COMMUNICATION DISORDER:

Communication disorders are among the most common disorders in childhood. To communicate effectively, children must have a mastery of language- that is the ability to understand and express ideas- using words and speech, the manner in which words are spoken.

EXPRESSIVE LANGUAGE DISORDER:

Expressive language disorder is diagnosed when a child demonstrates a selective deficit in expressive language development relative to receptive language skills and nonverbal intelligence. Thus, a child with expressive language disorder may be identified using the Wechsler Intelligence Scale for Children III (WISC-III) in that verbal intellectual level may appear to be depressed compared with the child’s overall intelligence quotient (IQ). A child with expressive language disorder is likely to function below the expected levels of acquired vocabulary, correct tense usage, complex sentence construction, and world recall. Children with expressive language disorder often present verbally as younger than their age.

Epidemiology:

The prevalence of expressive language disorder is estimated to be as high as 6 percent in children between the ages of 5 and 11 years of age. Surveys have indicated rates of expressive language as high as 15 percent in children under age 3 years. In school-age children over the age of 11 years, the estimates are lower, ranging from 3 percent to 5 percent . The disorder is two to three times more common in boys than in girls an is most prevalent among children whose relatives have a family history of phonological disorder or other communication disorders.

Etiology:

The specific cause of developmental expressive language disorder is likely to be multifactorial. Subtle cerebral damage and maturational lags in cerebral development have been postulated as underlying causes. Some children with language disorders have difficulty processing information in a time-limited manner.

DSM-IV-TR Diagnostic Criteria for Expressive Language Disorder:

A. The scores obtained from standardized individually administered measures of expressive language development are substantially below those obtained from standardized measures of both nonverbal intellectual capacity and receptive language development. The disturbance may be manifest clinically by symptoms that include having a markedly limited vocabulary, making errors in tense, or having difficulty recalling words or producing sentences with developmentally appropriate length or complexity .

B. The difficulties with expressive language interfere with academic or occupational achievement or with social communication.

C. Criteria are not met for mixed receptive-expressive language disorder or a pervasive developmental disorder.

D. If mental retardation, a speech-motor or sensory deficit, or environmental deprivation is present, the language difficulties are in excess of those usually associated with these problems.

Coding note: If a speech-motor or sensory deficit or a neurological condition is present, code the condition in AXIS III.

Treatment:

Controversy exists among experts, whether interventions for young children with expressive language difficulties should be initiated as soon as it is noted, or whether waiting until age 4 or 5 years is the optimal time to begin treatment. Treatment for expressive language disorder is still generally not initiated unless it persists after the preschools years.

MIXED RECPTIVE-EXPRESSIVE LANGUAGE DISORDER:

Children with mixed receptive-expressive learning disorders exhibit impaired skills in the expression and reception (understanding and comprehension) of spoken language. The expressive difficulties in these children may be similar to those of children with only expression language disorder, which is characterized by limited vocabulary, use of simplistic sentences, and short sentences usage. Children with receptive language difficulties may be experiencing additional deficits in basic authority processing sills, such as discriminating between sounds, rapid sound changes, associated of sounds and symbols, and the memory of sound sequences.

Epidemiology:

Mixed receptive-expressive language disorder is believed to occur in about 5 percent of pre-schoolers and to persist in approximately 3 percent of school-age children. It is less common than expressive language language disorder alone. Mixed receptive-expressive language disorder is believed to be at least twice as prevalent in boys as in girls.

Etiology:

Language disorder most likely have multiple determinants, including genetic factors, developmental brain abnormalities, environmental influences, neurodevelopmental immaturity, and auditory processing features in the brain.

DSM-IV-TR Diagnostic Criteria for Mixed Receptive-Expressive Language Disorder:

A. The scores obtained from a battery of standardized individually administered measures of both receptive and expressive language development are substantially below those obtained from standardized measures of nonverbal intellectual capacity. Symptoms include those for expressive language disorder as well as difficulty understanding words, sentences, or specific type of words, such as spatial terms.

B. The difficulties with receptive and expressive language significantly interfere with academic or occupational achievement or with social communication.

C. Criteria are not met for a pervasive developmental disorder.D. If mental retardation, a speech-motor or sensory deficit, or environmental deprivation is present

, the language difficulties are in excess of those usually associated with these problemsCoding note: if a speech-motor or sensory deficit or a neurological condition is present , code the condition on AXIS III

Treatment:

A comprehensive speech and language evaluation is recommended for children with mixed receptive-expressive language disorder, before embarking on a speech and language remediation program.

PHONOLOGICAL DISORDER:

Children with phonological disorder are unable to produce sounds correctly because of omissions of sounds, distortions of sound, or atypical pronunciation. Typical speech disturbance in this order include omitting the last sounds of the word

(e.g., saying mou for mouse or dri for drink), or substituting one sound for another (saying bwu instead of blue or tup for cup)

Epidemiology:

Surveys indicate that the prevalence of phonological disorder is at least 3 percent in pre-schoolers, 2 percent in children 6 to 7 years of age, and 0.5 percent in 17-year-old-adolescents. Approximately 7 to 8 percent of 5-year-old children in one large community sample had speech sound production problems of developmental, structural, or neurological origins.

Etiology:

The likely causes of phonological disturbance include multiple variables-perinatal problems, genetic factors, auditory processing problems, hearing impairment, and structural abnormalities related to speech.

DSM-IV-TR Diagnostic Criteria of Phonological Dysfunctions:

A. Failure to us developmentally expected speech sounds that are appropriate for age and dialect e.g., errors in sound production, use, representation, or organization such as, but not limited to , substitution of one sound for another use of /t/ for target /k/ for sound] or omissions for sound such as final consonants.

B. The difficulties in speech sound production interfere with academic or occupational achievement or with social communication.

C. If mental retardation, a speech-motor or sensory deficit, or environmental deprivation is present, the speech difficulties are in excess of those usually associated with these problems.

Coding note: if a speech-motor or sensory deficit, or a neurological condition is present, code the condition on AXIS III

Treatment:

Treatment is typically recommended for children with moderate to severe developmental phonological disorders. Two main approaches have been used successfully to improve phonological difficulties

STUTTERING:

Stuttering is a condition in which the normal flow of speech is disrupted by involuntary speech motor events. Stuttering can include a variety of specific disruptions of fluency, including sound or syllable repetitions, sound prolongations, dysrhythmic phonations, and complete blocking or unusual pauses between sounds and syllables of words.

Epidemiology:

Surveys conducted mainly in the United States and Europe indicate the prevalence of stuttering is about 1 percent in the general population. Stuttering tends to be most common in young children has often resolved spontaneously by the time the child is older. The typical age of onset is 2 to 7 years of age with a peak at age 5 years. Estimates are that up to 3 to 4 percent of individuals may have stuttered at some time in their lives. Approximately 80 percent of young children who stutter are likely to have a spontaneous remission over time.

Etiology:

Converging evidence indicates that causes of stuttering is multifactorial, including genetic, neurophysiological, and psychological factors that predispose a child to have poor speech fluency.

DSM-IV-TR Diagnostic Criteria for Stuttering:

A. Disturbance in the normal fluency and time patterning of speech (inappropriate for the individual’s age), characterized by frequent occurrences of one or more of the following :(1) Sound and syllable repetitions(2) Sound prolongations(3) Interjections(4) Broken words (e.g., pauses within a word )(5) Audible or silent blocking (filled and unfilled pauses in speech)(6) Circumlocutions (word substitutions to avoid problematic words)(7) Words produced with an excess of physical tension(8) Monosyllabic whole-word repetitions (e.g., “I-I-I-I see him”)

B. The disturbance in fluency interferes with academic or occupational achievement or with social communication.

C. If a speech-motor or sensory deficit is present, the speech difficulties are in excess of those usually associated with these problems

Coding note: if a speech-motor or sensory deficit or a neurological condition is present , code the condition on Axis III

Treatment:

Two distinct forms of intervention have been used in the treatment of stuttering. Direct speech therapy typically targets modifications of the stuttering response to fluent-sounding speech by systematic steps and rules of speech mechanics that the person can practice. Another form of therapy for stuttering targets diminishing tension and anxiety during speech.

COMMUNICATION DISORDER NOT OTHERWISE SPECIFIED:

Disorders that do not meet the diagnostic criteria for any specific communication disorder fall into the category of communication disorder not otherwise specified. An example is voice disorder, in which the patient has an abnormality of in pitch, loudness, quality, tone or resonance.

DSM-IV-TR Diagnostic Criteria for Communication Disorder Not Otherwise Specified:

This category of disorders in communication that do not meet criteria for any specific communication disorder; for example, a voice disorder (i.e., an abnormality of vocal pitch, loudness, quality, tone, or resonance)