Communication Disorders

Types of communication disorders

The difference between speech and language matters: speech is the physical production of sounds, while language is the system of words and rules used to share meaning. A child can speak clearly but have a language disorder, or have rich language but unclear speech. For speech-specific problems, see speech disorders.

Causes and risk factors

In children:

• often no single cause; family history of speech or language problems is common
• hearing loss, including from repeated ear infections with fluid
• premature birth and low birth weight
• autism spectrum disorder, intellectual disability, cerebral palsy
• genetic syndromes such as Down syndrome and fragile X
• cleft lip and palate

In adults:

• stroke, the leading cause of aphasia
• traumatic brain injury
• neurological diseases: Parkinson's disease, ALS, multiple sclerosis, dementia
• head and neck cancer and its treatment
• vocal cord damage from overuse, reflux or smoking

Bilingualism does not cause language disorders. Children learning two languages may mix them, which is normal.

Warning signs in children

Any loss of language or social skills at any age needs prompt assessment.

Warning signs in adults

• trouble finding words or understanding others
• slurred, slow or effortful speech
• a hoarse, breathy or strained voice lasting more than 4 weeks
• difficulty following conversations, or changes in reading or writing
• trouble swallowing alongside speech changes

Diagnosis

1. Hearing test for every child with speech or language concerns.
2. Speech-language evaluation by a speech-language pathologist (SLP), using standardized tests, conversation samples and play.
3. Developmental, medical and genetic assessment when other concerns exist.
4. In adults: neurological examination, brain imaging for sudden changes, and voice assessment with laryngoscopy by an ENT specialist.

Treatment

• Speech-language therapy: individual or group sessions targeting sounds, vocabulary, sentence building, fluency, voice or social communication. Parents and teachers learn strategies to use every day.
• Hearing aids, cochlear implants and ear tubes where hearing loss contributes.
• Augmentative and alternative communication (AAC): sign language, picture boards and speech-generating devices. AAC supports, rather than delays, speech development.
• Educational support: an Individualized Education Program (IEP) or 504 plan in US schools; early intervention services from birth to age 3 under IDEA Part C.
• Treatment of underlying conditions, such as stroke rehabilitation or voice therapy and surgery for vocal cord lesions.

Outlook

Many children with speech and language delays catch up, especially with early therapy. Language disorders can persist and affect reading and learning, so ongoing support at school matters. Adults with aphasia often improve substantially in the first months after a stroke and can keep improving for years with therapy.

Frequently asked questions

What are the types of communication disorders?

The main types are speech disorders (sound production, fluency and voice), language disorders (understanding and using language), social communication disorders, hearing disorders and cognitive-communication disorders. Many people have more than one type.

What is the difference between a speech disorder and a language disorder?

A speech disorder affects how sounds are physically produced, such as unclear speech or stuttering. A language disorder affects understanding or using words and sentences to share meaning. A person can have one without the other, or both.

What causes communication disorders in children?

Often there is no single cause. Contributing factors include family history, hearing loss, premature birth, autism, intellectual disability, genetic syndromes, cleft palate and neurological conditions. Learning two languages does not cause communication disorders.

When should I worry about my child's speech?

Talk to your pediatrician if your child has no words by about 15 months, is not combining two words by 2 years, is hard for strangers to understand by 4 years, or loses words or skills at any age. Early assessment and therapy work best.

Can adults develop communication disorders?

Yes. Adults can develop aphasia or slurred speech after a stroke or brain injury, voice disorders from overuse or vocal cord problems, and speech and language changes in Parkinson's disease, ALS or dementia. Sudden changes are an emergency.