04 - 31.4 Communication Disorders

31.4 Communication Disorders

2005;11:331. Ismail S, Buckley S, Budacki R, Jabbar A, Gallicano GI. Screening, diagnosing and prevention of fetal alcohol syndrome: Is this syndrome treatable? Dev Neurosci. 2010;32:91–100. Obi O, Braun KVN, Baio J, Drews-Botsch C, Devine O, Yeargin-Allsopp M. Effect of incorporating adaptive functioning scores on the prevalence of intellectual disability. Am J Intellect Dev Disabil. 2011;116:360–370. Reyes M, Croonenberghs J, Augustybs I, Eerdekens M. Long-term use of risperidone in children with disruptive behavior disorders and subaverage intelligence: Efficacy, safety, and tolerability. J Child Adolesce Psychopharmacol. 2006;16:60– 27. Rowles BM, Findling RL. Review of pharmacotherapy options for the treatment of attention-deficit/hyperactivity disorder (ADHD) and ADHD-like symptoms in children and adolescents with developmental disorders. Dev Disabil Res Rev. 2010;16:273–282. Stuart H. United Nations convention on the rights of persons with disabilities: A roadmap for change. Curr Opin Psychiatry.2012;25:365–369. Sturgeon X, Le T, Ahmed MM, Gardiner KJ. Pathways to cognitive deficits in Down syndrome. Prog Brain Res. 2012;197:73–100. United Nations General Assembly. Convention on the Rights of Persons with Disabilities (CRPD). Geneva: United Nations; December 13, 2006. Wijetunge LS, Chatterji S, Wyllie DJ, Kind PC. Fragile X syndrome: From targets to treatments. Neuropharmacology. 2013;68:83–96. Willen EJ. Neurocognitive outcomes in pediatric HIV. Ment Retard Dev Disabil Res Rev. 2006;12:223–228. 31.4 Communication Disorders Communication disorders range from mild delays in acquiring language to expressive or mixed receptive–expressive disorders, phonological disorders, and stuttering, which may remit spontaneously or persist into adolescence or even adulthood. Language delay is one of the most common very early childhood developmental delays, affecting up to approximately 7 percent of 5-year-olds. The rates of language disorders are understandably higher in preschoolers than in school-age children; rates were reported to be close to 20 percent of 4-year-olds in the Early Language in Victoria Study (ELVS). To communicate effectively, children must have a mastery of multiple aspects of language—that is, the ability to understand and express ideas—using words and speech, and express themselves in vernacular language. In the Fifth Edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Language Disorder includes both expressive and mixed receptive–expressive problems. DSM-5 speech disorders include Speech Sound Disorder (formerly known as Phonological Disorder) and Childhood-Onset Fluency Disorder (Stuttering). Children with expressive language deficits have difficulties expressing their thoughts with words and sentences at a level of sophistication expected for their age and developmental level in other areas. These children may struggle with limited vocabularies, speak in sentences that are short or ungrammatical, and often present descriptions of situations that are disorganized, confusing, and infantile. They may be delayed in developing an understanding and a

memory of words compared with others their age. Children with language disorder are at higher risk for developing reading difficulties. Current expert consensus considers reading comprehension impairment a form of language impairment, distinct from other reading deficits such as dyslexia. Language and speech are pragmatically intertwined, despite the distinct categories of language disorders and speech disorders in DSM-5. Language competence spans four domains: phonology, grammar, semantics, and pragmatics. Phonology refers to the ability to produce sounds that constitute words in a given language and the skills to discriminate the various phonemes (sounds that are made by a letter or group of letters in a language). To imitate words, a child must be able to produce the sounds of a word. Grammar designates the organization of words and the rules for placing words in an order that makes sense in that language. Semantics refers to the organization of concepts and the acquisition of words themselves. A child draws from a mental list of words to produce sentences. Children with language impairments exhibit a wide range of difficulties with semantics that include acquiring new words, storage and organization of known words, and word retrieval. Speech and language evaluations that are sufficiently broad to test all of the preceding skill levels will be more accurate in evaluating a child’s remedial needs. Pragmatics has to do with skill in the actual use of language and the “rules” of conversation, such as pausing so that a listener can answer a question and knowing when to change the topic when a break occurs in a conversation. By age 2 years, toddlers without speech or language delay may know a few words or up to 200 words, and by age 3 years, most children understand the basic rules of language and can converse effectively. Table 31.4a-1 provides an overview of typical milestones in language and nonverbal development. Table 31.4a-1 Normal Development of Speech, Language, and Nonverbal Skills in Children

Over the last decade there have been an increasing number of investigative studies of speech and language interventions with positive outcomes identified in numerous areas of language. These include improvements in expressive vocabulary, syntax usage, and overall phonologic development. Most interventions are targeted strategies for the child’s particular deficit, and delivered by speech and language therapists.