Pediatric Therapy Services

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Communication disorders can be a source of frustration for children as well as their parents and caregivers, which is why they are so often misdiagnosed as behavioral problems. Identifying a communication disorder requires some thoughtful and continued observation, as well as the help of a trained professional. If your child exhibits several or all of the following challenges, he/she may be struggling with a communication disorder:

• Difficulty understanding questions or following directions
• Difficulty making requests/demands
• Sentences with words in the wrong order or disorganized stories
• Grammatical errors involving tense (goed/went), plurals (geeses/geese) and pronouns (her/his)
• Limited vocabulary
• Short and disconnected sentences
• Difficulty producing and sequencing the speech sounds
• Difficulty with pitch, volume, tone and other qualities of voice
• Problems with normal fluency and flow of speech

If a family is concerned about their child’s communication development, a consultation with a licensed speech–language pathologist is recommended.

Articulation: Articulation disorders involve issues with sound production usually characterized by substituting one sound for another (e.g., wabbit for ‘rabbit’), omitting a sound (e.g., ca for ‘car’), adding a sound (e.g., adding an unnecessary sound to an appropriately pronounced word), or distorting a sound (e.g., saying ‘sock’ with a distorted /s/ sound that cannot be clearly distinguished as another sound). These errors make it difficult – if not impossible – for people to understand your child’s intentions, in which case the speech is deemed “unintelligible.”

Fluency: The umbrella term, “fluency disorders” is used to include stuttering (i.e., involuntary pauses, repetition of sounds, and blocks) and cluttering (too-rapid speech with an odd rhythm). Stuttering can consist of both primary and secondary behaviors. A primary behavior is the speech difficulty that occurs, such as a repetition of a sound, syllable, word or phrase, while a secondary behavior could involve physical tension of the mouth, excessive blinking of the eyes, or avoiding specific sounds.

Voice: Voice difficulties are related to abnormalities in voice quality, pitch, and loudness that are inappropriate for an individual's age, gender, and/or cultural background. Voice disorders can be recognized based on some of the following signs and symptoms: 

• Hoarse sounding voice
• Breathy sounding voice
• Scratchy sounding voice
• Rough sounding voice 
• Speaking at an unnatural pitch 
• Vocal fatigue
• Complaints of a lump in the throat 

Apraxia of Speech: There are two forms of apraxia of speech. Acquired apraxia and childhood apraxia of speech. Acquired apraxia can occur in people of all ages. This condition causes people to lose the speech-making abilities that they once had. Childhood apraxia of speech is present from birth. It is a disorder in which the brain cannot coordinate the muscle movements of the mouth, tongue, jaw, and lips in order to correctly produce sounds, syllables, and words. Some of the most common warning signs that should suggest seeking professional care include:

• Little vocal play or babbling
• Robotic sounding speech
• Omission of essential sounds
• Difficulty imitating words on request
• Inconsistency in sound production
• Groping with the tongue, lips, or jaw when attempting to speak
• Behavioral disorders, temper tantrums, and inflexibility in social situations

Receptive Language: Receptive language refers to the ability to understand others and comprehend the meaning behind written or spoken words. Receptive language disorders can cause difficulties with following directions, understanding instructions at home or within the educational setting, or responding appropriately to questions and requests.

Expressive Language: Expressive language refers to the ability to communicate thoughts and feelings through words, gestures, signs, and/or symbols. An expressive language disorder is one in which the person struggles to get their meaning or messages across to other people.

Pragmatic Language: Pragmatic language disorders, also referred to as a social communication disorder, involve impairment in understanding and/or use of social aspects of language. Children with pragmatic language disorders or social communication disorders may exhibit the following challenges: 

• Making inappropriate or unrelated comments during conversation
• Inability to introduce or maintain a topic
• Difficulty taking turns during conversation 
• Trouble making eye contact during conversation
• Trouble relating to peers 
• Trouble using variation in their language
• Inability to make inferences or understand jokes 

Cognitive communication disorders involve a wide array of communication difficulties, including the inability to use meaningful speech, write and gesture, or interact in social situations. It also causes memory issues, challenges with organization and problem solving skills due to damage to the areas of the brain that controls the ability to think. Cognitive communication disorders can be caused by a number of factors, including but not limited to:

• Birth defects
• Neurological disorders (e.g., Cerebral palsy) 
• Traumatic brain injury (TBI) 
• Stroke 
• Tumors 
• Diseases 

• ASHA
• CSHA
• Autism Speaks
• The Stuttering Foundation
• Apraxia-Kids
• National Down Syndrome Society 
• Birth Injury Center