie, Pearl, and Mario.

There are many kinds of speech and language disorders that can affect children. In this fact sheet, we’ll talk about four major areas in which these impairments occur. These are the areas of:

Articulation | speech impairments where the child produces sounds incorrectly (e.g., lisp, difficulty articulating certain sounds, such as “l” or “r”);

Fluency | speech impairments where a child’s flow of speech is disrupted by sounds, syllables, and words that are repeated, prolonged, or avoided and where there may be silent blocks or inappropriate inhalation, exhalation, or phonation patterns;

Voice | speech impairments where the child’s voice has an abnormal quality to its pitch, resonance, or loudness; and

Language | language impairments where the child has problems expressing needs, ideas, or information, and/or in understanding what others say. ( 1 )

These areas are reflected in how “speech or language impairment” is defined by the nation’s special education law, the Individuals with Disabilities Education Act, given below. IDEA is the law that makes early intervention services available to infants and toddlers with disabilities, and special education available to school-aged children with disabilities.

Definition of “Speech or Language Impairment” under IDEA

The Individuals with Disabilities Education Act, or IDEA, defines the term “speech or language impairment” as follows:

Development of Speech and Language Skills in Childhood

Speech and language skills develop in childhood according to fairly well-defined milestones (see below). Parents and other caregivers may become concerned if a child’s language seems noticeably behind (or different from) the language of same-aged peers. This may motivate parents to investigate further and, eventually, to have the child evaluated by a professional.

______________________

More on the Milestones of Language Development

What are the milestones of typical speech-language development? What level of communication skill does a typical 8-month-old baby have, or a 18-month-old, or a child who’s just celebrated his or her fourth birthday?

You’ll find these expertly described in How Does Your Child Hear and Talk? , a series of resource pages available online at the American Speech-Language-Hearing Association (ASHA): http://www.asha.org/public/speech/development/chart.htm

Having the child’s hearing checked is a critical first step. The child may not have a speech or language impairment at all but, rather, a hearing impairment that is interfering with his or her development of language.

It’s important to realize that a language delay isn’t the same thing as a speech or language impairment. Language delay is a very common developmental problem—in fact, the most common, affecting 5-10% of children in preschool. ( 2 ) With language delay, children’s language is developing in the expected sequence, only at a slower rate. In contrast, speech and language disorder refers to abnormal language development. ( 3 ) Distinguishing between the two is most reliably done by a certified speech-language pathologist such as Christina, the SLP in our opening story.

Characteristics of Speech or Language Impairments

The characteristics of speech or language impairments will vary depending upon the type of impairment involved. There may also be a combination of several problems.

A voice disorder involves problems with the pitch, loudness, resonance, or quality of the voice. ( 6 ) The voice may be hoarse, raspy, or harsh. For some, it may sound quite nasal; others might seem as if they are “stuffed up.” People with voice problems often notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use. ( 7 )

Language has to do with meanings, rather than sounds. ( 8 ) A language disorder refers to an impaired ability to understand and/or use words in context. ( 9 ) A child may have an expressive language disorder (difficulty in expressing ideas or needs), a receptive language disorder (difficulty in understanding what others are saying), or a mixed language disorder (which involves both).

Some characteristics of language disorders include:

improper use of words and their meanings,
inability to express ideas,
inappropriate grammatical patterns,
reduced vocabulary, and
inability to follow directions. ( 10 )

What Causes Speech and Language Disorders?

Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, intellectual disabilities, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.

Of the 6.1 million children with disabilities who received special education under IDEA in public schools in the 2005-2006 school year, more than 1.1 million were served under the category of speech or language impairment. ( 11 ) This estimate does not include children who have speech/language problems secondary to other conditions such as deafness, intellectual disability, autism, or cerebral palsy. Because many disabilities do impact the individual’s ability to communicate, the actual incidence of children with speech-language impairment is undoubtedly much higher.

Finding Help

Because all communication disorders carry the potential to isolate individuals from their social and educational surroundings, it is essential to provide help and support as soon as a problem is identified. While many speech and language patterns can be called “baby talk” and are part of children’s normal development, they can become problems if they are not outgrown as expected.

Therefore, it’s important to take action if you suspect that your child has a speech or language impairment (or other disability or delay). The next two sections in this fact sheet will tell you how to find this help.

Help for Babies and Toddlers

Since we begin learning communication skills in infancy, it’s not surprising that parents are often the first to notice—and worry about—problems or delays in their child’s ability to communicate or understand. Parents should know that there is a lot of help available to address concerns that their young child may be delayed or impaired in developing communication skills. Of particular note is the the early intervention system that’s available in every state.

Early intervention is a system of services designed to help infants and toddlers with disabilities (until their 3rd birthday) and their families. It’s mandated by the IDEA. Through early intervention, parents can have their young one evaluated free of charge, to identify developmental delays or disabilities, including speech and language impairments.

If a child is found to have a delay or disability, staff work with the child’s family to develop what is known as an Individualized Family Services Plan , or IFSP . The IFSP will describe the child’s unique needs as well as the services he or she will receive to address those needs. The IFSP will also emphasize the unique needs of the family, so that parents and other family members will know how to support their young child’s needs. Early intervention services may be provided on a sliding-fee basis, meaning that the costs to the family will depend upon their income.

To identify the EI program in your neighborhood | Ask your child’s pediatrician for a referral to early intervention or the Child Find in the state. You can also call the local hospital’s maternity ward or pediatric ward, and ask for the contact information of the local early intervention program.

Help for School-Aged Children, including Preschoolers

Just as IDEA requires that early intervention be made available to babies and toddlers with disabilities, it requires that special education and related services be made available free of charge to every eligible child with a disability, including preschoolers (ages 3-21). These services are specially designed to address the child’s individual needs associated with the disability—in this case, a speech or language impairment.

Many children are identified as having a speech or language impairment after they enter the public school system. A teacher may notice difficulties in a child’s speech or communication skills and refer the child for evaluation. Parents may ask to have their child evaluated. This evaluation is provided free by the public school system.

If the child is found to have a disability under IDEA—such as a speech-language impairment—school staff will work with his or her parents to develop an Individualized Education Program , or IEP . The IEP is similar to an IFSP. It describes the child’s unique needs and the services that have been designed to meet those needs. Special education and related services are provided at no cost to parents.

There is a lot to know about the special education process, much of which you can learn at the Center for Parent Information and Resources (CPIR). We offer a wide range of publications and resource pages on the topic. Enter our special education information at: http://www.parentcenterhub.org/repository/schoolage/

Educational Considerations

Communication skills are at the heart of the education experience. Eligible students with speech or language impairments will want to take advantage of special education and related services that are available in public schools.

The types of supports and services provided can vary a great deal from student to student, just as speech-language impairments do. Special education and related services are planned and delivered based on each student’s individualized educational and developmental needs.

Most, if not all, students with a speech or language impairment will need speech-language pathology services . This related service is defined by IDEA as follows:

(15) Speech-language pathology services includes—

(i) Identification of children with speech or language impairments;

(ii) Diagnosis and appraisal of specific speech or language impairments;

(iii) Referral for medical or other professional attention necessary for the habilitation of speech or language impairments;

(iv) Provision of speech and language services for the habilitation or prevention of communicative impairments; and

Thus, in addition to diagnosing the nature of a child’s speech-language difficulties, speech-language pathologists also provide:

individual therapy for the child;
consult with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; and
work closely with the family to develop goals and techniques for effective therapy in class and at home.

Speech and/or language therapy may continue throughout a student’s school years either in the form of direct therapy or on a consultant basis.

Tips for Teachers

— Learn as much as you can about the student’s specific disability. Speech-language impairments differ considerably from one another, so it’s important to know the specific impairment and how it affects the student’s communication abilities.

— Recognize that you can make an enormous difference in this student’s life! Find out what the student’s strengths and interests are, and emphasize them. Create opportunities for success.

—If you are not part of the student’s IEP team, a sk for a copy of his or her IEP . The student’s educational goals will be listed there, as well as the services and classroom accommodations he or she is to receive.

— Make sure that needed accommodations are provided for classwork, homework, and testing. These will help the student learn successfully.

— Consult with others (e.g., special educators, the SLP) who can help you identify strategies for teaching and supporting this student, ways to adapt the curriculum, and how to address the student’s IEP goals in your classroom.

— Find out if your state or school district has materials or resources available to help educators address the learning needs of children with speech or language impairments. It’s amazing how many do!

— Communicate with the student’s parents . Regularly share information about how the student is doing at school and at home.

Tips for Parents

— Learn the specifics of your child’s speech or language impairment. The more you know, the more you can help yourself and your child.

— Be patient. Your child, like every child, has a whole lifetime to learn and grow.

— Meet with the school and develop an IEP to address your child’s needs. Be your child’s advocate. You know your son or daughter best, share what you know.

— Be well informed about the speech-language therapy your son or daughter is receiving. Talk with the SLP, find out how to augment and enrich the therapy at home and in other environments. Also find out what not to do!

— Give your child chores. Chores build confidence and ability. Keep your child’s age, attention span, and abilities in mind. Break down jobs into smaller steps. Explain what to do, step by step, until the job is done. Demonstrate. Provide help when it’s needed. Praise a job (or part of a job) well done.

— Listen to your child. Don’t rush to fill gaps or make corrections. Conversely, don’t force your child to speak. Be aware of the other ways in which communication takes place between people.

— Talk to other parents whose children have a similar speech or language impairment. Parents can share practical advice and emotional support. See if there’s a parent nearby by visiting the Parent to Parent USA program and using the interactive map.

— Keep in touch with your child’s teachers. Offer support. Demonstrate any assistive technology your child uses and provide any information teachers will need. Find out how you can augment your child’s school learning at home.

Readings and Articles

We urge you to read the articles identified in the References section. Each provides detailed and expert information on speech or language impairments. You may also be interested in:

Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2491683/

Organizations to Consult

ASHA | American Speech-Language-Hearing Association Information in Spanish | Información en español. 1.800.638.8255 | [email protected] | www.asha.org

NIDCD | National Institute on Deafness and Other Communication Disorders 1.800.241.1044 (Voice) | 1.800.241.1055 (TTY) [email protected] | http://www.nidcd.nih.gov/

American Cleft Palate and Craniofacial Association (ACPA) 1.800.242.5338 | https://acpacares.org/

Childhood Apraxia of Speech Association of North America | CASANA http://www.apraxia-kids.org

National Stuttering Foundation 1.800.937.8888 | [email protected] | http://www.nsastutter.org/

Stuttering Foundation 1.800.992.9392 | [email protected] | http://www.stuttersfa.org/

1 | Minnesota Department of Education. (2010). Speech or language impairments . Online at: http://education.state.mn.us/MDE/EdExc/SpecEdClass/DisabCateg/SpeechLangImpair/index.html

2 | Boyse, K. (2008). Speech and language delay and disorder . Retrieved from the University of Michigan Health System website: http://www.med.umich.edu/yourchild/topics/speech.htm

4 | American Speech-Language-Hearing Association. (n.d.). Speech sound disorders: Articulation and phonological processes . Online at: http://www.asha.org/public/speech/disorders/speechsounddisorders.htm

5 | Cincinnati Children’s Hospital. (n.d.). Speech disorders . Online at: http://www.cincinnatichildrens.org/health/s/speech-disorder/

6 | National Institute on Deafness and Other Communication Disorders. (2002). What is voice? What is speech? What is language? Online at: http://www.nidcd.nih.gov/health/voice/pages/whatis_vsl.aspx

7 | American Academy of Otolaryngology — Head and Neck Surgery. (n.d.). About your voice . Online at: http://www.entnet.org/content/about-your-voice

8 | Boyse, K. (2008). Speech and language delay and disorder . Retrieved from the University of Michigan Health System website: http://www.med.umich.edu/yourchild/topics/speech.htm

9 | Encyclopedia of Nursing & Allied Health. (n.d.). Language disorders . Online at: http://www.enotes.com/nursing-encyclopedia/language-disorders

10 | Ibid .

11 | U.S. Department of Education. (2010, December). Twenty-ninth annual report to Congress on the Implementation of the Individuals with Disabilities Education Act: 2007 . Online at: http://www2.ed.gov/about/reports/annual/osep/2007/parts-b-c/index.html

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Comprehenisve Overview of Speech and Language Impairments

Comprehensive overview of speech and language impairments.

Speech and language disorders refer to problems in communication and related areas such as oral motor function. These delays and disorders range from simple sound substitutions to the inability to understand or use language or use the oral-motor mechanism for functional speech and feeding. Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.

More than one million of the students served in the public schools’ special education programs in the 2000-2001 school year were categorized as having a speech or language impairment. This estimate does not include children who have speech/language problems secondary to other conditions such as deafness. Language disorders may be related to other disabilities such as mental retardation, autism, or cerebral palsy. It is estimated that communication disorders (including speech, language, and hearing disorders) affect one of every 10 people in the United States.

Characteristics

A child's communication is considered delayed when the child is noticeably behind his or her peers in the acquisition of speech and/or language skills. Sometimes a child will have greater receptive (understanding) than expressive (speaking) language skills, but this is not always the case.

Speech disorders refer to difficulties producing speech sounds or problems with voice quality. They might be characterized by an interruption in the flow or rhythm of speech, such as stuttering, which is called dysfluency. Speech disorders may be problems with the way sounds are formed, called articulation or phonological disorders, or they may be difficulties with the pitch, volume or quality of the voice. There may be a combination of several problems. People with speech disorders have trouble using some speech sounds, which can also be a symptom of a delay. They may say "see" when they mean "ski" or they may have trouble using other sounds like "l" or "r." Listeners may have trouble understanding what someone with a speech disorder is trying to say. People with voice disorders may have trouble with the way their voices sound.

A language disorder is an impairment in the ability to understand and/or use words in context, both verbally and nonverbally. Some characteristics of language disorders include improper use of words and their meanings, inability to express ideas, inappropriate grammatical patterns, reduced vocabulary and inability to follow directions. One or a combination of these characteristics may occur in children who are affected by language learning disabilities or developmental language delay. Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate.

Educational Implications

Because all communication disorders carry the potential to isolate individuals from their social and educational surroundings, it is essential to find appropriate timely intervention. While many speech and language patterns can be called "baby talk" and are part of a young child's normal development, they can become problems if they are not outgrown as expected. In this way an initial delay in speech and language or an initial speech pattern can become a disorder which can cause difficulties in learning. Because of the way the brain develops, it is easier to learn language and communication skills before the age of 5. When children have muscular disorders, hearing problems or developmental delays, their acquisition of speech, language and related skills is often affected

Speech-language pathologists assist children who have communication disorders in various ways. They provide individual therapy for the child; consult with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; and work closely with the family to develop goals and techniques for effective therapy in class and at home. The speech-language pathologist may assist vocational teachers and counselors in establishing communication goals related to the work experiences of students and suggest strategies that are effective for the important transition from school to employment and adult life.

Technology can help children whose physical conditions make communication difficult. The use of electronic communication systems allow nonspeaking people and people with severe physical disabilities to engage in the give and take of shared thought.

Specific Types of Communication Disorders

What is aphasia.

Aphasia is a language disorder that results from damage to portions of the brain that are responsible for language. For most people, these are parts of the left side (hemisphere) of the brain. Aphasia usually occurs suddenly, often as the result of a stroke or head injury, but it may also develop slowly, as in the case of a brain tumor. The disorder impairs both the expression and understanding of language as well as reading and writing. Aphasia may co-occur with speech disorders such as dysarthria or apraxia of speech, which also result from brain damage.

What causes aphasia?

Aphasia is caused by damage to one or more of the language areas of the brain. Many times, the cause of the brain injury is a stroke. A stroke occurs when, for some reason, blood is unable to reach a part of the brain. Brain cells die when they do not receive their normal supply of blood, which carries oxygen and important nutrients. Other causes of brain injury are severe blows to the head, brain tumors, brain infections, and other conditions of the brain.

How is aphasia diagnosed?

Aphasia is usually first recognized by the physician who treats the individual for his or her brain injury. Frequently this is a neurologist. The physician typically performs tests that require the individual to follow commands, answer questions, name objects, and converse. If the physician suspects aphasia, the individual is often referred to a speech-language pathologist, who performs a comprehensive examination of the person's ability to understand, speak, read, and write.

What Is Apraxia of Speech?

Apraxia of speech, also known as verbal apraxia or dyspraxia, is a speech disorder in which a person has trouble saying what he or she wants to say correctly and consistently. It is not due to weakness or paralysis of the speech muscles (the muscles of the face, tongue, and lips). The severity of apraxia of speech can range from mild to severe.

What Are the Types and Causes of Apraxia?

There are two main types of speech apraxia: acquired apraxia of speech and developmental apraxia of speech. Acquired apraxia of speech can affect a person at any age, although it most typically occurs in adults. It is caused by damage to the parts of the brain that are involved in speaking, and involves the loss or impairment of existing speech abilities. The disorder may result from a stroke, head injury, tumor, or other illness affecting the brain. Acquired apraxia of speech may occur together with muscle weakness affecting speech production (dysarthria) or language difficulties caused by damage to the nervous system (aphasia).

Developmental apraxia of speech (DAS) occurs in children and is present from birth. It appears to affect more boys than girls. This speech disorder goes by several other names, including developmental verbal apraxia, developmental verbal dyspraxia, articulatory apraxia, and childhood apraxia of speech. DAS is different from what is known as a developmental delay of speech, in which a child follows the "typical" path of speech development but does so more slowly than normal.

The cause or causes of DAS are not yet known. Some scientists believe that DAS is a disorder related to a child's overall language development. Others believe it is a neurological disorder that affects the brain's ability to send the proper signals to move the muscles involved in speech. However, brain imaging and other studies have not found evidence of specific brain lesions or differences in brain structure in children with DAS. Children with DAS often have family members who have a history of communication disorders or learning disabilities. This observation and recent research findings suggest that genetic factors may play a role in the disorder.

What Are the Symptoms?

People with either form of apraxia of speech may have a number of different speech characteristics, or symptoms. One of the most notable symptoms is difficulty putting sounds and syllables together in the correct order to form words. Longer or more complex words are usually harder to say than shorter or simpler words. People with apraxia of speech also tend to make inconsistent mistakes when speaking. For example, they may say a difficult word correctly but then have trouble repeating it, or they may be able to say a particular sound one day and have trouble with the same sound the next day. People with apraxia of speech often appear to be groping for the right sound or word, and may try saying a word several times before they say it correctly. Another common characteristic of apraxia of speech is the incorrect use of "prosody" -- that is, the varying rhythms, stresses, and inflections of speech that are used to help express meaning.

Children with developmental apraxia of speech generally can understand language much better than they are able to use language to express themselves. Some children with the disorder may also have other problems. These can include other speech problems, such as dysarthria; language problems such as poor vocabulary, incorrect grammar, and difficulty in clearly organizing spoken information; problems with reading, writing, spelling, or math; coordination or "motor-skill" problems; and chewing and swallowing difficulties.

The severity of both acquired and developmental apraxia of speech varies from person to person. Apraxia can be so mild that a person has trouble with very few speech sounds or only has occasional problems pronouncing words with many syllables. In the most severe cases, a person may not be able to communicate effectively with speech, and may need the help of alternative or additional communication methods.

How Is It Diagnosed?

Professionals known as speech-language pathologists play a key role in diagnosing and treating apraxia of speech. There is no single factor or test that can be used to diagnose apraxia. In addition, speech-language experts do not agree about which specific symptoms are part of developmental apraxia. The person making the diagnosis generally looks for the presence of some, or many, of a group of symptoms, including those described above. Ruling out other contributing factors, such as muscle weakness or language-comprehension problems, can also help with the diagnosis.

To diagnose developmental apraxia of speech, parents and professionals may need to observe a child's speech over a period of time. In formal testing for both acquired and developmental apraxia, the speech-language pathologist may ask the person to perform speech tasks such as repeating a particular word several times or repeating a list of words of increasing length (for example, love, loving, lovingly). For acquired apraxia of speech, a speech-language pathologist may also examine a person's ability to converse, read, write, and perform non-speech movements. Brain-imaging tests such as magnetic resonance imaging (MRI) may also be used to help distinguish acquired apraxia of speech from other communication disorders in people who have experienced brain damage.

How Is It Treated?

In some cases, people with acquired apraxia of speech recover some or all of their speech abilities on their own. This is called spontaneous recovery. Children with developmental apraxia of speech will not outgrow the problem on their own. Speech-language therapy is often helpful for these children and for people with acquired apraxia who do not spontaneously recover all of their speech abilities.

Speech-language pathologists use different approaches to treat apraxia of speech, and no single approach has been proven to be the most effective. Therapy is tailored to the individual and is designed to treat other speech or language problems that may occur together with apraxia. Each person responds differently to therapy, and some people will make more progress than others. People with apraxia of speech usually need frequent and intensive one-on-one therapy. Support and encouragement from family members and friends are also important.

In severe cases, people with acquired or developmental apraxia of speech may need to use other ways to express themselves. These might include formal or informal sign language, a language notebook with pictures or written words that the person can show to other people, or an electronic communication device such as a portable computer that writes and produces speech.

Auditory Preocessing Disorder (APD)

What is auditory processing.

Auditory processing is a term used to describe what happens when your brain recognizes and interprets the sounds around you. Humans hear when energy that we recognize as sound travels through the ear and is changed into electrical information that can be interpreted by the brain. The "disorder" part of auditory processing disorder means that something is adversely affecting the processing or interpretation of the information.

Children with APD often do not recognize subtle differences between sounds in words, even though the sounds themselves are loud and clear. For example, the request "Tell me how a chair and a couch are alike" may sound to a child with APD like "Tell me how a couch and a chair are alike." It can even be understood by the child as "Tell me how a cow and a hair are alike." These kinds of problems are more likely to occur when a person with APD is in a noisy environment or when he or she is listening to complex information.

APD goes by many other names. Sometimes it is referred to as central auditory processing disorder (CAPD). Other common names are auditory perception problem, auditory comprehension deficit, central auditory dysfunction, central deafness, and so-called "word deafness."

What causes auditory processing difficulty?

We are not sure. Human communication relies on taking in complicated perceptual information from the outside world through the senses, such as hearing, and interpreting that information in a meaningful way. Human communication also requires certain mental abilities, such as attention and memory. Scientists still do not understand exactly how all of these processes work and interact or how they malfunction in cases of communication disorders. Even though your child seems to "hear normally," he or she may have difficulty using those sounds for speech and language.

The cause of APD is often unknown. In children, auditory processing difficulty may be associated with conditions such as dyslexia, attention deficit disorder, autism, autism spectrum disorder, specific language impairment, pervasive developmental disorder, or developmental delay. Sometimes this term has been misapplied to children who have no hearing or language disorder but have challenges in learning.

What are the symptoms of possible auditory processing difficulty?

Children with auditory processing difficulty typically have normal hearing and intelligence. However, they have also been observed to

Have trouble paying attention to and remembering information presented orally
Have problems carrying out multistep directions
Have poor listening skills
Need more time to process information
Have low academic performance
Have behavior problems
Have language difficulty (e.g., they confuse syllable sequences and have problems developing vocabulary and understanding language)
Have difficulty with reading, comprehension, spelling, and vocabulary

How is suspected auditory processing difficulty diagnosed in children?

You, a teacher, or a day care provider may be the first person to notice symptoms of auditory processing difficulty in your child. So talking to your child's teacher about school or preschool performance is a good idea. Many health professionals can also diagnose APD in your child. There may need to be ongoing observation with the professionals involved.

Much of what will be done by these professionals will be to rule out other problems. A pediatrician or a family doctor can help rule out possible diseases that can cause some of these same symptoms. He or she will also measure growth and development. If there is a disease or disorder related to hearing, you may be referred to an otolaryngologist--a physician who specializes in diseases and disorders of the head and neck.

To determine whether the child has a hearing function problem, an audiologic evaluation is necessary. An audiologist will give tests that can determine the softest sounds and words a person can hear and other tests to see how well people can recognize sounds in words and sentences. For example, for one task, the audiologist might have the child listen to different numbers or words in the right and the left ear at the same time. Another common audiologic task involves giving the child two sentences, one louder than the other, at the same time. The audiologist is trying to identify the processing problem.

A speech-language pathologist can find out how well a person understands and uses language. A mental health professional can give you information about cognitive and behavioral challenges that may contribute to problems in some cases, or he or she may have suggestions that will be helpful. Because the audiologist can help with the functional problems of hearing and processing, and the speech-language pathologist is focused on language, they may work as a team with the child.

Developmental Dyspraxia

What is developmental dyspraxia.

Developmental dyspraxia is a disorder characterized by an impairment in the ability to plan and carry out sensory and motor tasks. Generally, individuals with the disorder appear "out of sync" with their environment. Symptoms vary and may include poor balance and coordination, clumsiness, vision problems, perception difficulties, emotional and behavioral problems, difficulty with reading, writing, and speaking, poor social skills, poor posture, and poor short-term memory. Although individuals with the disorder may be of average or above average intelligence, they may behave immaturely.

Is there any treatment?

Treatment is symptomatic and supportive and may include occupational and speech therapy, and "cueing" or other forms of communication such as using pictures and hand gestures. Many children with the disorder require special education.

What is the prognosis?

Developmental dyspraxia is a lifelong disorder. Many individuals are able to compensate for their disabilities through occupational and speech therapy.

Landau-Kleffner Syndrome

What is landau-kleffner syndrome.

Landau-Kleffner syndrome (LKS) is a childhood disorder. A major feature of LKS is the gradual or sudden loss of the ability to understand and use spoken language. All children with LKS have abnormal electrical brain waves that can be documented by an electroencephalogram (EEG), a recording of the electric activity of the brain. Approximately 80 percent of the children with LKS have one or more epileptic seizures that usually occur at night. Behavioral disorders such as hyperactivity, aggressiveness and depression can also accompany this disorder. LKS may also be called infantile acquired aphasia, acquired epileptic aphasia or aphasia with convulsive disorder. This syndrome was first described in 1957 by Dr. William M. Landau and Dr. Frank R. Kleffner, who identified six children with the disorder.

What are the signs of Landau-Kleffner syndrome?

LKS occurs most frequently in normally developing children who are between 3 and 7 years of age. For no apparent reason, these children begin having trouble understanding what is said to them. Doctors often refer to this problem as auditory agnosiaor "word deafness." The auditory agnosia may occur slowly or very quickly. Parents often think that the child is developing a hearing problem or has become suddenly deaf. Hearing tests, however, show normal hearing. Children may also appear to be autistic or developmentally delayed.

The inability to understand language eventually affects the child's spoken language which may progress to a complete loss of the ability to speak (mutism). Children who have learned to read and write before the onset of auditory agnosia can often continue communicating through written language. Some children develop a type of gestural communication or sign-like language. The communication problems may lead to behavioral or psychological problems. Intelligence usually appears to be unaffected.

The loss of language may be preceded by an epileptic seizure that usually occurs at night. At some time, 80 percent of children with LKS have one or more seizures. The seizures usually stop by the time the child becomes a teenager. All LKS children have abnormal electrical brain activity on both the right and left sides of their brains.

Laryngeal Papillomatosis

What is laryngeal papillomatosis.

Laryngeal papillomatosis is a disease consisting of tumors that grow inside the larynx (voice box), vocal cords, or the air passages leading from the nose into the lungs (respiratory tract). It is a rare disease caused by the human papilloma virus (HPV). Although scientists are uncertain how people are infected with HPV, they have identified more than 60 types of HPVs. Tumors caused by HPVs, called papillomas, are often associated with two specific types of the virus (HPV 6 and HPV 11). They may vary in size and grow very quickly. Eventually, these tumors may block the airway passage and cause difficulty breathing.

Laryngeal papillomatosis affects infants and small children as well as adults. Between 60 and 80 percent of cases occur in children, usually before the age of three. Because the tumors grow quickly, young children with the disease may find it difficult to breathe when sleeping, or they may experience difficulty swallowing. Adults with laryngeal papillomatosis may experience hoarseness, chronic coughing, or breathing problems.

How is laryngeal papillomatosis disagnosed?

There are several tests to diagnose laryngeal papillomatosis. Two routine tests are indirect and direct laryngoscopy. An indirect laryngoscopy is done in an office by a speech-language pathologist or by a doctor. To examine the larynx for tumors, the doctor places a small mirror in the back of the throat and angles the mirror down towards the larynx. A direct laryngoscopy is performed in the operating room under general anesthesia.

This procedure is usually used with children or adults during lengthy examinations to minimize discomfort. It involves looking directly at the larynx. Direct laryngoscopy allows the doctor to view the vocal folds and other parts of the larynx under high magnification and samples of unusual tissue lesions that may be in the larynx or other parts of the throat.

Spasmodic dysphonia

What is spasmodic dysphonia.

Spasmodic dysphonia (or laryngeal dystonia) is a voice disorder caused by involuntary movements of one or more muscles of the larynx or voice box. Individuals who have spasmodic dysphonia may have occasional difficulty saying a word or two or they may experience sufficient difficulty to interfere with communication. Spasmodic dysphonia causes the voice to break or to have a tight, strained or strangled quality. There are three different types of spasmodic dysphonia.

What are the types of Spasmodic Dysphonia?

The three types of spasmodic dysphonia are adductor spasmodic dysphonia, abductor spasmodic dysphonia and mixed spasmodic dysphonia.

What are the features of spasmodic dysphonia?

In adductor spasmodic dysphonia, sudden involuntary muscle movements or spasms cause the vocal folds (or vocal cords) to slam together and stiffen. These spasms make it difficult for the vocal folds to vibrate and produce voice. Words are often cut off or difficult to start because of the muscle spasms. Therefore, speech may be choppy and sound similar to stuttering. The voice of an individual with adductor spasmodic dysphonia is commonly described as strained or strangled and full of effort. Surprisingly, the spasms are usually absent while whispering, laughing, singing, speaking at a high pitch or speaking while breathing in. Stress, however, often makes the muscle spasms more severe.

In abductor spasmodic dysphonia, sudden involuntary muscle movements or spasms cause the vocal folds to open. The vocal folds can not vibrate when they are open. The open position of the vocal folds also allows air to escape from the lungs during speech. As a result, the voices of these individuals often sound weak, quiet and breathy or whispery. As with adductor spasmodic dysphonia, the spasms are often absent during activities such as laughing or singing.

Mixed spasmodic dysphonia involves muscles that open the vocal folds as well as muscles that close the vocal folds and therefore has features of both adductor and abductor spasmodic dysphonia.

(For other types of Communication Disorders and further information on this topic, , use NASET's table of hundreds of links to Speech and Language Impairments. This table will be found when you close out of this window.)

Brice, A. (2001). Children with communication disorders (ERIC Digest #E617). Arlington, VA: ERIC Clearinghouse on Disabilities and Gifted Education. (Available online at: http://ericec.org/digests/e617.html )

Charkins, H. (1996). Children with facial differences: A parents' guide. Bethesda, MD: Woodbine House. (Telephone: 800.843.7323. Web: www.woodbinehouse.com )

Cleft Palate Foundation. (1997). For parents of newborn babies with cleft lip/cleft palate. Chapel Hill, NC: Author. (Telephone: 800.242.5338. Also available online at: www.cleftline.org )

Gruman-Trinker, C. (2001). Your cleft-affected child: The complete book of information, resources and hope. Alameda, CA: Hunter House. (Web: www.hunterhouse.com )

Hamaguchi, P. M. (2001). Childhood speech, language, & listening problems: What every parent should know (2nd ed.). New York: John Wiley & Sons, Inc. (Telephone: 800.225.5945. Web: www.wiley.com )

Organizations

Alliance for Technology Access 2175 E. Francisco Boulevard, Suite L San Rafael, CA 94901 800.455.7970; 415.455.4575 Email: [email protected] Web: www.ataccess.org

American Speech-Language-Hearing Association (ASHA) 10801 Rockville Pike Rockville, MD 20852 301.897.5700 (V/TTY); 800.638.8255 Email: [email protected] Web: www.asha.org

Childhood Apraxia of Speech Association of North America (CASANA) 123 Eisele Road Cheswick, PA 15024 412.767.6589 Email: [email protected] Web: www.apraxia-kids.org

Cleft Palate Foundation 104 South Estes Drive, Suite 204 Chapel Hill, NC 27514 800.242.5338; 919.933.9044 Email: [email protected] Web: www.cleftline.org

Easter Seals--National Office 230 West Monroe Street, Suite 1800 Chicago, IL 60606 312.726.6200 312.726.4258 (TTY) 800.221.6827 Email: [email protected] Web: www.easter-seals.org

Learning Disabilities Association of America (LDA) 4156 Library Road Pittsburgh, PA 15234-1349 412.341.1515 Email: [email protected] Web: www.ldaamerica.org

Scottish Rite Foundation Southern Jurisdiction, U.S.A., Inc. 1733 Sixteenth Street, N.W. Washington, DC 20009-3199 202.232.3579 Web: www.srmason-sj.org/web/index.htm

Trace Research and Development Center University of Wisconsin-Madison 1550 Engineering Dr. 2107 Engineering Hall Madison, WI 53706 608.262-6966; 608.263.5408 (TTY) Email:

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Language and Speech Disorders in Children

Helping children learn language, what to do if there are concerns.

Detecting problems

Children are born ready to learn a language, but they need to learn the language or languages that their family and environment use. Learning a language takes time, and children vary in how quickly they master milestones in language and speech development. Typically developing children may have trouble with some sounds, words, and sentences while they are learning. However, most children can use language easily around 5 years of age.

Parents and caregivers are the most important teachers during a child’s early years. Children learn language by listening to others speak and by practicing. Even young babies notice when others repeat and respond to the noises and sounds they make. Children’s language and brain skills get stronger if they hear many different words. Parents can help their child learn in many different ways, such as

Responding to the first sounds, gurgles, and gestures a baby makes.
Repeating what the child says and adding to it.
Talking about the things that a child sees.
Asking questions and listening to the answers.
Looking at or reading books.
Telling stories.
Singing songs and sharing rhymes.

This can happen both during playtime and during daily routines.

Parents can also observe the following:

How their child hears and talks and compare it with typical milestones for communication skills external icon .
How their child reacts to sounds and have their hearing tested if they have concerns .

Learn more about language milestones . Watch milestones in action.

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Some languages are visual rather than spoken. American Sign Language uses visual signals, including gestures, facial expressions, and body movement to communicate.

Some children struggle with understanding and speaking and they need help. They may not master the language milestones at the same time as other children, and it may be a sign of a language or speech delay or disorder.

Language development has different parts, and children might have problems with one or more of the following:

Not hearing the words (hearing loss).
Not understanding the meaning of the words.
Not knowing the words to use.
Not knowing how to put words together.
Knowing the words to use but not being able to express them.

Language and speech disorders can exist together or by themselves. Examples of problems with language and speech development include the following:

Difficulty with forming specific words or sounds correctly.
Difficulty with making words or sentences flow smoothly, like stuttering or stammering.
Language delay – the ability to understand and speak develops more slowly than is typical
Aphasia (difficulty understanding or speaking parts of language due to a brain injury or how the brain works).
Auditory processing disorder (difficulty understanding the meaning of the sounds that the ear sends to the brain)

Learn more about language disorders external icon .

Language or speech disorders can occur with other learning disorders that affect reading and writing. Children with language disorders may feel frustrated that they cannot understand others or make themselves understood, and they may act out, act helpless, or withdraw. Language or speech disorders can also be present with emotional or behavioral disorders, such as attention-deficit/hyperactivity disorder (ADHD) or anxiety . Children with developmental disabilities including autism spectrum disorder may also have difficulties with speech and language. The combination of challenges can make it particularly hard for a child to succeed in school. Properly diagnosing a child’s disorder is crucial so that each child can get the right kind of help.

Detecting problems with language or speech

Doctor examining toddler's ear with mom smiling

If a child has a problem with language or speech development, talk to a healthcare provider about an evaluation. An important first step is to find out if the child may have a hearing loss. Hearing loss may be difficult to notice particularly if a child has hearing loss only in one ear or has partial hearing loss, which means they can hear some sounds but not others. Learn more about hearing loss, screening, evaluation, and treatment .

A language development specialist like a speech-language pathologist external icon will conduct a careful assessment to determine what type of problem with language or speech the child may have.

Overall, learning more than one language does not cause language disorders, but children may not follow exactly the same developmental milestones as those who learn only one language. Developing the ability to understand and speak in two languages depends on how much practice the child has using both languages, and the kind of practice. If a child who is learning more than one language has difficulty with language development, careful assessment by a specialist who understands development of skills in more than one language may be needed.

Treatment for language or speech disorders and delays

Children with language problems often need extra help and special instruction. Speech-language pathologists can work directly with children and their parents, caregivers, and teachers.

Having a language or speech delay or disorder can qualify a child for early intervention external icon (for children up to 3 years of age) and special education services (for children aged 3 years and older). Schools can do their own testing for language or speech disorders to see if a child needs intervention. An evaluation by a healthcare professional is needed if there are other concerns about the child’s hearing, behavior, or emotions. Parents, healthcare providers, and the school can work together to find the right referrals and treatment.

What every parent should know

Children with specific learning disabilities, including language or speech disorders, are eligible for special education services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) external icon and Section 504 external icon , an anti-discrimination law.

Get help from your state’s Parent Training and Information Center external icon

The role of healthcare providers

Healthcare providers can play an important part in collaborating with schools to help a child with speech or language disorders and delay or other disabilities get the special services they need. The American Academy of Pediatrics has created a report that describes the roles that healthcare providers can have in helping children with disabilities external icon , including language or speech disorders.

More information

CDC Information on Hearing Loss

National Institute on Deafness and Other Communication Disorders external icon

Birth to 5: Watch me thrive external icon

The American Speech-Language-Hearing Association external icon

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Monica Marzinske, CCC-SLP

Speech-language therapy.

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Speaking clearly: Help for people with speech and language disorders

Speech-Language

Speaking and language abilities vary from person to person. Some people can quickly articulate exactly what they are thinking or feeling, while others struggle being understood or finding the right words.

These struggles could be due to a speech or language disorder if communication struggles cause ongoing communication challenges and frustrations. Speech and language disorders are common.

It's estimated that 5% to 10% of people in the U.S. have a communication disorder. By the first grade, about 5% of U.S. children have a noticeable speech disorder. About 3 million U.S. adults struggle with stuttering and about 1 million U.S. adults have aphasia. These conditions make reading, speaking, writing and comprehending difficult.

People with speech and language disorders can find hope in rehabilitation. Speech-language pathologists can evaluate and treat these disorders. This can lead to a happier, healthier and more expressive life.

Types of speech and language disorders

Speech and language disorders come in many forms, each with its own characteristics:.

Aphasia People with aphasia have difficulty with reading, writing, speaking or understanding information they've heard. The intelligence of a person with aphasia is not affected.
Dysarthria People with dysarthria demonstrate slurred or imprecise speech patterns that can affect the understanding of speech.
Apraxia A person with this disorder has difficulty coordinating lip and tongue movements to produce understandable speech.
Dysphagia This condition refers to swallowing difficulties, including food sticking in the throat, coughing or choking while eating or drinking, and other difficulties.
Stuttering This speech disorder involves frequent and significant problems with normal fluency and flow of speech. People who stutter know what they want to say but have difficulty saying it.
Articulation disorder People with this disorder have trouble learning how to make specific sounds. They may substitute sounds, such as saying "fum" instead of "thumb".
Phonological disorder Phonological processes are patterns of errors children use to simplify language as they learn to speak. A phonological disorder may be present if these errors persist beyond the age when most other children stop using them. An example is saying "duh" instead of "duck."
Voice Voice disorders include vocal cord paralysis, vocal abuse and vocal nodules, which could result in vocal hoarseness, changes in vocal volume and vocal fatigue.
Cognitive communication impairment People with cognitive communication impairment have difficulty with concentration, memory, problem-solving, and completion of tasks for daily and medical needs.

Speech and language disorders are more common in children. It can take time to develop the ability to speak and communicate clearly. Some children struggle with finding the right word or getting their jaws, lips or tongues in the correct positions to make the right sounds.

In adults, speech and language disorders often are the result of a medical condition or injury. The most common of these conditions or injuries are a stroke, brain tumor, brain injury, cancer, Parkinson's disease, multiple sclerosis, Lou Gehrig's disease or other underlying health complications.

Treatment options

Speech and language disorders can be concerning, but speech-language pathologists can work with patients to evaluate and treat these conditions. Each treatment plan is specifically tailored to the patient.

Treatment plans can address difficulties with:

Speech sounds, fluency or voice
Understanding language
Sharing thoughts, ideas and feelings
Organizing thoughts, paying attention, remembering, planning or problem-solving
Feeding and swallowing
Vocabulary or improper grammar use

Treatment typically includes training to compensate for deficiencies; patient and family education; at-home exercises; or neurological rehabilitation to address impairments due to medical conditions, illnesses or injury.

Treatment options are extensive and not limited by age. Children and adults can experience the benefits of treatment.

If you or a loved one are struggling with speech and language issues, you are not alone. Millions of people experience similar daily challenges. Better yet, help is available.

Monica Marzinske is a speech-language pathologist in New Prague , Minnesota.

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Signs and Symptoms of a Speech Language Disorder

The signs and symptoms of speech and language disorders differ between type and between children and adults. For an overview of what to consider see below. For more information about speech-language developmental milestones for children birth-five click here. In children, parents should watch for the following signs of speech and language disorders:

Shows a lack of attention to sounds (birth- 1year)
Doesn’t respond when you call his/her name (7 months-1 year)
Has difficulty interact socially (infancy and older)
Has difficulty following or understanding what you say (starting at 1 year)
Says only a few sounds or words or makes only a few gestures (18 months to 2 years)
Says words that are not easily understood (18 months to 2 years)
Does not combine words (starting at 2 years)
Struggles to say sounds or words (3 to 4 years)

In adults, signs of speech and language disorders include:

Struggles to say sounds or words
Repeats words or parts of words
Says words in the wrong order
Struggles with using words and understanding others
Has difficulty imitating speech sounds
Speaks at a slow rate

Sometimes a strong accent can make communication difficult and cause frustration when a speaker is misunderstood or asked to repeat themselves. Although an accent is not a speech impairment, Northeast Hearing & Speech can help individuals who need assistance for accent reduction. Click here to view our accent reduction services.

General Information About Speech and Language Disorders

Definition of speech and language disorders.

One quarter of the students served in the public schools’ special education programs (almost 1 million children in the 1993-94 school year) were categorized as having a speech or language impairment. This estimate does not include children who have speech/language problems secondary to other conditions such as deafness. Language disorders may be related to other disabilities such as mental retardation, autism or cerebral palsy. It is estimated that communication disorders (including speech, language and hearing disorders) affect one of every 10 people in the United States.

Characteristics

A child’s communication is considered delayed when the child is noticeably behind his or her peers in the acquisition of speech and/or language skills. Sometimes a child will have greater receptive (understanding) than expressive (speaking) language skills, but this is not always the case.

Speech disorders refer to difficulties producing speech sounds or problems with voice quality. They might be characterized by an interruption in the flow or rhythm of speech, such as stuttering, which is called dysfluency. Speech disorders may be problems with the way sounds are formed, called articulation or phonological disorders, or they may be difficulties with the pitch, volume or quality of the voice. There may be a combination of several problems. People with speech disorders have trouble using some speech sounds, which can also be a symptom of a delay. They may say “see” when they mean “ski” or they may have trouble using other sounds like “l” or “r”. Listeners may have trouble understanding what someone with a speech disorder is trying to say. People with voice disorders may have trouble with the way their voices sound.

Educational implications

Because all communication disorders carry the potential to isolate individuals from their social and educational surroundings, it is essential to find appropriate timely intervention. While many speech and language patterns can be called “baby talk” and are part of a young child’s normal development, they can become problems if they are not outgrown as expected. In this way an initial delay in speech and language or an initial speech pattern can become a disorder which can cause difficulties in learning. Because of the way the brain develops, it is easier to learn language and communication skills before the age of 5. When children have muscular disorders, hearing problems or developmental delays, their acquisition of speech, language and related skills is often affected.

Speech-language pathologists assist children who have communication disorders in various ways. They provide individual therapy for the child; consult with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; and work closely with the family to develop goals and techniques for effective therapy in class and at home. Technology can help children whose physical conditions make communication difficult. The use of electronic communication systems allow nonspeaking people and people with severe physical disabilities to engage in the give and take of shared thought.

Vocabulary and concept growth continues during the years children are in school. Reading and writing are taught and, as students get older, the understanding and use of language becomes more complex. Communication skills are at the heart of the education experience. Speech and/or language therapy may continue throughout a student’s school year either in the form of direct therapy or on a consultant basis. The speech-language pathologist may assist vocational teachers and counselors in establishing communication goals related to the work experiences of students and suggest strategies that are effective for the important transition from school to employment and adult life.

Communication has many components. All serve to increase the way people learn about the world around them, utilize knowledge and skills, and interact with colleagues, family and friends.

Berkowitz, S. (1994). “The cleft palate story: A primer for parents of children with cleft lip and palate.” Chicago, IL: Quintessence. (Telephone: 1-800-621-0387.)

Bernthal, J.E. & Bankson, N.W. (1993). “Articulation and phonological disorders” (3rd ed.). Englewood Cliffs, NJ: Prentice Hall. (Available from Prentice Hall, Englewood Cliffs, NJ 07632. Telephone: 1-800-947-7700.)

Beukelman, D.R., & Mirenda, P. (1992). “Augmentative and alternative communication: Management of severe communication disorders in children and adults.” Baltimore, MD: Paul H. Brookes. (Telephone: 1-800-638-3775.)

Organizations

Alliance for Technology Access 2175 E. Francisco Blvd., Suite L San Rafael, CA 94901 (415) 455-4575
American Speech-Language-Hearing Association (ASHA) 10801 Rockville Pike Rockville, MD 20852 (301) 897-5700 (V/TT); 1-800-638-8255 E-Mail: [email protected]
Learning Disabilities Association of America (LDA) 4156 Library Road Pittsburgh, PA 15234 (412) 341-1515; (412) 341-8077
Division for Children with Communication Disorders c/o Council for Exceptional Children (CEC) 1920 Association Drive Reston, VA 22091-1589 (703) 620-3660
National Easter Seal Society 230 West Monroe Street, Suite 1800 Chicago, IL 60606-4802 (312) 726-6200; (312) 726-4258 (TT) 1-800-221-6827 (Toll Free); (312) 726-6200 (312) 726-4258 (TTY) E-Mail: [email protected]
Scottish Rite Foundation Southern Jurisdiction, U.S.A., Inc. 1733 Sixteenth Street, N.W. Washington, DC 20009-3199 (202) 232-3579
Trace Research and Development Center University of Wisconsin - Madison S-151 Waisman Center Madison, WI 53705-2280 (608) 262-6966; (608) 263-5408 (TTY)

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Committee on the Evaluation of the Supplemental Security Income (SSI) Disability Program for Children with Speech Disorders and Language Disorders; Board on the Health of Select Populations; Board on Children, Youth, and Families; Institute of Medicine; Division of Behavioral and Social Sciences and Education; National Academies of Sciences, Engineering, and Medicine; Rosenbaum S, Simon P, editors. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington (DC): National Academies Press (US); 2016 Apr 6.

Cover of Speech and Language Disorders in Children

Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program.

Hardcopy Version at National Academies Press

2 Childhood Speech and Language Disorders in the General U.S. Population

Speech and language disorders in children include a variety of conditions that disrupt children's ability to communicate. Severe speech and language disorders are particularly serious, preventing or impeding children's participation in family and community, school achievement, and eventual employment. This chapter begins by providing an overview of speech and language development and disorders. It then addresses the following topics within the committee's charge: (1) current standards of care for assessing and diagnosing speech and language disorders; (2) causes of and risk factors for these disorders; (3) their prevalence and its relationship to age, development, and gender; and (4) common comorbidities (i.e., other co-occurring conditions).

OVERVIEW OF CHILDHOOD SPEECH AND LANGUAGE DISORDERS

Differentiating Language from Speech

The words “language” and “speech” are often used interchangeably in casual conversation, but in the context of communication disorders, it is important to understand the differences between them. 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, 2009 ).

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, 1999 ). 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.

In this report, the terms “speech disorders,” “language disorders,” and “speech and language disorders” are used (see Box 1-2 ). The terms “speech disorders” and “language disorders” are used only to refer to these disorders as defined in this chapter, while the term “speech and language disorders” denotes all of the disorders encompassed by these two categories.

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. As discussed in the later section of this chapter on causes and risk factors, virtually every factor that threatens prenatal development of the fetus—from genetic abnormalities, to nutritional deficiencies, to exposure to environmental toxins—is associated with an increased risk of developing speech and/or language disorders. 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.g., Locke, 2011 ). The social experiences and skills that occur during the infant's first months of life are important precursors to pragmatic language skills: the infant first learns to engage in reciprocal interactions and to convey communicative intentions through nonlinguistic means such as gestures, and begins to accomplish these same goals through language forms such as early words. 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 (babbling), a precursor to articulating recognizable words (e.g., Kent, 1999 ).

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, 2015 ; Pelucchi et al., 2009 ; Werker et al., 2012 ). When tested using behavioral measures, most 12- to 18-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.g., Miller and Paul, 1995 ). They also can produce at least a few intelligible words during this period (e.g., Squires et al., 2009 ), showing that they are acquiring both expressive language and speech skills. Their speech skills progress in a systematic fashion over the next few years, as they learn first to say relatively simpler consonants (e.g., “m,” “d,” “n”) and later to say more challenging consonants (e.g., “s,” “th,” “sh”) and consonant clusters (e.g., “bl,” “tr,” “st”) ( Shriberg, 1993 ). 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.g., Fenson et al., 2007 ). 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.g., Boudreau, 2008 ). 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., 2013 ). 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, 2013 ). 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, 2012 ; Duke et al., 2013 ).

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., 2013 ; Goldstein and Gildersleeve-Neumann, 2012 ; Kohnert and Derr, 2012 ).

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, 1995 ; Hurtado et al., 2014 ). 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.g., Hoff, 2013 ). 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, 2010 ; Parish et al., 2010 ; Pentimonti et al., 2014 ).

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 (pharynx), then modify this voiced stream to yield the speech sounds, or phonemes, of the speaker's native language ( Caruso and Strand, 1999 ). 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, voice disorders, and stuttering. 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, 1999 ). 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, 2008 ; Pennington et al., 2009 ). Neuromuscular conditions, including stroke, infections (e.g., polio, meningitis), cerebral palsy, and trauma, can cause dysarthria. Another rare speech sound disorder, childhood apraxia of speech , is caused by difficulty with planning and programming speech movements ( ASHA, 2007 ). 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., 2006 ). 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. Dysfluent speech contains an excessive amount of repetitions of sounds, words, and phrases, and involuntary breaks, or “blocks.” Severe stuttering can effectively prevent a speaker from speaking at all; it may also lead to other abnormal physical and emotional behaviors as the speaker struggles to end a particular block or avoid blocks in the future ( Conture, 2001 ).

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, 2013 ; WHO, 1992 ). 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.g., Sameroff, 2009 ). 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 ( walking ), or may not understand complex sentences (e.g., The man that the boy saw was running away ). 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, 2014 ). In fact, the Individuals with Disabilities Education Act (IDEA) (Section 300.8) defines a specific learning disability as “a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations.” Strong evidence suggests that early language disorders increase the risk of poor literacy, mental health, and employment outcomes well into adulthood (e.g., Atkinson et al., 2015 ; Clegg et al., 2015 ; Law et al., 2009 ). 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 2-1 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.

DIAGNOSING SPEECH AND LANGUAGE DISORDERS

Speech and language disorders can accompany or result from any of the conditions that interfere with the development of perceptual, motor, cognitive, or socioemotional function. Accordingly, conditions as varied as Down syndrome, fragile X syndrome, autism spectrum disorder, traumatic brain injury, and being deaf or hard of hearing are known to increase the potential for childhood speech and/or language disorders, and many children with such conditions will also have speech and language 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 (2014) 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., 2014 ). Conversely, some children who have primary speech sound disorders as preschoolers have deficits in reading and spelling during their elementary school years ( Lewis et al., 2011 ). In short, considerable evidence suggests that spoken language skills, including speech sound production, constitute an integrated system and that clear deficits in one area may coexist with deficits in other areas that can compromise future development in language-related domains such as literacy. Intensive monitoring of speech and language development in such children is important for early detection and intervention to lessen the effects of speech and language disorders.

In many children, however, speech and language disorders occur for unknown reasons. In such children, diagnosing speech and language disorders is a complex process that requires assessing not only speech and language skills but also cognitive, perceptual, motor, and socioemotional development; biological, medical, and socioeconomic circumstances; and cultural and linguistic environments. Best-practice guidelines recommend evaluating across multiple domains and obtaining information from multiple sources, including a combination of formal, standardized, or norm-referenced tests; criterion-referenced observations by speech-language pathologists and other professionals; and judgments of familiar caregivers about the child's speech and language competence relative to community expectations for children of the same age ( ASHA, 2004 ; Nelson et al., 2006 , 2008 ; Royal College of Speech & Language Therapists, 2005 ; Shevell et al., 2003 ; Wilkinson et al., 2013 ).

On norm-referenced tests, children's scores are compared with average scores from large, representative samples of children of the same age. Children scoring below a cutoff value are defined as having a deficit, and severity is defined according to how far below average their scores fall. Deficits can range from mild to severe. In clinical practice, scores that fall more than two but less than three standard deviations below the mean are described as severely or extremely low; only 2.14 percent of children would be expected to score this poorly. Scores that fall three or more standard deviations below the mean are extraordinarily low; only 0.13 percent of children would be expected to score this poorly ( Urbina, 2014 ). Figure 2-1 represents these numbers in graphic terms. It shows that only 1 child in 1,000 would be expected to score three or more standard deviations below the mean, and only about 22 children in 1,000 would score more than two but less than three standard deviations below the mean.

In a normative sample of 1,000 children, only 1 child (shown in orange) is expected to score three or more standard deviations below the mean. Another 22 children (shown in light green) are expected to score more than two but less than three standard (more...)

In practice, few norm-referenced speech and language tests include a separate severity category for scores that are three or more standard deviations below the mean; all scores two or more standard deviations below the mean are classified together as “severe” or “very low” ( Spaulding et al., 2012 ). As noted in Chapter 1 , these clinical criteria for defining severity are not identical to the legal standards for severity specified in the regulations for the Supplemental Security Income (SSI) program, which also considers functional limitations (that are the result of the interactive and cumulative effects of all impairments) to determine the severity. Chapter 4 includes an in-depth review of how children are evaluated for disability in the SSI eligibility determination process.

Norm-referenced testing is not always possible because children may be too young or too disabled to participate in formal standardized testing procedures. In children younger than 3 years and others incapable of formal testing, behaviors and skills are compared with those of typically developing children using criterion-referenced measures or observational checklists ( Salvia et al., 2012 ). Some criterion-referenced measures involve detailed observations of specific skills, such as parent checklists of the number of words that children say. For example, 3-year-old children are expected to say 50 or more different words; those who fail to reach this criterion may be identified as having a significant vocabulary delay. Similarly, by 9-10 months of age, children are expected to communicate with their caregivers using nonlinguistic signals such as pointing and clapping; a 12-month-old who appears uninterested in others and fails to produce such basic communicative precursors to language may be identified as having a significant delay in the pragmatic domain of language. Still other criterion-referenced measures involve more global judgments of whether the child's language abilities are generally commensurate with those of peers, such as asking parents whether they are concerned about their child's ability to talk or understand as well as other children of the same age. In many cases, children are diagnosed as having language delays when their level of performance on some criterion-referenced skill is inconsistent with age to a significant degree, usually defined as a “percentage of delay” relative to chronological age. For example, a 24-month-old with the skills of children half her age (i.e., 12-month-old children) can be described as having a 50 percent delay; if her skills are comparable to those of 18-month-olds, she is described as having a 25 percent delay. In many states, delays of more than 20-25 percent are used to identify children under age 3 years for early intervention under Part C of the 2004 IDEA ( Ringwalt, 2015 ).

Validated norm-referenced tests may not be available for children who are members of cultural and linguistic communities that are not represented adequately in normative samples (e.g., AERA et al., 2014 ; Roseberry-McKibbin, 2014 ). In addition, norm-referenced test scores may be influenced by such extraneous factors as additional or confounding deficits (e.g., poor vision, inability to respond actively to test items), fatigue, and emotional state on a given day ( Urbina, 2014 ). Finally, norm-referenced testing may not adequately reflect the functional limitations that speech and language deficits impose on the child's ability to participate in some demanding, real-world contexts. For example, a child with a speech sound disorder may be able to articulate a single word reasonably clearly on a norm-referenced speech test, but be incapable of coordinating the many events necessary to produce an intelligible sentence in fast-paced, dynamic conversation. Similarly, a child with an expressive language disorder may be able to produce single words and short phrases successfully elicited by a norm-referenced test, but be incapable of producing grammatical sentences, much less stories that include them. And a child with a receptive language disorder may understand words presented individually and point to a picture on a norm-referenced test, but be unable to comprehend sentences, especially if the sentences are lengthy, complex, spoken at the normal rate of two to four words per second, or spoken in noisy or distracting environments. For all of these reasons, best diagnostic practices require that evidence from norm- and criterion-referenced testing by professionals be considered in conjunction with judgments made by people who are familiar with the child's usual functioning in his or her daily environment (e.g., Paul and Norbury, 2012 ).

CAUSES AND RISK FACTORS

This chapter now turns to an overview of known underlying causes of speech and language disorders, followed by a summary of factors that have been associated with an increased risk of speech and language disorders having no known cause. Although prevalence estimates are available for some of the causes described below, and speech and language disorders are frequently mentioned among their sequelae, evidence on the percentage of speech and language disorders attributable solely to the underlying condition is not available. For example, Down syndrome, a chromosomal disorder with a prevalence of 1:700 live births, causes deficits spanning multiple areas of development, including not only speech and language but also cognition and sensorimotor skills, making it difficult to quantify the syndrome's causal role specifically in speech and language disorders.

Speech and Language Disorders with Known Causes

Determining the underlying etiology of a speech or language disorder is essential to providing the child with an appropriate set of interventions and the parents with an understanding of the cause and natural history of their child's disability. A variety of congenital and acquired conditions may result in abnormal speech and/or language development. These conditions include primary disorders of hearing, as well as specific genetic diseases, brain malformation syndromes, inborn errors of metabolism, toxic exposures, nutritional deficiencies, injuries, and epilepsy.

Children who are deaf or hard of hearing provide an especially clear example of the interrelationships among the many causes and consequences of speech and language disorders in childhood ( Fitzpatrick, 2015 ). Because adequate hearing is critically important for developing and using receptive language, expressive language, and speech, being deaf or hard of hearing can lead to speech and language disorders, which in turn contribute to socioemotional and academic disabilities. This is particularly the case when the onset of hearing problems is either congenital or acquired during the first several years of life. Therefore, it is essential that hearing be assessed in children being evaluated for speech and language disorders.

Childhood hearing loss may result from or be associated with a wide variety of causes, which are categorized in Box 2-2 . Hearing may be affected by disorders of either the sensory component of the auditory system (i.e., peripheral) or the processing of auditory information within the brain (i.e., central). Peripheral causes may be either unilateral or bilateral and are subdivided into conductive types, which are due to developmental or acquired abnormalities of the structures of the outer or middle ear, and sensorineural types, which are due to a variety of disorders affecting the sound-sensing organ—the cochlea—and its nerve that goes to the brain—the cochlear nerve.

Examples of Conditions Affecting Hearing Early in Life That May Affect the Development of Speech and Language.

Conductive-related causes of reduced hearing levels include congenital structural malformations of the outer and inner ear, consequences of acute or recurrent middle-ear infections, eustachian tube dysfunction, tumors, and trauma. Sensorineural types are even more diverse. A variety of genetic disorders have been identified that affect the function of the cochlea or cochlear nerve, and the disorder may be sporadic or inherited in an autosomal dominant, autosomal recessive, or X-linked manner, depending on the specific gene. Sensorineural types may be secondary to medical illness or even treatments for babies who must be placed in neonatal intensive care units because of either prematurity or a variety of perinatal disorders, such as hypoxia (oxygen deficiency), disturbances of blood flow, infections, or hyperbilirubinemia (excessive bilirubin levels that lead to jaundice and brain dysfunction known as kernicterus). Prenatal infections due to maternal cytomegalovirus, toxoplasmosis, or rubella (TORCH infections) can have a significant congenital impact on the sensorineural hearing mechanism, as can postnatal infectious illnesses such as meningitis (inflammation of membranes around the brain and spinal cord). Ironically, the treatment of meningitis or other bacterial infections with certain antibiotics can result in decreased hearing levels, as some of these life-saving drugs are ototoxic (i.e., harmful to structures of the ear). The impact of antibiotics on central hearing function is much less common in childhood and generally does not lead to total deafness.

The best-recognized cause affecting central hearing is Landau-Kleffner syndrome, or acquired epileptic aphasia, a rare condition that typically presents in early childhood with either minimal speech and language development or loss of previously acquired speech and language due to cortical deafness secondary to persistent epileptiform activity in the electroencephalogram, even in the absence of clinical seizures. Lastly, neonatal hyperbilirubinemia (kernicterus) can impact both sensorineural and central hearing, the latter as a result of dysfunction at the level of the brainstem. Importantly, in addition to the causes described above, many factors that impact hearing are themselves caused by, or co-occur with, underlying conditions that affect other aspects of children's development.

Apart from being deaf or hard of hearing, there are a diverse set of conditions that should be considered as other potential causes of speech and language disorders, as summarized in Box 2-2 . As is the case with hearing, abnormal development of anatomic structures critical to the proper generation of speech may lead to speech sound disorders or voice disorders. For example, articulation and phonological disorders may result from cleft palate. A wide variety of genetic syndromes are known to be associated with disordered speech and language development. These include well-characterized conditions that are due to an abnormal number of a specific chromosome, such as Down syndrome (associated with three rather than two copies of chromosome 21) ( Tedeschi et al., 2015 ) or Klinefelter syndrome (which occurs in boys who have a normal Y chromosome together with two or more X chromosomes, rather than one X chromosome).

Well-recognized genetic syndromes due to a mutation in a single gene (such as fragile X syndrome, neurofibromatosis type I, Williams syndrome, and tuberous sclerosis) are associated with speech or language disorders, and current research has demonstrated that alterations in small groups of genes (copy number variations such as 16p11.2 deletion) may increase the risk of a speech or language disability. In general, when indicated by history and clinical examination, these genetic conditions can be detected with clinically available blood-based laboratory tests. Primary malformations of the central nervous system—such as hydrocephalus (an expansion of the fluid-filled cavities within the brain), agenesis of the corpus callosum (the absence of the main structure that connects the right and left hemispheres of the brain), and both gross and microscopic abnormalities of cortical development (cortical dysplasia, an abnormal layering or location of neurons)—also may be associated with speech and language disorders. In general, these primary disruptions in brain anatomy may be diagnosed by magnetic resonance imaging (MRI) and in some cases discovered via an in utero maternal-fetal ultrasound examination.

A variety of prenatal and postnatal toxic exposures may result in abnormal brain development with resultant neurodevelopmental consequences. Maternal alcohol and other substance use are well recognized in this regard, as is postnatal exposure to lead. Similarly, abnormal prenatal growth, postnatal nutritional deprivation, and hypothyroidism (underactive thyroid) have developmental consequences. Injuries to the developing brain, such as perinatal stroke from brain hemorrhages or ischemia (inadequate blood supply), accidental trauma, and nonaccidental trauma (child abuse), must also be considered, as must such neoplastic conditions as primary brain tumors, metastatic disease, and the consequences of oncological therapies (e.g., chemotherapy and radiation). Some children with cerebral palsy (a condition that results in abnormal motor development and that has numerous causes) may also have an associated speech or language disorder. In addition, speech and language disorders may be secondary to poorly controlled epilepsy associated with a variety of causes, including structural abnormalities in cortical development, genetic disorders (e.g., mutations in ion channel genes), and complex epileptic encephalopathies (e.g., West, Lennox-Gastault, or Landau-Kleffner syndromes) ( Campbell et al., 2003 ; Feldman and Messick, 2009 ).

Box 2-3 presents a listing of examples of speech and language disorders with known causes.

Examples of Speech and Language Disorders with Known Causes.

Risk Factors Associated with Speech and Language Disorders with No Known Cause

In addition to the etiologies described above, a number of variables have been associated with an increased risk of childhood speech and/or language disorders with no known cause. Findings in this literature are somewhat inconsistent ( Harrison and McLeod, 2010 ; Nelson et al., 2006 ), varying with characteristics of the children examined (e.g., age, phenotype, severity, comorbidity) and with research design features (e.g., sample size, control for confounding, statistical analyses).

Studies of speech and language disorders in children, such as speech sound disorders ( Lewis et al., 2006 , 2007 ) and specific language impairment ( Barry et al., 2007 ; Bishop, 2006 ; Bishop and Hayiou-Thomas, 2008 ; Rice, 2012 ; Tomblin and Buckwalter, 1998 ), show that these conditions are familial (i.e., risk for these disorders is elevated for family members of affected individuals) and that this familiality is partially heritable (i.e., genetic factors shared among biological family members contribute to family aggregation). However, heritability estimates (i.e., the proportion of phenotypic variance that can be attributed to genetic variance) for some speech and language disorders, such as specific language impairment, have been inconsistent ( Bishop and Hayiou-Thomas, 2008 ). For example, twin studies on heritability of language disorders have shown a range of estimates of heritability, from 45 percent for deficient language achievement ( Tomblin and Buckwalter, 1998 ) to 25 percent for specific language impairment ( DeThorne et al., 2005 ). One study of 579 4-year-old twins with low language performance and their co-twins found heritability was greater for more severe language impairment, suggesting a stronger influence of genes at the lower end of language ability ( Viding et al., 2004 ). Finally, a review of twin data found that the environment shared by the twins was “relatively unimportant” in causing specific language impairment compared with genetic factors ( Bishop, 2006 ). Overall, the evidence suggests that susceptibility to speech and language disorders results from interactions between genetic and environmental factors ( Newbury and Monaco, 2010 ).

To date, the evidence best supports a cumulative risk model in which increases in risk are larger for combinations of risk factors than for individual factors ( Harrison and McLeod, 2010 ; Lewis et al., 2015 ; Pennington and Bishop, 2009 ; Reilly et al., 2010 ; Whitehouse et al., 2014 ). In a study of speech sound disorders, for example, Campbell and colleagues (2003) found that three variables—male sex, low maternal education, and positive family history of developmental communication disorders—were individually associated with increased odds of speech sound disorder, but the odds of such a disorder were nearly eight times larger in a child with all three risk factors than in a child with none of them. Based on a national database in the United Kingdom, Dockrell and colleagues (2014) report higher odds (2.5) of speech, language, and communication needs in boys than in girls, and they document a strong social gradient for childhood speech, language, and communication disorders in which the odds were 2.3 times greater for children entitled to free school lunches and living in more deprived neighborhoods than for children without these factors. It is important to note that risk indices such as odds ratios cannot provide evidence on the proportion of cases of the disorder that are caused by the factor in question, both because they could reflect the influence of some other, unknown causal factor and because they are influenced by the composition of the samples (e.g., base rate, severity) in which they are calculated.

Research has shown a strong association between poverty and developmental delays, such as language delays. For example, in a study of 513 3-year-olds who had been exposed to risk factors that included inadequate income, lack of social supports, poor maternal prenatal care, and high family stress, King and colleagues (2005) found that 10 percent of children—four times the expected 2.5 percent—had severe delays, scoring two or more standard deviations below the mean on a norm-referenced language test. Walker and colleagues (2011) showed that experiences in early life affect the structure and functioning of the brain. For example, a malnourished expectant mother who faces barriers in accessing prenatal care is at risk of having a child who is premature, is small for his or her gestational age, or experiences perinatal complications ( Adams et al., 1994 ; Walker et al., 2011 ). Children exposed to such factors in the womb are at increased risk for developing a disability such as specific language impairment ( Spitz et al., 1997 ; Stanton-Chapman et al., 2004 ). Lastly, a variety of other psychosocial factors—including deprivation of appropriate stimuli from parents and caretakers ( Akca et al., 2012 ; Fernald et al., 2013 ; Hart and Risley, 1995 ), excess media (television and screen time) exposure ( Christakis et al., 2009 ; Zimmerman et al., 2007 ), and poor sleep hygiene ( Earle and Myers, 2014 )—need to be considered as potential risk factors for speech and language disorders.

Law and colleagues (2000) found that there existed no systematic synthesis of the evidence concerning the prevalence of pediatric speech and language disorders with primary causes; their observation remains true in 2015 ( Wallace et al., 2015 ). Estimating the prevalence of these disorders with confidence is difficult for several reasons. First, because the characteristics of these disorders differ with age, the diagnostic tools by which they are identified necessarily vary in format, ranging from simple parental reports at the earliest ages to formal standardized testing at later ages. Second, because these disorders can vary in scope—from problems with relatively discrete skills (e.g., producing individual speech sounds) to problems with broader and less observable sets of abilities (e.g., drawing inferences from or comprehending language that is ambiguous, indirect, or nonliteral)—there exists no single diagnostic tool capable of addressing the full range of pediatric speech and language skills. Third, as with many pediatric psychological and behavioral disorders, diagnostic criteria involve integrating observations from multiple sources and time points.

As a result, there currently is no single reference standard for identifying pediatric speech and language disorders of primary origin in children of all ages. Instead, prevalence estimates come from studies that focused on different ages and used different diagnostic tools and criteria. Law and colleagues (2000) found a median prevalence of 5.95 percent in the four studies they reviewed; they observe that this value is consistent with several other estimates, but emphasize the need for caution pending additional evidence from well-designed population studies.

The following subsections describe prevalence estimates from studies that have attempted to distinguish speech disorders from language disorders. However, these estimates also must be viewed with caution, given differences among studies in sample composition and diagnostic criteria.

Consistent with the varying expectations for speech skills in children of different ages, estimates of the incidence (i.e., the risk of acquiring a disorder for an individual in a specified population) and prevalence (i.e., the percentage of individuals affected by a disorder in a specified population at a specific point in time) of speech disorders vary according to age, the presence of other neurodevelopmental disorders, and the diagnostic criteria employed.

Most of the literature on the prevalence of speech disorders has focused on children with articulation or phonological disorders due to unknown causes. Shriberg and colleagues (1999 , cited in Pennington and Bishop, 2009 ) report a mean prevalence of 8.2 percent for such disorders; Bishop (2010) estimates prevalence at 10 percent. The prevalence of these disorders varies with age, however, decreasing from 15-16 percent at age 3 ( Campbell et al., 2003 ) to approximately 4 percent at age 6 ( Shriberg et al., 1999 ). Evidence suggests that speech sound disorders affect more boys than girls ( Eadie et al., 2015 ), particularly in early life. In preschoolers, the ratio of affected boys to girls is 2 or 3:1, declining by age 6 to 1.2:1 ( Pennington and Bishop, 2009 ; Shriberg et al., 1999 ). Although many children with speech sound disorders as preschoolers will progress into the normal range by the time of school entry, the close ties between spoken and written language have motivated many studies of the extent to which speech sound disorders are associated with an increased risk of reading, writing, or spelling disorders. To date, evidence from several studies (e.g., Lewis et al., 2015 ; Pennington and Bishop, 2009 ; Skebo et al., 2013 ) suggests that in comparison with their unaffected peers, children with speech sound disorders but normal-range language skills may have somewhat lower reading scores than their peers, but they rarely meet eligibility criteria for a reading disability ( Skebo et al., 2013 ). However, severity has not been considered to date in studies of the relationship between speech sound disorders and reading skills ( Skebo et al., 2013 ).

Little evidence is available concerning the epidemiology of voice disorders in children (dysphonias) not attributable to other developmental disorders. In a prospective population-based cohort of 7,389 8-year-old British children, 6-11 percent were identified as dysphonic; male sex, number of siblings, asthma, and frequent upper respiratory infections were among the factors associated with an increased risk of voice disorders ( Carding et al., 2006 ).

Stuttering is estimated to have a lifetime incidence of 5 percent but a population prevalence of just under 1 percent ( Bloodstein and Ratner, 2008 ). The prevalence of stuttering before the age of 6 years is much higher than that at later ages; evidence from several sources suggests that rates of natural recovery from stuttering in children before age 6 may be as high as 85 percent ( Yairi and Ambrose, 2013 ). Evidence indicates that stuttering affects only slightly more boys than girls during the preschool period, although higher ratios of affected males to females have been observed at later ages. Finally, approximately 60 percent of cases of developmental stuttering co-occur with other speech and language disorders ( Kent and Vorperian, 2013 ).

As with speech disorders, estimates of the prevalence of language disorders vary across studies by age, the presence of other neurodevelopmental disorders, and the diagnostic criteria employed. Language disorders with no known cause, sometimes referred to as “specific” (or “primary”) language impairments (e.g., Reilly et al., 2014 ), are highly prevalent, affecting 6-15 percent of children when identified through formal norm-referenced testing in population-based samples ( Law et al., 2000 ). This is consistent with the cutoff values of 1.0-1.5 standard deviations below the mean employed in several investigations (e.g., Tomblin et al., 1997b ). By contrast, prevalence estimates are generally higher when based on parent or teacher reports. For example, in a survey of parents and teachers conducted in a nationally representative sample of 4,983 4- to 5-year-old children in Australia, McLeod and Harrison (2009) found that prevalence estimates based on parent and teacher reports were somewhat higher than those based on norm-referenced testing, with 22-25 percent of children perceived as having deficits in talking (expressive language) and 10-17 percent as having deficits in understanding (receptive language). As noted by Law and colleagues (2000) , the discrepancy between prevalence rates defined according to norm- and criterion-referenced methods could be due to a number of factors, including the inability of norm-referenced tests to capture or reflect the child's language functioning in relatively more challenging situations, such as classrooms and conversations.

Language disorders that have no known cause have been reported to affect more boys than girls, but it appears that the gender imbalance is greater in clinical than in population-based samples (e.g., Pennington and Bishop, 2009 ). For example, the ratio of affected males to females has ranged from 2:1 to 6:1 across several clinical samples, but boys were only slightly more likely to be affected than girls (1.3:1) in a large population-based sample of U.S. kindergarten children ( Tomblin et al., 1997b ).

As noted earlier, many aspects of literacy depend heavily on the language knowledge and skills that children acquire before they enter school ( Catts and Kamhi, 2012 ), and children with severe language disorders have a substantially increased risk of deficits in reading and academic achievement. Estimates vary, but children diagnosed with language disorders with no known cause as preschoolers are at least four times more likely to have reading disabilities than their unaffected peers ( Pennington and Bishop, 2009 ). Similarly, evidence from a large-scale, prospective methodologically sound cohort study of kindergarteners followed longitudinally showed that the majority of those with language disorders with no known cause continued to exhibit language and/or academic difficulties through adolescence ( Tomblin and Nippold, 2014 ).

One study that helped frame the committee's understanding of prevalence estimates of speech and language disorders was a study of specific language impairment conducted by Tomblin and colleagues (1997b) . This study selected a geographic region in the upper Midwest of the United States and sampled rural, suburban, and urban schools within that region. All eligible 5- to 6-year-old children were systematically screened and followed up with diagnostic testing for specific language impairment. Children were not included if they spoke a language other than English, failed a hearing test, or demonstrated low functioning in nonverbal intelligence (suggesting overall lower intellectual functioning). When a cutoff 1.25 standard deviations below the mean (i.e., approximately the 10th percentile, or the lowest 10 percent of the normative sample) on at least two language scores was used, the prevalence rate of specific language impairment was estimated at 7.4 percent of kindergarten children. The prevalence of specific language impairment for boys was 8 percent and for girls was 6 percent.

When the cutoff was set at two standard deviations below the mean (i.e., approximately the 2nd percentile), the prevalence estimate dropped to 1.12 percent. Using 1.25 standard deviations below the mean as the criterion, there were slightly higher rates of specific language impairment among African American and Native American children relative to white and Hispanic children. Only 29 percent of the parents of the kindergarteners diagnosed with specific language impairment reported having been informed that their children had speech or language problems. It is important to note that large-scale epidemiological studies on autism spectrum disorder, learning disorders, and attention deficit hyperactivity disorder have clearly demonstrated that active case-finding strategies lead to higher and more accurate rates of identification of children with neurodevelopmental disorders ( Barbaresi et al., 2002 , 2005 , 2009 ; CDC, 2014 ; Katusic et al., 2001 ) relative to studies depending only on parent reports. Studies that followed this sample of children with specific language impairment into their school years demonstrated that as a group, they also experienced lower academic achievement.

The Tomblin et al. (1997a) study underscores several methodological issues relevant for the current report: differences in severity level for case identification, comorbidity with other disorders considered primary disabilities, and differences in prevalence related to gender and racial or ethnic identity. Subsequent studies with the children included in this study identified low maternal and paternal education and paternal history of speech, learning, or intellectual difficulties as risk factors for specific language impairment ( Tomblin et al., 1997a ).

Table 2-1 provides a summary of prevalence estimates from the studies of U.S. children that the committee also reviewed. This list is not the result of a meta-analysis, nor is it exhaustive; rather, the table includes a number of well-designed studies that employed clear and consistent definitions. The committee reviewed numerous well-designed studies and meta-analyses from other countries (e.g., Beitchman et al., 1996a , b , c [Canada]; Law et al., 2000 [United Kingdom, others]; McLeod and Harrison, 2009 [Australia]). For the purposes of this study, however, the committee limited the summary of prevalence estimates to U.S. children. Table 2-1 includes the populations and conditions studied, the diagnostic criteria used to identify the conditions, and the prevalence of the conditions (or percent positive). Confidence intervals are included when available. As noted earlier, and as is evident from the table, the studies reviewed vary greatly in terms of ages, diagnostic tools or criteria, and methods used. The estimates presented in the table (in addition to estimates based on national survey data presented in Chapter 5 ) indicate that speech and language disorders affect between 3 and 16 percent of U.S. children.

Estimates of the Prevalence of Speech and Language Disorders from Studies of U.S. Children.

COMMON COMORBIDITIES

An examination of comorbidities (i.e., other co-occurring conditions) of speech and language disorders is complicated by the central role of language and communication in the development and behavior of children and adolescents. Speech and language disorders are a definitional component of certain conditions, most prominently autism spectrum disorder ( American Psychiatric Association, 2013 ). Other neurodevelopmental disorders, including cognitive impairment, are universally associated with varying degrees of delays and deficits in language and communication skills ( American Psychiatric Association, 2013 ). In addition to their co-occurrence with a wide range of neurodevelopmental disorders, speech and language delays in toddlers and preschool-age children are associated with a significantly increased risk for long-term developmental challenges, such as language-based learning disorders ( Beitchman et al., 1996a , b , c , 1999 , 2001 , 2014 ; Brownlie et al., 2004 ; Stoeckel et al., 2013 ; Voci et al., 2006 ; Young et al., 2002 ). While specific language impairments (i.e., those not associated with other diagnosable neurodevelopmental disorders) are relatively common, it is likely that substantially greater numbers of children and adolescents experience significant speech and/or language impairment associated with other diagnosable disorders. Finally, speech and language delays and deficits may lead to impairments in other aspects of a child's functional skills (e.g., social interaction, behavior, academic achievement) even when not associated with other diagnosable disorders ( Beitchman et al., 1996c , 2001 , 2014 ; Brownlie et al., 2004 ; Voci et al., 2006 ; Young et al., 2002 ). This section, therefore, examines the association of speech and language disorders from the following perspectives: (1) speech and language disorders that are comorbid with other diagnosable disorders, and (2) speech and language disorders in early childhood that confer a quantifiable risk for the later development of comorbid conditions. Together, these two perspectives create a comprehensive picture of the association of speech and language disorders with other neurodevelopmental disorders.

Autism spectrum disorder is a highly prevalent neurodevelopmental disorder, affecting an estimated 1 in 68 8-year-old children in the United States ( CDC, 2014 ). By definition, all children with autism spectrum disorder have deficits in communication, ranging from a complete absence of verbal and nonverbal communication skills, to atypical language (e.g., echolalia or “scripted” language), to more subtle deficits in pragmatic (i.e., social) communication ( American Psychiatric Association, 2013 ). The formal diagnostic criteria for autism spectrum disorder require documentation of deficits in the social-communication domain ( American Psychiatric Association, 2013 ). In clinical practice, when children present with significant delays in the development of communication skills, autism spectrum disorder is one of the primary diagnostic considerations ( Myers and Johnson, 2007 ).

All children and adolescents with intellectual disability have varying degrees of impairment in communication skills ( American Psychiatric Association, 2013 ). Among those with mild intellectual disability, deficits in communication may be relatively subtle, including inability to understand or employ highly abstract language or impairment in social communication. In contrast, children and adolescents with severe or profound levels of intellectual disability may be able only to communicate basic requests, understand concrete instructions, and communicate with simple phrases or single words; others may be unable to employ or understand spoken language. A number of specific genetic disorders are directly associated with varying degrees of intellectual disability together with abnormalities of speech and language (see Box 2-3 ). Some of these genetic conditions often are also associated with specific profiles of speech and language impairment ( Feldman and Messick, 2009 ). Examples include dysfluent speech in children with Down syndrome, echolalia in boys with fragile X syndrome, and fluent but superficial social language in children with Williams syndrome ( Feldman and Messick, 2009 ).

Language-based learning disorders, including reading and written language disorders, are often associated with speech and language disorders. The association between language impairment and reading disorders has been demonstrated in studies examining the likelihood that family members of subjects with language impairment are at increased risk for reading disorder ( Flax et al., 2003 ). Both epidemiologic and clinic-based studies have demonstrated that children with speech sound disorders and language disorders are at increased risk for reading disorder ( Pennington and Bishop, 2009 ). Similarly, multiple studies have demonstrated a strong association between attention deficit hyperactivity disorder and speech and language disorders ( Pennington and Bishop, 2009 ; Tomblin, 2014 ).

The comorbidity of speech and language disorders and other neurodevelopmental disorders may not be apparent in pre-school-age children, since these very young children may not yet manifest the developmental lags or symptoms required to make comorbid diagnoses of such conditions as learning disorders and attention deficit hyperactivity disorder. In their prospective community-based study, for example, Beitchman and colleagues (1989) found significant differences in measures of “reading readiness” among 5-year-old children with poor language comprehension compared with children with either high overall speech and language ability or isolated articulation difficulties ( Beitchman et al., 1989 ). Similarly, there was a tendency for 5-year-olds with a combination of low articulation and poor language comprehension to have higher teacher ratings of hyperactivity and inattention and lower maternal ratings of social competence ( Beitchman et al., 1989 ). By age 12, the children who earlier had shown combined deficits in speech and language had significantly lower levels of reading achievement and higher rates of diagnosed psychiatric disorders (57.1 percent versus 23.7 percent for children with normal speech and language at age 5) ( Beitchman et al., 1994 ). By age 19, children with documented language impairment at age 5 had significantly higher rates of reading disorder (36.8 percent versus 6.4 percent), math disorder (53.9 percent versus 12.2 percent), and psychiatric disorders (40 percent versus 21 percent) compared with their peers with normal language ability at age 5 ( Young et al., 2002 ).

In summary, speech and language disorders are frequently identified in association with (i.e., comorbid with) a wide range of other neurodevelopmental disorders. Children with comorbid conditions can be expected to be more severely impaired and to experience greater functional limitations (due to the interactive and cumulative effects of multiple conditions) than children who do not have comorbid conditions. Furthermore, young children with language impairments are at high risk for later manifestation of learning and psychiatric disorders. It is therefore important both to carefully examine the speech and language skills of children with other developmental disorders and to identify other neurodevelopmental disorders among children presenting with speech and language impairment. Among populations of children with conditions as diverse as autism spectrum disorder, attention deficit hyperactivity disorder, traumatic brain injury, and genetic disorders, speech and language disorders may be the most easily identified impairments because of the central role of language and communication in the functional capacity of children and adolescents.

FINDINGS AND CONCLUSIONS

2-1. Speech and language disorders are prevalent, affecting between 3 and 16 percent of U.S. children. Prevalence estimates vary according to age and the diagnostic criteria employed, but best evidence suggests that approximately 2 percent of children have speech and/or language disorders that are severe according to clinical standards. 2-2. Some speech and language disorders result from known biological causes. 2-3. In many cases, these disorders have no identifiable cause, but factors including male sex and reduced socioeconomic and educational resources have been associated with an increased risk of the disorders. 2-4. Diagnosing speech and language disorders in children is a complex process that requires integrating information on speech and language with information on biological and medical factors, environmental circumstances, and other areas of development. 2-5. Speech and language disorders frequently co-occur with other neurodevelopmental disorders and may be among the earliest symptoms of serious neurodevelopmental conditions. 2-6. Children with severe speech and language disorders have an increased risk of a variety of adverse outcomes, including mental health and behavior disorders, learning disabilities, poor academic achievement, and limited employment and social participation.

Conclusions

2-1. Severe speech and language disorders represent serious threats to children's social, emotional, educational, and employment outcomes. 2-2. Severe speech and language disorders are debilitating at any age, but their impacts on children are particularly serious because of their widespread adverse effects on development and the fact that these negative consequences cascade and build on one another over time. 2-3. Severe speech and language disorders may be one of the earliest detectable symptoms of other serious neurodevelopmental conditions; for this reason, they represent an important point of entry to early intervention and other services. 2-4. It is critically important to identify such disorders for two reasons: first, because they may be an early symptom of other serious neurodevelopmental disorders, and second, so that interventions aimed at forestalling or minimizing their adverse consequences can be undertaken.

Adams CD, Hillman N, Gaydos GR. Behavioral difficulties in toddlers: Impact of socio-cultural and biological risk factors. Journal of Clinical Child Psychology. 1994; 23 (4):373–381.
Adams-Chapman I, Bann C, Carter SL, Stoll BJ. Language outcomes among ELBW infants in early childhood. Early Human Development. 2015; 91 (6):373–379. [ PMC free article : PMC4442021 ] [ PubMed : 25955535 ]
AERA (American Educational Research Association), APA (American Psychological Association), and NCME (National Council on Measurement in Education). Standards for educational and psychological testing. Washington, DC: AERA; 2014.
Akca OF, Ugur C, Colak M, Kartal OO, Akozel AS, Erdogan G, Uslu RI. Underinvolved relationship disorder and related factors in a sample of young children. Early Human Development. 2012; 88 (6):327–332. [ PubMed : 21955500 ]
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, DC: American Psychiatric Association; 2013.
ASHA (American Speech-Language-Hearing Association). Preferred practice patterns for the profession of speech-language pathology. 2004. [September 29, 2015]. http://www .asha.org/policy/PP200400191 .htm .
ASHA. Childhood apraxia of speech. 2007. [September 29, 2015]. http://www .asha.org/policy/TR2007-00278 .htm .
Atkinson L, Beitchman J, Gonzalez A, Young A, Wilson B, Escobar M, Chisholm V, Brownlie E, Khoury JE, Ludmer J, Villani V. Cumulative risk, cumulative outcome: A 20-year longitudinal study. PLoS ONE. 2015; 10 (6):e0127650. [ PMC free article : PMC4452593 ] [ PubMed : 26030616 ]
Barbaresi WJ, Katusic SK, Colligan RC, Shane Pankratz V, Weaver AL, Weber KJ, Mrazek DA, Jacobsen SJ. How common is attention-deficit/hyperactivity disorder? Incidence in a population-based birth cohort in Rochester, Minn. Archives of Pediatrics and Adolescent Medicine. 2002; 156 (3):217–224. [ PubMed : 11876664 ]
Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Jacobsen SJ. Math learning disorder: Incidence in a population-based birth cohort 1976-82, Rochester, Minn. Ambulatory Pediatrics. 2005; 5 (5):281–289. [ PubMed : 16167851 ]
Barbaresi WJ, Colligan RC, Weaver AL, Katusic SK. The incidence of clinically diagnosed versus research-identified autism in Olmsted County, Minnesota, 1976-1997: Results from a retrospective, population-based study. Journal of Autism and Developmental Disorders. 2009; 39 (3):464–470. [ PMC free article : PMC2859841 ] [ PubMed : 18791815 ]
Barry JG, Yasin I, Bishop DV. Heritable risk factors associated with language impairments. Genes, Brain, and Behavior. 2007; 6 (1):66–76. [ PMC free article : PMC1974814 ] [ PubMed : 17233642 ]
Beitchman JH, Hood J, Rochon J, Peterson M, Mantini T, Majumdar S. Empirical classification of speech/language impairment in children: I. Identification of speech/language disorders. Journal of the American Academy of Child & Adolescent Psychiatry. 1989; 28 (1):112–117. [ PubMed : 2914823 ]
Beitchman JH, Brownlie EB, Inglis A, Wild J, Mathews R, Schachter D, Kroll R, Martin S, Ferguson B, Lancee W. Seven-year follow-up of speech/language-impaired and control children: Speech/language stability and outcome. Journal of the American Academy of Child & Adolescent Psychiatry. 1994; 33 (9):1322–1330. [ PubMed : 7995800 ]
Beitchman JH, Wilson B, Brownlie EB, Walters H, Lancee W. Long-term consistency in speech/language profiles: I. Developmental and academic outcomes. Journal of the American Academy of Child & Adolescent Psychiatry. 1996a; 35 (6):804–814. [ PubMed : 8682762 ]
Beitchman JH, Wilson B, Brownlie EB, Walters H, Inglis A, Lancee W. Long-term consistency in speech/language profiles: II. Behavioral, emotional and social outcomes. Journal of the American Academy of Child & Adolescent Psychiatry. 1996b; 35 (6):815–825. [ PubMed : 8682763 ]
Beitchman JH, Brownlie EB, Inglis A, Wild J, Mathews R, Schachter D, Kroll R, Martin S, Ferguson B, Lancee W. Seven-year follow-up of speech/language impaired and control children: Psychiatric outcomes. Journal of the American Academy of Child & Adolescent Psychiatry. 1996c; 37 (8):961–970. [ PubMed : 9119943 ]
Beitchman JH, Douglas L, Wilson B, Johnson C, Young A, Atkinson L, Escobar M, Taback N. Adolescent substance use disorders: Findings from a 14-year follow-up of speech/language-impaired and control children. Journal of Clinical Child & Adolescent Psychology. 1999; 28 (3):312–321. [ PubMed : 10446680 ]
Beitchman JH, Wilson B, Johnson CJ, Atkinson L, Young A, Adlaf E, Escobar M, Douglas L. Fourteen-year follow-up of speech/language-impaired and control children: Psychiatric outcome. Journal of the American Academy of Child & Adolescent Psychiatry. 2001; 40 (1):75–82. [ PubMed : 11195567 ]
Beitchman JH, Brownlie EB, Bao L. Age 31 mental health outcomes of childhood language and speech disorders. Journal of the American Academy of Child & Adolescent Psychiatry. 2014; 53 (10):1102–1110. [ PubMed : 25245354 ]
Béna F, Bruno DL, Eriksson M, van Ravenswaaij-Arts C, Stark Z, Dijkhuizen T, Gerkes E, Gimelli S, Ganesamoorthy D, Thuresson AC, Labalme A, Till M, Bilan F, Pasquier L, Kitzis A, Dubourgm C, Rossi M, Bottani A, Gagnebin M, Sanlaville D, Gilbert-Dussardier B, Guipponi M, van Haeringen A, Kriek M, Ruivenkamp C, Antonarakis SE, Anderlid BM, Slater HR, Schoumans J. Molecular and clinical characterization of 25 individuals with exonic deletions of NRXN1 and comprehensive review of the literature. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics. 2013; 162 (4):388–403. [ PubMed : 23533028 ]
Bishop DVM. What causes specific language impairment in children? Current Directions in Psychological Science. 2006; 15 (5):217–221. [ PMC free article : PMC2582396 ] [ PubMed : 19009045 ]
Bishop DVM. Which neurodevelopmental disorders get researched and why? PLoS ONE. 2010; 5 (11):e15112. [ PMC free article : PMC2994844 ] [ PubMed : 21152085 ]
Bishop DVM, Hayiou-Thomas ME. Heritability of specific language impairment depends on diagnostic criteria. Genes, Brain, and Behavior. 2008; 7 (3):365–372. [ PMC free article : PMC2324210 ] [ PubMed : 17919296 ]
Bloodstein O, Ratner NB. A handbook on stuttering. 6th ed. New York: Thomson Delmar; 2008.
Boudreau D. Narrative abilities: Advances in research and implications for clinical practice. Topics in Language Disorders. 2008; 28 (2):99–114.
Brownlie EB, Beitchman JH, Escobar M, Young A, Atkinson L, Johnson C, Wilson B, Douglas L. Early language impairment and young adult delinquent and aggressive behavior. Journal of Abnormal Child Psychology. 2004; 32 (4):453–467. [ PubMed : 15305549 ]
Brumbach ACD, Goffman L. Interaction of language processing and motor skill in children with specific language impairment. Journal of Speech, Language, and Hearing Research. 2014; 57 (1):158–171. [ PMC free article : PMC4004610 ] [ PubMed : 24023372 ]
Campbell TF, Dollaghan CA, Rockette HE, Paradise JL, Feldman HM, Shriberg LD, Sabo D, Kurs-Lasky M. Risk factors for speech delay in three-year-old children. Child Development. 2003; 74 :346–357. [ PubMed : 12705559 ]
Carding PN, Roulstone S, Northstone K. ALSPAC Study Team. The prevalence of childhood dysphonia: A cross-sectional study. Journal of Voice. 2006; 20 (4):623–630. [ PubMed : 16360302 ]
Caruso AJ, Strand EA. Clinical management of motor speech disorders in children. Caruso A, Strand E, editors. New York: Thieme; 1999. pp. 1–27. (Motor speech disorders in children: Definitions, background, and a theoretical framework).
Catts HW, Kamhi AG. Language and reading disabilities. Boston, MA: Pearson; 2012.
Caye-Thomasen P, Dam MS, Omland SH, Mantoni M. Cochlear ossification in patients with profound hearing loss following bacterial meningitis. Acta Oto-Laryngologica. 2012; 132 (7):720–725. [ PubMed : 22497482 ]
CDC (Centers for Disease Control and Prevention). Developmental disabilities monitoring network surveillance year 2010 principal investigators. Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2010. Morbidity and Mortality Weekly Report Surveillance Summaries. 2014; 63 (2):1–21. [ PubMed : 24670961 ]
Chang B, Walsh CA, Apse K, Bodell A. Polymicrogyria overview. Seattle, WA: GeneReviews; 2007.
Christakis DA, Gilkerson J, Richards JA, Zimmerman FJ, Garrison MM, Xu D, Gray S, Yapanel U. Audible television and decreased adult words, infant vocalizations, and conversational turns: A population-based study. Archives of Pediatrics and Adolescent Medicine. 2009; 163 (6):554–558. [ PubMed : 19487612 ]
Clegg J, Law J, Rush R, Peters TJ, Roulstone S. The contribution of early language development to children's emotional and behavioral functioning: An analysis of data from the Children in Focus sample from the ALSPAC birth cohort. Journal of Child Psychology and Psychiatry. 2015; 56 (1):67–75. [ PubMed : 24980269 ]
Cohen BE, Durstenfeld A, Roehm PC. Viral causes of hearing loss: A review for hearing health professionals. Trends in Hearing. 2014; 18 [ PMC free article : PMC4222184 ] [ PubMed : 25080364 ]
Conture EG. Stuttering: Its nature, assessment, and treatment. Needham Heights, MA: Allyn & Bacon; 2001.
Corujo-Santana C, Falcón-González J, Borkoski-Barreiro S, Pérez-Plasencia D, Ramos-Macías Á. The relationship between neonatal hyperbilirubinemia and sensorineural hearing loss. Acta Otorrinolaringologica Espanola. 2015; 66 (6):326–331. [ PubMed : 25638013 ]
Crystal D. Dictionary of linguistics and phonetics. Hoboken, NJ: Wiley-Blackwell; 2009.
Dennis M. Language disorders in children with central nervous system injury. Journal of Clinical and Experimental Neuropsychology. 2010; 32 (4):417–432. [ PMC free article : PMC3057107 ] [ PubMed : 20397297 ]
DeThorne LS, Petrill SA, Hayiou-Thomas ME, Plomin R. Low expressive vocabulary: High heritability as a function of more severe cases. Journal of Speech, Language, and Hearing Research. 2005; 48 (4):792–804. [ PubMed : 16378474 ]
Dockrell J, Lindsay G, Roulstone S, Law J. Supporting children with speech, language and communication needs: An overview of the results of the Better Communication Research Programme. International Journal of Language & Communication Disorders. 2014; 49 (5):543–557. [ PubMed : 24961589 ]
Duke NK, Cartwright KB, Hilden KR. Handbook of language and literacy: Development and disorders. 2nd ed. Stone CA, Silliman ER, Ehren BJ, Wallach GP, editors. New York: Guilford Press; 2013. pp. 451–468. (Difficulties with reading comprehension).
Dunklebarger J, Branstetter B, Lincoln A, Sippey M, Cohen M, Gaines B, Chi D. Pediatric temporal bone fractures: Current trends and comparison of classification schemes. The Laryngoscope. 2014; 124 (3):781–784. [ PubMed : 24347062 ]
Eadie P, Morgan A, Okoumunne OC, Eecen KT, Wake M, Reilly S. Speech sound disorder at 4 years: Prevalence, comorbidities, and predictors in a community cohort of children. Developmental Medicine and Child Neurology. 2015; 57 (6):578–584. [ PubMed : 25403868 ]
Earle FS, Myers EB. Building phonetic categories: An argument for the role of sleep. Frontiers in Psychology. 2014; 5 :1192. [ PMC free article : PMC4234907 ] [ PubMed : 25477828 ]
Feldman HM, Messick C. Developmental-behavioral pediatrics. 4th ed. Carey WB, Crocker AC, Coleman WL, Elias ER, Feldman HM, editors. Philadelphia, PA: Saunders; 2009. pp. 717–729. (Language and speech disorders).
Fenson L, Marchman VA, Thal DJ, Dale PS, Reznick JS, Bates E. MacArthur-Bates communicative development inventories. 2nd ed. Baltimore, MD: Paul H. Brookes Publishing Co.; 2007.
Fernald A, Marchman VA, Weisleder A. SES differences in language processing skill and vocabulary are evident at 18 months. Developmental Science. 2013; 16 (2):234–248. [ PMC free article : PMC3582035 ] [ PubMed : 23432833 ]
Fitzpatrick E. Handbook of clinical neurology, Ch. 19. Aminoff MJ, Boller F, Swaab DF, editors. Vol. 129. Philadelphia, PA: Elsevier; 2015. pp. 335–356. (Neurocognitive development in congenitally deaf children).
Flax JF, Realpe-Bonilla T, Hirsch LS, Brzustowicz LM, Bartlett CW, Tallal P. Specific language impairment in families: Evidence for co-occurrence with reading impairments. Journal of Speech, Language, and Hearing Research. 2003; 46 (3):530–543. [ PubMed : 14696984 ]
Ford LC, Sulprizio SL, Rasgon BM. Otolaryngological manifestations of velocardiofacial syndrome: A retrospective review of 35 patients. The Laryngoscope. 2000; 110 (3):362–367. [ PubMed : 10718420 ]
Friedrich M, Wilhelm I, Born J, Friederici AD. Generalization of word meanings during infant sleep. Nature Communications. 2015; 6 [ PMC free article : PMC4316748 ] [ PubMed : 25633407 ]
Gallagher A, Tanaka N, Suzuki N, Liu H, Thiele EA, Stufflebeam SM. Diffuse cerebral language representation in tuberous sclerosis complex. Epilepsy Research. 2013; 104 (1):125–133. [ PMC free article : PMC3574215 ] [ PubMed : 23092910 ]
Gejão MG, Ferreira AT, Silva GK, Anastácio-Pessan FDL, Lamônica DAC. Communicative and psycholinguistic abilities in children with phenylketonuria and congenital hypothyroidism. Journal of Applied Oral Science. 2009; 17 (Suppl):69–75. [ PMC free article : PMC5467373 ] [ PubMed : 21499658 ]
Gillam RB, Peña ED, Bedore LM, Bohman TM, Mendez-Perez A. Identification of specific language impairment in bilingual children. Part 1: Assessment in English. Journal of Speech, Language, and Hearing Research. 2013; 56 :1813–1823. [ PMC free article : PMC5902172 ] [ PubMed : 23882008 ]
Glynn F, Fitzgerald D, Earley MJ, Rowley H. Pierre Robin sequence: An institutional experience in the multidisciplinary management of airway, feeding and serous otitis media challenges. International Journal of Pediatric Otorhinolaryngology. 2011; 75 (9):1152–1155. [ PubMed : 21764465 ]
Goderis J, De Leenheer E, Smets K, Van Hoecke H, Keymeulen A, Dhooge I. Hearing loss and congenital CMV infection: A systematic review. Pediatrics. 2014; 134 (5):972–982. [ PubMed : 25349318 ]
Goldstein BA, Gildersleeve-Neumann C. Bilingual language development and disorders in Spanish-English speakers. Goldstein BA, editor. Baltimore, MD: Paul H. Brookes Publishing Co.; 2012. pp. 285–309. (Phonological development and disorders).
Hanson E, Bernier R, Porche K, Jackson FI, Goin-Kochel RP, Snyder LG, Snow AV, Wallace AS, Campe KL, Zhang Y, Chen Q, D'Angelo D, Moreno-De-Luca A, Orr PT, Boomer KB, Evans DW, Kanne S, Berry L, Miller FK, Olson J, Sherr E, Martin CL, Ledbetter DH, Spiro JE, Chung WK, Simons C. The cognitive and behavioral phenotype of the 16p11.2 deletion in a clinically ascertained population. Biological Psychiatry. 2015; 77 (9):785–793. [ PMC free article : PMC5410712 ] [ PubMed : 25064419 ]
Harrison LJ, McLeod S. Risk and protective factors associated with speech and language impairment in a nationally representative sample of 4- to 5-year-old children. Journal of Speech, Language, and Hearing Research. 2010; 53 (2):508–529. [ PubMed : 19786704 ]
Hart B, Risley T. Meaningful differences in the everyday experiences of young American children. Baltimore, MD: Paul H. Brookes Publishing Co.; 1995.
Hoff E. Interpreting the early language trajectories of children from low-SES and language minority homes: Implications for closing achievement gaps. Developmental Psychology. 2013; 49 (1):4–14. [ PMC free article : PMC4061698 ] [ PubMed : 22329382 ]
Hudson LJ, Murdoch B. Speech and language disorders in childhood brain tumours. Acquired Neurological Speech/Language Disorders in Childhood. 1990:245–268.
Hurtado N, Grüter T, Marchman VA, Fernald A. Relative language exposure, processing efficiency and vocabulary in Spanish-English bilingual toddlers. Bilingualism: Language and Cognition. 2014; 17 (1):189–202.
Ilves P, Tomberg T, Kepler J, Laugesaar R, Kaldoja ML, Kepler K, Kolk A. Different plasticity patterns of language function in children with perinatal and childhood stroke. Journal of Child Neurology. 2014; 29 (6):756–764. [ PMC free article : PMC4230975 ] [ PubMed : 23748202 ]
Jambaque I, Pinabiaux C, Lassonde M. Cognitive disorders in pediatric epilepsy. Handbook of Clinical Neurology. 2012; 111 :691–695. [ PubMed : 23622216 ]
Jing W, Zongjie H, Denggang F, Na H, Bin Z, Aifen Z, Xijiang H, Cong Y, Yunping D, Ring HZ. Mitochondrial mutations associated with aminoglycoside ototoxicity and hearing loss susceptibility identified by meta-analysis. Journal of Medical Genetics. 2015; 52 (2):95–103. [ PubMed : 25515069 ]
Jurewicz J, Polanska K, Hanke W. Chemical exposure early in life and the neurodevelopment of children—an overview of current epidemiological evidence. Annals of Agricultural and Environmental Medicine. 2013; 20 (3):465–486. [ PubMed : 24069851 ]
Katusic SK, Colligan RC, Barbaresi WJ, Schaid DJ, Jacobsen SJ. Incidence of reading disability in a population-based birth cohort, 1976-1982, Rochester, Minn. Mayo Clinic Proceedings. 2001; 76 (11):1081–1092. [ PubMed : 11702896 ]
Kent RD. Clinical management of motor speech disorders in children. Caruso AJ, Strand EA, editors. New York: Thieme; 1999. pp. 29–71. (Motor control: Neurophysiology and functional development).
Kent RD, Vorperian HK. Speech impairment in Down syndrome: A review. Journal of Speech, Language, and Hearing Research. 2013; 56 (1):178–210. [ PMC free article : PMC3584188 ] [ PubMed : 23275397 ]
Kim YS, Apel K, Al Otaiba S. The relation of linguistic awareness and vocabulary to word reading and spelling for first-grade students participating in response to intervention. Language, Speech, and Hearing Services in Schools. 2013; 44 (4):337–347. [ PMC free article : PMC3852899 ] [ PubMed : 23833281 ]
King TM, Rosenbert LA, Fuddy L, McFarlane E, Sia C, Duggan AK. Prevalence and early identification of language delays among at-risk three year olds. Journal of Developmental and Behavioral Pediatrics. 2005; 26 (4):293–303. [ PubMed : 16100502 ]
Klein-Tasman BP, Janke KM, Luo W, Casnar CL, Hunter SJ, Tonsgard J, Trapane P, van der Fluit F, Kais LA. Cognitive and psychosocial phenotype of young children with neurofibromatosis-1. Journal of the International Neuropsychological Society. 2014; 20 (1):88–98. [ PMC free article : PMC4249943 ] [ PubMed : 24229851 ]
Kohnert K, Derr A. Language intervention with bilingual children. In. Goldstein BA, editor. Baltimore, MD: Paul H. Brookes Publishing Co.; Bilingual language development and disorders in Spanish-English speakers. 2012:337–356.
Law J, Boyle J, Harris F, Harkness A, Nye C. Prevalence and natural history of primary speech and language delay: Findings from a systematic review of the literature. International Journal of Language & Communication Disorders. 2000; 35 (2):165–188. [ PubMed : 10912250 ]
Law J, Rush R, Schoon I, Parsons S. Modeling developmental language difficulties from school entry into adulthood: Literacy, mental health, and employment outcomes. Journal of Speech, Language, and Hearing Research. 2009; 52 (6):1401–1416. [ PubMed : 19951922 ]
Lewis BA, Shriberg LD, Freebairn LA, Hansen AJ, Stein CM, Taylor HG, Iyengar SK. The genetic bases of speech sound disorders: Evidence from spoken and written language. Journal of Speech, Language, and Hearing Research. 2006; 49 (6):1294–1312. [ PubMed : 17197497 ]
Lewis BA, Freebairn LA, Hansen AJ, Miscimarra L, Iyengar SK, Taylor HG. Speech and language skills of parents of children with speech sound disorders. American Journal of Speech-Language Pathology. 2007; 16 (2):108–118. [ PubMed : 17456889 ]
Lewis BA, Avrich AA, Freebairn LA, Hansen AJ, Sucheston LE, Kuo I, Taylor HG, Iyengar SK, Stein CM. Literacy outcomes of children with early childhood speech sound disorders: Impact of endophenotypes. Journal of Speech, Language, and Hearing Research. 2011; 54 (6):1628–1643. [ PMC free article : PMC3404457 ] [ PubMed : 21930616 ]
Lewis BA, Freebairn L, Tag J, Ciesla AA, Iyengar SK, Stein CM, Taylor HG. Adolescent outcomes of children with early speech sound disorders with and without language impairment. American Journal of Speech-Language Pathology/American Speech-Language-Hearing Association. 2015; 24 (2):150–163. [ PMC free article : PMC4477798 ] [ PubMed : 25569242 ]
Locke J. Handbook of psycholinguistic and cognitive processes: Perspectives in communication disorders. Guendouzi J, Loncke F, Williams MJ, editors. New York: Psychology Press; 2011. pp. 3–29. (The development of linguistic systems: Insights from evolution).
Lozano R, Vino A, Lozano C, Fisher SE, Deriziotis P. A de novo FOXP1 variant in a patient with autism, intellectual disability and severe speech and language impairment. European Journal of Human Genetics. 2015; 23 (12):1702–1707. [ PMC free article : PMC4795189 ] [ PubMed : 25853299 ]
Lum JA, Conti-Ramsden G, Morgan AT, Ullman MT. Procedural learning deficits in specific language impairment (SLI): A meta-analysis of serial reaction time task performance. Cortex. 2014; 51 :1–10. [ PMC free article : PMC3989038 ] [ PubMed : 24315731 ]
Luquetti DV, Heike CL, Hing AV, Cunningham ML, Cox TC. Microtia: Epidemiology and genetics. American Journal of Medical Genetics Part A. 2012; 158A (1):124–139. [ PMC free article : PMC3482263 ] [ PubMed : 22106030 ]
McGee CL, Bjorkquist OA, Riley EP, Mattson SN. Impaired language performance in young children with heavy prenatal alcohol exposure. Neurotoxicology and Teratology. 2009; 31 (2):71–75. [ PMC free article : PMC2683242 ] [ PubMed : 18938239 ]
McLeod S, Harrison LJ. Epidemiology of speech and language impairment in a nationally representative sample of 4- to 5-year-old children. Journal of Speech, Language, and Hearing Research. 2009; 52 (5):1213–1229. [ PubMed : 19403947 ]
Mildinhall S. Speech and language in the patient with cleft palate. Frontiers of Oral Biology. 2012; 16 :137–146. [ PubMed : 22759677 ]
Miller JF, Paul R. The clinical assessment of language comprehension. Baltimore, MD: Paul H. Brookes Publishing Co.; 1995.
Moleski M. Neuropsychological, neuroanatomical, and neurophysiological consequences of CNS chemotherapy for acute lymphoblastic leukemia. Archives of Clinical Neuropsychology. 2000; 15 (7):603–630. [ PubMed : 14590198 ]
Morgan AT, Vogel AP. Intervention for dysarthria associated with acquired brain injury in children and adolescents. Cochrane Database of Systematic Reviews. 2008;(3):CD006279. [ PMC free article : PMC6492483 ] [ PubMed : 18646143 ]
Myers SM, Johnson CP. Management of children with autism spectrum disorders. Pediatrics. 2007; 120 (5):1162–1182. [ PubMed : 17967921 ]
Næss KAB, Lervåg A, Lyster SAH, Hulme C. Longitudinal relationships between language and verbal short-term memory skills in children with Down syndrome. Journal of Experimental Child Psychology. 2015; 135 :43–55. [ PubMed : 25819288 ]
Nelson HD, Nygren P, Walker M, Panoscha R. Screening for speech and language delay in preschool children: Systematic evidence review of the US Preventive Services Task Force. Pediatrics. 2006; 117 (2):e298–e319. [ PubMed : 16452337 ]
Nelson HD, Bougatsos C, Nygren P. Universal newborn hearing screening: systematic review to update the 2001 US Preventive Services Task Force Recommendation. Pediatrics. 2008; 122 (1):e266–e276. [ PubMed : 18595973 ]
Newbury DF, Monaco AP. Genetic advances in the study of speech and language disorders. Neuron. 2010; 68 (2):309–320. [ PMC free article : PMC2977079 ] [ PubMed : 20955937 ]
Parish SL, Grinstein-Weiss M, Yeo YH, Rose RA, Rimmerman A. Assets and income: Disability-based disparities in the United States. Social Work Research. 2010; 34 (2):71–82.
Parker M, Bitner-Glindzicz M. Genetic investigations in childhood deafness. Archives of Disease in Childhood. 2015; 100 (3):271–278. [ PubMed : 25324569 ]
Patterson M, Paparella MM. Otitis media with effusion and early sequelae: Flexible approach. Otolaryngologic Clinics of North America. 1999; 32 (3):391–400. [ PubMed : 10393775 ]
Paul LK. Developmental malformation of the corpus callosum: A review of typical callosal development and examples of developmental disorders with callosal involvement. Journal of Neurodevelopmental Disorders. 2011; 3 (1):3–27. [ PMC free article : PMC3163989 ] [ PubMed : 21484594 ]
Paul R, Norbury CF. Language disorders from infancy through adolescence: Listening, speaking, reading, writing, and communicating. 4th ed. St. Louis, MO: Elsevier; 2012.
Pelucchi B, Hay JF, Saffran JR. Statistical learning in a natural language by 8-month-old infants. Child Development. 2009; 80 (3):674–685. [ PMC free article : PMC3883431 ] [ PubMed : 19489896 ]
Pennington BF, Bishop DVM. Relations among speech, language, and reading disorders. Annual Review of Psychology. 2009; 60 :283–306. [ PubMed : 18652545 ]
Pennington L, Miller N, Robson S. Speech therapy for children with dysarthria acquired before three years of age. Cochrane Database of Systematic Reviews. 2009;(4):CD006937. [ PubMed : 19821391 ]
Pentimonti JM, Justice LJ, Kaderavek JN. School-readiness profiles of children with language impairment: Linkages to home and classroom experiences. International Journal of Language & Communication Disorders. 2014; 49 (5):567–583. [ PubMed : 24894359 ]
Perry BD, Beauchaine T, Hinshaw SP. Child maltreatment: A neurodevelopmental perspective on the role of trauma and neglect in pyschopathology. Child and Adolescent Psychopathology. 2008:93–129.
Pinborough-Zimmerman J, Satterfield R, Miller J, Bilder D, Hossain S, McMahon W. Communication disorders: Prevalence and comorbid intellectual disability, autism, and emotional/behavioral disorders. American Journal of Speech-Language Pathology. 2007; 16 (4):359–367. [ PubMed : 17971495 ]
Plyler E, Harkrider AW. Serial auditory-evoked potentials in the diagnosis and monitoring of a child with Landau-Kleffner syndrome. Journal of the American Academy of Audiology. 2013; 24 (7):564–571. [ PubMed : 24047944 ]
Reilly S, Wake M, Ukoumunne OC, Bavin E, Prior M, Cini E, Conway L, Eadie P, Bretherton L. Predicting language outcomes at 4 years of age: Findings from Early Language in Victoria Study. Pediatrics. 2010; 126 (6):e1530–e1537. [ PubMed : 21059719 ]
Reilly S, Tomblin B, Law J, McKean C, Mensah F, Morgan A, Goldfield S, Nicholson J, Wake M. Specific language impairment: A convenient label for whom? International Journal of Language & Communication Disorders. 2014; 49 (4):415–433. [ PMC free article : PMC4303922 ] [ PubMed : 25142091 ]
Rice ML. Toward epigenetic and gene regulation models of specific language impairment: Looking for links among growth, genes, and impairments. Journal of Neurodevelopmental Disorders. 2012; 4 (1):1. [ PMC free article : PMC3534233 ] [ PubMed : 23176600 ]
Ringwalt S. Summary table of states' and territories' definitions of/criteria for IDEA Part C eligibility. Chapel Hill, NC: Early Childhood Technical Assistance Center; 2015.
Robertson C, Finer N. Term infants with hypoxic-ischemic encephalopathy: Outcome at 3.5 years. Developmental Medicine & Child Neurology. 1985; 27 (4):473–484. [ PubMed : 4029517 ]
Roseberry-McKibbin C. Multicultural students with special language needs. 4th ed. Oceanside, CA: Academic Communication Associates; 2014.
Royal College of Speech & Language Therapists. Clinical guidelines (Ch. 5.2). Taylor-Groh S, editor. Bicester, UK: Speechmark Publishing Ltd.; 2005. pp. 19–24. (Preschool children with communication, language & speech needs).
Salvia J, Ysseldyke J, Bolt S. Assessment: In special and inclusive education. Boston, MA: Cengage Learning; 2012.
Sameroff A. The transactional model. Washington, DC: American Psychological Association; 2009.
Saporta AS, Kumar A, Govindan RM, Sundaram SK, Chugani HT. Arcuate fasciculus and speech in congenital bilateral perisylvian syndrome. Pediatric Neurology. 2011; 44 (4):270–274. [ PubMed : 21397168 ]
Schreiber JE, Gurney JG, Palmer SL, Bass JK, Wang M, Chen S, Zhang H, Swain M, Chapieski ML, Bonner MJ, Mabbott DJ, Knight SJ, Armstrong CL, Boyle R, Gajjar A. Examination of risk factors for intellectual and academic outcomes following treatment for pediatric medulloblastoma. Neuro-Oncology. 2014; 16 (8):1129–1136. [ PMC free article : PMC4096173 ] [ PubMed : 24497405 ]
Shevell M, Ashwal S, Donley D, Flint J, Gingold M, Hirtz D, Majnemer A, Noetzel M, Sheth RD. Practice parameter: Evaluation of the child with global developmental delay. Report of the Quality Standards Subcommittee of the American Academy of Neurology and The Practice Committee of the Child Neurology Society. Neurology. 2003; 60 (3):367–380. [ PubMed : 12578916 ]
Shiga T, Shimbo T, Yoshizawa A. Multicenter investigation of lifestyle-related diseases and visceral disorders in thalidomide embryopathy at around 50 years of age. Birth Defects Research. Part A, Clinical and Molecular Teratology. 2015; 103 (9):787–793. [ PMC free article : PMC5157726 ] [ PubMed : 26033770 ]
Shriberg LD. Four new speech and prosody-voice measures for genetics research and other studies in developmental phonological disorders. Journal of Speech and Hearing Research. 1993; 36 :105–140. [ PubMed : 8450654 ]
Shriberg LD, Tomblin JB, McSweeny JL. Prevalence of speech delay in 6-year-old children and comorbidity with language impairment. Journal of Speech, Language, and Hearing Research. 1999; 42 (6):1461–1481. [ PubMed : 10599627 ]
Simpson NH, Addis L, Brandler WM, Slonims V, Clark A, Watson J, Scerri TS, Hennessy ER, Bolton PF, Conti-Ramsden G, Fairfax BP, Knight JC, Stein J, Talcott JB, O'Hare A, Baird G, Paracchini S, Fisher SE, Newbury DF. Increased prevalence of sex chromosome aneuploidies in specific language impairment and dyslexia. Developmental Medicine & Child Neurology. 2014; 56 (4):346–353. [ PMC free article : PMC4293460 ] [ PubMed : 24117048 ]
Skebo CM, Lewis BA, Freebairn LA, Tag J, Ciesla AA, Stein CM. Reading skills of students with speech sound disorders at three stages of literacy development. Language, Speech, and Hearing Services in Schools. 2013; 44 (4):360–373. [ PMC free article : PMC4393556 ] [ PubMed : 23833280 ]
Soleymani Z, Keramati N, Rohani F, Jalaei S. Factors influencing verbal intelligence and spoken language in children with phenylketonuria. Indian Pediatrics. 2015; 52 (5):397–401. [ PubMed : 26061925 ]
Spaulding TJ, Szulga MS, Figueroa C. Using norm-referenced tests to determine severity of language impairment in children: Disconnect between U.S. policy makers and test developers. Language, Speech, and Hearing Services in Schools. 2012; 43 (2):176–190. [ PubMed : 22269585 ]
Spitz RV, Tallal P, Flax J, Benasich AA. Look Who's Talking: A Prospective Study of Familial Transmission of Language Impairments. Journal of Speech, Language, and Hearing Research. 1997; 40 (5):990–1001. [ PubMed : 9328871 ]
Squires J, Twombly E, Bricker D, Potter L. ASQ-3: Ages & Stages Questionnaires. 3rd ed. Baltimore, MD: Paul H. Brookes Publishing Co.; 2009.
Stanton-Chapman TL, Chapman DA, Kaiser AP, Hancock TB. Cumulative risk and low-income children's language development. Topics in Early Childhood Special Education. 2004; 24 (4):227–237.
Stoeckel RE, Colligan RC, Barbaresi WJ, Weaver AL, Killian JM, Katusic SK. Early speech-language impairment and risk for written language disorder: A population-based study. Journal of Developmental & Behavioral Pediatrics. 2013; 34 (1):38–44. [ PMC free article : PMC3546529 ] [ PubMed : 23275057 ]
Sun L, Wallach GP. Language disorders are learning disabilities: Challenges on the divergent and diverse paths to language learning disability. Topics in Language Disorders. 2014; 34 (1):25–38.
Swarts JD, Bluestone CD. Eustachian tube function in older children and adults with persistent otitis media. International Journal of Pediatric Otorhinolaryngology. 2003; 67 (8):853–859. [ PubMed : 12880664 ]
Takahashi H, Takahashi K, Liu FC. Forkhead Transcription Factors: Vital Elements in Biology and Medicine. Maiese K, editor. New York: Springer; 2010. pp. 117–129. (FOXP genes, neural development, speech and language disorders).
Tedeschi AS, Roizen NJ, Taylor HG, Murray G, Curtis CA, Parikh AS. The prevalence of congenital hearing loss in neonates with Down syndrome. The Journal of Pediatrics. 2015; 166 (1):168–171. [ PubMed : 25444523 ]
Tomblin JB. Understanding individual differences in language development across the school years. Tomblin JB, Nippold MA, editors. New York: Psychology Press; 2014. pp. 166–203. (Educational and psychosocial outcomes of language impairment in kindergarten).
Tomblin JB, Buckwalter PR. Heritability of poor language achievement among twins. Journal of Speech, Language, and Hearing Research. 1998; 41 (1):188–199. [ PubMed : 9493744 ]
Tomblin JB, Nippold MA, editors. Understanding individual differences in language development across the school years. New York: Psychology Press; 2014.
Tomblin JB, Smith E, Zhang X. Epidemiology of specific language impairment: Prenatal and perinatal risk factors. Journal of Communication Disorders. 1997a; 30 (4):325–344. [ PubMed : 9208366 ]
Tomblin JB, Records NL, Buckwalter P, Xhang X, Smith E, O'Brien M. Prevalence of specific language impairment in kindergarten children. Journal of Speech, Language, and Hearing Research. 1997b; 40 (6):1245–1260. [ PMC free article : PMC5075245 ] [ PubMed : 9430746 ]
Troia GA. Handbook of language and literacy: Development and disorders. 2nd ed. Stone CA, Silliman ER, Ehren BJ, Wallach GP, editors. New York: Guilford Press; 2013. pp. 227–245. (Phonological processing deficits and literacy learning).
Urbina S. Essentials of behavioral science: Essentials of psychological testing. 2nd ed. Somerset, NJ: Wiley; 2014.
Viding E, Spinath FM, Price TS, Bishop DV, Dale PS, Plomin R. Genetic and environmental influence on language impairment in 4-year-old same-sex and opposite-sex twins. Journal of Child Psychology and Psychiatry. 2004; 45 (2):315–325. [ PubMed : 14982245 ]
Vinchon M, Rekate H, Kulkarni AV. Pediatric hydrocephalus outcomes: A review. Fluids and Barriers of the CNS. 2012; 9 (1):18. [ PMC free article : PMC3584674 ] [ PubMed : 22925451 ]
Voci SC, Beitchman JH, Brownlie EB, Wilson B. Social anxiety in late adolescence: The importance of early childhood language impairment. Journal of Anxiety Disorders. 2006; 20 (7):915–930. [ PubMed : 16503112 ]
Walker SP, Wachs TD, Grantham-McGregor S, Black MM, Nelson CA, Huffman SL, Baker-Henningham H. Inequality in early childhood: risk and protective factors for early child development. Lancet. 2011; 9799 (378):1325–1338. [ PubMed : 21944375 ]
Wallace IF, Berkman ND, Watson LR, Coyne-Beasley T, Wood CT, Cullen K, Lohr KN. Screening for speech and language delay in children 5 years old and younger: A systematic review. Pediatrics. 2015; 136 (2):e448–e462. [ PubMed : 26152671 ]
Werker JF, Yeung HH, Yoshida KA. How do infants become experts at native-speech perception? Current Directions in Psychological Science. 2012; 21 (4):221–226.
Whitehouse AJO, Shelton WMR, Ing C, Newnham JP. Prenatal, perinatal, and neonatal risk factors for specific language impairment: A prospective pregnancy cohort study. Journal of Speech, Language, and Hearing Research. 2014; 57 (4):1418–1427. [ PubMed : 24686440 ]
Wilkinson J, Bass C, Diem S, Gravley A, Harvey L, Maciosek M, McKeon K, Milteer L, Owens J, Rothe P, Snellman L, Solberg L, Vincent P. Institute for Clinical Systems Improvement health care guideline: Preventive services for children and adolescents. 2013. [September 29, 2015]. https://www .icsi.org /_asset/x1mnv1/PrevServKids-Interactive0912.pdf .
WHO (World Health Organization). The ICD-10 classification of mental and behavioral disorders: Clinical descriptions and diagnostic guidelines. Geneva, Switzerland: WHO; 1992.
Yairi E, Ambrose N. Epidemiology of stuttering: 21st century advances. Journal of Fluency Disorders. 2013; 38 (2):66–87. [ PMC free article : PMC3687212 ] [ PubMed : 23773662 ]
Yan J, Oliveira G, Coutinho A, Yang C, Feng J, Katz C, Sram J, Bockholt A, Jones IR, Craddock N, Cook EH Jr., Vicente A, Sommer SS. Analysis of the neuroligin 3 and 4 genes in autism and other neuropsychiatric patients. Molecular Psychiatry. 2005; 10 (4):329–332. [ PubMed : 15622415 ]
Young AR, Beitchman JH, Johnson C, Douglas L, Atkinson L, Escobar M, Wilson B. Young adult academic outcomes in a longitudinal sample of early identified language impaired and control children. Journal of Child Psychology and Psychiatry. 2002; 43 (5):635–645. [ PubMed : 12120859 ]
Zimmerman FJ, Christakis DA, Meltzoff AN. Associations between media viewing and language development in children under age 2 years. The Journal of Pediatrics. 2007; 151 (4):364–368. [ PubMed : 17889070 ]
Cite this Page Committee on the Evaluation of the Supplemental Security Income (SSI) Disability Program for Children with Speech Disorders and Language Disorders; Board on the Health of Select Populations; Board on Children, Youth, and Families; Institute of Medicine; Division of Behavioral and Social Sciences and Education; National Academies of Sciences, Engineering, and Medicine; Rosenbaum S, Simon P, editors. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program. Washington (DC): National Academies Press (US); 2016 Apr 6. 2, Childhood Speech and Language Disorders in the General U.S. Population.
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What Are Language Disorders?

Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

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Children come to the world almost pre-programmed to learn the language of their environment. But while it appears automatic for a child to learn to read, speak, and understand communication around them—the pace at which these skills are learned vary among children. In some cases, children may not meet certain developmental milestones .

A language disorder occurs when a child is unable to compose their thoughts , ideas, and messages using language. This is known as an expressive language disorder. When a child faces difficulty in understanding what is communicated via language, this is called a receptive language disorder.

Sometimes, a child may live with a mix of expressive and receptive language disorders. A lack of understanding or poor expression of language does not always indicate a language disorder, however. This could simply be the result of a speech delay.

Read on to learn about the types, characteristics, causes, and trusted treatment methods to manage language disorders in children .

Types of Language Disorders in Children

With language , there are specific achievements expected when children mark a certain age. At 15 months, it is likely that a child can recognize between five to ten people when they are named by parents or caregivers. At 18 months, it is expected that a child can respond to simple directives like ‘let’s go outside’ without challenges. This is an already receptive child.

If at 18 months, a child is unable to pronounce ‘mama’ and ‘dada’, or if at 24 months, this child does not have at least 25 words in their vocabulary—this could signal an expressive language disorder.

Receptive Language Disorder

When a child struggles to understand the messages communicated to, or around them, this can be explained as a receptive disorder. Children with receptive challenges will usually display these difficulties before the age of four.

Receptive difficulties may be observed where a child does not properly understand oral communication directed at, or around them.

In such cases, the child struggles to understand the spoken conversations or instructions directed around them. Likewise, written words may be difficult to process. Simple gestures to come, go, or sit still may also prove challenging to comprehend.

Expressive Language Disorders

Expressive language disorders occur when a child is unable to use language to communicate their thoughts or feelings.

In this sense, oral communication is just one of the affected areas. A child may also consider written communications difficult to express.

Children with expressive disorders will find it difficult to name objects, tell stories, or make gestures to communicate a point. This disorder can cause challenges with asking or answering questions, and may lead to improper grammar usage when communicating.

Symptoms of Language Disorders

Language disorders are a common observation in children. Up to 1 out of 20 children exhibit at least one symptom of a language disorder as they grow. The symptoms of receptive disorders include:

Difficulty understanding words that are spoken
Challenges with following spoken directions
Experiencing strain with organizing thoughts

Expressive language disorders are identified through the following traits in children:

Struggling to piece words into a sentence
Adopting simple and short words when speaking
Arranging spoken words in a skewed manner
Difficulty finding correct words when speaking
Resorting to placeholders like ‘er’ when speaking
Skipping over important words when communicating
Using tenses improperly
Repeating phrases or questions when answering

Causes of Language Disorders

With a language disorder, the child does not develop the normal skills necessary for speech and language. The factors responsible for language disorders are unknown, this explains why they are often termed developmental disorders .

Disabilities or Brain Injury

Despite the uncertainty around the causes of these disorders, certain factors have strong links to these conditions. In particular, other developmental disorders like autism and hearing loss commonly co-occur with language disorders. Likewise, a child with learning disabilities may also live with language disorders.

Aphasia is another condition linked with language disorders. This condition develops from damage to the portion of the brain responsible for language. Aphasia may be caused by a stroke, blows to the head, and brain infections. The injury may increase the chances of developing a language disorder.

Diagnosis of Language Disorders

To determine if a child has a language disorder, the first step is to receive an expert’s assessment of their condition.

A speech-language pathologist or a neuropsychologist may administer standardized tests. These are to review the child’s levels of language reception and expression.

The Link Between Deafness and Language Problems

In making their assessment, the health expert will conduct a hearing test to discover if the child suffers from hearing loss. This is because deafness is one of the most common causes of language problems.

Treatment of Language Disorders

Language disorders can have far-reaching effects on the life of a child. These disorders can lead to poor social interactions, or a dependence on others as an adult. Challenges with reception and expression can also lead to reading challenges, or problems with learning .

To manage this condition, parents/guardians should exercise patience and care when dealing with children managing language disorders. While it can be challenging, children already experience frustration when dealing with others and expressing themselves. Caregivers can provide a place of comfort for children who have learning challenges.

For expert guidance, a speech-language pathologist can work with children and their guardians to improve communication and expression.

Because language disorders can be emotionally taxing, parents and children with these disorders can try therapy . This will help in navigating the emotional and behavioral issues caused by language impairments.

NCBI. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program .

MedlinePlus. Language Disorders in Children .

Ritvo A, Volkmar F, Lionello-Denolf K et al. Receptive Language Disorders . Encyclopedia of Autism Spectrum Disorders . 2013:2521-2526. doi:10.1007/978-1-4419-1698-3_1695

Reindal L, Nærland T, Weidle B, Lydersen S, Andreassen O, Sund A. Structural and Pragmatic Language Impairments in Children Evaluated for Autism Spectrum Disorder (ASD) . J Autism Dev Disord . 2021. doi:10.1007/s10803-020-04853-1

National Institute on Deafness and Other Communication Disorders. Aphasia .

Centers for Disease Control and Prevention. Language and Speech Disorders in Children .

By Elizabeth Plumptre Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

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HEALTH & FITNESS

National Speech-Language Hearing Month aims to end stigmas

PHILADELPHIA (WPVI) -- May is National Speech Language Hearing Month.

Millions of Americans suffer from related disorders and, unfortunately, the stigmas surrounding them.

Robert M. Augustine, the former President of the American Speech Language Hearing Association, joined Brighter News to speak more about this.

Some high-profile names are helping bring awareness to aphasia, including President Joe Biden, who has discussed his late son Beau's struggle.

Biden has also spoken openly about how coping with a stutter was one of his greatest challenges as a young person and that he still sometimes struggles with halting speech in his public appearances.

Pennsylvanian Senator John Fetterman has also battled aphasia, as well as actor Bruce Willis and talk show host Wendy Williams.

Hearing loss is another disorder that is not just an older person problem. Many younger Americans battle it and the stigmas that come with it.

Augustine talks about where can adults with communication disorders can find help. For more, watch the interview above.

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Speech Language Pathology Student Outcome Data

The master of science (m.s.) in speech-language pathology, on-time program completion rates, praxis examination pass rates of test-takers.

Note: The Praxis examination reporting period is the testing year or examination cycle, not the year of graduation for the test-takers. The data for each reporting period may include test-takers who graduated from the program within the prior 3 years.

University Resources

Talk therapy? AI may detect 'earliest symptoms' of dementia by analyzing speech patterns

A new artificial intelligence-powered tool aims to detect signs of dementia, Alzheimer’s and other memory disorders by analyzing a person’s speech and language patterns.

The system is called CognoSpeak. Researchers at the University of Sheffield in the U.K. developed it.

In early trials that included both Alzheimer’s patients and cognitively heathy people, the tool showed 90% accuracy in identifying those with dementia — which is just as accurate as "pen-and-paper tests," according to a press release announcing the new tool.

AI TOOL GIVES DOCTORS PERSONALIZED ALZHEIMER’S TREATMENT PLANS FOR DEMENTIA PATIENTS

The patient communicates with a "virtual agent" displayed via a web browser on a computer, laptop or tablet.

The virtual agent poses certain questions to patients — similar to the ones used to test memory skills during in-person consultations — and also asks them to describe pictures and test their verbal fluency.

READ ON THE FOX NEWS APP

At that point, CognoSpeak’s built-in AI technology analyzes the patient’s language and speech patterns to detect any cognitive warning signs.

Researchers next plan to test the tool on 700 participants from U.K. memory clinics , with funding provided by the National Institute for Health and Care Research.

The goal is for CognoSpeak to help enable faster diagnosis by serving as a "middle man" between the general practitioner and the dementia specialist.

The physician would refer the patient to CognoSpeak and the test results would be routed back to the doctor — who would then decide whether the patient needed further memory care.

INTERNET USE BY SENIORS ON REGULAR BASIS COULD SLASH THEIR DEMENTIA RISK, STUDY SUGGESTS

"Waiting for a possible diagnosis of dementia can be a very anxious time for patients and their families," said Dr. Dan Blackburn from the University of Sheffield’s Department of Neuroscience in the press release. "This tool could help patients start treatments sooner, reduce waiting times and give people certainty earlier."

He added, "This would also free up clinicians’ valuable time and mean that those who need specialist care get access to it as quickly as possible."

One of the earliest symptoms of dementia is struggling to find words and pausing during speech, noted Dr. James Galvin, director of the Comprehensive Center for Brain Health at the University of Miami Miller School of Medicine, in a statement provided to Fox News Digital.

Galvin was not involved in CognoSpeak’s research or development.

"Using AI to analyze speech in the primary care setting could be a quick, reliable way to assess cognitive status, even if a person does not offer a memory complaint," he said.

Dr. Michael Kleiman, PhD, a research assistant professor of neurology at the Comprehensive Center for Brain Health at the University of Miami Miller School of Medicine, is a colleague of Galvin’s who has studied the link between speech behavior and detection of early stages of cognitive impairment.

IOWA WOMAN, 27, HAS 99% CHANCE OF DEVELOPING DEMENTIA: ‘I NEEDED TO KNOW’

"Speech patterns in general are highly useful at identifying cognitive impairment, and some of the components of CognoSpeak, including picture descriptions, are frequently used by neuropsychologists and neurologists to assess and diagnose dementia," Kleiman said. (He also has no affiliation with CognoSpeak.)

"If this tool is able to effectively process the speech data in an accurate and efficient manner, as well as keep patients engaged, we would expect that it would be useful for clinicians when assessing cognitive impairment," he added.

As with all diseases, early detection is key, experts agree — which is why the speed of CognoSpeak could be beneficial.

"Given that Alzheimer’s disease and other dementias are progressive, it is important to catch these changes early in order to implement available interventions when they can be most effective to slow down cognitive decline," Percy Griffin, PhD, the director of scientific engagement at the Alzheimer’s Association in Chicago, Illinois , said to Fox News Digital.

While experts agree that the role of AI in neurology shows promise, more research is needed before it can be relied upon as a primary indicator.

"Although this technology is encouraging, more work is needed in larger, more representative study populations to further validate the utility of AI tools like this one in helping to diagnose Alzheimer’s," said Griffin.

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"In the future, this could be another tool in the toolbox for early detection of Alzheimer’s," he added.

And while speech testing is useful, experts noted that it’s not the only component necessary for diagnosing dementia.

"Other aspects of cognition — in particular, memory — and a detailed neurological examination must also be examined to establish a true diagnosis," Kleiman said.

Ideally, Percy added, the availability of non-invasive and potentially less expensive approaches to early detection and diagnosis — a combination of blood tests, simple digital tests and other tools — would make cognitive assessments available to more people.

Around 5.8 million people in the U.S. have Alzheimer’s disease and related dementias, according to the Centers for Disease Control and Prevention (CDC).

The number of cases is expected to reach 14 million by 2060.

While speech testing is useful, experts noted that it’s not the only component necessary for diagnosing dementia. iStock

IMAGES

Speech/Language Impairment Fact Sheet
Speech Language Impairment: Students with Disabilities
Speech and Language Impairment Fact Sheet
Speech Impediment Guide: Definition, Causes & Resources
Speech and Language Impairments in Children: Causes, Characteristics
Characteristics/Symptoms

VIDEO

Specific Language Impairment and Developmental Delays
Speech and Language impairment
Visual impairment #characteristics , identification, causes and signs b. ed 2nd year
A case Study of Speech and Language Impairment
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Visual Impairment meaning, definition, causes, symptoms, types

COMMENTS

Speech and Language Impairment
Characteristics of Speech or Language Impairments. The characteristics of speech or language impairments will vary depending upon the type of impairment involved. There may also be a combination of several problems. When a child has an articulation disorder, he or she has difficulty making certain sounds. These sounds may be left off, added ...
Speech and Language Disorders
Disorders of speech and language are common in preschool age children. Disfluencies are disorders in which a person repeats a sound, word, or phrase. Stuttering may be the most serious disfluency. It may be caused by: Genetic abnormalities. Emotional stress. Any trauma to brain or infection.
Speech and Language Impairments
Characteristics of Speech or Language Impairments. The characteristics of speech or language impairments will vary depending upon the type of impairment involved. There may also be a combination of several problems. When a child has an articulation disorder, he or she has difficulty making certain sounds. These sounds may be left off, added ...
Speech and Language Disorders
Speech and Language Disorders. Speech is how we say sounds and words. People with speech problems may: not say sounds clearly. have a hoarse or raspy voice. repeat sounds or pause when speaking, called stuttering. Language is the words we use to share ideas and get what we want. A person with a language disorder may have problems:
Speech disorders: Types, symptoms, causes, and treatment
Dysarthria occurs when damage to the brain causes muscle weakness in a person's face, lips, tongue, throat, or chest. Muscle weakness in these parts of the body can make speaking very difficult ...
Comprehenisve Overview of Speech and Language Impairments
Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. ... Some characteristics of language disorders include improper use of words and their meanings, inability to express ideas ...
Language and Speech Disorders in Children
Having a language or speech delay or disorder can qualify a child for early intervention (for children up to 3 years of age) and special education services (for children aged 3 years and older). Schools can do their own testing for language or speech disorders to see if a child needs intervention. An evaluation by a healthcare professional is ...
Spoken Language Disorders
A spoken language disorder represents a persistent difficulty in the acquisition and use of listening and speaking skills across any of the five language domains: phonology, morphology, syntax, semantics, and pragmatics. Language disorders may persist across the life span, and symptoms may change over time. A spoken language disorder can occur ...
Speech and language impairment
Speech and language impairment are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency.. A speech impairment is characterized by difficulty in articulation of words. Examples include stuttering or problems producing particular sounds. Articulation refers to the sounds, syllables, and phonology produced by the individual.
Speech Impairment: Types and Health Effects
There are three general categories of speech impairment: Fluency disorder. This type can be described as continuity, smoothness, rate, and effort in speech production. Voice disorder. A voice ...
SLI: What We Know and Why It Matters
The incidence of SLI was recently estimated in a study funded by the National Institutes of Health to be 7.6% among 5-year-old children. This compares with well under 1% for Down syndrome and autism, to use just two examples of disorders with a secondary effect on language development. One study showed that 70% of children tested at age 5 and ...
Speech-Language Impairment: How to Identify the Most Common and Least
Introduction. Speech-language deficits are the most common of childhood disabilities and affect about 1 in 12 children or 5% to 8% of preschool children. The consequences of untreated speech-language problems are significant and lead to behavioral challenges, mental health problems, reading difficulties, and academic failure including in-grade retention and high school dropout.
Quick Facts
Audiologists are healthcare professionals who provide patient-centered care in the prevention, identification, diagnosis, and evidence-based treatment of hearing, balance, and other auditory disorders for people of all ages. Approximately 37.5 million Americans report having some trouble hearing. ( source)
Developmental Language Disorder
Developmental language disorder (DLD) is one of the most common developmental disorders, affecting approximately 1 in 14 children in kindergarten. Developmental language disorder (DLD) is a communication disorder that interferes with learning, understanding, and using language. These language difficulties are not explained by other conditions ...
Help for speech, language disorders
People with speech and language disorders can find hope in rehabilitation. Speech-language pathologists can evaluate and treat these disorders. This can lead to a happier, healthier and more expressive life. Types of speech and language disorders Speech and language disorders come in many forms, each with its own characteristics: Aphasia
Signs and Symptoms of a Speech Language Disorder
Struggles to say sounds or words (3 to 4 years) In adults, signs of speech and language disorders include: Struggles to say sounds or words. Repeats words or parts of words. Says words in the wrong order. Struggles with using words and understanding others. Has difficulty imitating speech sounds. Speaks at a slow rate.
General Information About Speech and Language Disorders
It is estimated that communication disorders (including speech, language and hearing disorders) affect one of every 10 people in the United States. Characteristics. A child's communication is considered delayed when the child is noticeably behind his or her peers in the acquisition of speech and/or language skills.
Speech and Language Disorders Factsheet (for Schools)
Students with speech and language impairments may benefit from individualized education programs (IEPs) or 504 education plans. If your student is being treated for a speech or language problem, part of the treatment may include seeing a speech-language pathologist during the school day. Therapy may be one or more times a week, depending on the ...
Speech and Language Developmental Milestones
A checklist of milestones for the normal development of speech and language skills in children from birth to 5 years of age is included below. These milestones help doctors and other health professionals determine if a child is on track or if he or she may need extra help. Sometimes a delay may be caused by hearing loss, while other times it ...
Childhood Speech and Language Disorders in the General U.S. Population
Speech and language disorders in children include a variety of conditions that disrupt children's ability to communicate. Severe speech and language disorders are particularly serious, preventing or impeding children's participation in family and community, school achievement, and eventual employment. This chapter begins by providing an overview of speech and language development and disorders.
PDF Specific Language Impairment
Specific language impairment (SLI) is a communication disorder that interferes with the development of language skills in children who have no hearing loss. SLI can affect a child's speaking, listening, reading, and writing. SLI is also called developmental language disorder, language delay, or developmental dysphasia.
What's the Difference Between Speech Disorders and Language-Based
A child with this type of speech impairment may hesitate or stutter or have blocks of silence when speaking. Language-based learning disabilities (LBLD) are very different from speech impairments. LBLD refers to a whole spectrum of difficulties associated with young children's understanding and use of spoken and written language.
Language Disorders: Definition, Types, Causes, Remedies
A language disorder occurs when a child is unable to compose their thoughts, ideas, and messages using language. This is known as an expressive language disorder. When a child faces difficulty in understanding what is communicated via language, this is called a receptive language disorder. Sometimes, a child may live with a mix of expressive ...
Addressing the Impacts of Acquired Communication Disorders on Sexuality
Semantic Scholar extracted view of "Addressing the Impacts of Acquired Communication Disorders on Sexuality: Speech-Language Pathologists' and Clinical Psychologists' Beliefs and Practice Patterns" by Laura L. Wolford et al. ... characteristics and causes of language impairment in childhood and where have they heard about it? A European survey.
National Speech-Language Hearing Month aims to end stigmas
PHILADELPHIA (WPVI) -- May is National Speech Language Hearing Month. Millions of Americans suffer from related disorders and, unfortunately, the stigmas surrounding them. Robert M. Augustine, the ...
Clinical Experiences
CSD 408A50 Advanced Speech Pathology Clinic - Complete one, 3-hour enrollment in this during your last fall semester (last term on campus). CSD 408A60 External: Educational - All students will complete one full-time, 10-week internship in a school for 5 semester hours.
International Journal of Language & Communication Disorders: Vol 59, No 3
The Royal College of Speech and Language Therapists (RCSLT) IJLCD is the RCSLT's widely-respected international research journal. Find out more about the RCSLT - the services they provide, the campaign work they do with governments and partner organisations and their activities with educators.
Tips for Communicating With Adults Who Have a Speech or Language Disorder
Speech and language disorders are common in adults. Some people have difficulties understanding language, whereas other people have trouble expressing themselves. Some people have difficulties with both. Be a good communication partner! To help someone understand you better, do these things:
Speech Language Pathology Student Outcome Data
The Master of Science (M.S.) in speech-language pathology On-Time Program Completion Rates. Reporting Period # Completed within Expected Time Frame % Completed within Expected Time Frame; 2022-2023: 32: 94%: 2021-2022: 33: 97%: ... Communication Sciences and Disorders. Contact Us; Fairchild Hall 204; Follow us on: Facebook; Twitter; Instagram;
Talk therapy? AI may detect 'earliest symptoms' of dementia by
A new artificial intelligence-powered tool called CognoSpeak aims to detect signs of dementia, Alzheimer's and other memory disorders by analyzing a person's speech and language patterns.

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