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Communication Disorders

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Our voices, our speech and our language are all tools; all three must function properly if we are to communicate with each other. Our voice is mechanical; we push air from our lungs through the vocal cords in the larynx, they vibrate, and we make a sound. Speech is more complicated. The muscles of the tongue, lips, jaw and vocal tract coordinate the action of producing recognizable sounds that we call language. Language itself is not just expressed verbally; we make gestures, we write, and we sign. But all of these techniques conform to a set of shared rules that allow us to communicate and those rules comprise our language.

We begin to gain speech and language skills in infancy, when we learn that crying can produce needs like food or attention. Within a short time, we sort what we hear into speech sounds and begin to learn and understand language. This begins well before we speak. The first three years of life are crucial for acquiring language. In situations where this exposure and interaction do occur, the effect on our ability to communicate can last a lifetime.

The lifetime effect of communication disorders is supported by research into the correlation between language disorders and unemployment. One study revealed that participants who had difficulty in communication are unemployed at rate just over 40%. The rate of unemployment for individuals with speech disorder, in particular, stood at between 67 and 76 percent.

What is expressive language disorder?

People with expressive language disorder will either speak rarely or use language that is conspicuously less complex that than of their peers.  They may rely on gesturing instead of verbal speech.

Expressive language disorder can occur at any time during childhood as the effect of a trauma or a neurological disorder. It can also be a congenital and/or developmental disorder that is noticed when the child reaches the age at which they would normally begin to speak.  Children experiencing this disorder may also be hyperactive, disobedient, have temper tantrums and/or a short attention span, suck their thumbs, and be prone to accidents.

How prevalent is expressive language disorder?

Expressive language disorder is relatively uncommon. Three to five percent of school age children are diagnosed as having an expressive language disorder, two to three times as many boys as girls. There may be a genetic and/or environmental component, as it is most prevalent in families with a history of the disorder.

What is phonological disorder?

A phonological disorder causes mistakes in sound production, the substitute of one sound for another, or sounds such as final consonants are left out. A person may substitute an easily pronounced letter for one that is a bit hard to articulate; an example would be saying “wabbit” rather than rabbit. If a word begins with two consonants, only one may be used (such as saying “poon” rather than “spoon”. Blue can become “bu” and car can be pronounced “ca”.

Problems with the structure involved in speech production (the mouth, jaw, tongue, and larynx) or any neurological abnormalities must be ruled out, and otherwise normal language development must occur.

Accurate information about the prevalence of phonological disorder is scarce. However, experts estimate that 10 percent of children under the age of 8 and 5 percent over that age are diagnosed with this disorder. Boys are two to three times more likely to show the symptoms of phonological disorder than are girls. A large percentage of children diagnosed are found in large and/or low income families.

What is stuttering?

Stuttering consists of sound repetitions, prolongations, pauses within words and word substitutions to avoid blocking. To make this a bit easier to understand, repetitions sound like “th-th-this”, and “ttthis” is a prolongation. Sometimes, no sound at all is made. Stuttering can occur more frequently in certain situations or with certain words or sounds.

At one time, it was believed that stuttering was caused by a psychological disturbance. This theory has given way to the idea that the basis of stuttering lies in the incomplete use of both halves of the brain or a cerebral abnormality, while other experts believe that it’s a learned response to certain stimuli. The actual cause is most probably a combination of factors that include genetics and environment.

Stuttering develops in stages that begin during the preschool period; at this age, stuttering usually occurs as the result of excitement or when the child is upset. It can become chronic in the elementary school years, while, after the age of 8 and through early adolescence, stuttering comes and goes in response to certain situations or stressors. In late adolescence and adulthood, the person believes that they’re going to stutter and becomes embarrassed and fearful, avoiding occasions in which they must speak.

World history is filled with public figures who stuttered – Winston Churchill, King George IV (the subject of the very successful film, The King’s Speech), and the vice president of the United States, Joe Biden. In the entertainment industry, James Earl Jones, John Stossel (a newsman with the American Broadcasting Company (ABC)), singer Carly Simon, and actors Samuel L Jackson and Bruce Willis have all struggled with this disorder.

What treatments are available for communication disorders?

Recovery from phonological disorder is usually spontaneous and does not require intervention. However, effective treatment for the other communication disorders is available and can be crucial to the development and psychological well being of the child.  Language problems can cause a child to have a poor self-image, become frustrated or develop depression. For that reason, therapy should begin as soon as the diagnosis is made.

Therapy for expressive language disorder uses a behavioral approach, therapy includes work with phonemes (sound units such as the sound of “k” in kit or skill), and vocabulary and sentence structure building. Treatment for stuttering is based on the idea that it is a learned form of behavior and includes encouraging the person to overcome their fear and speak, even if that means that they will stutter.  Clients are helped to reduce their emotional reaction to stuttering and learn to just speak without thinking about it.

The Stuttering Foundation of America offers these suggestions for both parents and teacher of children who stutter.

  • Keep eye contact and give the child enough time to finish speaking.
  • Try not to fill in words or sentences.
  • Let him/her know by your manner and actions that you are listening to what they’re saying—not how they say it.
  • Model wait time – taking two seconds before you answer a child’s question – and insert more pauses into your own speech to help reduce speech pressure.

Therapy for communication disorders does not ignore the needs of the family; raising a child who has a language disorder can be difficult and parental counseling can be very helpful.

Where can I find help with communication disorders? 

The National Institute on Deafness and Other Communication Disorders, found at http://www.nidcd.nih.gov/, offers links to local therapists and support groups, as does the Speech Foundation of America. Sometimes I Just Stutter, a book written by Eelco de Geus for children aged 7 to 12 is available for download athttp://www.stutteringhelp.org/Default.aspx?tabid=209

References

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC: Author.

Kaplan, H.I., &Sadoc, B.J. (1996). Concise Textbook of Clinical Psychiatry. Baltimore, MD: Williams & Wilkins.

Ruben, R.R. (2000). Redefining the survival of the fittest: Communication disorders in the 21st century. The Laryngoscope, 110 (2), 241.