Communication Disorders Study Guide

Introduction to Communication Disorders

  • Communication disorders involve problems with receiving, processing, sending, and comprehending information.

  • Manifest early or develop later due to medical conditions.

  • Severity ranges from mild to profound.

  • Can co-occur with other developmental disorders like hearing impairment, intellectual disability, and autism.

  • Language and speech are intertwined.

Definitions

  • Language: Use of symbols (spoken, signed, written) in a rule-governed manner for communication.

  • Speech: Expressive production of sounds, including articulation, fluency, voice, and resonance.

Classifications of Communication Disorders

  • DSM-5: Language disorder, speech sound disorder, child-onset fluency disorder, social (pragmatic) communication disorder.

  • ASHA: Speech disorder, language disorder, hearing disorder, central auditory processing disorder.

Speech Disorders

  • Impairment of articulation, fluency, and/or voice.

    • Articulation Disorder: Atypical production of speech sounds

    • Fluency Disorder: Interruption in the flow of speaking

    • Voice Disorder: Abnormal production/absence of vocal quality, pitch, loudness, etc.

Language Disorders

  • Impaired comprehension and/or use of spoken, written, or other symbol systems.

    • Form: Syntax, morphology, phonology.

    • Content: Semantics.

    • Function: Pragmatics.

Hearing Disorders

  • Impaired sensitivity of the auditory system, affecting detection, recognition, and comprehension.

Central Auditory Processing Disorder (CAPD)

  • Problems in processing auditory information in the brain.

  • NOT due to intellectual impairment.

Language Disorder Diagnostic Subcategories in DSM-V

  • Language Disorder

  • Speech Sound Disorder

  • Childhood Onset Fluency Disorder

  • Social Communication Disorder

  • Unspecified Communication Disorder

Neural Basis of Language: A Dual-Stream System

  • Ventral Route: Maps auditory input onto lexical-conceptual (semantic) representations (temporal lobe).

  • Dorsal Route: Maps auditory input onto articulatory motor representations (frontal and temporal-parietal lobes).

Types of Language Disorders

  • Expressive: Difficulties in production; better prognosis.

  • Receptive: Difficulties in comprehension; impacts expressive language.

  • Mixed (Receptive-Expressive): Impaired receptive and expressive skills.

Epidemiology of Language Disorders

  • Most common developmental disabilities during preschool period (10-15%).

  • 4% at school age.

  • More common in boys and those with a family history of communication disorders.

ICD-11 Criteria for Developmental Language Disorder

  • Persistent deficits in acquisition, understanding, production, or use of language.

  • Exclusions: Autism, nervous system diseases, deafness, selective mutism.

Genetic Factors in Language Disorder

  • FOXP2: Affects expression of other genes related to neuronal organization and axonal growth.

  • CNTNAP2: Associated with LD, ASD, and SSD; important for neuron development.

Other Genetic Factors

  • Chromosome linkages: 13, 16, and 19.

  • Associations within ATP2C2 and CMIP genes.

Environmental Factors

  • Lower socioeconomic status, large family size, recurrent otitis media, neglectful home environment, later birth order.

  • Maternal language complexity predictive of child language development.

Role of Sequential Learning

  • Impairment in procedural learning ability is found in language disorders.

  • Genes: FOXP2, CNTNAP2, ROBO1.

Cognitive Bases of Language Disorder

  • Memory impairments: Phonological short-term memory, working memory, procedural memory.

  • Deficits in perceptual and information processing.

  • Executive dysfunction.

Language Disorder and Atypical Cerebral Lateralization

  • Reduced language laterality.

  • Genetic models: Endophenotype, pleiotropy, additive/interactive risks, neuroplasticity.

Neuroimaging Findings in Language Disorder

  • Structural Imaging: Reduced grey matter, atypical development of subcortical structures, lower cerebral volumes.

  • Functional Imaging: Reduced brain activity in left posterior STG.

Expressive Language Disorder: Clinical Features

  • Selective deficit in expressive language; nonverbal intelligence and receptive skills are better than expression.

  • Emotional problems may develop in school-age children.

  • Comorbidity: ADHD, anxiety disorders, oppositional defiant disorder, learning disorders.

Mixed Receptive-Expressive Language Disorder

  • Impaired skills in both expression and reception.

  • Higher comorbidity than expressive language disorder alone.

  • Prognosis is less favorable than for expressive language disorder alone.

Treatment Strategies

  • Early intervention to guide children and parents toward meaningful language production.

  • Therapeutic Process: Assessing, planning, implementing, and evaluating speech-language therapy services.

Tips for Different Modalities

  • Auditory: Minimize visual distractions, use audio recordings, allow repetition.

  • Visual: Use demonstrations, modeling, colors, and high-stimulus items.

  • Tactile/Kinesthetic: Use hands-on materials, drawing, and assembling.

Language Intervention

  • Clinician-Oriented: Clinician selects goals and stimuli (Drill, Drill play, Modeling).

  • Child-Oriented: Indirect language stimulation in natural settings.

  • Hybrid: Natural activities with targeted language forms.

Child-Onset Fluency Disorder (Stuttering)

  • Involves abnormal dysfluencies causing a perceived loss of speech control.

  • Accompanied by physical tension, negative reactions, secondary behaviors, and avoidance.

Epidemiology of Stuttering

  • Affects approximately 5% of preschool-age children.

  • More common in males.

  • Familial risk.

Theoretical Perspectives About Stuttering

  • Stuttering as a Disorder of Brain Organization: Lack of hemispheric dominance.

  • Stuttering as a Disorder of Timing: Temporal disruption of muscular movements.

  • Stuttering and altered auditory feedback

  • Stuttering as a Language Production Deficit

  • Stuttering as a Multifactorial Dynamic Disorder

  • Stuttering as a learned behavior

Genetic factors

Biochemical markers

Clinical Aspects of Stuttering

  • Repetitions, prolongations, and blocks.

  • Physical tension and secondary behaviors.

  • Avoidance and emotional reactions.

Evolving Phases in the Development of Stuttering

  • Phase 1: Preschool period, episodic, repetition.

  • Phase 2: Elementary school years, chronic, awareness.

  • Phase 3: After age 8, situational, word substitutions.

  • Phase 4: Late adolescence/adulthood, fear, avoidance.

  • Diagnosing childhood-onset uency disorder (stuttering) is typically straightforward if all the four phases is readily recognized.

Formal Testing

  • Assessment of Stuttering Severity: Stuttering Severity Instrument SSI3, TOCS

Differential Diagnosis

  • Tourette's disorder: Vocal tics and repetitive vocalizations of Tourette's disorder should be distinguishable from the repetitive sounds of childhood- onset uency disorder by their nature and timing.

  • Normal Speech Dysfluencies: Typically occurs between ages 2-7 years, with a heightened occurrence between 2.5-4 years.

Co-morbidity

  • Language disorders (expressive or mixed receptive-expressive), phonological or articulation disorders.

Risk factors for persistent stuttering include:

  • Male sex

  • Familial stuttering (especially persistent familial stuttering

  • Age at onset of stuttering >3–4 years

  • Constant level / No reduction in stuttering severity within the initial 7–12 months

Treatment Goals

  • Reduce the frequency of stuttering

  • Reduce the abnormality of stuttering

  • Reduce negative feelings about stuttering & speakingReduce negative thoughts and attitudes about stuttering and speaking

  • Reduce avoidance

  • Increase overall communication abilities

  • Create an environment that facilitates uency

  • Increase freedom to speak

Main Lines of Stuttering Intervention

  • Behavioral modification therapy

  • Psychological therapy

  • Pharmacological therapy

  • Use of technology devices and feedback

  • Indirect apporach

  • Direct approach

  • Counseling (Parents and Teacher)

Lidcombe Program (Direct Approach)

Fluency Shaping Approach

Stuttering Modi cation Therapy

The purposes of these approches is to:

  • Identi cation

  • Desensitization

  • Modi cation

  • Stabilization

Pharmacologic Treatment of Stuttering

Other Clinical Trials

Altered Auditory Feedback

Speech Sound Disorders (SSD)

  • Phonological Disorder is for Language DO

  • Articulation Disorder is for Speech DO

Types of Misarticulation

  • Omissions/deletions: Sounds are not produced.

  • Substitutions: One or more sounds are substituted.

  • Distortions: Correct phoneme is approximated but articulated incorrectly.

  • Whole-word/syllable-level errors: Weak syllables are deleted.

Diagnostic Criteria for SSD

Comorbidity

Course and prognosis

Assessment Guidelines

Treatment factor

Treatment approches

Language Overview

  • language structure is comprised of Content, Form and Use

Social (Pragmatic) Communication Disorder (SCD)

Causes of SCD

  • A family history of communication disorders, autism spectrum disorder, or speci c learning disorder increases the risk

  • Genetic in uences are contributing factors

  • multifactorial, with developmental and environmental in uences also playing a role

  • Differential Diagnosis: Autism Spectrum Disorder, Social Anxiety Disorder, Attention-Deficit/Hyperactivity Disorder, intellectual disability

Intervention

  • Main focus is improving Social interactions, social cognition, language processing, pragmatic skills

  • Interventions should include Direct and Indirect approches