Communication in children can be disordered because of a problem with voice, hearing, speech, language, or a combination. Diagnosis involves evaluation of each of these components.
More than 10% of children have a communication disorder. A disorder in one component may affect another component. For example, hearing impairment impairs voice modulation and can lead to disordered voice. Hearing loss due to otitis media can interfere with language development. All communication disorders, including voice disorders, may interfere with academic performance and social relationships.
More than 6% of school-age children have a voice problem, most often hoarseness. The cause is often chronic overuse of the voice and/or speaking too loudly. The most common corresponding anatomic abnormality is vocal cord nodules (see Vocal Cord Polyps, Nodules, and Granulomas). Other laryngeal lesions or endocrine abnormalities may also contribute. Hearing loss can contribute by impairing the ability to sense voice volume and thus modulate voice force. Nodules usually resolve with voice therapy and only rarely require surgery.
For a discussion of hearing disorders, see Hearing Impairment in Children.
About 5% of children entering first grade have a speech disorder. In speech disorders, speech production is impaired. Speech disorders include the following:
Speech therapy is helpful in many primary speech disorders. Children who have lesions that cause velopharyngeal insufficiency generally require surgery as well as speech therapy.
About 5% of otherwise healthy children have difficulty with language comprehension or expression (called specific language impairment). Boys are more often affected, and genetic factors probably contribute. Alternatively, language problems can develop secondary to another disorder (eg, traumatic brain injury, intellectual disability, hearing loss, neglect or abuse, autism, attention-deficit/hyperactivity disorder).
Children may benefit from language therapy. Some children with specific language impairment recover spontaneously.
Parents can be taught to seek medical attention if a child has impaired communication (eg, inability to say at least 2 words by the first birthday). Assessment should include neurologic and ENT examinations. Hearing and language are assessed; laryngoscopy should be considered if a voice disorder (eg, hoarseness, breathy voice) is suspected.
Last full review/revision April 2014 by Udayan K. Shah, MD
Content last modified April 2014