Disorders of communication include deficits in language, speech, and communication.
Speech is the expressive production of sounds and includes an individual’s articulation, fluency, voice, and resonance quality. Language includes the form, function, and use of a conventional system of symbols (i.e., spoken words, sign language, written words, pic- tures) in a rule-governed manner for communication. Communication includes any verbal or nonverbal behavior (whether intentional or unintentional) that inﬂuences the behavior, ideas, or attitudes of another individual. Assessments of speech, language and communi- cation abilities must take into account the individual's cultural and language context, particularly for individuals growing up in bilingual environments. The standardized mea— sures of language development and of nonverbal intellectual capacity must be relevant for the cultural and linguistic group (i.e., tests developed and standardized for one group may not provide appropriate norms for a different group). The diagnostic category of commu- nication disorders includes the following: language disorder, speech sound disorder, childhood-onset ﬂuency disorder (stuttering), social (pragmatic) communication disor- der, and other specified and unspecified communication disorders.
Diagnostic Criteria 315.39 (F80.9)
A. Persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written. sign language, or other) due to deficits in comprehension or produc- tion that include the following: 1. Reduced vocabulary (word knowledge and use).
2. Limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology).
3. Impairments in discourse (ability to use vocabulary and connect sentences to ex- plain or describe a topic or series of events or have a conversation).
B. Language abilities are substantially and quantitiably below those expected for age, re- sulting in functional limitations in effective communication, social participation, aca- demic achievement. or occupational performance, individually or in any combination.
C. Onset of symptoms is in the early developmental period.
D. The difficulties are not attributable to hearing or other sensory impairment. motor dys- function, or another medical or neurological condition and are not better explained by in- tellectual disability (intellectual developmental disorder) or global developmental delay.
The core diagnostic features of language disorder are difficulties in the acquisition and use of language due to deficits in the comprehension or production of vocabulary, sentence structure, and discourse. The language deficits are evident in spoken communication, written communication, or sign language. Language learning and use is dependent on both receptive and expressive skills. Expressive ability refers to the production of vocal, ges- tural, or verbal signals, while receptive ability refers to the process of receiving and com- prehending language messages. Language skills need to be assessed in both expressive and receptive modalities as these may differ in severity. For example, an individual’s ex- pressive language may be severely impaired, while his receptive language is hardly im- paired at all.
Language disorder usually affects vocabulary and grammar, and these effects then limit the capacity for discourse. The child’s first words and phrases are likely to be delayed in onset; vocabulary size is smaller and less varied than expected; and sentences are shorter and less complex with grammatical errors, especially in past tense. Deficits in com- prehension of language are frequently underestimated, as children may be good at using context to infer meaning. There may be word-finding problems, impoverished verbal def- initions, or poor understanding of synonyms, multiple meanings, or word play appro- priate for age and culture. Problems with remembering new words and sentences are manifested by difficulties following instructions of increasing length, difficulties rehears- ing strings of verbal information (e.g., remembering a phone number or a shopping list), and difficulties remembering novel sound sequences, a skill that may be important for learning new words. Difficulties with discourse are shown by a reduced ability to provide adequate information about the key events and to narrate a coherent story.