Part Two of Neurodevelopmental Disorders covers disorders of communication. These include Language Disorder, Speech Sound Disorder, Social (Pragmatic) Communication Disorder, and Childhood-Onset Fluency Disorder, all of which are discussed below.
Have you ever been in the middle of a conversation and suddenly could not find the right word? What about getting “word salad,” or when you pick the wrong word, while trying to tell a story? While occasionally experiencing these issues is normal, the persistent inability to structure a sentence and/or use appropriate vocabulary is considered Language Disorder.
Persons with Language Disorder have significant trouble with multiple forms of language, including, but not limited to: speaking, writing, sign language, and so forth. These difficulties cause additional issues with producing and comprehending language.
Criteria for Diagnosis
There are four requirements for diagnosis with Language Disorder. Two of these requirements are that the symptoms and difficulties began during the early developmental period of the person and that they are not due to another neurodevelopmental disorder, as discussed in Part One of Neurodevelopmental Disorders.
Diagnosis with Language Disorder also requires that the individual have: a limited vocabulary and knowledge about how to use words; a limited ability to form sentences based on grammar rules; and, an impaired ability to tell a story, connect sentences, and/or hold a conversation. These difficulties must also be below the ‘normal’ standard for the individual’s current age and cause them functional issues in social, academic, and/or occupational contexts or situations (Diagnostic and Statistical Manual of Mental Disorders, 2013).
Childhood Onset Fluency Disorder
Actor James Earl Jones has one of the most famous voices; it is recognized across generations. He was the voice of Darth Vader in the 70s and 80s, Mufasa in The Lion King movies, and he is currently the voice that introduces CNN. Did you know that this famous actor and voiceover artist once had a severe stutter?
Childhood-onset Fluency Disorder, commonly referred to as stuttering, is a “disturbance in the normal fluency and time patterning of speech” (Diagnostic and Statistical Manual of Mental Disorders, 2013). Disturbances include, but are not limited to, pausing between syllables of a word, pausing between words, and repeating monosyllabic words, such as “I, I, I, I”. The magnitude of speech disruption is dependent upon the stress a person is under to communicate, like making a public speech.
Criteria for Diagnosis
Although it may seem that diagnosis would be as simple as acknowledging that an individual is stuttering, there are still specific criteria to be met. Diagnosis requires a disturbance in fluency that occurs in one or more of the following ways: repeating sounds and syllables, pausing within words, substituting words in order to avoid a challenging word, repeating words that have one syllable, placing excess emphasis on words or syllables, pausing within speech, and extension of sounds of consonants and vowels. These disturbances must cause nervousness and apprehension about speaking and/or limit the individual’s ability to effectively communicate (Diagnostic and Statistical Manual of Mental Disorders, 2013).
Social (Pragmatic) Communication Disorder
Have you ever participated in a conversation where the other person continuously interrupted your speaking? What about talking with someone who never makes eye contact? Have you ever thought to yourself that someone persistently violated your personal space and they seemed to not notice? What about when an adult is talking to a child as though they understand incredibly formal language? Each of these examples deals with verbal and nonverbal pragmatic skills.
Social (Pragmatic) Communication Disorder is a difficulty with pragmatics, which is what you say, how you say it, and what your body communicates. It also refers to understanding “the knowledge and beliefs of the speaker and the relation between the speaker and the listener” (Pragmatics, n.d.). Some features of this disorder are a misunderstanding and/or not following social rules and cues, a misinterpreting of verbal and nonverbal indicators, and not “changing language according to the needs of the listener or situation” (Diagnostic and Statistical Manual of Mental Disorders, 2013).
Criteria for Diagnosis
The first criterion for diagnosis with Social (Pragmatic) Communication Disorder is “persistent difficulties in the social use of verbal and nonverbal communication” (Diagnostic and Statistical Manual of Mental Disorders, 2013). Diagnosis requires that difficulties be seen in four areas. One, communicating for social purposes, which includes greetings that are appropriate for the time and place; two, altering style of speech and the use of vocabulary to match the audience and the environment; three, not interrupting while others are speaking, aligning verbal and nonverbal cues, and clarifying oneself if misunderstood; and fourth, “understanding what is not explicitly stated and nonliteral or ambiguous meanings of language” (Diagnostic and Statistical Manual of Mental Disorders, 2013).
The remaining criterions for diagnosis with Social (Pragmatic) Communication Disorder are the same as with all neurodevelopmental disorders. The deficits must cause disturbances or create limitations across multiple contexts: social, academic, occupational; the symptoms must begin in the persons early developmental period; and, the symptoms must not be better explained by another disorder.
Speech Sound Disorder
It is hard to stop oneself from babbling at a baby and it can be very rewarding when the baby babbles in reply! In fact, if babbling were intelligible, understanding the wants and needs of babies and toddlers would be much easier. It is perfectly normal for babies and toddlers to have unintelligible speech, however, by the age of four, it is developmentally appropriate for children to be easily understood though verbal communication. Continued issues producing sounds is considered Speech Sound Disorder.
Criteria for Diagnosis
An individual is given the diagnosis of Speech Sound Disorder when they have consistent problems producing the sounds that form words. This problem causes their speech to be unintelligible and/or prevents their message from being communicated verbally. Thusly, this difficulty interferes with their “social participation, academic achievement, and/or occupational performance” (Diagnostic and Statistical Manual of Mental Disorders, 2013).
There are two additional criterion for diagnosis with Speech Sound Disorder, and they are the same as with the other neurodevelopmental disorders. The difficulties must cause disturbances or create limitations across multiple contexts; the symptoms must begin in the persons early developmental period; and, the symptoms must not be better explained by another disorder. Some of the disorders that must be ruled out prior to diagnosing an individual with Speech Sound Disorder, include but are not limited to: cleft palate, hearing loss, cerebral palsy, and/or a traumatic brain injury.
The final installation of Neurodevelopmental Disorders! Part Three covers disorders of movement! Stay tuned!
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 6 January 2018]. dsm.psychiatryonline.org
Pragmatics. (n.d.). Retrieved January 11, 2018, from http://www.dictionary.com/browse/pragmatics?s=t