What Is Meant
by "Communication Disorders"?
The term communication disorders encompasses
a wide variety of problems in language, speech,
and hearing. Speech and language impairments
include articulation problems, voice disorders,
fluency problems (such as stuttering), aphasia
(difficulty in using words, usually as a result
of a brain injury), and delays in speech and/or
language. Speech and language delays may be due
to many factors, including environmental factors
or hearing loss.
Hearing impairments include partial hearing and
deafness. Deafness may be defined as a loss
sufficient to make auditory communication
difficult or impossible without amplification.
There are four types of hearing loss. Conductive
hearing losses are caused by diseases or
obstructions in the outer or middle ear and can
usually be helped with a hearing aid.
Sensorineural losses result from damage to the
sensory hair cells of the inner ear or the
nerves that supply it and may not respond to the
use of a hearing aid. Mixed hearing losses are
those in which the problem occurs both in the
outer or middle ear and in the inner ear. A
central hearing loss results from damage to the
nerves or brain.
Many communication disorders result from other
conditions such as learning disabilities,
cerebral palsy, mental retardation, or cleft lip
or cleft palate.
What Are Some Characteristics of Children with
Communication Disorders?
A child with speech or language delays may
present a variety of characteristics including
the inability to follow directions, slow and
incomprehensible speech, and pronounced
difficulties in syntax and articulation. Syntax
refers to the order of words in a sentence, and
articulation refers to the manner in which
sounds are formed. Articulation disorders are
characterized by the substitution of one sound
for another or the omission or distortion of
certain sounds.
Stuttering or dysfluency is a disorder of speech
flow that most often appears between the ages of
3 and 4 years and may progress from a sporadic
to a chronic problem. Stuttering may
spontaneously disappear by early adolescence,
but speech and language therapy should be
considered.
Typical voice disorders include hoarseness,
breathiness, or sudden breaks in loudness or
pitch. Voice disorders are frequently combined
with other speech problems to form a complex
communication disorder.
A child with a possible hearing problem may
appear to strain to hear, ask to have questions
repeated before giving the right answer,
demonstrate speech inaccuracies (especially
dropping the beginnings and endings of words),
or exhibit confusion during discussion.
Detection and diagnosis of hearing impairment
have become very sophisticated. It is possible
to detect the presence of hearing loss and
evaluate its severity in a newborn child.
Students who speak dialects different from
standard English may have communication problems
that represent either language differences or,
in more severe instances, language disorders.
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How Many Children Have Communication
Disorders?
The overall estimate for speech and language
disorders is widely agreed to be 5% of
school-aged children. This figure includes voice
disorders (3%) and stuttering (1%). The
incidence of elementary school children who
exhibit delayed phonological (articulation)
development is 2% to 3%, although the percentage
decreases steadily with age.
Estimates of hearing impairments vary
considerably, with one widely accepted figure of
5% representing the portion of school-aged
children with hearing levels outside the normal
range. Of this number, 10% to 20% require some
type of special education. Approximately
one-third of students who are deaf attend
residential schools. Two-thirds attend day
programs in schools for students who are deaf or
day classes located in regular schools. The
remainder are mainstreamed into regular school
programs.
What Are the Educational Implications of
Communication Disorders?
Many speech problems are developmental rather
than physiological, and as such they respond to
remedial instruction. Language experiences are
central to a young child's development. In the
past, children with communication disorders were
routinely removed from the regular class for
individual speech and language therapy. This is
still the case in severe instances, but the
trend is toward keeping the child in the
mainstream as much as possible. In order to
accomplish this goal, teamwork among the
teacher, speech and language therapist,
audiologist, and parents is essential. Speech
improvement and correction are blended into the
regular classroom curriculum and the child's
natural environment.
Amplification may be extremely valuable for the
child with a hearing impairment. Students whose
hearing is not completely restored by hearing
aids or other means of amplification have unique
communication needs. Children who are deaf are
not automatically exposed to the enormous
amounts of language stimulation experienced by
hearing children in their early years. For deaf
children, early, consistent, and conscious use
of visible communication modes such as sign
language, finger spelling, and cued speech
and/or amplification and aural/oral training can
help reduce this language delay. Some educators
advocate a strict oral approach in which the
child is required to use as much speech as
possible, while others favor the use of sign
language and finger spelling combined with
speech, an approach known as total
communication. There is increasing consensus
that whatever system works best for the
individual should be used.
Many children with hearing impairments can be
served in the regular classroom with support
services. In addition to amplification,
instructional aids such as captioned films and
high interest/low vocabulary reading materials
are helpful. For most children with hearing
impairments, language acquisition and
development are significantly delayed, sometimes
leading to an erroneously low estimate of
intelligence.
Students whose physical problems are so severe
that they interfere with or completely inhibit
communication can frequently take advantage of
technological advances that allow the individual
to make his or her needs and wants known,
perhaps for the first time.
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