Communication disorders

COMMUNICATION
DISORDERS
DR.ASHWATHI.J
FINAL YEAR PSYCHIATRY RESIDENT
SSIMS & RC

INTRODUCTION
v Range from mild delays in acquiring language to expressive or mixed receptive-
expressive disorders, phonological disorders and stuttering, which may remit
spontaneously or persist into adolescence.
v Language delay – one of the most common very early childhood developmental
delays, affecting up to approximately 7% of 5-year olds.
v Rates of language disorders are understandably higher inn pre-schoolers than inn
school-age children.

vAs per DSM-5, communication disorders are classified as
A) Language disorders – includes expressive ad mixed receptive-expressive
problems.
B) Speech disorders – speech sound disorder (phonological disorder) and childhood-
onset fluency disorder (stuttering).

LANGUAGE
üLanguage and speech are pragmatically intertwined, despite the distinct categories of
language and speech disorders in DSM-5
ü Language competence spans four domains:
1) PHONOLOGY – ability to produce sounds that constitute words in a given language and the
skills to discriminate the various phonemes( sounds that are made by a letter or a group of
letters in a language).
2) GRAMMAR – designates the organisation of words and the rules for placing words in an
order that makes sense in that language.
3) SEMANTICS – organisation of concepts and the acquisition of words themselves.
4) PRAGMATICS –skill in the actual use of language and the rules of conversation, such as
pausing so that a listener can answer a question and knowing when to change the topic when a
break occurs in the conversation.

LANGUAGE DEVELOPMENT
Age Development
6 months infants will laugh and coo
9 months babble and verbalise syllables such as dadada or
mamama
12 months imitate vocalizations and can often speak at least
one word
2 years name an action in a picture and are able to make
themselves understood through their verbalizations
about half of the time.
3 years can speak understandably, and are able to name
a colour and describe what they see with several
adjectives.
4 years children typically can name at least 4 colours, and
can converse understandably

LANGUAGE DISORDER
§Consists of difficulties in the acquisition and use of language across many modalities,
including spoken and written, due to deficits in comprehension or production based on
both expressive and receptive skills.
§Include : reduced vocabulary, limited abilities in forming sentences using the rules of
grammar and impairments in conversing based on difficulties using vocabulary to
connect sentences in descriptive ways.
§Two deficits : 1) Expressive language deficits
2) Mixed receptive and expressive deficits

EXPRESSIVE LANGUAGE
DEFICITS
qPrior to entering preschool, the development of proficiency in vocabulary and
language usage is highly variable, and influenced by the amount and quality of
verbal interactions with family members.
qAfter beginning school, a child's language skills are significantly influenced by the
level of verbal engagement in school.
qwhen a child demonstrates a selective deficit in expressive language
development relative to receptive language skills and nonverbal intellectual
function.
qIn Wechsler Intelligence Scale for Children III (WISC-III) - verbal intellectual level
may appear to be depressed compared with the child's overall intelligence quotient
(IQ).

EXPRESSIVE LANGUAGE DEFICITS
JLanguage deficits can be acquired during childhood (secondary to trauma or a
neurological disorder) or developmental or congenital (without any obvious cause).
JMost childhood language disorders fall into the developmental category.
JExpressive language disturbance often appears in the absence of comprehension
difficulties, whereas receptive dysfunction generally diminishes proficiency in the
expression of language.

EPIDEMIOLOGY :
• <4 years – 20%
5 – 11 years – 6%
>11 years – 3-5%
•Two to three times more common in boys
•most prevalent among children whose relatives have a family history of phonologic
disorder or other communication disorders.

COMORBIDITY :
v attention-deficit/hyperactivity disorder (19%), anxiety disorders (10%),
oppositional defiant disorder and conduct disorder (7%).
vAt higher risk for a speech disorder, receptive difficulties, and other learning
disorders.

ETIOLOGY :
ØMultifactorial.
ØMRI studies : diminished left-right brain asymmetry in the peri-sylvian and planum
temporale regions
ØLeft handedness or ambi-laterality appears to be associated with expressive
language problems with more frequency than right handedness.
ØEnvironmental factors are postulated to contribute to developmental language
disorders.

DIAGNOSIS :
a) Markedly below-age level verbal or sign language, accompanied by a low score on
standardized expressive verbal tests, is diagnostic of expressive deficits in language disorder.
b) CARTER NEUROCOGNITIVE ASSESSMENT - itemizes and quantifies skills in areas of
social awareness, visual attention, auditory comprehension, and vocal communication even
when there are compromised expressive language and motor skills in very young children-
up to 2 years of age
c) To confirm the diagnosis, a child is given standardized expressive language and nonverbal
intelligence tests.
d) Family history should include the presence or absence of expressive language disorder
among relatives

CLINICAL FEATURES:
a. vague when telling a story and use many filler words such as "stuff' and "things"
instead of naming specific objects.
b. Essential feature - impairment in the development of age-appropriate expressive
language, which results in the use of verbal or sign language markedly below the
expected level in view of a child's nonverbal intellectual capacity
c. Language understanding (decoding) skills remain relatively intact.
d. When severe, the disorder becomes recognizable by about the age of 18 months,
when a child fails to utter spontaneously or even echo single words or sounds.
e. By the age of 4 years, most children with expressive language disturbance can
speak in short phrases, but may have difficulty retaining new words
f. Emotional problems involving poor self image, frustration, and depression may
develop in school-age children.

DIFFERENTIAL DIAGNOSIS:
1. In mixed receptive-expressive language disorder, language comprehension (decoding) is
markedly below the expected age-appropriate level, whereas in expressive language
disorder, language comprehension remains within normal limits.
2. In autism spectrum disorders, children often have impaired language, symbolic and
imagery play, appropriate use of gesture, or capacity to form typical social relationships.
In contrast, children with expressive language disorder become very frustrated with their
disorder, and are usually highly motivated to make friends despite their disability.
3. Children with acquired aphasia or dysphasia have a history of early normal language
development; the disordered language had its onset after a head trauma or other
neurologic disorder (e.g., a seizure disorder).
4. Children with selective mutism have normal language development. Often these children
will speak only in front of family members (e.g., mother, father, and siblings). Children
affected by selective mutism are socially anxious and withdrawn outside the family.

PATHOLOGY AND LABORATORY EXAMINATION:
an audiogram to rule out hearing loss.
COURSE AND PROGNOSIS:
§The prognosis worsens the longer it persists in a child; prognosis is dependent on the
severity of the disorder.
§If children do not develop mood disorders or disruptive behaviour problems, the
prognosis is better. The presence or absence of hearing loss, or intellectual disability,
impedes remediation and leads to a worse prognosis
§The rapidity and extent of recovery depends on the severity of the disorder, the
child's motivation to participate in speech and language therapy, and the timely
initiation of therapeutic interventions.

TREATMENT
qPrimary goal for early childhood speech and language treatment is to guide children and
their parents toward greater production of meaningful language.
qParent-Child Interaction Therapy (PCIT) for school-aged children with expressive language
impairment is particularly efficacious in improving a child's verbal initiation, mean length of
utterances, and the proportion of child-to-parent utterances.
qTreatment is generally not initiated unless it persists after the pre-school years.
qLanguage therapy
a) aimed at using words to improve communication strategies and social interactions.
b) consists of behaviourally reinforced exercises and practice with phonemes (sound units),
vocabulary, and sentence construction.
c) The goal is to increase the number of phrases by using block building methods and
conventional speech therapies.
qDirect interventions – use a speech and language pathologist who works directly with the
child.
qMediated interventions – a speech and language professional teaches a child’s teacher or
parent how to promote therapeutic languages technique.

MIXED RECEPTIVE AND EXPRESSIVE
DEFICITS
vimpaired ability in sound discrimination, deficits in auditory processing, or poor
memory for sound sequences and impaired skills in the expression and reception
(understanding and comprehension) of spoken language.
vRecognition may be delayed because of early misattribution of their communication
by teachers and parents as a behavioural problem rather than a deficit in
understanding.

EPIDEMIOLOGY :
§Occur less frequently than expressive deficits.
§5% in pre-schoolers
§3% in school age children
§At least twice as prevalent in boys as in girls.
COMORBIDITY :
§At high risk for additional speech and language disorders, learning disorders, and
additional psychiatric disorders.
§ About half of children with these deficits have pronunciation difficulties leading to
speech sound disorder, and about half have reading disorder.
§ADHD is present in at least one third of children with mixed receptive-expressive
language disturbances.

DEFICITS
ETIOLOGY
•Language disorders most likely have multiple determinants
a) genetic factors,
b) developmental brain abnormalities,
c) environmental influences,
d) neurodevelopmental immaturity, and
e) auditory processing features in the brain.
•An underlying impairment of auditory discrimination, because most children with the
disorder are more responsive to environmental sounds than to speech sounds.

DIAGNOSIS
qIn mixed receptive-expressive language disorder, receptive dysfunction coexists with
expressive dysfunction. Therefore, standardized tests for both receptive and
expressive language abilities must be given to anyone suspected of having language
disorder with mixed receptive-expressive disturbance.
qTo confirm the diagnosis : A markedly below-expected level of comprehension of
verbal or sign language with intact age-appropriate nonverbal intellectual capacity,
confirmation of language difficulties by standardized receptive language tests, and
the absence of autism spectrum disorder.

CLINICAL FEATURES
üEssential feature - impairment in both language comprehension and language
expression.
üClinical features of the receptive component - appear before the age of 4 years.
üSevere forms - apparent by the age of 2 years;
ü mild forms may not become evident until age 7 (second grade) or older, when
language becomes complex.
üshow markedly delayed and below-normal ability to comprehend (decode) verbal
or sign language, although they have age-appropriate nonverbal intellectual
capacity.
üHave auditory sensory difficulties and compromised ability to process visual
symbols, such as explaining the meaning of a picture ( many children )

üWhereas at 18 months, a child with expressive language deficits only comprehends
simple commands and can point to familiar household objects when told to do so, a
child of the same age with mixed receptive-expressive language disturbance
typically cannot either point to common objects or obey simple commands
üA child with mixed receptive-expressive language deficits may appears to be deaf.
He or she responds normally to sounds from the environment, but not to spoken
language.
üSeizure disorders and reading disorder are common among the relatives of children
with mixed receptive-expressive problems.
PATHOLOGY AND LABORATORY EXAMINATION
§An audiogram - to rule out or confirm the presence of deafness or auditory deficits.
§A history of the child and family and observation of the child in various settings help
to clarify the diagnosis.

DIFFERENTIAL DIAGNOSIS :
Intellectual disability, selective mutism, acquired aphasia, and autism spectrum
disorder should also be ruled out.
qoverall prognosis - less favorable than that for expressive language disturbance
alone.
qWhen the mixed disorder is identified in a young child, it is usually severe, and the
short term prognosis is poor.
qYoung children with severe mixed receptive-expressive language deficits are likely
to have learning disorders in the future.
qPrognosis - varies widely and depends on the nature and severity of the damage.

TREATMENT :
§A comprehensive speech and language evaluation.
§A review of the literature indicates that it is not more beneficial to address
receptive deficits before expressive, and in fact, in some cases, remediation of
expressive language may reduce or eliminate the need for receptive language
remediation.
§Pre-schoolers with mixed receptive-expressive language problems optimally receive
interventions designed to promote social communication and literacy as well as oral
language.
§ For children at the kindergarten level, optimal intervention includes direct teaching
of key pre-reading skills as well as social skills training.
§early goal of interventions for young children - achievement of rudimentary
reading skills, in that these skills are protective against the academic and
psychosocial ramifications of falling behind early on in reading.

DEFICITS
§Psychotherapy - who have associated emotional and behavioral problems.
§Family counselling in which parents and children can develop more effective, less
frustrating means of communicating may be beneficial.

SPEECH SOUND DISORDER/
PHONOLOGICAL DISORDER
§Speech sound development is believed to be based on both linguistic and motor
development that must be integrated to produce sounds
§have difficulty pronouncing speech sounds correctly due to omissions of sounds,
distortions of sounds, or atypical pronunciation.
§Can also occur in patterns because a child has an interrupted airflow instead of a
steady airflow preventing their words to be pronounced (e.g., pat for pass or bacuum
for vacuum).

§Can be mistaken for younger children because of their difficulties in producing
speech sounds correctly.
§Speech sound disturbances such as dysarthria and dyspraxia are not diagnosed
as speech sound disorder if they are known to have a neurological basis,
according to DSM-5 .
§Typically, these deficits are not caused by anatomical, structural, physiological,
auditory, or neurological abnormalities.

EPIDEMIOLOGY :
§3% in pre-schoolers
§2% in children between 6-7years
§0.5% in 17-year old adolescents
§two to three times more common in boys than in girls.
§more common among first-degree relatives of patients with the disorder
§Misarticulating after the age of 7 years is likely to represent a speech sound
disorder.

COMORBIDITY :
vDisorders most commonly present with speech sound disorders are language
disorder, reading disorder, developmental coordination disorder and enuresis.
vChildren with both speech sound and language disorders are at greatest risk for
attentional problems and specific learning disorders.
vChildren with speech sound disorder in the absence of language disorder have
lower risk of comorbid psychiatric disorders and behavioural problems.

ETIOLOGY
§Contributing factors leading to speech disturbance may include perinatal problems ,
environmental factors, genetic factors, and auditory processing problems
§Likelihood of neuronal cause - more likely to manifest "soft neurological signs" as well
as language disorder and a higher-than-expected rate of reading disorder
§The high proportion of speech sound disorder in certain families implies a genetic
component in the development of this disorder.

DIAGNOSIS
qThe diagnosis is made by comparing the speech sounds of a given child with the
expected skill level of others of the same age, especially consonants, resulting in
sound omissions, substitutions, and distortions of phonemes.
qSpeech sound disorder cannot be accounted for by structural or neurological
abnormalities, and typically, it is accompanied by normal language development

CLINICAL FEATURES:
§Children with speech sound disorder are delayed in, or incapable of, producing
accurate speech sounds that are expected for their age, intelligence, and dialect.
§have difficulty pronouncing speech sounds correctly due to omissions of sounds,
distortions of sounds, or atypical pronunciation.
§omitting the last sounds of the word (e.g., saying mou for mouse or drin for drink) /
substituting one sound for another (saying bwu instead of blue or tup for cup).
§Distortions in sounds can occur when children allow too much air to escape from the
side of their mouths while saying sounds like sh or producing sounds like s or z with
their tongue protruded.
very mild cases a single speech sound (i.e., phoneme) may be
affected
less severe cases may not be apparent until the age of 6 years
severe cases first recognized at between 2 and 3 years of
age.

OMISSIONS are thought to be the most serious type of misarticulating, with substitutions
the next most serious and distortions the least severe type.
DIFFERENTIAL DIAGNOSIS :
determine that the misarticulating is sufficiently severe to be considered impairing, rather
than a normative developmental process of learning to speak.
determine that no physical abnormalities account for the articulation errors and must rule
out neurological disorders that may cause dysarthria, hearing impairment and mental
retardation.
obtain an evaluation of receptive and expressive language to determine that the speech
difficulty is not solely attributable to the above mentioned disorders.

COURSE and PROGNOSIS
§Spontaneous remission of symptoms is common in children whose misarticulating
involves only a few phonemes.
§Children who persist in exhibiting articulation problems after the age of 5 years may
be experiencing a myriad of other speech and language impairments, so that a
comprehensive evaluation may be indicated at that time.
§Children older than 5 years of age with articulation problems are at a higher risk for
auditory perceptual problems.
§Spontaneous recovery after the age of 8 years is rare.

TREATMENT
§Early intervention can be helpful.
§INDICATION : when a child's articulation and intelligibility is noticeably different than peers
by 8 years of age, speech deficits often lead to problems with peers, learning, and self-
image, especially when the disorder is so severe that many consonants are misarticulated, and
when errors involve omissions and substitutions of phonemes, rather than distortions – treatment
needs to be considered.
§Mainly two approaches :
1. PHONOLOGICAL APPROACH, for children with extensive patterns of multiple speech
sound errors that may include final consonant deletion, or consonant cluster reduction.
Exercises in this approach to treatment focus on guided practice of specific sounds, such as
final consonants, and when that skill is mastered, practice is extended to use in meaningful
words and sentences.
2. TRADITIONAL APPROACH for children who produce substitution or distortion errors in just
a few sounds. In this approach, the child practices the production of the problem sound
while the clinician provides immediate feedback and cues concerning the correct
placement of the tongue and mouth for improved articulation.

§Children who have errors in articulation because of abnormal swallowing resulting in
tongue thrust and lips are treated with exercises that improve swallowing patterns
and, in turn, improve speech
§Speech therapy is clearly indicated for children who have not shown
spontaneous improvement by the third or fourth grade and is provided by speech-
language pathologist.
§it is important to give support to children with phonological disorders and, whenever
possible, to support prosocial activities and social interactions with peers.
§Parental counselling and monitoring of child-peer relationships and school behaviour
can help minimize social impairment in children with speech sound and language
disorder.

CHILD-ONSET FLUENCY DISORDER
(STUTTERING)
Øbegins during the first years of life
Øcharacterized by disruptions in the normal flow of speech by involuntary speech
motor events
Øinclude a variety of specific disruptions of fluency, including sound or syllable
repetitions, sound prolongations, dysrhythmic phonation and complete blocking or
unusual pauses between sounds and syllables of words.
Ø In severe cases, the stuttering may be accompanied by accessory or secondary
attempts to compensate such as respiratory, abnormal voice phonation or tongue
clicks.
ØAssociated behaviours, such as eye blinks, facial grimacing, head jerks, and
abnormal body movements, may be observed before or during the disrupted speech.

(STUTTERING)
ØEarly intervention is important because children who receive early intervention have
been found to be more than 7 times more likely to have full resolution of their
stuttering.
ØWhen stuttering becomes chronic, persisting into adulthood, the rates of concurrent
social anxiety disorder are reported to be between 40 and 60 percent.

(STUTTERING)
EPIDEMIOLOGY
§prevalence is 1.6% approximately in the general population
§typical age of onset is 2 to 7 years of age, with 90 percent of children exhibiting
symptoms by age 7 years.
§ Approximately 65 to 80 % of young children who stutter are likely to have a
spontaneous remission over time.
§three to four males for every one female.
§more common among family members of affected children than in the general
population. Reports suggest that for male persons who stutter, 20 percent of their
male children and 1 0 percent of their female children will also stutter.

COMORBIDITY
Other disorders that coexist : phonological disorder, expressive language disorder,
mixed receptive - expressive language disorder, and ADHD.
Very young children show some delay in the development of
language and articulation without
additional disorders of speech and
language.
Pre-schoolers and school-age children increased incidence of social anxiety,
school refusal, and other anxiety
symptoms.
Older children not necessarily have comorbid speech and
language disorders, but often manifest
anxiety symptoms and disorders
persists into adolescence social isolation occurs at higher rates than
in the general adolescent population.

ETIOLOGY
Ømultifactorial, including genetic, neurophysiological, and psychological factors that
predispose a child to have poor speech fluency
ØTheories about the cause of stuttering :
1) organic model : include those that focus on incomplete lateralization or abnormal
cerebral dominance. Several studies using EEG found that stuttering males had right
hemispheric alpha suppression across stimulus words and tasks; nonstutterers had left
hemispheric suppression.
2) learning theories - include the semantogenic theory, in which stuttering is basically
a learned response to normative early childhood disfluencies. Another learning model
focuses on classic conditioning, in which the stuttering becomes conditioned to
environmental factors.

(STUTTERING)
Øfamily members of these children often exhibit an increased incidence of a variety
of speech and language disorders.
ØStuttering is most likely to be caused by a set of interacting variables that include
both genetic and environmental factors.

CLINICAL FEATURES
ØAppears between the ages of 18 months and 9 years, with 2 sharp peaks of onset
between the ages of 2 to 3.5 years and 5 to 7 years.
Ødoes not begin suddenly; it typically develops over weeks or months with a
repetition of initial consonants, whole words that are usually the first words of a
phrase, or long words.
ØAs the disorder progresses, the repetitions become more frequent, with consistent
stuttering on the most important words or phrases.
ØEven after it develops, stuttering may be absent during oral readings, singing, and
talking to pets or inanimate objects.

Four gradually evolving phases in the development of stuttering :
PHASE 1
occurs during the preschool period. Initially,
episodic and appears for weeks or months
between long interludes of normal speech. A
high percentage of recovery from these
periods of stuttering occurs. During this phase,
present most often when excited or upset and
under other conditions of communicative
pressure.
PHASE 2
occurs in the elementary school years. The
disorder is chronic, with few if any intervals of
normal speech. Affected children become
aware of their speech difficulties and regard
themselves as stutterers. In phase 2, the
stuttering occurs mainly with the major parts of
speech nouns, verbs, adjectives, and adverbs.
PHASE 3
after the age of 8 years and up to adulthood,
most often in late childhood and early
adolescence. During phase 3 , stuttering comes
and goes largely in response to specific
situations, such as reciting in class, speaking to
strangers, making purchases in stores, and
using the telephone.
PHASE 4
typically appears in late adolescence and
adulthood.

ØStutterers may have associated clinical features: vivid, fearful anticipation of
stuttering, with avoidance of particular words, sounds, or situations in which stuttering
is anticipated; and eye blinks, tics, and tremors of the lips or jaw.
ØFrustration, anxiety, and depression are common among those with chronic stuttering
DIFFERENTIAL DIAGNOSIS:
1. Normal speech dysfluency in preschool years is difficult to differentiate from
incipient stuttering. Children who stutter appear to be tense and uncomfortable
with their speech pattern, in contrast to young children who are non-fluent in their
speech but seem to be at ease.
2. Spastic dysphonia is a stuttering-like speech disorder distinguished from
stuttering by the presence of an abnormal breathing pattern.
3. Cluttering is a speech disorder characterized by erratic and dysrhythmic speech
patterns of rapid and jerky spurts of words and phrases. In cluttering, those
affected are usually unaware of the disturbances, whereas, after the initial phase
of the disorder, stutterers are aware of their speech difficulties.

•Course is long term with periods of partial remission lasting for weeks or months and
exacerbations occurring most frequently when a child is under pressure to
communicate.
•MILD CASES- 50 – 80% recover spontaneously.
•School-age children who stutter chronically – may have impaired peer relationships
as a result of teasing and social rejection.
•Associated with anxiety disorders in chronic cases and approx. half of individuals
with persistent stuttering have social anxiety disorder.

TREATMENT
1. Lidcombe program
- based on operant conditioning model
- parents use praise for periods of time in which the child does not stutter, and
intervene when the child does stutter to request the child to self-correct the stuttered
word.
- administered at home by parents, under the supervision of a speech and language
therapist
2. Family-based, parent-child interaction therapy (PCIT) - identifies stressors
possibly associated with increased stuttering and aims to diminish these stressors
3. Speaking each syllable in time to a particular rhythm has led to diminished
stuttering in adults. This treatment program appears to be promising when
administered early on, to pre-schoolers.

4. Direct speech therapy - targets modification of the stuttering response to fluent
sounding speech by systematic steps and rules of speech mechanics that the
person can practice.
5. Other treatments utilise breathing exercises and relaxation techniques, to help
children slow the rate of speaking and modulate speech volume.
6. Stutterers who have poor self-image, comorbid anxiety disorders or depressive
disorders are likely to require additional treatments with cognitive-behavioural
therapy (CBT) and/or pharmacologic agents

SOCIAL (PRAGMATIC)
COMMUNICATION DISORDER
@persistent deficits in using verbal and nonverbal communication for social purposes
in the absence of restricted and repetitive interests and behaviours.
@Deficits may be exhibited by difficulty in understanding and following social rules
of language, gesture, and social context.
@This may limit a child's ability to communicate effectively with peers, in academic
settings, and in family activities.
COMORBIDITY:
Commonly associated with language disorder, ADHD, specific learning disorders and
social anxiety disorder.

ETIOLOGY
ØA family history of communication disorders, autism spectrum disorder, or specific
learning disorder all appear to increase the risk suggests that genetic
influences are contributing to the development of this disorder.
Øgiven its frequent comorbidity with both language disorder and ADHD,
developmental and environmental influences are likely to also play a role

CLINICAL FEATURES
qimpaired ability to effectively use verbal and nonverbal communication for social
purposes and occurs in the absence of restricted and repetitive interests and
behaviours.
qAlthough the preceding deficits begin in the early developmental period, the
diagnosis is rarely made in a child younger than 4 years of age.
qThe deficits in social communication lead to impairment in function in social situations,
in developing relationships, and in family and academic settings

DIFFERENTIAL DIAGNOSIS
1. AUTISM SPECTRUM DISORDER - most easily distinguished when the prominence of
restricted and repetitive interests and behaviours characteristic of autistic
spectrum disorder is present. In many cases of autism, the restrictive interests and
behaviour are present only in the early developmental period and not obvious in
older childhood. considered only when the restricted interests and repetitive
behaviours have never been present.
2. SOCIAL ANXIETY DISORDER - social communication skills are present, but not
manifested in feared social situations. In social (pragmatic) communication
disorder, appropriate social communication skills are not present in any
setting.

3. INTELLECTUAL DISABILITY - social communication skills may be deficits in children
with intellectual disability. only when social communication skills are clearly
more severe than the intellectual disability.
§course and outcome - highly variable and dependent on both the severity of the
disorder and potential interventions administered
§in the milder forms of the disorder, social communication deficits may not be
identified until adolescence, when language and social interactions are sufficiently
complex that deficits stand out.
§early pragmatic deficits may cause lasting impairment in social relationships and in
academic progress.

TREATMENT:
a) There are few data to date to inform an evidence-based treatment for social
(pragmatic) communication disorder, or to fully distinguish it from other disorders
with overlapping symptoms
b) A randomized controlled trial of a social communication intervention directed
specifically at children with SCD aimed at three areas of communication:
(1) social understanding and social interaction;
(2) verbal and nonverbal pragmatic skills, including conversation; and
(3) language processing, involving making inferences, and learning new words

UNSPECIFIED COMMUNICATION
DISORDER
Disorders that do not meet the diagnostic criteria for any specific communication
disorder
1) VOICE DISORDER - an abnormality in pitch, loudness, quality, tone, or resonance.
To be coded as a disorder, the voice abnormality must be sufficiently severe to
impair academic achievement or social communication
2) CLUTTERING - associated speech abnormality in which the disturbed rate and
rhythm of speech impair intelligibility. Speech is erratic and dysrhythmic and consists
of rapid, jerky spurts that are inconsistent with normal phrasing patterns. The
disorder usually occurs in children between 2 and 8 years of age; associated with
learning disorders and other communication disorders.

REFERENCES
Kaplan and Sadock synopsis of Psychiatry
Kaplan comprehensive textbook of psychiatry, 10th edition
DSM-5

Communication disorders

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Communication disorders

Similar to Communication disorders (20)

Recently uploaded

Recently uploaded (20)

Communication disorders