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Communication Disorders in Children

by Udayan K. Shah, MD

A communication disorder can involve hearing, voice, speech, language, or a combination.

More than 10% of children have a communication disorder. A disorder in one area of communication may affect another area. For example, hearing impairment disrupts the ability to adjust the pitch or tone of the voice and can lead to a voice disorder. Hearing loss caused by an ear infection (see Overview of Middle Ear Infections in Young Children) can interfere with language development. All communication disorders, including voice disorders, may interfere with performance at school and with social relationships.

There are several types.

Hearing impairment

Voice disorders

More than 6% of school-age children have a voice problem, most often hoarseness. These problems usually result from long-term overuse of the voice, speaking too loudly, or a combination. Many children with voice problems have small nodules on the vocal cords (see Vocal Cord Polyps, Nodules, and Granulomas). It is not clear how much the voice problems contribute to causing nodules or how much the nodules contribute to causing voice problems.

Nodules usually resolve with voice therapy and only rarely require surgery.

Speech disorders

In these disorders, the production of a speech sound is difficult. As a result, children are less able to communicate meaningfully. About 5% of children entering the first grade have a speech disorder. Speech disorders include the following:

  • Hypernasal voice quality or speaking through the nose: This disorder is typically caused by a cleft palate or other facial defect (see Facial Defects).

  • Stuttering: Developmental stuttering, the usual form of stuttering, typically begins between the ages of 2 years and 5 years and is more common among boys. The cause is unknown, but stuttering commonly runs in families. Nervous system disorders are not common causes of stuttering.

  • Articulation disorders: Children with these disorders have difficulty forming sounds because controlling and coordinating the muscles used to produce speech is difficult. Most children with an articulation disorder have no detectable physical cause but some have a nervous system disorder that impairs the coordination of muscles needed for speech. The impaired muscle coordination may also cause difficulty swallowing (dysphagia—see Difficulty Swallowing), and difficulty swallowing may become apparent before difficulty speaking. Hearing disorders and a defect of the tongue, lip, or palate can also impair articulation.

Speech therapy is helpful in many speech disorders. A cleft palate is almost always repaired surgically, but children still usually require speech therapy as well.

Language disorders

The ability to use, understand, or express language can be reduced in otherwise healthy children (called specific language impairment). Thus, the ability to communicate is greatly impaired, limiting educational, social, and vocational opportunities. This disorder occurs in about 5% of children and is more common among boys. Abnormal genes appear to play a role in many cases. Alternatively, language problems can develop because of another disorder, such as a brain injury, intellectual disability (see Intellectual Disability), hearing loss (see Hearing Impairment in Children), neglect or abuse (see Overview of Child Neglect and Abuse), autism (see Autism Spectrum Disorders), or attention-deficit/hyperactivity disorder (see Attention-Deficit/Hyperactivity Disorder).

Some children appear to recover on their own. Others need language therapy. Some respond poorly to therapy.


To diagnose voice and speech disorders, doctors examine the mouth, ears, and nose. Hearing tests are done, and the nervous system is assessed. If a voice disorder is suspected, doctors may look at the voice box with a mirror or a thin, flexible viewing tube (called a nasopharyngolaryngoscope), which is inserted through the nose.

Language disorders are diagnosed by comparing the child’s language with that expected for children of the same age.

Most important, parents or caretakers should be alert for communication problems in children and should contact a doctor if they suspect such a problem. Checklists of communication developmental landmarks are available and can help parents and caregivers detect a problem (see National Institute on Deafness and Other Communications Disorders ). For example, if children cannot say at least two words by their first birthday, they may have a communication disorder.