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Communication Disorders in Children


Udayan K. Shah

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Sep 2020| Content last modified Sep 2020

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 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

See Hearing Impairment in Children.

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. 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.
  • 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), 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, hearing loss, neglect or abuse, autism, or attention-deficit/hyperactivity disorder.

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

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