speech and communication disorder meaning

Communication Disorders

Reviewed by Psychology Today Staff

Communication disorders are a group of neurodevelopmental conditions that involve persistent problems related to language and speech. They most commonly occur in children but can persist into adulthood. It is estimated that nearly one in 10 American children has some type of communication disorder.

Language competence involves two main elements: production , or the ability to translate one's thoughts into words and phrases, and comprehension , or the ability to understand what others say Speech refers specifically to sound produced orally. Children and adults who struggle in language and/or speech may have a communication disorder.

In the DSM-5 , communication disorders are broken into the following categories:

• Language disorder
• Speech sound disorder
• Childhood-onset fluency disorder (stuttering)
• Social (pragmatic) communication disorder
• Unspecified communication disorder

Communication disorders can affect language, speech, or auditory processing.

Language disorder, as defined by the DSM-5 , is marked by "persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign language, or other) due to deficits in comprehension or production." Such deficits may include limited vocabulary, limited ability to form sentences, and limited capacity to use language to communicate relative to what is expected for one's age and developmental level. (To learn more about recognizing and treating language disorder, see our Diagnosis Dictionary. )

Social (pragmatic) communication disorder involves "difficulties in the social use of verbal and nonverbal communication ," such as a lack of ability to alter communication to fit particular contexts (e.g., a classroom), to grasp normal rules of conversation, or to understand nonliteral meanings of language. Someone with this disorder may also struggle to take turns in a conversation or stay on topic, which can make it difficult to make and keep friendships.

One category of speech disorder is dysfluency. Childhood -onset fluency disorder (formerly referred to as stuttering ) is characterized by a disruption in the flow of speech and includes repetitions of speech sounds, hesitations before and during speaking, and/or prolongations of speech sounds. (To learn more about recognizing and treating childhood-onset fluency disorder, see our Diagnosis Dictionary. )

Articulation difficulties—problems forming and combining sounds, usually by omitting, distorting, or substituting them—are commonly found in people who have speech disorders. Children with difficulties in these areas may be diagnosed with what's known as a speech sound disorder. (To learn more about recognizing and treating these disorders, see our Diagnosis Dictionary. )

Voice disorders include difficulties with the quality, pitch, and loudness of one's voice (prosody). Individuals with voice disorders may have trouble with the way their voices sound, and listeners may have trouble understanding a person with this speech pathology.

Auditory Processing (Hearing)

Central auditory processing disorder, as described by the International Statistical Classification of Diseases and Related Health Problems ( ICD ), is "characterized by impairment of the auditory processing, resulting in deficiencies in the recognition and interpretation of sounds by the brain." This disorder is not included in the DSM-5.

According to the DSM-5, communication disorders include language disorder, speech sound disorder, childhood-onset fluency disorder (formerly known as stuttering), and social (pragmatic) communication disorder. Someone may also be diagnosed with an unspecified communication disorder when they present with persistent problems in language and speech but do not meet the criteria for any specific disorder. Auditory processing disorder is not included in the DSM-5 but is sometimes considered a communication disorder. Auditory processing disorder is included in the ICD-10, another widely used diagnostic manual. 

According to the National Institute on Deafness and Other Communication Disorders, 5 percent of U.S. children between the ages of 3 and 17 had a speech disorder in 2016, while 3.3 percent of children had a language disorder. Approximately 1 percent of U.S children have childhood-onset fluency disorder specifically.

Autism is not currently considered a communication disorder. However, autism has many similarities to social (pragmatic) communication disorder, which was first added to the DSM in 2013; in the past, individuals who met the criteria for social communication disorder may have instead received an autism diagnosis. Someone with autism and someone with social communication disorder may both have trouble communicating with the people around them or making sense of social situations. The individual with autism, however, will also display autism-specific symptoms such as repetitive behavior or restricted interests. 

Before diagnosing a communication disorder, a healthcare provider should first rule out hearing loss or other physical problems that could be interfering with the individual’s ability to communicate. After that, a careful assessment, usually conducted by a speech-language pathologist or a similarly qualified specialist, will determine whether a communication disorder is present. This assessment will typically include interviews with the individual and/or their parents, symptom questionnaires, and a family medical history, as communication disorders are thought to have a strong genetic component.

Behavior problems are not in themselves a symptom of communication disorders. However, individuals with communication disorders may at times feel frustrated by their inability to understand others or make themselves understood, and may act out or withdraw as a result. Communication disorders also frequently co-occur with other conditions, such as ADHD , that may present with behavioral challenges.

Some causes of communication problems include hearing loss, neurological disorders, brain injury, vocal cord injury, autism, intellectual disability, drug abuse , physical impairments such as cleft lip or palate, emotional or psychiatric disorders, and developmental disorders. The DSM-5 generally separates distinct medical and neurological conditions from communication disorders. Frequently, the cause of a communication disorder is unknown.

Communication disorders are thought to have a significant genetic component and frequently run in families. Some studies have found that as many as 70 percent of children with a language disorder, for example, have a family member who also has the disorder. 

Individuals with a family history of communication disorders are thought to be at heightened risk. Sustaining a brain injury also increases the risk that someone will develop a communication disorder.

There is no known way to prevent communication disorders, other than taking steps to avoid brain injuries. However, early diagnosis and proactive treatment can help minimize the negative effects of the disorders and help children and adults learn to cope with their challenges.

The best way to approach treatment for a communication disorder is to focus on early intervention.

Parents should be aware of the typical age at which their child should be reaching each developmental milestone. The first 3 years of life are thought to be especially critical to the development of speech and language skills, as the brain is developing and maturing rapidly. By 4 to 6 months, a baby typically babbles in a manner that resembles speech, using a variety of sounds, and responds to changes in voice tone. After one year, it is normal for a child to, for example, understand some simple words for items, to communicate with physical gestures, and to use one or two words. From ages 1 to 2 and beyond, children regularly pick up new words and begin to use multiple words together.

If a parent has concerns about their child's speech or language development, they should talk to their family doctor, who may refer them to a speech-language pathologist trained to treat communication disorders. Treatment may involve interactive, communication-based activities for parent and child and, potentially, group or individual therapy .

Most treatment interventions for communication disorders have been primarily studied in children. However, some evidence suggests that adults with communication disorders can benefit from treatment as well, especially if that treatment primarily focuses on managing (rather than overcoming) symptoms. An adult who stutters, for example, can work with a speech-language pathologist to develop strategies for managing stuttering-related anxiety or prepare for situations where stuttering most frequently occurs. Adults with communication disorders may also benefit from support groups, where they can talk to others about how their communication disorder affects their life and what they’ve done to cope.

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Communication Disorders

• A communication disorder is a neurodevelopmental disorder characterized by impairments in sending, receiving, processing, or comprehending verbal, nonverbal, or graphic language, speech, and/or communication.
• Communication disorders may be developmental or acquired (secondary to trauma or neurological disorder).
• Language is one of five major streams of development, within which developmental milestone acquisition occurs at a specific rate in an orderly and sequential manner [1] .
• Deviation from these milestones may signal the presence of a communication disorder
• For further developmental information, please see the American Academy of Pediatrics’ Bright Futures ( http://brightfutures.aap.org/index.html ) or the CDC’s Milestones ( http://www.cdc.gov/NCBDDD/actearly/milestones/index.html )

• Communication disorders fall into a number of separate diagnoses (language disorder, speech sound disorder, childhood-onset dluency disorder, social communication disorder) and are classified under the Neurodevelopmental Disorders section of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) [2] .

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Types of Communication Disorders

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Symptoms of Communication Disorders

Causes of communication disorders, comorbidities.

• Assessing SCD

Communication disorders (CD) are associated with difficulties in language, speech, verbal, and nonverbal communication . This includes impairments in either language comprehension, speech, social cues, facial expressions, gestures, or emotional perception.

Moreover, these verbal and nonverbal cues were not developed during childhood, as normally expected.

Symptoms of CDs usually lie on a spectrum of severity, in which impairments can be mild or more profound. They also tend to coexist with each other, in which an individual is diagnosed with multiple types of CDs.

There are various types of CDs. Although they are different, most share common impairments in verbal and non-verbal communication, displaying difficulties in the following areas:

• Language comprehension
• Social cues
• Facial expressions
• Emotional perception

There is no definitive cause of CDs; however, genetic factors and things that affect brain development in the early developmental period can play a role.

For an individual to be diagnosed with a CD they must meet the diagnostic criteria stated in fifth edition of the The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and other mental health classification books.

Social (pragmatic) communication disorder (SCD) was the most recent CD included in this diagnostic manual, in an effort to distinguish this isolated communication disorder from the requirement for social communication difficulties and restrictive/repetitive behaviors that are part of the current autism spectrum disorder (ASD) diagnosis.

DSM-5 Diagnostic Criteria for Social Communication Disorder

According to the DSM-5, an individual meets the criteria for SCD if they display the following symptoms:

Social issues in verbal and nonverbal communication regarding:

• Transitions in conversations, depending on the setting
• Social rules during a conversation, like waiting until it’s your turn to speak
• Comprehending indirect communication

Symptoms have been present since childhood and create difficulties in:

• Functioning
• Communication and social engagement
• Academic or occupational performance
• Relationships

The final criterion is that an individual must not meet the criteria for autism spectrum or other disorder.

Communication Disorders Are Mostly Diagnosed in Children

CDs can be diagnosed in both adults and children. Most research on social impairment, however, has been performed in toddlers, kids, and adolescents.

CDs are ideally recognized during childhood, during which time the child can receive therapy to help in developing communication and social skills.

Once an adult, it can be more difficult to discover and treat, since these impairments are no longer developmental concerns, but social habits that interfere with communication and societal norms.

Below are the types of communication disorders listed in the DSM-5:

• Social (pragmatic) communication disorder
• Language disorder
• Speech-sound disorder
• Childhood-onset fluency disorder
• Unspecified communication disorder

Social (Pragmatic) Communication Disorder

Social communication disorder (SCD) or pragmatic coomunication disorder, consists of impairments with verbal and nonverbal communication specifically involved in social interaction. SCD does not impact language comprehension, such as grammar or punctuation.

Individuals who have SCD experience difficulties in the following areas of social communication:

• Pragmatics , which is interpreting your surroundings to discern the meaning of linguistic context.
• Conceptualizing sentences that are indirect or nonliteral, such as “ metaphors , humor, and aphorisms."
• Verbal communication due to a lack of understanding of social cues and behaviors, like not always knowing when or how to greet people or interjecting during a conversation before the appropriate time. 
• Nonverbal communication , such as gestures, eye contact , and facial expressions can also be difficult to comprehend for those with SCD. 
• Understanding emotions ; those with SCD have trouble expressing their own emotions and understanding the emotional context of a situation.

Language Disorder

Language disorders (LD) consist of difficulties in the acquisition and use of language across different modalities such as spoken, written, or sign language. Individuals will most likely find it challenging to produce content that involves:

• Phonology (sound system)
• Morphology (word system)
• Pragmatics 

Speech Sound Disorders

Speech disorder is a persistent difficulty with producing speech sounds and challenges with articulating words fluently. It causes limitation in effective communication and being understood. To be diagnosed, the symptoms have to interfere with social, academic, or work performance. It needs to have its onset in early development and it can't be due to medical conditions such as deafness, a cleft palate, or brain injury.

Childhood-onset Fluency Disorder

Childhood-onset fluency disorder is also known as stuttering. It occurs when a child's speech is impacted in ways that interfere with normal fluency and pattern of speech. It can include:

• Interrupted speech (known as speech blocks)
• Prolonging sounds
• Repeating sounds or syllables

The disturbance causes anxiety or limitations in social, academic, or work functioning. Although there can be the development of adult-onset fluency disorder, for this specific condition, the onset needs to be in the early developmental period and not due to a medical or neurological condition.

Unspecified Communication Disorder

Unspecified communication disorder applies to children who exhibit some of the symptoms that are characteristic of other CDs. However, children with unspecified communication disorder don't meet the exact diagnostic criteria of any of the other communication disorders.

There are instances in which CDs can be present along with other neurodevelopmental disorders . There can also be overlap, such as those with autism spectrum disorder (ASD) , who specifically share common challenges with social communication—as do individuals who are diagnosed with SCD. However, there need to be other symptoms present to meet criteria for an ASD disorder.

SCD and other communication disorders commonly co-occur with other neurodevelopmental disorders like attention deficit hyperactivity disorder (ADHD).

Assessing Communication Disorders

It can sometimes be challenging to diagnose communication disorders. It can involve different professionals, including pediatricians, audiologists, speech-language pathologists, teachers, and developmental psychologists.

Since it can often be difficult for clinicians to examine a child’s usual interaction in social settings, reports from parents and teachers are important in the assessment.

Parents and teachers assess the child’s communication and social interactions every day and report the behavior to the clinician.

There are checklist screening tools that both parents and teachers may complete. The clinician may observe and rate the child's conversational and communication skills .

Observations

Examiners may conduct “structured observations” by creating a setting in which they can provide certain social interaction to observe the child’s responses and reactions.

They also observe both verbal and nonverbal communication between the child and adults. They analyze how the child converses, asks questions, and responds to questions. Examiners additionally examine facial expressions, gestures, and eye movements.

Assessments

Clinicians use certain assessment measures to assess different aspects of a child's communication skills. This may involve asking them to identify and interpret specific factors of stories and express these narratives coherently. These measures explore how the individual interprets indirect or figurative language; such as metaphors, humor, and idioms.

Treatment for communication disorders may include speech and language therapy and social skills training.

For example, in SCD these sessions may work to try to expand one’s knowledge of linguistics, concepts and storytelling. Interventions may seek to develop metapragmatic awareness (MPA) which is “the ability to identify explicitly and reflect upon pragmatic rules (MP explicitation).”

Speech-language therapists can facilitate sessions, in which they work on developing phonology and monopoly language acquisition. This helps individuals expand their speech and written language skills. 

A Word From Verywell

If you or your child is displaying signs of a communication disorder, it's best to speak to a doctor for a possible evaluation. It can be frustrating for an individual or loved one to experience a CD because symptoms may make it hard to express oneself and build relationships. However, there are treatment options available to enhance communication skills and help you feel more comfortable in social situations over time.

Definitions of communication disorders and variations. Ad Hoc Committee on Service Delivery in the Schools. American Speech-Language-Hearing Association. ASHA Suppl . 1993;35(3 Suppl 10):40-41.

Topal Z, Demir Samurcu N, Taskiran S, Tufan AE, Semerci B. Social communication disorder: a narrative review on current insights. Neuropsychiatr Dis Treat . 2018;14:2039-2046. Published 2018 Aug 13. doi:10.2147/NDT.S121124

Norbury CF. Practitioner review: Social (pragmatic) communication disorder conceptualization, evidence and clinical implications. J Child Psychol Psychiatry . 2014;55(3):204-216. doi:10.1111/jcpp.12154

Pennington L, Dave M, Rudd J, Hidecker MJC, Caynes K, Pearce MS. Communication disorders in young children with cerebral palsy. Dev Med Child Neurol . 2020;62(10):1161-1169. doi:10.1111/dmcn.14635

National Institute on Deafness and Other Communication Disorders. Stuttering .

Swineford L.B, Thurm A, Baird G, et al.  Social (pragmatic) communication disorder: a research review of this new DSM-5 diagnostic category .  J Neurodevelop Disord  2014;6:41. doi:10.1186/1866-1955-6-41

Prizant BM, Audet LR, Burke GM, Hummel LJ, Maher SR, Theadore G. Communication disorders and emotional/behavioral disorders in children and adolescents. J Speech Hear Disord . 1990;55(2):179-192. doi:10.1044/jshd.5502.179

Lockton E, Adams C, Collins A. Do children with social communication disorder have explicit knowledge of pragmatic rules they break? A comparison of conversational pragmatic ability and metapragmatic awareness. Int J Lang Commun Disord . 2016;51(5):508-517. doi:10.1111/1460-6984.12227

Slonims V, Pasco G. Communication disorders in preschool children. Pediatrics and Child Health. 2009;19(10): 453-456. doi: 10.1016/j.paed.2009.05.009

Barnard-Brak L, Richman DM, Chesnut SR, Little TD. Social Communication Questionnaire scoring procedures for autism spectrum disorder and the prevalence of potential social communication disorder in ASD. Sch Psychol Q . 2016;31(4):522-533. doi:10.1037/spq0000144

Brukner-Wertman Y, Laor N, Golan O. Social (Pragmatic) Communication Disorder and Its Relation to the Autism Spectrum: Dilemmas Arising From the DSM-5 Classification. J Autism Dev Disord . 2016;46(8):2821-2829. doi:10.1007/s10803-016-2814-5

Foley-Nicpon M, L Fosenburg S, G Wurster K, Assouline SG. Identifying High Ability Children with DSM-5 Autism Spectrum or Social Communication Disorder: Performance on Autism Diagnostic Instruments. J Autism Dev Disord . 2017;47(2):460-471. doi:10.1007/s10803-016-2973-4

Mandy W, Wang A, Lee I, Skuse D. Evaluating social (pragmatic) communication disorder. J Child Psychol Psychiatry . 2017;58(10):1166-1175. doi:10.1111/jcpp.12785

By Tiara Blain, MA Tiara Blain, MA, is a freelance writer for Verywell Mind. She is a health writer and researcher passionate about the mind-body connection, and holds a Master's degree in psychology.

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Many disorders can affect our ability to speak and communicate. They range from saying sounds incorrectly to being completely unable to speak or understand speech. Causes include:

• Hearing disorders and deafness
• Voice problems , such as dysphonia or those caused by cleft lip or palate
• Speech problems like stuttering
• Developmental disabilities
• Learning disabilities
• Autism spectrum disorder
• Brain injury

Some speech and communication problems may be genetic. Often, no one knows the causes. By first grade, about 5% of children have noticeable speech disorders. Speech and language therapy can help.

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• Article: Communication disability in low and middle-income countries: a call to action.
• Article: Development and validation of a predictive model for poor prognosis of...
• Article: Communication strategies for adults in palliative care: the speech-language therapists' perspective.
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The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Health Library Communication Disorders

What is a communication disorder.

Many children will experience a temporary delay in speech and language development. Most will eventually catch up. Others will continue to have difficulty with communication development.

The following are common speech and language disorders found in children:

Speech Disorders

A speech disorder is characterized by difficulty with speech and sound production, voice, resonance, or fluency (the flow of speech). These are described below:

Speech Sound Disorders

A child with a speech sound disorder is unable to say all of the speech sounds in words. This can make the child’s speech hard to understand. People may not understand the child in everyday situations. For most children, the cause of the speech sound disorder is unknown. Other speech sound disorders can be linked to things such as a cleft palate, problems with the teeth, hearing loss, or difficulty controlling the movements of the mouth.

Reasons for Concern

• The child doesn't babble using consonant sounds (particularly b, d, m and n) by age 8 or 9 months.
• The child uses mostly vowel sounds or gestures to communicate after 18 months.
• The child's speech cannot be understood by many people at age 3.
• The child's speech is difficult to understand at age 4 or older

Voice Disorders

The voice is produced as air from the lungs moves up through and vibrates the vocal folds. This is called phonation. With voice disorders, the voice may be harsh, hoarse, raspy, cut in and out, or show sudden changes in pitch. Voice disorders can be due to vocal nodules, cysts, papillomas, paralysis or weakness of the vocal folds.

• The voice is hoarse, harsh or breathy.
• The voice is always too loud or too soft.
• The pitch is inappropriate for the child’s age or gender.
• The voice often breaks or suddenly changes pitch.
• Frequent loss of voice

Resonance Disorders

Resonance is the overall quality of the voice. A resonance disorder is when the quality of the voice changes as it travels through the different-shaped spaces of the throat, nose and mouth. Resonance disorders include the following:

• Hyponasality (Denasality): This is when not enough sound comes through the nose, making the child sound “stopped up.” This might be caused by a blockage in the nose or by allergies.
• Hypernasality: This happens when the movable, soft part of the palate (the velum) does not completely close off the nose from the back of the throat during speech. Because of this, too much sound escapes through the nose. This can be due to a history of cleft palate, a submucous cleft, a short palate, a wide nasopharynx, the removal of too much tissue during an adenoidectomy, or poor movement of the soft palate.
• Cul-de-Sac Resonance: This is when there is a blockage of sound in the nose, mouth or throat. The voice sounds muffled or quiet as a result.
• Speech sounds hyponasal or hypernasal
• Air is heard coming out of the nose during speech

Fluency Disorders (Stuttering)

Fluency is the natural “flow” or forward movement of speech. Stuttering is the most common type of fluency disorder. Stuttering happens when there are an abnormal number of repetitions, hesitations, prolongations, or blocks in this rhythm or flow of speech. Tension may also be seen in the face, neck, shoulders or fists. There are many theories about why children stutter. At present, the cause is most likely linked to underlying neurological differences in speech and language processing. Internal reactions from the person talking, and external reactions from other listeners, may impact stuttering, but they do not cause stuttering.

• The parents are concerned about stuttering.
• The child has an abnormal number of repetitions, hesitations, prolongations or blocks in the natural flow of speech.
• The child exhibits tension during speech.
• The child avoids speaking due to a fear of stuttering.
• The child considers themself to be someone who stutters.

Language Disorders

A language disorder is characterized by difficulty conveying meaning using speech, writing or even gestures. There are two main types of language disorders: receptive and expressive. Causes of language disorders are unknown in many children. Known causes may include hearing loss, intellectual disabilities, emotional disturbance, a lack of environmental exposure to language, or brain injury.

Receptive Language Disorders

• Difficulty understanding words and/or sentences
• Difficulty attending to the speech of others
• Difficulty with following directions and learning

Expressive Language Disorder

• Difficulty using the right words when talking
• Difficulty combining words to make sentences
• Limited vocabulary
• Difficulty putting sentences together correctly
• If the child does not use any words by 16-18 months.
• The child cannot follow simple instructions, such as "Give me your shoe" by 18 months.
• The child cannot point to body parts or common objects when asked by 18 months.
• The child has not started combining words by age 2.
• The child does not use complete sentences by age 3.
• The child imitates or “echoes” parts of questions or commands instead of responding appropriately by age 3. For example, when asked "What's your name?" the child says, "Your name".
• The child’s sentences are still short or jumbled by age 4.
• The child often uses words incorrectly by age 4. For example, a child may say "cut" for "scissors," or "dog" for "cow".

Causes of a Communication Disorder

A child may be at risk for a communication disorder if there is a history of the following:

• Cleft lip or cleft palate
• Craniofacial anomalies
• Velopharyngeal insufficiency
• Dental malocclusion
• Oral-motor dysfunction
• Neurological disease/dysfunction or brain injury
• Respirator dependency, respiratory compromise, or tracheostomy
• Vocal fold pathology
• Developmental delay
• Prematurity or traumatic birth
• Hearing loss or deafness

Treatment for Communication Disorders

Early intervention is very important for children with communication disorders. Treatment is best started during the toddler or preschool years.  These years are a critical period of normal language learning. The early skills needed for normal speech and language development can be evaluated even in infants. At that age, the speech-language pathologist works with the parents on stimulating speech and language development in the home. Active treatment in the form of individual therapy usually starts between the ages of 2 and 4 years.

If you have concerns with your child’s communication skills, discuss them with your child’s doctor. The doctor will likely refer the child to a speech-language pathologist for evaluation and treatment. All children with speech and language disorders should also have their hearing tested.

Helping Your Child

Children learn speech and language skills by listening to the speech of others and practicing as they talk to others. Parents are the most important teachers for their child in their early years. They can help the child by giving lots of opportunities to listen and talk. This can be done by frequently pointing out and naming important people, places, and things. They can also read and talk to the child during the day, especially during daily routines, interactive play and favorite activities.

Parents can give the child models of words and sentences to repeat. Parents can also set up opportunities for the child to answer questions and talk. Listening to music, singing songs, and sharing nursery rhymes are also great ways to build speech and language skills while having fun with your child.

For more information, contact the Division of Speech-Language Pathology, 513-636-4341 .

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Communication Disorders

Children's hospital of philadelphia, what are communication disorders.

There are several different types of communication disorders, including the following:

Expressive language disorder. Expressive language disorder identifies developmental delays and difficulties in the ability to produce speech.

Mixed receptive-expressive language disorder. Mixed receptive-expressive language disorder identifies developmental delays and difficulties in the ability to understand spoken language and produce speech.

What causes communication disorders?

Communication disorders may be developmental or acquired. The cause may be related to biological problems such as abnormalities of brain development, or possibly by exposure to toxins during pregnancy, such as abused substances or environmental toxins such as lead. A genetic factor is sometimes considered a contributing cause in some cases.

Who is affected by communication disorders?

For unknown reasons, boys are diagnosed with communication disorders more often than girls. Children with communication disorders frequently have other psychiatric disorders as well.

What are the symptoms of communication disorders?

The following are the most common symptoms of communication disorders. However, each child may experience symptoms differently.

Young children with communication disorders may not speak at all, or may have a limited vocabulary for their age. Some children with communication disorders have difficulty understanding simple directions or are unable to name objects. Most children with communication disorders are able to speak by the time they enter school, however, they continue to have problems with communication.

School-aged children often have problems understanding and formulating words. Teens may have more difficulty with understanding or expressing abstract ideas.

The symptoms of communication disorders may resemble other problems or medical conditions. Always consult your child's doctor for a diagnosis.

How are communication disorders diagnosed?

Most children with communication disorders are first referred for speech and language evaluations when their delays in communicating are noted. A child psychiatrist is usually consulted, especially when emotional or behavioral problems are also present. A comprehensive evaluation also involves psychometric testing (testing designed to assess logical reasoning abilities, reactions to different situations, and thinking performance; not tests of general knowledge) and psychological testing of cognitive abilities.

Treatment for communication disorders

Specific treatment for communication disorders will be determined by your child's doctor, special education teachers, and speech/language and mental health professionals based on:

Your child's age, overall health, and medical history

Extent of the disorder

Type of disorder

Your child's tolerance for specific medications or therapies

Expectations for the course of the disorder

Your opinion or preference

A coordinated effort between parents, teachers, and speech/language and mental health professionals provides the basis for individualized treatment strategies that may include individual or group remediation, special classes, or special resources. Two approaches are usually considered. Remedial techniques are used to increase communication skills in the areas of the deficit. A second approach helps the child build on his or her strengths to circumvent his or her communication deficit.

Prevention of communication disorders

Specific preventive measures to reduce the incidence of communication disorders are not known at this time. However, early detection and intervention can address the developmental needs and academic difficulties to improve the quality of life experienced by children with communication disorders.

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Common Speech and Language Disorders

Speech and language problems may make it hard for your child to understand and speak with others, or make the sounds of speech. They're common, affecting as many as one in 12 kids and teens in the U.S.

Kids with these disorders often have trouble when they learn to read and write, or when they try to be social and make friends. But treatment helps most children improve, especially if they start it early.

Adults can also have these disorders. It may have started in childhood, or they may have them because of other problems such as brain injuries, stroke , cancer , or dementia .

Speech Disorders

For children with speech disorders, it can be tough forming the sounds that make up speech or putting sentences together. Signs of a speech disorder include:

• Trouble with p, b, m, h, and w sounds at 1 to 2 years of age
• Problems with k, g, f, t, d, and n sounds between the ages of 2 and 3
• When people who know the child well find it hard to understand them

The causes of most speech disorders are unknown.

There are three major types:

Articulation: It’s hard for your child to pronounce words. They may drop sounds or use the wrong sounds and say things like “wabbit” instead of “rabbit.” Letters such as p, b, and m are easier to learn. Most kids can master those sounds by age 2. But r, l, and th sounds take longer to get right.

Fluency: Your child may have problems with how their words and sentences flow. Stuttering is a fluency disorder. That’s when your child repeats words, parts of words, or uses odd pauses. It’s common as kids approach 3 years of age. That’s when a child thinks faster than they can speak. If it lasts longer than 6 months, or if your child is more than 3.5 years old, get help.

Voice: If your child speaks too loudly, too softly, or is often hoarse, they may have a voice disorder. This can happen if your child speaks loudly and with too much force. Another cause is small growths on the vocal cords called nodules or polyps. They’re also due to too much voice stress.

Language Disorders

Does your child use fewer words and simpler sentences than their friends? These issues may be signs of a language disorder. For kids with this disorder, it’s hard to find the right words or speak in complete sentences. It may be tough for them to make sense of what others say. Your child may have this disorder if they:

• Don’t babble by 7 months
• Only speak a few words by 17 months
• Can’t put two words together by 2 years
• Have problems when they play and talk with other kids from the ages of 2 to 3

There are two major types of language disorders. It’s possible for a child to have both.

Receptive: This is when your child finds it hard to understand speech. They may find it hard to:

• Follow directions
• Answer questions
• Point to objects when asked

Expressive : If your child has trouble finding the right words to express themselves, they may have this type of language disorder. Kids with an expressive disorder may find it tough to:

• Ask questions
• String words into sentences
• Start and continue a conversation

It’s not always possible to trace the cause of language disorders. Physical causes of this type of disorder can include head injuries , illness, or ear infections . These are sometimes called acquired language disorders.

Other things that make it more likely include:

• A family history of language problems
• Being born early
• Down syndrome
• Poor nutrition

Doctors don’t always know what causes your child’s condition. Remember, these kinds of disorders have nothing to do with how smart your child is. Often, kids with language disorders are smarter than average.

Diagnosis and Treatment

Speech and language disorders are legally defined disabilities. Your child may get testing and treatment through your state’s early intervention program or local public schools. Some services are free.

Your child may see a speech language pathologist, or SLP. The SLP may try to find out if your child:

• Can follow directions
• Is able to name common objects
• Knows how to play with toys
• Can hold books the right way

The SLP will first check your child’s hearing. If that’s OK, the SLP will do tests to find out what kind of disorder may be present, if it’s a short-term problem or one that needs treatment, and what treatment plan to recommend.

How to Help Your Child

Children learn and grow at their own pace. The younger they are, the more likely they are to make mistakes. So you’ll want to learn the milestones. Know what skills your child should be able to master at a given age.

To help your child with their speech and language skills:

• Talk to your child, even as a newborn .
• Point to objects and name them.
• When your child is ready, ask them questions.
• Respond to what they say, but don’t correct mistakes.
• Read to your child at least 15 minutes a day.

If your child has one of these disorders, don’t assume they’ll outgrow it. But treatment does help most kids get better. The sooner they get it, the better the results.

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Social Communication Disorder

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The scope of this Practice Portal page is social communication disorder across the life span.

See the Social Communication Disorder Evidence Map for summaries of the available research on this topic.

Social communication disorder (SCD) is characterized by persistent difficulties with the use of verbal and nonverbal language for social purposes. Primary difficulties may be in social interaction , social understanding , pragmatics , language processing , or any combination of the above (Adams, 2005). Social communication behaviors such as eye contact, facial expressions, and body language are influenced by sociocultural and individual factors (Curenton & Justice, 2004; Inglebret et al., 2008). There is a wide range of acceptable norms within and across individuals, families, and cultures. Specific communication challenges may become apparent when difficulties arise in the following:

• communicating for social purposes in ways that are appropriate for the particular social context
• changing communication to match the context or needs of the listener
• following rules for conversation and storytelling
• understanding nonliteral or ambiguous language
• understanding that which is not explicitly stated
• sentence grammar and lexical semantics
• inferential language
• discourse comprehension
• misinterpretation of contextual meaning

This definition is consistent with the diagnostic criteria for social (pragmatic) communication disorder detailed in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013). Please note that certain references cited in this page may predate this definition. Therefore, specific terminology relating to “social (pragmatic) communication disorder” may not be used in all cases, but information may still be relevant and considered for the SCD population.

SCD can result in a wide array of problems, including difficulty participating in social settings, developing peer and/or romantic relationships, achieving academic success, and performing successfully on the job.

SCD may be a distinct diagnosis or may co-occur with other conditions. In the case of autism spectrum disorder , social communication problems are a defining feature, along with restricted, repetitive patterns of behavior. Therefore, SCD cannot be diagnosed in conjunction with autism spectrum disorder.

Definitions

Social communication encompasses the following components:

• pragmatics —communication that focuses on goal-consistent language use in social contexts (N. Nelson, 2010)
• social interaction —communication that occurs between at least two individuals
• social cognition —an understanding of the mental and emotional states of self and others, social schemes, and social knowledge that beliefs and values cause social events, expected socially appropriate behavior and consequences of inappropriate behavior
• language processing —internal generation of language (expressive), and understanding and interpretation of language (receptive)

Social communication enables individuals to share experiences, thoughts, and emotions. Social communication skills are needed for language expression and comprehension in nonverbal, spoken, written, and visual–gestural (sign language) modalities.

Social communication skills include the ability to

• adjust speech style based on context,
• understand the perspectives of others,
• understand and appropriately use the rules for verbal and nonverbal communication, and
• use the structural aspects of language (e.g., vocabulary, syntax, and phonology).

For more details, see the American Speech-Language-Hearing Association’s (ASHA’s) resources on Components of Social Communication and Social Communication Benchmarks .

Incidence and Prevalence

Incidence of SCD refers to the number of new cases identified in a specified time period.

Prevalence of SCD refers to the number of people who are living with SCD in a given time period.

Precise estimates of the incidence and prevalence of SCD have been difficult to determine because many investigations draw on varied populations and employ inconsistent or ambiguous definitions of the disorder.

Using different definitions of SCD, the preliminary estimates of SCD in eighth graders ranged from 7% to 11% (Ellis Weismer, Tomblin, et al., 2021). A history of developmental language disorder (DLD) was indicated to be a significant risk factor for SCD. The percentage of children with SCD and a history of DLD (30%) was 3 times greater than that of children with SCD without a history of DLD (9%; Ellis Weismer, Tomblin, et al., 2021).

Studies reported results based on gender; however, there were no indications whether the data collected were based on sex assigned at birth, gender identity, or both. A higher proportion of male children were indicated to have SCD. According to Ellis Weismer, Rubenstein, et al. (2021), developmental disability with likely SCD was found to have a male-to-female ratio of 2.5:1.

Social communication problems can be associated with several other disorders and populations. For example, out of a clinical sample of 47 individuals with schizophrenia, 77% were found to have pragmatic impairments (Bambini et al., 2016). Additionally, infants born late or moderately preterm (i.e., 32–36 weeks’ gestation) were 1.3 times more likely to be identified with delayed social competence compared to peers born at term (Johnson et al., 2015). Additional data on incidence and prevalence may be available for co-occurring conditions with other defining symptoms and characteristics.

Signs and Symptoms

Signs and symptoms of SCD include deficits in social interaction, social understanding, pragmatics, and language processing (see ASHA’s resource on Components of Social Communication ).

Specific behaviors affected by SCD depend on the individual’s age, the expected stage of development (see ASHA’s resource on Social Communication Benchmarks ), and the communication context. Some examples of behaviors affected by SCD include

• using appropriate greetings;
• changing language and communication style based on setting or partner;
• telling and understanding stories;
• engaging in conversation (e.g., initiating or entering a conversation, topic maintenance, turn-taking, responsivity, providing the right amount of information);
• repairing communication breakdowns (e.g., rephrasing when misunderstood);
• using appropriate verbal (e.g., prosodic features) and nonverbal (e.g., gestures) signals to regulate interactions;
• interpreting the verbal and nonverbal signals of others during an interaction
• understanding ambiguous or figurative language;
• making inferences (understanding information that is not explicitly stated); and
• forming and maintaining close relationships.

The causes of SCD as a primary diagnosis are unknown. SCD is often defined in terms of the specific condition with which it is associated. See ASHA’s Practice Portal pages on Intellectual Disability , Spoken Language Disorders , Written Language Disorders , Pediatric Traumatic Brain Injury , Traumatic Brain Injury in Adults , Aphasia , and Dementia for information about social communication skills in these populations.

Roles and Responsibilities

Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of social communication disorder (SCD) in children and adults. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); advocacy; and education, administration, and research. See ASHA’s Scope of Practice in Speech-Language Pathology (ASHA, 2016).

Appropriate roles for SLPs include the following:

• Educating other professionals on the needs of individuals with SCD and the role of SLPs in screening, assessing, diagnosing, and managing SCD.
• Screening social communication skills as part of a comprehensive speech and language evaluation or whenever SCD is suspected.
• Conducting a culturally and linguistically relevant comprehensive speech and language assessment, when appropriate.
• Diagnosing the presence of SCD.
• Referring the individual to other professionals for a comprehensive and/or differential diagnosis to determine etiology and to facilitate access to comprehensive services.
• Developing culturally and linguistically relevant treatment and intervention plans focused on helping the individual achieve social communication competence, documenting progress, and determining appropriate dismissal criteria.
• Recommending related services when necessary, depending on the primary diagnosis (e.g., clinical psychologists, marriage and family counselors, social workers, and mental health workers who lead parent training sessions).
• Counseling individuals with SCD and their families/caregivers.
• Providing education to individuals with SCD, their communication partners, their families/caregivers, and the general public, aimed at reducing the impact of SCD across contexts.
• Consulting and collaborating with families, individuals with SCD, other professionals, support personnel, peers, and other invested parties to identify priorities and build consensus on an intervention plan focused on functional outcomes (see ASHA’s resources on Interprofessional Education/Interprofessional Practice [IPE/IPP] , Person- and Family-Centered Care , and Family-Centered Practice ) .
• Remaining informed of research related to SCD and advancing the knowledge base of the nature of the disability, screening, diagnosis, prognostic indicators, assessment, treatment, and service delivery for individuals with SCD.
• Advocating for individuals with SCD and their families at the local, state, and national levels.

As indicated in the ASHA Code of Ethics (ASHA, 2023), SLPs who serve this population should be specifically educated and appropriately trained to do so.

See the Assessment section of the Social Communication Disorder Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

Speech and Language

Screening of social communication skills is conducted whenever SCD is suspected or as part of a comprehensive speech and language evaluation for any individual with communication concerns.

Screening typically includes the use of competency-based tools such as interviews and observations, self-report questionnaires, and norm-referenced report measures completed by parents, teachers, or significant others.

Hearing screening is conducted to rule out hearing loss as a contributing factor to social communication difficulties. Hearing screening is within the Scope of Practice in Speech-Language Pathology (ASHA, 2016). A referral for a full audiologic evaluation is necessary if the individual fails the hearing screening.

If the individual is deaf or hard of hearing and wears hearing aids or implantable devices, the hearing devices need to be inspected by an audiologist during annual audiology appointments to ensure that they are in working order. The hearing device should be worn by the individual during screening for SCD (and during comprehensive SCD assessment, when recommended).

See ASHA’s Practice Portal pages on Childhood Hearing Screening , Adult Hearing Screening , Hearing Loss in Children , and Hearing Loss in Adults .

Populations to Consider for Screening

Screening is merited for children not previously diagnosed with a specific disorder but who demonstrate remarkable difficulties in social interaction, conversation, or interpreting nonliteral language. This includes children with subclinical deficits with structural language or vocabulary (Adams, 2015).

Children with attention-deficit/hyperactivity disorder (ADHD) tend to display higher rates of pragmatic difficulties when compared with typically developing peers—and different degrees of pragmatic language impairment than children with autism spectrum disorder (ASD; Carruthers et al., 2021). Generally, hyperactivity and inattention are highly associated with pragmatic language difficulties (Green et al., 2014). Given the correlation between ADHD and pragmatic deficits SLPs may consider students/clients with an existing diagnosis of ADHD for screening or potential further assessment for SCD.

Children with an acquired brain injury or a neurological disorder are another population to consider for potential screening for SCD. Such injuries or disorders can lead to impairment in emotion regulation, which may, in turn, affect social skills (Kok et al., 2014). Children with pediatric traumatic brain injury (TBI) may have difficulty with high-level social understanding (e.g., theory of mind, pragmatic language; On et al., 2021), and children with moderate-to-severe TBI are more at risk for social understanding or interaction difficulties (Rosema et al., 2012).

Other children who have been exposed to maltreatment (abuse and/or neglect) are at risk for delayed or low average language development that can include social cognition deficits and pragmatic language delays (Hwa-Frowlich, 2015). Children with disruptive behavior disorder (formerly known as emotional behavior disorder) may have impairments in social cognition, theory of mind, language development (including language delays), executive function, and poor narrative development (Helland et al., 2014; Westby, 2015).

Screening for SCD may help identify a separate diagnosis and/or relevant areas for treatment and further assessment of pragmatic skills even if a diagnosis of SCD is not ultimately applied. Although the references above relate to the pediatric population, an SLP may reasonably infer that adults who have these concurrent diagnoses (e.g., ADHD) should also be considered for screening. In adulthood, SCD can arise secondary to TBI, right hemisphere damage, aphasia, and neurodegenerative disorders such as Alzheimer’s disease (Cummings, 2007, 2021).

Comprehensive Assessment

When screening results indicate the need for further evaluation, individuals are referred for a comprehensive speech and language assessment or to other professionals as needed. When the individual has a diagnosed co-occurring condition, the SLP’s role is to be aware of overlapping or similar signs and symptoms and to assess specifically for social communication components.

Assessment of social communication should be culturally sensitive; be functional; and involve the collaborative efforts of families, caregivers, classroom teachers, SLPs, special educators, psychologists, employers, communication partners, the treatment team, and other professionals as needed (e.g., vocational counselors).

Social norms and constructs vary across environments, individuals, and communities, and there is a wide range of acceptable social norms that exist within each. This variability makes the assessment of SCD challenging. It is critical for an evaluator to demonstrate sensitivity to the wide range of acceptable norms that exist within each setting by increasing their familiarity with the specific social norms defined by each of the individual’s social groups.

SLPs develop self-awareness of core elements of social communication (i.e., pragmatics, social interaction, social understanding, and language processing). SLPs also reflect on the setting, context, and resulting expectations of social communication on a case-by-case basis. Differences in social communication norms are not disorders. Diagnosis considers an individual’s ability to adapt to the social norms of their environment or community.

Please see ASHA’s resource on Cultural Competence Checklist: Personal Reflection [PDF] for further information.

Consistent with the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) framework (ASHA, 2023; World Health Organization, 2001), comprehensive assessment is conducted to identify and describe

• impairments in body structure and function, including underlying strengths and weaknesses in communication and communication-related areas;
• comorbid deficits or health conditions, such as spoken or written language disorders, ADHD, or developmental disabilities;
• limitations in activity and participation, including functional communication and interpersonal interactions;
• contextual (environmental and personal) factors that serve as barriers to or facilitators of successful communication and life participation; and
• the impact of communication impairments on the individual’s quality of life.

See ASHA’s resource on the International Classification of Functioning, Disability, and Health (ICF) for examples of handouts featuring assessment data consistent with the ICF framework . Social determinants of health can influence how individuals access all areas within the ICF framework. Please see the Social Determinants of Health Workgroup for further information.

The following items are listed in order of less complex to more complex. SLPs may assess the individual’s ability to

• use verbal and nonverbal means of communication, including natural gestures, speech, signs, pictures, and written words, as well as other augmentative and alternative communication systems (see ASHA’s Practice Portal page on Augmentative and Alternative Communication );
• understand and interpret the verbal and nonverbal communication of others, including gestures, intonation, and facial expressions;
• initiate spontaneous communication verbally (e.g., saying “hi”) or nonverbally (e.g., waving “hello”);
• change conversational topics, maintain conversation, and repair communication breakdowns;
• take turns in functional activities across communication partners and settings;
• comprehend verbal and nonverbal discourse in social, academic, vocational, and community settings;
• understand figurative and ambiguous language, respond appropriately, and make inferences when information is not explicitly stated;
• attribute mental and emotional states (e.g., thoughts, beliefs, and feelings) to oneself and others (theory of mind);
• communicate for a range of social functions that are reciprocal and that promote the development of relationships and social networks; and
• access literacy and academic instruction as well as curricular, extracurricular, and vocational activities.

Both formal and informal assessments are used to assess social communication skills. A mixture of contexts should be considered during assessment. As with screening, competency-based tools, self-report questionnaires, norm-referenced direct assessments, and report measures (e.g., parent, teacher, employer, and significant other) are frequently used. Tasks that mimic real-world situations and naturalistic observations can be used to gather information about an individual’s communication skills in simulated social situations or in everyday social settings. Review evidence for each assessment’s validity and reliability as part of evidence-based assessment selection. See ASHA’s resource on Assessment Tools, Techniques, and Data Sources for general information about assessment options.

Assessment may result in

• the diagnosis of SCD,
• description of the characteristics and severity of the disorder,
• recommendations for intervention and support, and
• a referral to other professionals as needed.

Assessment Considerations

Assessment of social communication skills considers the individual’s age, cultural norms and values, and expected stage of development. See ASHA’s resource on Social Communication Benchmarks for age-specific social communication skills. See also ASHA’s Practice Portal page on Cultural Responsiveness . Evidence-based and culturally responsive practice takes client/student/caregiver perspective into consideration in both assessment and treatment. This is especially relevant in the assessment of SCD. SLPs recognize that neurodiversity and differences in communication behaviors are inherent to an individual’s identity. SLPs work in collaboration with the individual and their caregivers to assure that services align with the client’s values and goals.

Izaryk et al. (2021) propose that best practice for the assessment of SCD may include the combination of several different approaches and the inclusion of data from multiple sources. There is a noted lack of ecological validity in standardized assessments given the dynamic nature of social communication, so SLPs may combine both formal (i.e., standardized) and informal assessments. Further challenges in the assessment of SCD include that (a) it is difficult to conceptualize, (b) it crosses diagnoses, and (c) there is a lack of understanding of the typical development of social communication (Izaryk et al., 2021).

It is important to consider the age of onset and the duration of hearing loss when assessing social communication skills in individuals who are deaf or hard of hearing. These factors play a role in the development of language and communication skills.

Differential Diagnosis

SLPs play an important role in the differential diagnosis of SCD and other disorders. When differentially diagnosing between SCD and ASD, consider that older children may no longer exhibit overt repetitive behaviors, interests, or activities. However, subtle repetitive patterns may still be present (e.g., patterns of speech or compulsive retracing over letters while writing). Accurate diagnosis is essential for planning an effective intervention strategy. Per Brukner-Wertman et al. (2016), SCD should be considered after ruling out ASD as a potential diagnosis.

Differential diagnosis of children with developmental language disorder and SCD is challenging. However, children with SCD have more difficulty with the ability to identify a social or an emotional state associated with pragmatic errors (Adams et al., 2018). Children with SCD have relative strengths in structural aspects of language (e.g., syntax and morphology) compared to children with developmental language disorder.

Eligibility for Services in Schools

The Individuals with Disabilities Education Improvement Act of 2004 (IDEA) requires the use of a variety of assessment tools and strategies, consultation with parents/guardians, and administration of technically sound instruments to determine eligibility for special education services. IDEA also stipulates that assessments must be administered in a language or form that is most likely to provide accurate information. No tools that discriminate on a racial or cultural basis should be used in any context, including determining eligibility for services.

Children and adolescents with SCD are eligible for speech-language pathology services, regardless of performance on cognitive or language assessments. ASHA does not support such cognitive referencing (i.e., comparing IQ scores to language scores to determine eligibility).

Coding and Payment

SLPs may encounter Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013) codes related to SCD; however, these cannot be used for billing and payment purposes. See ASHA’s billing and reimbursement resources for information on billing, coding, and coverage of speech-language pathology services.

See the Treatment section of the Social Communication Disorder Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

Consistent with the World Health Organization (2001) framework, intervention is designed to

• capitalize on strengths and address weaknesses related to underlying functions that affect social communication;
• facilitate the individual’s activities and participation in social interactions by helping them acquire new skills and strategies; and
• modify contextual factors that serve as barriers and enhance facilitators of successful communication and participation.

See ASHA’s resource on the International Classification of Functioning, Disability, and Health (ICF) for examples of handouts featuring goals consistent with the International Classification of Functioning, Disability and Health framework .

Treatment planning

• recognizes the importance of involving the individual and family,
• considers variations in cultural and societal norms and values,
• focuses on functional outcomes, and
• tailors goals to address the individual’s specific needs in a variety of natural environments.

Treatment typically involves collaboration with a variety of professionals (e.g., classroom teachers, special educators, psychologists, and vocational counselors). See ASHA’s resources on Collaboration and Teaming and Interprofessional Education/Interprofessional Practice (IPP/IPE).

Treatment Strategies

Treatment strategies for SCD focus on increasing active engagement and building independence in natural communication environments. One-on-one, clinician-directed interventions are useful for teaching new skills. Group interventions are used in conjunction with one-on-one services to practice skills in functional communication settings and to promote generalization. In school settings, intervention often includes environmental arrangements, teacher-mediated interventions, and peer-mediated interventions (Timler, 2008).

Treatment Modalities

The treatment modalities described below may be used to implement various treatment options.

Augmentative and alternative communication— an area of clinical practice that supplements or compensates for impairments in speech-language production and/or comprehension, including spoken and written modes of communication. Augmentative and alternative communication falls under the broader umbrella of assistive technology, or the use of any equipment, tool, or strategy to improve functional daily living in individuals with disabilities or limitations. See ASHA’s Practice Portal page on Augmentative and Alternative Communication for further information.

Computer-based instruction— use of computer technology and/or computerized programs for teaching language skills, including vocabulary, social skills, social understanding, and social problem solving.

Video-based instruction (also called “video modeling”)—an observational mode of teaching that uses video recordings to provide a model of a target behavior or skill. Video recordings of desired behaviors are observed and then imitated by the individual. The learner’s performance of the desired behavior(s) can be videotaped for later review.

Treatment Options

Below are brief descriptions of both general and specific treatments for addressing SCD. This list is not exhaustive, and the inclusion of any specific treatment approach does not imply endorsement from ASHA.

For additional treatment options that address social communication skills in school-age children, see ASHA’s Practice Portal pages on Autism Spectrum Disorder , Spoken Language Disorders , and Pediatric Traumatic Brain Injury . For treatment options in adult populations, see ASHA’s Practice Portal pages on Traumatic Brain Injury in Adults , Aphasia , and Dementia .

Behavioral Interventions/Techniques

Behavioral interventions and techniques can be used to modify existing behaviors or teach new behaviors. These approaches are based on principles of learning that include identifying desired behaviors (e.g., social skills), gradually shaping these behaviors through selective reinforcement, and fading reinforcement as behaviors are learned.

Behavioral approaches can be used to modify or teach social communication behaviors in one-on-one, discrete trial instruction or in naturalistic settings with peers or other communication partners. Positive behavior support is one example of a behavioral intervention approach that can be used to foster appropriate and effective social communication (Carr et al., 2002).

Peer-Mediated/Peer-Implemented Interventions

Peer-mediated or peer-implemented interventions are those in which typically developing peers are taught strategies to facilitate play and social interactions with children who have SCD.

Social Communication Treatments

The interventions below specifically aim to improve social communication skills.

Comic strip conversations— conversations between two or more people illustrated by simple drawings in a comic strip format. The drawings illustrate what people are saying and doing and what they might be thinking. The process of creating the comic strip slows the conversation down, allowing more time for an individual to understand the information being exchanged. Comic strip conversations can be used for conflict resolution, problem solving, communicating feelings and perspectives, and reflecting on something that happened (Gray, 1994; Hutchins & Prelock, 2006).

SCORE skills strategy— a social skills program that takes place in a cooperative small group and focuses on five social skills: (S) share ideas, (C) compliment others, (O) offer help or encouragement, (R) recommend changes nicely, and (E) exercise self-control (Vernon et al., 1996; Webb et al., 2004).

Social communication intervention— an intervention program that focuses on functional social communication goals and carries out the intervention in a “plan, do, and review” framework. There is a particular emphasis on how those involved in an interaction feel about the interaction and motivations for reaching social goals. The “do” phase may involve the child learning social scripts. The “review” phase encourages the child to reflect on the social encounter they completed and how their activities and those of others contributed to the outcomes (Fujiki & Brinton, 2017).

Social Communication Intervention Project —speech and language therapy for school-age children with pragmatic and social communication needs. The Social Communication Intervention Project focuses on social understanding and social interpretation (e.g., understanding social context cues and emotional cues), pragmatics (e.g., managing conversation, improving turn-taking), and language processing (e.g., improving narrative construction, understanding nonliteral language; Adams et al., 2012).

Social scripts— a prompting strategy to teach children how to use varied language during social interactions. Scripted prompts (visual and/or verbal) are gradually faded as children use them more spontaneously (K. Nelson, 1978).

Social skills groups— an intervention that uses instruction, role play, and feedback to teach ways of interacting appropriately with peers. Groups typically consist of two to eight individuals with SCD and a teacher or an adult facilitator. Social skills groups can be used across a wide range of ages, including school-age children and adults.

Social Stories™— a highly structured intervention that uses stories to explain social situations to children and help them learn socially appropriate behaviors and responses. Initially developed for use with children with autism, it has been shown to benefit children with other disorders (Gray et al., 2002; Schneider & Goldstein, 2009).

Cultural and Linguistic Considerations

Social norms are an intrinsic part of culture and communication. These norms may vary across and within cultures. It is essential that clinicians acquire knowledge of their client’s individual cultural norms to determine what is typical for that client within their environment. There is no universal norm for appropriate social behaviors that exists across all cultures. This can be observed in how we modify our communication rules with our partners, coworkers, peers, and family elders. Once the clinician is able to determine the rules of communication for a client, the clinician can determine if variations in patterns reflect communication differences or a disorder. See ASHA’s Practice Portal page on Cultural Responsiveness . There are, however, some universal elements of pragmatic development that are observed in children across cultures, such as the need to develop joint attention skills and the understanding that others’ thoughts may differ from one’s own (this is known as “theory of mind”).

Treatment is conducted in the language(s) used by the individual. A bilingual service provider or the assistance of a trained interpreter may be necessary to provide treatment. See ASHA’s Practice Portal pages on Multilingual Service Delivery in Audiology and Speech-Language Pathology  and Collaborating With Interpreters, Transliterators, and Translators . See also ASHA’s resource on Person- and Family-Centered Care .

Transitioning Youth and Adults

Social communication skills are crucial for adolescents as they explore peer relationships and learn about friendship, loyalty, and individual differences (Seltzer, 2009). Social communication skills are equally important beyond the high school years—in postsecondary school, on the job, and in social settings.

The expectations for social communication change or evolve as the individual’s social settings or opportunities change. For example, expectations for social communication in a high school classroom are different from social communication expectations in a postsecondary classroom or in a workplace. Adolescents must learn to adapt and evolve their social communication style/skills as they adjust to these new social settings and their roles in these settings. Social communication problems tend to persist as adolescents transition to these new roles (Whitehouse et al., 2009).

School-based SLPs are often involved in transition planning to help mitigate the impact of social communication difficulties and to ease the transition to adulthood. See ASHA’s resource on Postsecondary Transition Planning . Social communication assessments with adequate psychometric properties are available for this age range (Poll et al., 2021).

Intervention and supports for adults with social communication needs may be available in various forms (e.g., social skills groups, conversation groups, life skills groups, and workshops) and from a variety of providers (e.g., SLPs, psychologists, college counselors, and vocational counselors). Intervention for these populations often focuses on improving conversational skills, navigating social situations, and encouraging participation in daily activities to the fullest extent possible. See ASHA’s Practice Portal pages on Traumatic Brain Injury in Adults , Aphasia , and Dementia .

Individuals Who Are Deaf or Hard of Hearing

Deaf or hard of hearing children are at greater risk for developing social skills difficulties when they experience periods of linguistic/cognitive deprivation and sensory fatigue (Szarkowski et al., 2020; Yoshinaga-Itano et al., 2020). SLPs should be aware of these potential causes of social challenges, which may fall outside the parameters of a true SCD, particularly to avoid possible misdiagnosis.

Many social language skills are learned through exposure to events that are witnessed or overheard (i.e., incidental learning). Some of these avenues for learning are not readily available to individuals who are deaf or hard of hearing, and this can have a negative impact on the development of social competencies (Calderon & Greenberg, 2003).

Programs to help children overcome these challenges begin early by promoting parent–child communication. Parents can help “fill in the gaps” by helping children understand and interpret what they have not directly heard (Calderon & Greenberg, 2003). Parents can also help by modeling healthy ways to interact and by teaching acceptable social behaviors (Schlesinger & Meadow-Orlans, 1972; Yoshinaga-Itano et al., 2020).

It is important for adolescents who are deaf or hard of hearing to feel that they are a part of their social network and to be able to interact effectively within this network (Calderon & Greenberg, 2003).

Interventions during the adolescent years include

• social skills training aimed at improving interpersonal skills (e.g., Ashori, 2019; Lemanek et al., 1986; Schloss & Smith, 1990; Vernosfaderani, 2014);
• curriculum-based interventions that promote the development of social skills through teacher modeling and cooperative learning and by incorporating social skills lessons into other class lessons and activities (Luetke-Stahlman, 1995); and
• theory of mind training to improve social interactions and peer relationships (Knoors & Marschark, 2020; Westby, 2017).

See ASHA's Practice Portal page Language and Communication of Deaf and Hard of Hearing Children for further information. 

Service Delivery

See the Service Delivery section of the Social Communication Disorder Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

In addition to determining the type of speech and language treatment that is optimal for individuals with SCD, SLPs consider other service delivery variables—including format, provider, dosage, and setting—that may affect treatment outcomes.

Format refers to the structure of the treatment session (e.g., group and/or individual). The appropriateness of the treatment format often depends on the relevant communication setting and goal of therapy. For example, one-on-one treatment sessions can be used to teach specific social communication skills. Group sessions (e.g., group conversation therapy, classroom-wide interventions, and integrated social interaction groups) provide opportunities to practice these skills with a variety of communication partners in natural communication settings.

Provider refers to the person providing treatment. Treatment for individuals with SCD often involves collaborative efforts that include families and other communication partners, classroom teachers, special educators, psychologists, vocational counselors, and SLPs. It can also include family- or peer-meditated learning.

Treatment is conducted in the language(s) used by the individual. A bilingual service provider or the assistance of a trained interpreter may be necessary when there is not a client–clinician language match. See ASHA’s Practice Portal pages on Multilingual Service Delivery in Audiology and Speech-Language Pathology  and Collaborating With Interpreters, Transliterators, and Translators .

Dosage refers to the frequency, intensity, and duration of service. Dosage depends on factors such as the age of the individual, their communication needs, and the presence of comorbid disorders or conditions. Regardless of the specific dosage parameters, social skills intervention addresses the functional communication needs of the individual and provides continuity of services across settings.

Setting refers to the location of treatment (e.g., SLP’s office, classroom, community, inpatient rehabilitation facility). To the extent possible, treatment is provided in naturalistic environments and incorporates activities that typically relate to those environments (e.g., group projects in the classroom setting).

ASHA Resources

• Assessment Tools, Techniques, and Data Sources
• Components of Social Communication
• Consumer Information Page: Social Communication
• Family-Centered Practice
• Person- and Family-Centered Care
• Perspectives Volume 6, Issue 1 of 2021
• Postsecondary Transition Planning
• Self-Assessment for Cultural Competence
• Similar . . . But Very Different
• Social Communication Benchmarks

Other Resources

This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA.

• Association for Positive Behavior Support
• Autism Navigator
• Building Resilience in Children With Hearing Loss in General Education Classrooms: A Guide for Parents and Teachers of the Deaf
• BYU Building Social Skills With Books
• BYU Language Delay Lesson Plans
• BYU Social–Emotional, Pragmatic, and Language Concepts Highlighted in Children’s Story Books [PDF]
• Early Childhood Technical Assistance (ECTA) Center – Child Social-Communication Interaction Checklist [PDF]
• Hands & Voices: Socialization and the Child Who Is Deaf or Hard of Hearing [PDF]
• Hear and Say
• NMIT - Pragmatic Failures in Intercultural Communication [Video]
• Northwest Colorado Board of Cooperative Educational Services (NW BOCES) – Transition Inventories/Assessments [PDF]
• Pragmatics (English) [Video by D. Crystal]
• Pragmatics [Video by S. Pinker]
• RCSLT: New Long COVID Guidance and Patient Handbook
• Social Communication Skills – The Pragmatics Checklist [PDF]

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Adams, C. (2015). Assessment and intervention for children with pragmatic language impairment. In D. Hwa-Froelich (Ed.), Social communication development and disorders (pp. 141–169). Psychology Press.

Adams, C., Lockton, E., & Collins, A. (2018). Metapragmatic explicitation and social attribution in social communication disorder and developmental language disorder: A comparative study. Journal of Speech, Language, and Hearing Research, 61 (3), 604–618. https://doi.org/10.1044/2017_JSLHR-L-17-0026

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Ashori, M. (2019). The effectiveness of life skills training on the social skills of deaf students. Biomedical Journal of Scientific & Technical Research, 19 (3), 14276–14280. [PDF]

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Calderon, R., & Greenberg, M. (2003). Social and emotional development of deaf children. In M. Marschark & P. E. Spencer (Eds.), Oxford handbook of deaf studies, language, and education (pp. 177–189). Oxford University Press.

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Cummings, L. (Ed.). (2021). Handbook of pragmatic language disorders. Springer.

Curenton, S. M., & Justice, L. M. (2004). African American and Caucasian preschoolers’ use of decontextualized language: Literate language features in oral narratives. Language, Speech, and Hearing Services in Schools, 35, 240–253. https://doi.org/10.1044/0161-1461(2004/023)

Ellis Weismer, S., Rubenstein, E., Wiggins, L., & Durkin, M. S. (2021). A preliminary epidemiologic study of social (pragmatic) communication disorder relative to autism spectrum disorder and developmental disability without social communication deficits. Journal of Autism and Developmental Disorders , 51 (8), 2686–2696. https://doi.org/10.1007/s10803-020-04737-4

Ellis Weismer, S., Tomblin, J. B., Durkin, M. S., Bolt, D., & Palta, M. (2021). A preliminary epidemiologic study of social (pragmatic) communication disorder in the context of developmental language disorder. International Journal of Language & Communication Disorders , 56 (6), 1235–1248. https://doi.org/10.1111/1460-6984.12664

Fujiki, M., & Brinton, B. (2017). Social communication intervention for children with language impairment. In R. J. McCauley, M. E. Fey, & R. Gillam (Eds.), Treatment of language disorders in children . Brookes.

Gray, C. (1994). Comic strip conversations: Illustrated interactions that teach conversation skills to students with autism and related disorders. Future Horizons.

Gray, C., White, A. L., & McAndrew, S. (2002). My Social Stories book. Jessica Kingsley Publishers.

Green, B. C., Johnson, K. A., & Bretherton, L. (2014). Pragmatic language difficulties in children with hyperactivity and attention problems: An integrated review. International Journal of Language & Communication Disorders, 49 (1), 15–29. https://doi.org/10.1111/1460-6984.12056

Helland, W. A., Lundervold, A. J., Heimann, M., & Posserud, M.-B. (2014). Stable associations between behavioral problems and language impairments across childhood - The importance of pragmatic language problems, Research in Developmental Disabilities, 35 (5), 943-951. https://doi.org/10.1016/j.ridd.2014.02.016

Hutchins, T. L., & Prelock, P. A. (2006). Using social stories and comic strip conversations to promote socially valid outcomes for children with autism. Seminars in Speech and Language, 27 (1), 047–059. https://doi.org/10.1055/s-2006-932438

Hwa-Froelich, D. A. (2015). Social communication assessment and intervention for children exposed to maltreatment. In D. A. Hwa-Froelich (Ed.), Social communication development and disorders (pp. 287-319). Psychology Press.

Individuals With Disabilities Education Improvement Act of 2004, Pub. L. No. 108-446, § 118 Stat. 2647 (2004). http://idea.ed.gov/

Inglebret, E., Jones, C., & Pavel, D. M. (2008). Integrating American Indian/Alaska Native culture into shared storybook intervention. Language, Speech, and Hearing Services in Schools, 39, 521–527. https://doi.org/10.1044/0161-1461(2008/07-0051)

Izaryk, K., Edge, R., & Lechwar, D. (2021). A survey of speech-language pathologists’ approaches to assessing social communication disorders in children. Perspectives of the ASHA Special Interest Groups, 6 (1), 1–17. https://doi.org/10.1044/2020_PERSP-20-00147

Johnson, S., Matthews, R., Draper, E. S., Field, D. J., Maktelow, B. N., Marlow, N., Smith, L. K., & Boyle, E. M. (2015). Early emergence of delayed social competence in infants born late and moderately preterm. Journal of Developmental & Behavioral Pediatrics , 36 (9), 690–699. https://doi.org/10.1097/DBP.000000000000022

Knoors, H. E. T., & Marschark, M. (2020). Accommodating deaf and hard-of-hearing children with cognitive deficits. In M. Marschark & H. E. T. Knoors (Eds.), The Oxford handbook of deaf studies in learning and cognition (pp. 426–437). Oxford University Press.

Kok, T. B., Post, W. J., Tucha, O., de Bont, E. S. J. M., Kamps, W. A., & Klingma, A. (2014). Social competence in children with brain disorders: A meta-analytic review. Neuropsychology Review, 24 (2), 219–235. https://doi.org/10.1007/s11065-014-9256-7

Lemanek, K. L., Williamson, D. A., Gresham, F. M., & Jensen, B. J. (1986). Social skills training with hearing-impaired children and adolescents. Behavior Modification, 10 (1), 55–71. https://doi.org/10.1177/01454455860101004

Luetke-Stahlman, B. (1995). Classrooms, communication, and social competence. Perspectives in Education and Deafness, 13 (4), 12–16.

Nelson, K. (1978). How children represent knowledge of their world in and out of language: A preliminary report. In R. S. Siegler (Ed.), Children’s thinking: What develops? (pp. 255–273). Erlbaum.

Nelson, N. (2010). Language and literacy disorders: Infancy through adolescence. Allyn & Bacon.

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Poll, G. H., Maskalunas, C., Walls, L., Durbin, S., Hunken, H., & Petru, J. (2021). Measurement properties of social communication assessments for transition-age adolescents: A systematic review. Language, Speech, and Hearing Services in Schools, 52 (3), 917–936. https://doi.org/10.1044/2021_LSHSS-20-00141

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Schloss, P. J., & Smith, M. A. (1990). Teaching social skills to hearing-impaired students. Alexander Graham Bell Association for the Deaf.

Schneider, N., & Goldstein, H. (2009). Social Stories™ improve the on-task behavior of children with language impairment. Journal of Early Intervention, 31 (3), 250–264. https://doi.org/10.1177/1053815109339564

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Szarkowski, A., Young, A., Matthews, D., & Meinzen-Derr, J. (2020). Pragmatics development in deaf and hard of hearing children: A call to action. Pediatrics, 146 (Suppl. 3), S310–S315. https://doi.org/10.1542/peds.2020-0242L

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About This Content

Acknowledgments.

Content for ASHA’s Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the SCD page:

• Meher H. Banajee, PhD, CCC-SLP
• Bonnie Brinton, PhD, CCC-SLP
• Sylvia F. Diehl, PhD, CCC-SLP
• Martin Fujiki, PhD, CCC-SLP
• Sima D. Gerber, PhD, CCC-SLP
• Deborah A. Hwa-Froelich, PhD, CCC-SLP
• Kristen Izaryk, PhD, CCC-SLP
• Bonnie W. Johnson, PhD, CCC-SLP
• Lindee J. Morgan, PhD, CCC-SLP
• Gerard (Trace) Poll, PhD, CCC-SLP
• Patricia A. Prelock, PhD, CCC-SLP
• Geralyn R. Timler, PhD, CCC-SLP

Citing Practice Portal Pages

The recommended citation for this Practice Portal page is:

American Speech-Language-Hearing Association. (n.d.). Social communication disorder [Practice portal]. www.asha.org/Practice-Portal/Clinical-Topics/Social-Communication-Disorder/

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Module 13: Disorders of Childhood and Adolescence

Communication disorders, learning objectives.

• Describe the diagnosis and presentation of communication disorders
• Differentiate between communication disorders

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

The DSM-5 categorizes five communication disorders:

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

Language Disorder

Language disorder, also called developmental language disorder  or DLD (specifically when not caused by an intellectual development disorder) is defined purely in behavioral terms: there is no biological test. There are three points that need to be met for a diagnosis of developmental language disorder (DLD):

• The child has language difficulties that create obstacles to communication or learning in everyday life.
• The child’s language problems are unlikely to resolve by five years of age.
• The problems are not associated with a known biomedical condition such as brain injury, neurodegenerative conditions, genetic conditions or chromosome disorders like Down syndrome, sensorineural hearing loss, or autism spectrum disorder or intellectual development disorder (intellectual disability).

Watch this brief video on DLD.

You can view the transcript for “Developmental Language Disorder – Boys Town National Research Hospital Web” here (opens in new window) .

Developmental language disorder (DLD) is associated with aspects of the home environment, and it is often assumed that this is a causal link with poor language stimulation leading to weak language skills. Twin studies, however, show that two children in the same home environment can have very different language outcomes, suggesting we should consider other explanations for the link. Two twins growing up together are exposed to the same home environment, yet may differ radically in their language skills. Such different outcomes are, however, much more common in fraternal (non-identical) twins, who are genetically different. Identical twins share the same genes and tend to be much more similar in language ability. There can be some variation in the severity and persistence of DLD in identical twins, indicating that non-genetic factors affect the course of disorder, but it is unusual to find a child with DLD who has an identical twin with typical language. Current evidence suggests that there are many different genes that can influence language learning, and DLD results when a child inherits a particularly detrimental combination of risk factors, each of which may have only a small effect. Generally, children with DLD often grow into adults who have relatively low educational attainments,  and their children may share a genetic risk for language disorder.

Epidemiology

It has long been noted that males are more affected by DLD than females, with a sex ratio of affected males to females around 3:1 or 4:1.  However, the sex difference is much less striking in epidemiological samples, suggesting that similar problems may exist in females but are less likely to be detected.  The reason for the sex difference is not well understood. Prevalence studies have shown DLD is found in about 7% of five-year-olds, approximately one in every 15 children.

Treatment is usually carried out by speech and language therapists/pathologists, who use a wide range of techniques to stimulate language learning. Contemporary approaches to enhancing development of language structure, for younger children at least, are more likely to adopt Milieu methods, in which the intervention is interwoven into natural episodes of communication, and the therapist builds on the child’s utterances, rather than dictating what will be talked about. Interventions for older children may be more explicit, telling the children what areas are being targeted and giving explanations regarding the rules and structures they are learning, often with visual supports. Children’s language tend to improve over time, and without controlled studies, it can be hard to know how much of observed change is down to a specific treatment. There is, however, increasing evidence that direct 1:1 intervention with a speech and language therapist/pathologist can be effective for improving vocabulary and expressive language.

Speech Sound Disorder

Figure 1. Cleft lip.

Speech is the act of articulating sounds and can be impaired for all kinds of reasons—a structural problem such as cleft lip and cleft palate, a neurological problem affecting motor control of the speech apparatus  dysarthria , or inability to perceive distinctions between sounds because of hearing loss. Some distortions of speech sounds, such as a lisp, are commonly seen in young children. These misarticulations should not be confused with language problems, which involve the ability to select and combine linguistic elements to express meanings, and the ability to comprehend meanings.

Although speech disorders can be distinguished from language disorders, they can also co-occur. Speech sound disorder (SSD) is any problem with speech production arising from any cause. The prevalence of speech sound disorders (namely, articulation disorders or phonological disorders) in young children is 8%-9%. Five percent of U.S. children ages three through 17 have a speech disorder that lasted for a week or longer during the past 12 months.

The DSM-5 diagnostic criteria for speech sound disorder are as follows:

• A. A persistent difficulty with speech sound production interferes with speech intelligibility or prevents verbal communication of messages.
• B. The disturbance causes limitations in effective communication that interfere with social participation, academic achievement, or occupational performance, individually or in any combination.
• C. Onset of symptoms is in the early developmental period.
• D. The difficulties are not attributable to congenital or acquired conditions, such as cerebral palsy, cleft palate, deafness or hearing loss, traumatic brain injury, or other medical or neurological conditions.

Speech sound disorders may be subdivided into two primary types, articulation disorders (also called phonetic disorders) and phonemic disorders (also called phonological disorders). However, some may have a mixed disorder in which both articulation and phonological problems exist. Though speech sound disorders are associated with childhood, some residual errors may persist into adulthood.

Articulation Disorders

Articulation disorders (also called phonetic disorders , or simply artic disorders  for short) are based on difficulty learning to physically produce the intended phonemes. Articulation disorders have to do with the main articulators, which are the lips, teeth, alveolar ridge, hard palate, velum, glottis, and the tongue. If the disorder has anything to do with any of these articulators, then it is an articulation disorder. There are usually fewer errors than with a phonemic disorder, and distortions are more likely (though any omissions, additions, and substitutions may also be present). They are often treated by teaching the child how to physically produce the sound and having them practice its production until it (hopefully) becomes natural. Articulation disorders should not be confused with motor speech disorders, such as dysarthria (in which there is actual paralysis of the speech musculature) or developmental verbal dyspraxia (in which motor planning is severely impaired).

Phonemic Disorders

In a phonemic disorder (also called a phonological disorders), the child is having trouble learning the sound system of the language, failing to recognize which sound-contrasts also contrast meaning. For example, the sounds /k/ and /t/ may not be recognized as having different meanings, so “call” and “tall” might be treated as homophones, both being pronounced as tall . This confusion is called phoneme collapse, and in some cases many sounds may all be represented by one sound—e.g., /d/ might replace /t/, /k/, and /g/. As a result, the number of error sounds is often (though not always) greater than with articulation disorders, and substitutions are usually the most common error. Phonemic disorders are often treated using minimal pairs (two words that differ by only one sound) to draw the child’s attention to the difference and its effect on communication.

Some children with phonemic disorders may seem to be able to hear phoneme distinctions in the speech of others but not their own. This is called the fis phenomenon based on scenario in which a speech pathologist will say, “Did you say ‘fis,’ don’t you mean ‘fish’?” To which the child responds, “No, I didn’t say ‘fis,’ I said ‘fis’.” In some cases, the sounds produced by the child are actually acoustically different, but not significantly enough for others to distinguish—because those sounds are not phonemically unique to speakers of the language.

Though phonemic disorders are often considered language disorders in that it is the language system that is affected, they are also speech sound disorders in that the errors relate to use of phonemes. This relation makes them different from specific language impairment, which is primarily a disorder of the syntax (grammar) and usage of language rather than the sound system. However, the two can coexist, affecting the same person. Other disorders can deal with a variety of different ways to pronounce consonants. Some examples are glides and liquids. Glides occur when the articulatory posture changes gradually from consonant to vowel. Liquids can include /l/ and /ɹ/ .

Mixed speech sound disorders

Figure 2. Articulation and speech therapy can help address speech sound disorders.

Phonetic and phonemic errors may coexist in the same person. In such a case, the primary focus is usually on the phonological component but articulation therapy may be needed as part of the process, since teaching a child how to use a sound is not practical if the child does not know how to produce it.

Presentation

Errors produced by children with speech sound disorders are typically classified into four categories:

• omissions: Certain sounds are not produced—entire syllables or classes of sounds may be deleted; e.g., fi’ for fish or ‘at for cat .
• additions (or epentheses/commissions): An extra sound or sounds are added to the intended word; e.g. puh-lane for plane .
• distortions: Sounds are changed slightly so that the intended sound may be recognized but sounds “wrong,” or may not sound like any sound in the language.
• substitutions: One or more sounds are substituted for another; e.g., “wabbit” for rabbit or “tow” for cow .

In a typical two-year-old child, about 50% of speech may be intelligible. A four-year-old child’s speech should be intelligible overall, and a seven-year-old should be able to clearly produce most words consistent with community norms for their age. Misarticulation of certain difficult sounds ([l], [ɹ], [s], [z], [θ], [ð], [t͡ʃ], [d͡ʒ], and [ʒ]) may be normal up to eight years old. Children with speech sound disorder have pronunciation difficulties inappropriate for their age, and the difficulties are not caused by hearing problems, congenital deformities, motor disorders or selective mutism.

For most children, the disorder is not lifelong and speech difficulties improve with time and speech-language treatment. Prognosis is poorer for children who also have a language disorder, as a language disorder may be indicative of a learning disorder.

This short video demonstrates a few different therapies used to help children with a language disorder.

You can view the transcript for “Interventions for Speech Sound Disorders in Children” here (opens in new window) .

Childhood-Onset Fluency Disorder (Stuttering)

The DMS-5 characterizes stuttering as a childhood-onset “fluency disorder” (also known as  stammering  and  dysphemia ), and is a communication disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words, or phrases as well as involuntary silent pauses or blocks in which the person who stutters is unable to produce sounds. Stuttering also encompasses the abnormal hesitation or pausing before speech, referred to by people who stutter as  blocks , and the prolongation of certain sounds, usually vowels or semivowels. The term stuttering  covers a wide range of severity, from barely perceptible impediments that are largely cosmetic to severe symptoms that effectively prevent oral communication.

The impact of stuttering on a person’s functioning and emotional state can be severe and may include fears of having to enunciate specific vowels or consonants, fears of being caught stuttering in social situations, self-imposed isolation, anxiety, stress, shame, low self-esteem, being a possible target of bullying (especially in children), having to use word substitution and rearrange words in a sentence to hide stuttering, or a feeling of “loss of control” during speech. Stuttering is sometimes popularly seen as a symptom of anxiety, but there is no direct correlation in that direction.

Stuttering is generally not a problem with the physical production of speech sounds or putting thoughts into words. Acute nervousness and stress are not thought to cause stuttering, but they can trigger stuttering in people who have the speech disorder. Living with a stigmatized disability can result in anxiety and high allostatic stress load (chronic nervousness and stress) that reduce the amount of acute stress necessary to trigger stuttering in any given person who stutters, worsening the problem in the manner of a positive feedback system; the name stuttered speech syndrome  has been proposed for this condition.  Neither acute nor chronic stress, however, itself creates any predisposition to stuttering. The disorder is also  variable , which means that in certain situations, such as talking on the telephone or in a large group, the stuttering might be more severe or less, depending on whether or not the person who stutters is self-conscious about their stuttering. People who stutter often find that their stuttering fluctuates and that they have good days, bad days and stutter-free days. The times in which their stuttering fluctuates can be random.

Figure 3 . Most people who stutter tend to be boys, with an onset of about 2-5 years of age.

Almost 70 million people worldwide stutter,  about 1% of the world’s population. More boys stammer than girls, in the ratio of three to four boys for every one girl, because the male hypothalamic-pituitary-adrenal (HPA) axis is more active. As males produce more cortisol than females under the same provocation, they can be tense or anxious and become repetitive.

The risk for the development of a stutter usually ends by age five, and there doesn’t appear to be any effects of race, ethnicity, culture, bilingualism, or socioeconomic status (SES) on the development and prevalence of stuttering. [1]

Although the exact etiology, or cause, of stuttering is unknown, both genetics and neurophysiology are thought to contribute. Children who have first-degree relatives who stutter are three times as likely to develop a stutter.  However, twin and adoption studies suggest that genetic factors interact with environmental factors for stuttering to occur,  and many stutterers have no family history of the disorder.  There is evidence that stuttering is more common in children who also have concurrent speech, language, learning, or motor difficulties.  

Another view is that a stutter or stammer is a complex tic. This view is held for the following reasons: it always arises from the repetition of sounds or words; young children like repetition and the tenser they are feeling, the more they like this outlet for their tension—an understandable and quite normal reaction. They are capable of repeating all types of behavior. The more tension that is felt, the less one likes change. The more change, the greater can be the repetition. So, when a three-year-old finds he has a new baby brother or sister, he may start repeating sounds. The repetitions can become conditioned and automatic and ensuing struggles against the repetitions result in prolongations and blocks in his speech.

In a 2010 article, three genes were found by Dennis Drayna and his team to correlate with stuttering: GNPTAB, GNPTG, and NAGPA. Researchers estimated that alterations in these three genes were present in 9% of those who have a family history of stuttering.  For some people who stutter, congenital factors may play a role. These may include physical trauma at or around birth, learning disabilities, as well as cerebral palsy. In others, there could be added impact due to stressful situations such as the birth of a sibling, moving, or a sudden growth in linguistic ability.

There is clear empirical evidence for structural and functional differences in the brains of stutterers. Research is complicated somewhat by the possibility that such differences could be the consequences of stuttering rather than a cause, but recent research on older children confirms structural differences thereby giving strength to the argument that at least some of the differences are not a consequence of stuttering. There is also evidence of differences in linguistic processing between people who stutter and people who do not.  Brain scans of adult stutterers have found greater activation of the right hemisphere, which is associated with emotions, than of the left hemisphere, which is associated with speech. In addition, reduced activation in the left auditory cortex has been observed in the brains of those who stutter.  

This clip explains a little bit more about the etiology of stuttering.

You can view the transcript for “How Do People Develop a Stutter?” here (opens in new window) .

If you’re interested in learning more, especially regarding the perspectives of children who stutter, watch this CBS news clip .

There are many treatments and speech therapy techniques available that may help decrease speech disfluency in some people who stutter to the point where an untrained ear cannot identify a problem; however, there is essentially no cure for the disorder at present. The severity of the person’s stuttering would correspond to the amount of speech therapy needed to decrease disfluency. For severe stuttering, long-term therapy and hard work is required to decrease disfluency.

Social (Pragmatic) Communication Disorder

Social (pragmatic) communication disorder (SCD or SPCD) is a disorder where individuals have difficulties with verbal and nonverbal social communication.

The DSM-5 categorizes social (pragmatic) communication disorder (SCD) as a communication disorder within the domain of neurodevelopmental disorders, listed alongside other disorders of speech and language which typically manifest in early childhood. The DSM-5 diagnostic criteria for social communication disorder is as follows:

A. Individuals have persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:

• deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
• impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
• difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
• difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, and multiple meanings that depend on the context for interpretation).

B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination. C. The onset of symptoms is in the early developmental period (but deficits may not become fully manifested until social communication demands exceed limited capacities). D. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual development disorder (intellectual disability), global developmental delay, or another mental disorder.

Individuals with social communication disorder (SCD) have particular trouble understanding the meaning of what others are saying, and they are challenged in using language appropriately to get their needs met and interact with others. Children with the disorder often exhibit

• delayed language development;
• language disorders (similar to the acquired disorder of aphasia) such as word search pauses, jargoning, word order errors, word category errors, verb tense errors;
• stuttering or cluttering speech;
• repeating words or phrases;
• tendency to be concrete or prefer facts to stories; and
• pronouns or pronoun reversal.
• understanding questions.
• understanding choices and making decisions.
• following conversations or stories (conversations are “off-topic” or “one-sided”).
• extracting the key points from a conversation or story; they tend to get lost in the details.
• verb tenses.
• explaining or describing an event.
• understanding satire or jokes and contextual cues.
• reading comprehension.
• reading body language.
• making and maintaining friendships and relationships because of delayed language development.
• distinguishing offensive remarks.
• organizational skills.

According to Bishop and Norbury (2002), children with SCD can have fluent, complex, and clearly articulated expressive language but exhibit problems with the way their language is used. These children typically are verbose. However, they usually have problems understanding and producing connected discourse, instead giving conversational responses that are socially inappropriate, tangential, and stereotyped. They often develop eccentric interests but not as strong or obsessional as people with autism spectrum disorders.

The current view, therefore, is that the disorder has more to do with communication and information processing than language. For example, children with SCD will often fail to grasp the central meaning or saliency of events. This then leads to an excessive preference for routine and “sameness” (seen in autism spectrum disorders), as children with SCD struggle to generalize and grasp the meaning of situations that are new; it also means that more difficulties occur in a stimulating environment than in a one-to-one setting.

A further problem caused by SCD is the assumption of literal communication. This would mean that obvious, concrete instructions are clearly understood and carried out, whereas simple but non-literal expressions such as jokes, sarcasm, and general social chatting are difficult and can lead to misinterpretation. Lies are also a confusing concept to children with SCD as it involves knowing what the speaker is thinking, intending, and truly meaning beyond a literal interpretation.

Differences between SCD and Autism

Communication problems are also part of the autism spectrum disorder; however, individuals with autism also show a restricted pattern of behavior, according to behavioral psychologists. The diagnosis of SCD can only be given if autism has been ruled out.  It is assumed that those with autism have difficulty with the meaning of what is being said due to different ways of responding to social situations.

Prior to the release of the DSM-5 in 2013, SCD was not differentiated from a diagnosis of autism. However, there were a large number of cases of children experiencing difficulties with pragmatics that did not meet the criteria for autism. The differential diagnosis of SCD allows practitioners to account for social and communication difficulties that occur to a lesser degree than in children with autism. SCD is distinguished from autism by the absence of any history (current or past) of restricted/repetitive patterns of interest or behavior in SCD.

More research will need to be conducted to determine the true prevalence of SCD, due to it’s overlap with ASD and the newness of the diagnosis in the DSM-5; however a population estimate suggests the rates of SCD among children is about 7.5% and affects more boys than girls by a ratio of 2.6:1. Higher prevalence rates (23–33%) have been found in those with language disorders.

Treatment for SCD

Treatments for SCD are less established than for treatments for other disorders such as autism.  Similarities between SCD and some aspects of autism leads some researchers to try some treatments for autism with people with SCD.

Speech therapy can help individuals who have communication disorders. Speech and language therapy treatment focuses on communication and social interaction.  Speech therapists can work with clients on communication in various settings.

Watch this video for a short explanation of social communication disorder.

You can view the transcript for “What is Social Communication Disorder” here (opens in new window) .

Key Takeaways: Communication Disorders

childhood-onset fluency disorder (stuttering):  standard fluency and rhythm of speech is interrupted, often causing the repetition of whole words and syllables; may also include the prolongation of words and syllables, pauses within a word, and/or the avoidance of pronouncing difficult words and replacing them with easier words that the individual is better able to pronounce

communication disorder:  any disorder that affects someone’s ability to comprehend, detect, or apply language and speech to engage in discourse effectively with others

dysarthria:  a collective name for a group of speech disorders resulting from disturbances in muscular control over the speech mechanism due to damage of the central or peripheral nervous system; designates problems in oral communication due to paralysis, weakness, or incoordination of the speech musculature

social (pragmatic) communication disorder (SCD):  difficulties in the social uses of verbal and nonverbal communication in naturalistic contexts, which affects the development of social relationships and discourse comprehension

speech sound disorder:  previously called phonological disorder, problems with pronunciation and articulation of native language

unspecified communication disorder:  description for those who have symptoms of a communication disorder, but who do not meet all criteria, and whose symptoms cause distress or impairment

• Yairi, E., & Ambrose, N. (2013). Epidemiology of stuttering: 21st century advances. Journal of fluency disorders, 38(2), 66–87. https://doi.org/10.1016/j.jfludis.2012.11.002 ↵
• Modification, adaptation, and original content. Authored by : Chrissy Hicks for Lumen Learning. Provided by : Lumen Learning. License : CC BY-SA: Attribution-ShareAlike
• Social (pragmatic) communication disorder. Provided by : Wikipedia. Located at : https://en.wikipedia.org/wiki/Social_(pragmatic)_communication_disorder#:~:text=Social%20(pragmatic)%20communication%20disorder%20(,Impairment%20and%20Autism%20Spectrum%20Disorder. . License : CC BY-SA: Attribution-ShareAlike
• Communication Disorder. Provided by : Wikipedia. Located at : https://en.wikipedia.org/wiki/Communication_disorder#:~:text=A%20communication%20disorder%20is%20any,or%20use%20one's%20native%20language. . License : CC BY-SA: Attribution-ShareAlike
• Speech Sound Disorder. Provided by : Wikipedia. Located at : https://en.wikipedia.org/wiki/Speech_sound_disorder . License : CC BY: Attribution
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• Developmental language disorder. Provided by : Wikipedia. Located at : https://en.wikipedia.org/wiki/Developmental_language_disorder . License : CC BY-SA: Attribution-ShareAlike
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• How Do People Develop a Stutter?. Provided by : SciShow Psych. Located at : https://www.youtube.com/watch?time_continue=20&v=_5IOse0EdIo&feature=emb_logo . License : Other . License Terms : Standard YouTube License
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• What is Social Communication Disorder. Provided by : ADDitude Magazine. Located at : https://www.youtube.com/watch?v=XnBWtabeCFg&feature=emb_logo . License : Other . License Terms : Standard YouTube License
• Speech Sound Disorders in Children: An Articulatory Phonology Perspective. Authored by : Aravind Kumar Namasivayam, Deirdre Coleman, Aisling Ou2019Dwyer, and Pascal van Lieshout. Provided by : Frontiers in Psychology. Located at : . License : CC BY: Attribution
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Signs and Types of Communication Disorders

Posted on September 1, 2020

Communication is the act of exchanging information, wants, or needs to each other. Language is the platform in which we communicate via speech, sign language, picture exchange communication (PEC), augmentative and alternative communication (AAC), and more. A communication disorder is an impairment in the ability to use and/or comprehend verbal or nonverbal language.

Communication disorder is the big umbrella term and can include impairments in any of the following areas: speech, expressive and receptive language, pragmatics, fluency, or voice quality. It is an impairment in any of these areas that is impacting the person’s ability to communicate effectively. Language and speech disorders are more specific terms for communication disorders. Individuals may demonstrate one or any combination of communication disorders.

Language Disorders

A language disorder is impaired comprehension and/or use of verbal or nonverbal language. This may involve the form of language (phonology, morphology, syntax), the content of language (vocabulary), and/or the function of language in communication (pragmatics) in any combination.

• This individual may have difficulty following directions or formulating 2-3 word sentences.
• This individual may have difficulty using appropriate word forms (ie. plurals, present progressive, possessives) or answering questions appropriately.
• This individual may have difficulty following 2-step directions.
• This individual may not respond to their name consistently, may not maintain appropriate eye contact, and may have difficulty maintaining a topic in conversation.

Speech Disorders

A speech disorder is an impairment of the articulation of speech sounds, fluency and/or voice.

• This individual may make sound errors in words such as saying “tup” for “cup” or “swide” for “slide”. You may have difficulty in understanding them when they speak.
• There are many examples and types of speech sound errors. Some errors are developmental. This means the child may still be in the developmental window for acquiring that sound before being considered delayed.
• An excellent resource for development of speech sounds can be found here: http://mommyspeechtherapy.com/wp-content/downloads/forms/sound_development_chart.pdf.
• This individual may have word repetitions (“I I I want the truck”) or blocks in their speech (“I……..want the truck”).
• Often times if the child is under 5 years old, this would be considered developmental fluency. And the child’s fluency will gradually improve as they continue to develop their language skills.
• This individual may demonstrate a rough or strained voice quality when speaking.

Communication Disorders

Communication disorders can be acquired or developmental. A communication disorder may result in a primary disability or it may be secondary to other disabilities. Some causes include hearing loss, neurological disorders, brain injury, vocal cord injury, autism spectrum disorder, intellectual disability, drug abuse, physical impairments such as cleft lip or palate, emotional or psychiatric disorders, or developmental disorders. Frequently, the cause of a communication disorder is unknown.

The best way to approach treatment for a communication disorder is to focus on prevention and early intervention. “The first 3 years of life, when the brain is developing and maturing, is the most intensive period for acquiring speech and language skills,” according to the National Institute on Deafness and Other Communication Disorders. Follow us on social media for tips and ideas on growing your child’s speech and language skills! It is important to monitor your child’s developmental milestones, found here: https://charlottespeechhearing.com/wp-content/uploads/2017/03/when-to-refer-a-child.pdf .

If you suspect your child may have a communication disorder, please contact us for a speech and language evaluation by one of our speech language pathologists today!

For more speech-language resources, visit our Resources for Families page or YouTube channel.

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10 Most Common Speech-Language Disorders & Impediments

As you get to know more about the field of speech-language pathology you’ll increasingly realize why SLPs are required to earn at least a master’s degree . This stuff is serious – and there’s nothing easy about it.

In 2016 the National Institute on Deafness and Other Communication Disorders reported that 7.7% of American children have been diagnosed with a speech or swallowing disorder. That comes out to nearly one in 12 children, and gets even bigger if you factor in adults.

Whether rooted in psycho-speech behavioral issues, muscular disorders, or brain damage, nearly all the diagnoses SLPs make fall within just 10 common categories…

Types of Speech Disorders & Impediments

Apraxia of speech (aos).

Apraxia of Speech (AOS) happens when the neural pathway between the brain and a person’s speech function (speech muscles) is lost or obscured. The person knows what they want to say – they can even write what they want to say on paper – however the brain is unable to send the correct messages so that speech muscles can articulate what they want to say, even though the speech muscles themselves work just fine. Many SLPs specialize in the treatment of Apraxia .

There are different levels of severity of AOS, ranging from mostly functional, to speech that is incoherent. And right now we know for certain it can be caused by brain damage, such as in an adult who has a stroke. This is called Acquired AOS.

However the scientific and medical community has been unable to detect brain damage – or even differences – in children who are born with this disorder, making the causes of Childhood AOS somewhat of a mystery. There is often a correlation present, with close family members suffering from learning or communication disorders, suggesting there may be a genetic link.

Mild cases might be harder to diagnose, especially in children where multiple unknown speech disorders may be present. Symptoms of mild forms of AOS are shared by a range of different speech disorders, and include mispronunciation of words and irregularities in tone, rhythm, or emphasis (prosody).

Stuttering – Stammering

Stuttering, also referred to as stammering, is so common that everyone knows what it sounds like and can easily recognize it. Everyone has probably had moments of stuttering at least once in their life. The National Institute on Deafness and Other Communication Disorders estimates that three million Americans stutter, and reports that of the up-to-10-percent of children who do stutter, three-quarters of them will outgrow it. It should not be confused with cluttering.

Most people don’t know that stuttering can also include non-verbal involuntary or semi-voluntary actions like blinking or abdominal tensing (tics). Speech language pathologists are trained to look for all the symptoms of stuttering , especially the non-verbal ones, and that is why an SLP is qualified to make a stuttering diagnosis.

The earliest this fluency disorder can become apparent is when a child is learning to talk. It may also surface later during childhood. Rarely if ever has it developed in adults, although many adults have kept a stutter from childhood.

Stuttering only becomes a problem when it has an impact on daily activities, or when it causes concern to parents or the child suffering from it. In some people, a stutter is triggered by certain events like talking on the phone. When people start to avoid specific activities so as not to trigger their stutter, this is a sure sign that the stutter has reached the level of a speech disorder.

The causes of stuttering are mostly a mystery. There is a correlation with family history indicating a genetic link. Another theory is that a stutter is a form of involuntary or semi-voluntary tic. Most studies of stuttering agree there are many factors involved.

Dysarthria is a symptom of nerve or muscle damage. It manifests itself as slurred speech, slowed speech, limited tongue, jaw, or lip movement, abnormal rhythm and pitch when speaking, changes in voice quality, difficulty articulating, labored speech, and other related symptoms.

It is caused by muscle damage, or nerve damage to the muscles involved in the process of speaking such as the diaphragm, lips, tongue, and vocal chords.

Because it is a symptom of nerve and/or muscle damage it can be caused by a wide range of phenomena that affect people of all ages. This can start during development in the womb or shortly after birth as a result of conditions like muscular dystrophy and cerebral palsy. In adults some of the most common causes of dysarthria are stroke, tumors, and MS.

A lay term, lisping can be recognized by anyone and is very common.

Speech language pathologists provide an extra level of expertise when treating patients with lisping disorders . They can make sure that a lisp is not being confused with another type of disorder such as apraxia, aphasia, impaired development of expressive language, or a speech impediment caused by hearing loss.

SLPs are also important in distinguishing between the five different types of lisps. Most laypersons can usually pick out the most common type, the interdental/dentalised lisp. This is when a speaker makes a “th” sound when trying to make the “s” sound. It is caused by the tongue reaching past or touching the front teeth.

Because lisps are functional speech disorders, SLPs can play a huge role in correcting these with results often being a complete elimination of the lisp. Treatment is particularly effective when implemented early, although adults can also benefit.

Experts recommend professional SLP intervention if a child has reached the age of four and still has an interdental/dentalised lisp. SLP intervention is recommended as soon as possible for all other types of lisps. Treatment includes pronunciation and annunciation coaching, re-teaching how a sound or word is supposed to be pronounced, practice in front of a mirror, and speech-muscle strengthening that can be as simple as drinking out of a straw.

Spasmodic Dysphonia

Spasmodic Dysphonia (SD) is a chronic long-term disorder that affects the voice. It is characterized by a spasming of the vocal chords when a person attempts to speak and results in a voice that can be described as shaky, hoarse, groaning, tight, or jittery. It can cause the emphasis of speech to vary considerably. Many SLPs specialize in the treatment of Spasmodic Dysphonia .

SLPs will most often encounter this disorder in adults, with the first symptoms usually occurring between the ages of 30 and 50. It can be caused by a range of things mostly related to aging, such as nervous system changes and muscle tone disorders.

It’s difficult to isolate vocal chord spasms as being responsible for a shaky or trembly voice, so diagnosing SD is a team effort for SLPs that also involves an ear, nose, and throat doctor (otolaryngologist) and a neurologist.

Have you ever heard people talking about how they are smart but also nervous in large groups of people, and then self-diagnose themselves as having Asperger’s? You might have heard a similar lay diagnosis for cluttering. This is an indication of how common this disorder is as well as how crucial SLPs are in making a proper cluttering diagnosis .

A fluency disorder, cluttering is characterized by a person’s speech being too rapid, too jerky, or both. To qualify as cluttering, the person’s speech must also have excessive amounts of “well,” “um,” “like,” “hmm,” or “so,” (speech disfluencies), an excessive exclusion or collapsing of syllables, or abnormal syllable stresses or rhythms.

The first symptoms of this disorder appear in childhood. Like other fluency disorders, SLPs can have a huge impact on improving or eliminating cluttering. Intervention is most effective early on in life, however adults can also benefit from working with an SLP.

Muteness – Selective Mutism

There are different kinds of mutism, and here we are talking about selective mutism. This used to be called elective mutism to emphasize its difference from disorders that caused mutism through damage to, or irregularities in, the speech process.

Selective mutism is when a person does not speak in some or most situations, however that person is physically capable of speaking. It most often occurs in children, and is commonly exemplified by a child speaking at home but not at school.

Selective mutism is related to psychology. It appears in children who are very shy, who have an anxiety disorder, or who are going through a period of social withdrawal or isolation. These psychological factors have their own origins and should be dealt with through counseling or another type of psychological intervention.

Diagnosing selective mutism involves a team of professionals including SLPs, pediatricians, psychologists, and psychiatrists. SLPs play an important role in this process because there are speech language disorders that can have the same effect as selective muteness – stuttering, aphasia, apraxia of speech, or dysarthria – and it’s important to eliminate these as possibilities.

And just because selective mutism is primarily a psychological phenomenon, that doesn’t mean SLPs can’t do anything. Quite the contrary.

The National Institute on Neurological Disorders and Stroke estimates that one million Americans have some form of aphasia.

Aphasia is a communication disorder caused by damage to the brain’s language capabilities. Aphasia differs from apraxia of speech and dysarthria in that it solely pertains to the brain’s speech and language center.

As such anyone can suffer from aphasia because brain damage can be caused by a number of factors. However SLPs are most likely to encounter aphasia in adults, especially those who have had a stroke. Other common causes of aphasia are brain tumors, traumatic brain injuries, and degenerative brain diseases.

In addition to neurologists, speech language pathologists have an important role in diagnosing aphasia. As an SLP you’ll assess factors such as a person’s reading and writing, functional communication, auditory comprehension, and verbal expression.

Speech Delay – Alalia

A speech delay, known to professionals as alalia, refers to the phenomenon when a child is not making normal attempts to verbally communicate. There can be a number of factors causing this to happen, and that’s why it’s critical for a speech language pathologist to be involved.

The are many potential reasons why a child would not be using age-appropriate communication. These can range anywhere from the child being a “late bloomer” – the child just takes a bit longer than average to speak – to the child having brain damage. It is the role of an SLP to go through a process of elimination, evaluating each possibility that could cause a speech delay, until an explanation is found.

Approaching a child with a speech delay starts by distinguishing among the two main categories an SLP will evaluate: speech and language.

Speech has a lot to do with the organs of speech – the tongue, mouth, and vocal chords – as well as the muscles and nerves that connect them with the brain. Disorders like apraxia of speech and dysarthria are two examples that affect the nerve connections and organs of speech. Other examples in this category could include a cleft palette or even hearing loss.

The other major category SLPs will evaluate is language. This relates more to the brain and can be affected by brain damage or developmental disorders like autism. There are many different types of brain damage that each manifest themselves differently, as well as developmental disorders, and the SLP will make evaluations for everything.

Issues Related to Autism

While the autism spectrum itself isn’t a speech disorder, it makes this list because the two go hand-in-hand more often than not.

The Centers for Disease Control and Prevention (CDC) reports that one out of every 68 children in our country have an autism spectrum disorder. And by definition, all children who have autism also have social communication problems.

Speech-language pathologists are often a critical voice on a team of professionals – also including pediatricians, occupational therapists, neurologists, developmental specialists, and physical therapists – who make an autism spectrum diagnosis .

In fact, the American Speech-Language Hearing Association reports that problems with communication are the first detectable signs of autism. That is why language disorders – specifically disordered verbal and nonverbal communication – are one of the primary diagnostic criteria for autism.

So what kinds of SLP disorders are you likely to encounter with someone on the autism spectrum?

A big one is apraxia of speech. A study that came out of Penn State in 2015 found that 64 percent of children who were diagnosed with autism also had childhood apraxia of speech.

This basic primer on the most common speech disorders offers little more than an interesting glimpse into the kind of issues that SLPs work with patients to resolve. But even knowing everything there is to know about communication science and speech disorders doesn’t tell the whole story of what this profession is all about. With every client in every therapy session, the goal is always to have the folks that come to you for help leave with a little more confidence than when they walked in the door that day. As a trusted SLP, you will build on those gains with every session, helping clients experience the joy and freedom that comes with the ability to express themselves freely. At the end of the day, this is what being an SLP is all about.

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Aphasia is a disorder that affects how you communicate. It can impact your speech, as well as the way you write and understand both spoken and written language.

Aphasia usually happens suddenly after a stroke or a head injury. But it can also come on gradually from a slow-growing brain tumor or a disease that causes progressive, permanent damage (degenerative). The severity of aphasia depends on a number of things, including the cause and the extent of the brain damage.

The main treatment for aphasia involves treating the condition that causes it, as well as speech and language therapy. The person with aphasia relearns and practices language skills and learns to use other ways to communicate. Family members often participate in the process, helping the person communicate.

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Aphasia is a symptom of some other condition, such as a stroke or a brain tumor.

A person with aphasia may:

• Speak in short or incomplete sentences
• Speak in sentences that don't make sense
• Substitute one word for another or one sound for another
• Speak unrecognizable words
• Have difficulty finding words
• Not understand other people's conversation
• Not understand what they read
• Write sentences that don't make sense

Patterns of aphasia

People with aphasia may have different strengths and weaknesses in their speech patterns. Sometimes these patterns are labeled as different types of aphasia, including:

• Broca's aphasia
• Wernicke aphasia
• Transcortical aphasia
• Conduction aphasia
• Mixed aphasia
• Global aphasia

These patterns describe how well the person can understand what others say. They also describe how easy it is for the person to speak or to correctly repeat what someone else says.

Aphasia may develop slowly over time. When that happens, the aphasia may be labeled with one of these names:

• Logopenic aphasia
• Semantic aphasia
• Agrammatism

Many people with aphasia have patterns of speech difficulty that don't match these types. It may help to consider that each person with aphasia has unique symptoms, strengths and weaknesses rather than trying to label a particular type of aphasia.

Because aphasia is often a sign of a serious problem, such as a stroke, seek emergency medical care if you or a loved one suddenly develop:

• Difficulty speaking
• Trouble understanding speech
• Difficulty with word recall
• Problems with reading or writing

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The most common cause of aphasia is brain damage resulting from a stroke — the blockage or rupture of a blood vessel in the brain. Loss of blood to the brain leads to brain cell death or damage in areas that control language.

Brain damage caused by a severe head injury, a tumor, an infection or a degenerative process also can cause aphasia. In these cases, the aphasia usually occurs with other types of cognitive problems, such as memory problems or confusion.

Primary progressive aphasia is the term used for language difficulty that develops gradually. This is due to the gradual degeneration of brain cells located in the language networks. Sometimes this type of aphasia will progress to a more generalized dementia.

Sometimes temporary episodes of aphasia can occur. These can be due to migraines, seizures or a transient ischemic attack (TIA). A transient ischemic attack (TIA) occurs when blood flow is temporarily blocked to an area of the brain. People who've had a are at an increased risk of having a stroke in the near future.

Aphasia can create numerous quality-of-life problems because communication is so much a part of your life. Communication difficulty may affect your:

• Relationships
• Day-to-day function

Difficulty expressing wants and needs can result in embarrassment, frustration, isolation and depression. Other problems may occur together, such as more difficulty moving around and problems with memory and thinking.

Jun 11, 2022

• Clark DG. Approach to the patient with aphasia. https://www.uptodate.com/contents/search. Accessed May 24, 2022.
• Aphasia. Merck Manual Professional Edition. http://www.merckmanuals.com/professional/neurologic_disorders/function_and_dysfunction_of_the_cerebral_lobes/aphasia.html#v1034169. Accessed May 24, 2022.
• Clark DG. Aphasia: Prognosis and treatment. https://www.uptodate.com/contents/search. Accessed May 24, 2022.
• Aphasia. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/aphasia/. Accessed May 24, 2022.
• Aphasia. National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/voice/Pages/aphasia.aspx. Accessed May 24, 2022.
• Crosson B, et al. Neuroplasticity and aphasia treatments: New approaches for an old problem. Journal of Neurology, Neurosurgery and Psychiatry. 2019; doi:10.1136/jnnp-2018-319649.
• Elsner B, et al. Transcranial direct current stimulation (tDCS) for improving aphasia in adults with aphasia after stroke. Cochrane Database of Systematic Reviews. 2019; doi:10.1002/14651858.CD009760.pub4.
• Botha H, et al. Classification and clinicoradiologic features of primary progressive aphasia (PPA) and apraxia of speech. Cortex. 2015. doi:10.1016/j.cortex.2015.05.013.
• Kasselimis DS, et al. The unbridged gap between clinical diagnosis and contemporary research on aphasia: A short discussion on the validity and clinical utility of taxonomic categories. Brain and Language. 2017; doi:10.1016/j.bandl.2016.10.005.
• Clark H (expert opinion). Mayo Clinic. May 30, 2022.
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Expanding the Capabilities of Robot NAO to Enable Human-Like Communication with Children with Speech and Language Disorders

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