In my last entry, I offered some reasons for why children with ADHD may be evaluated for speech and language problems. In this entry, I'd like to continue along the same lines and discuss some of the specific disorders that cause problems for children.
Early in the evaluation of a child suspected of a communication disorder, it is necessary to ensure that the child can hear correctly. If the ability to hear is seriously in question in a child, hearing testing with an audiologist could be considered. This may be the only way to identify a subtle deficit in hearing that is causing problems with communication. In addition to hearing deficits, a cleft palate may be the root of a problem with communication. Neurological problems like cerebral palsy, apraxia, and aphasia can also cause problems with speech or language. Mental retardation is also a condition that very commonly results in a problem with communication, and standard tests of intelligence can often be helpful. As I said in my last entry, many medical problems respond better with early intervention, so it is not uncommon that a visit to a child psychiatrist's office results in a referral to an audiologist, psychometric testing, and/or a neurologist to ensure that no other illnesses are causing the child difficulty.
In addition to considering these medical issues, psychiatric disorders can cause speech or language problems, most notably autism. A detailed discussion of the psychiatric disorders that cause communications problems may be a topic of a future entry.
When considering whether a child has a communication problem, one of the first steps is evaluating whether the child has a delay or a disorder. Children may have delays in the development of speech or language, meaning they have not achieved milestones generally accepted as normal for a child's age. A delay in speech or language is a consideration if the child's words are different from other children in the same age, if a child hasn't spoken by age 1, or if the speech of a child is regularly unclear.
Children can also have disorders of speech or language which speak to a problem independent of development. Speech disorders include problems with the generation of speech and include stuttering and other problems with the fluency of speech, unusual characteristics in the quality of the child's voice, and problems articulating words. Language problems often involve problems with vocabulary, grammar, the rules and system involved in speech sound production, and problems with morphology. Problems with morphology involve difficulties with the rules that apply to the meaning of word units.
This is only the tip of the iceberg. There are many other subsets of speech and language disorders, and if a child has one, he or she often has another. This is why it's necessary to have a trained clinician assess a child and prescribe an appropriate course of therapy.