Communication Disorders

Which term communication disorders replaced

• ‘Learning disability’ (which was a lay term, not diagnostic)

Broad description of communication disorders (3)

• Diagnostic term that refers to deficits in language, speech + communication

• Affects encoding, retaining, communicating info

• Normal levels of intelligence

5 categories

• Language disorder

• Speech sound disorder

• Childhood-onset fluency disorder (stuttering)

• Social (pragmatic) communication disorder

• Unspecified communication disorder (don’t fully meet criteria for other 4)

Language disorder: overall description, how much delayed

• Substantial deficits in comprehension/expression of language

• Typically 12 months delayed/1.5 SD below mean

DSM-5 criteria for language disorder (A-D w/ description except for A)

A. Difficulties in acquisition + use of language

B. Impairments: lang. abilities well below age expectations

C. Onset: early dev period

D. Exclusionary: not due to sensory/motor impariment, medical/neurological condition

A. Difficulties in acquisition + use of language (3)

Across modalities (i.e., spoken, written, sign language, or other)

1. Reduced vocab

2. Limited sentence structure

3. Impairments in discourse

Prevalence of language disorders *don’t need to memorise exactly

• ~7% preschoolers

• 50% resolve by late adolescence

• Affects boys > girls (2:1)

• Associated with above-average rates of ADHD + social difficulties

Biological (genetic factors) associated with lang. disorder: heritability, stronger + weaker factors genetically influenced

• Heritable

• Strongest genetic influence for phonological deficits

• Temporal processing deficits more driven by environment

Biological (brain) factors associated w/ lang. disorder (2)

• Wernicke’s area (comprehension), Broca’s area (production)

• Reduced left hemisphere activity

Environmental factors associated w/ lang. disorders

• Recurrent otitis media (middle ear infection) during critical period

Intervention for lang. disorders

• Often self-corrects by age 6

• Speech pathology

• Good results with combined computer + teacher-assisted instruction

Notes on language disorders

• Relative strength of expressive vs comprehensive abilities may differ from child to child

Speech sound disorder: overall description

• Concerns speech production (articulation)

DSM-5 criteria (A-D): problem, impairments/what affected, onset, exclusionary

A. Problems w/ speech sound + production

B. Impairment: limitations in effective communication

C. Onset: early dev. period

D. Exclusionary: not attributable to congenital conditions (cerebral palsy, hearing loss)

Prevalence of speech sound disorder: , % in preschoolers, % resolved by adolescence, boys vs girls, associations

• ~2-3% in preschoolers

• 50% resolve by late adolescence

• Affects boys > girls (2:1)

• Associated with above-average rates of ADHD + social difficulties

Childhood-onset fluency disorder (stuttering): description (1)

• Repeated + prolonged pronunciation of syllables that interferes with communication

Onset + trajectory (2)

• Gradual onset age 2-7 (peak at 5)

• Often resolves with age, once a child has entered school

DSM-5 criteria (A-D): problem, impairmnet, onset,

A. Age-inappropriate disturbances in normal fluency and timing of speech

B. Impairment: limits effective communication or causes anxiety about speaking etc.

C. Onset: early dev.

D. Exclusionary: not due to speech-motor/sensory deficit or other mental disorder

Possible causes of stuttering: emotional, heritability, environmental factors (2)

• No evidence caused by emotional issues

• 70% heritability

• Premature birth, parental mental illness

Intervention for stuttering: when recommended, psychological intervention, behaviour therapy

• Recommended if parent/child frequently concerned (because most children outgrow stuttering, so need to toss up whether treatment would be intervention or interference)

• Psychological: teach parents to speak slowly + in short sentences to reduce pressure

• Behaviour therapy: positive reinforcement for fluency

Social (pragmatic) communication disorder (S(P)CD): description, what similar to

• Deficits in social (pragmatic) use of language (receptive + expressive), conversational norms, non-verbal communication such as eye contact and gestures

• Similar to ASD but without stereotypic behaviours/interests

DSM-5 criteria for social communication disorder: note, problem, impairments, onset, exclusionary

New in DSM

A. Difficulties in social use of verbal + non-verbal communication in all of listed criteria

B. Impairments: impacts effective communication and/or social participation

C. Onset: early dev (but may not manifest until required to communicate socially)

D. Exclusionary: not attributable to ASD, ID etc.

4 areas SCD children experience difficulties across

Difficulties in:

• social communication

• changing communication to match context

• following language rules, e.g. turn-taking in conversations

• understanding what is not explicitly said

Note on social communication disorder diagnosis in Aus

• Not yet common in Aus