Preparation for Child Psych PRITE and Boards
Revision as of 18:28, 9 September 2016 by Eugene Grudnikoff MD (Talk | contribs) (Diagnostic considerations)

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Disorders of communication are diagnosed in children with impairing deficits in language, speech, and communication. These terms are used interchangeably in the community, but actually refer to specific and distinct aspects of communication:

Language is a comprehensive system of verbal, written, or visual symbols used for communication. American Sign Language is one such system.

Speech is the production of sounds for the purpose of communication.

Communication is a general term for verbal and non-verbal behaviors, including unintentional behaviors, that carry some meaning to others.

Dysarthria is difficult or unclear articulation of speech that is otherwise linguistically normal.

  • Dysarthria may be a symptom of a neurodevelopmental disorder (speech sound disorder, intellectual disability), or organic problem (traumatic brain injury, stroke, cerebral palsy)

Diagnostic considerations

Visual summary of concepts and DSM-5 diagnoses of disorders of communication

Communication disorders are categorized under the Neurodevelopmental Disorders in the DSM-5 and thus, have an onset during the developmental period. Included are:

Language disorder (F80.9)

  • This disorder involves persistent difficulty in acquisition and use of language; it begins in early developmental period and can involve both receptive and expressive deficits.
    • Language disorder may involve difficulty with vocabulary, difficulty with putting words together in sentences (grammar and morphology), or difficulty using language to express an idea or discourse.
  • Prevalence is estimated at 8% at its peak, in 5-year-olds. (Toppelberg CO, JAACAP, 2000:39)

Speech sound disorder (F80.0)

  • This involves persistent difficulty with speech sound production that interferes with communication. Speech sound disorder is frequently co-morbid with language disorder.
  • It is important to consider deafness, regional dialects, organic causes of dysarthria (cerebral palsy, TBI, cleft palate), and selective mutism before diagnosing SSD.
  • Mostly intelligible speech is expected by 4 years of age. More advanced sounds (l, r, s, z) should be pronounced correctly by age 8.
  • Prevalence is about 4% in 6-year-olds, and higher in boys than girls.
  • Speech sound disorders involve difficulty with organization and perception of sounds (phonological disorder), and/or difficulty with coordinated vocalization of these sounds (articulation disorder).

Childhood-onset fluency disorder/stuttering (F80.81)

  • This disorder involves difficulty with speech fluency, and often involves fearful anticipation and avoidance behaviors. The onset is usually before 7 years of age.
  • Tourette's and tic disorders are important to rule out during evaluation

Social (pragmatic) communication disorder (F80.89)

  • Involves difficulty with social use of language and communication.

Other impairing communication disorders can be classified as Unspecified communication disorder (307.9/F80.9)

Evaluation and Treatment

  • careful diagnostic evaluation involves evaluation for sensory deficits, particularly hearing, neurological exam, and referral for standardized testing for learning and intellectual disabilities.
  • Communication disorders are not diagnosed in the presence of congenital or other acquired conditions, such as dysarthria associated with cerebral palsy or cleft palate, receptive language difficulties associated with intellectual disability, or Landau-Kleffner syndrome.
  • identifying co-morbid conditions is paramount for appropriate intervention
  • early referral to speech pathologist.