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 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 of communication disorders.
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 Vocal Cord Polyps, Nodules, Granulomas, Papillomas Vocal cord nodules, polyps, granulomas, and papillomas are noncancerous (benign) growths that cause hoarseness and a breathy voice. Vocal cord polyps are often the result of an acute injury... read more . 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 may be caused by a cleft palate Cleft Lip and Cleft Palate A cleft is an opening that can form in the lip (cleft lip), roof of the mouth (cleft palate), or both if the tissue does not join together completely during pregnancy. Cleft lip and cleft palate... read more
or other facial defect Introduction to Birth Defects of the Face, Bones, Joints, and Muscles Birth defects, also called congenital anomalies, are physical abnormalities that occur before a baby is born. "Congenital" means "present at birth." Birth defects of the face and limbs are fairly... read more .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 of stuttering 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 Difficulty Swallowing Some people have difficulty swallowing (dysphagia). In dysphagia, foods and/or liquids do not move normally from the throat (pharynx) to the stomach. People feel as though food or liquids become... read more ), 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 Rehabilitation for Speech Disorders Rehabilitation services are needed by people who have lost the ability to speak normally, often because of an injury, a stroke, an infection, a tumor, surgery, or a progressive disorder. Aphasia... read more 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 Overview of Head Injuries Head injuries that involve the brain are particularly concerning. Common causes of head injuries include falls, motor vehicle crashes, assaults, and mishaps during sports and recreational activities... read more , intellectual disability Intellectual Disability Intellectual disability is significantly below average intellectual functioning present from birth or early infancy, causing limitations in the ability to conduct normal activities of daily... read more , hearing loss Hearing Impairment in Children Hearing impairment refers to any degree of hearing loss, mild to severe, and can occur when there is a problem with a part of the ear, including the inner, middle, and outer ears, or the nerves... read more 
, neglect or abuse Overview of Child Neglect and Abuse Child maltreatment includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (for example, clergy, coach, or teacher)... read more 
, autism Autism Spectrum Disorders Autism spectrum disorders are conditions in which people have difficulty developing normal social relationships, use language abnormally or not at all, and show restricted or repetitive behaviors... read more , or attention-deficit/hyperactivity disorder Attention-Deficit/Hyperactivity Disorder (ADHD) Attention-deficit/hyperactivity disorder (ADHD) is poor or short attention span and/or excessive activity and impulsiveness inappropriate for the child’s age that interferes with functioning... read more .
Some children appear to recover on their own. Others need language therapy.
Diagnosis of Communication Disorders
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. For example, if children cannot say at least two words by their first birthday, they may have a communication disorder.
More Information
The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
National Institute on Deafness and Other Communications Disorders: Information about speech and language developmental milestones, including checklists by age and links to related topics
