Communication Disorders: Stuttering and Prevalence / Diagnosis of Communication Disorders
Stuttering is a speech production disorder characterized by the repeated and involuntary disruption of the smooth flow of speech. Children (and adults) who stutter find themselves unable to keep from compulsively repeating words and/or prolonging the pronunciation of various speech sounds and syllables. Children who stutter often feel pronounced fear and anxiety, especially when they are forced into speaking under pressure. In some cases, their struggle with language and speech becomes so emotionally painful that they try to avoid speaking altogether.
Symptoms of stuttering include:
- Disturbances in the time pattern, rhythm and flow of speech (e.g., the introduction of inappropriate pauses within words)
- Repetition of words or sounds
- Interjections (frequent use of "um" or "ah")
- Monosyllabic whole-word repetitions (e.g., I-I-I-I know)
- Lengthy pauses in sentences
- Sound prolongations
- Heightened fear and/or anxiety surrounding speech or speaking
- Avoidance of speaking (in some cases)
According to the DSM, children must display one or more of the above symptoms to be diagnosed with Stuttering. Symptoms must also significantly interfere with the child's academic, occupational, or social communication.
Having described the subtypes of communication disorders, we're now in a position to describe how common they are and how they are treated.
Prevalence of Communication Disorders
Communication disorders are relatively common. According to the American Speech, Language, Hearing Association, 24.1% (or 1,460,583) of children in public schools receiving special education services under the Individuals with Disabilities Education Act (IDEA) have communication disorders. Acquired language disorders (which arise after a period of normal development and result from hearing loss or some other type of trauma) appear to be less common than developmental types (which are present from very early on in children's development).
Some subtypes of communication disorders are more common than others. According to the DSM, 3 to 7% of children have Expressive Language Disorder, whereas Mixed Receptive-Expressive Language Disorder is found in only 3% of school-aged children. Phonological Disorder occurs in about 2% of 6-7 year-olds, but over time most children develop out of this condition so that by age 17 only 0.5% still meet the diagnostic criteria. Stuttering is present in about 1% of children age 10 and younger, and also declines over time. By late adolescence only 0.8% of children have Stuttering Disorder.
All Communication Disorders are more common in boys than in girls. For example, boys are three times more likely to develop a stuttering disorder than are girls.
Diagnosis of Communication Disorders
Children who seem to have any symptoms of a Communication Disorder should be assessed by a professional who is knowledgeable about normal milestones of speech and language development (e.g., a child psychologist, counselor, speech therapist or speech pathologist). Since these disorders are common, many schools employ in-house or consulting speech therapists who can assist in the diagnostic and treatment process.
As with many other conditions, the formal diagnosis of a communications disorder requires that special testing occur. With younger children, communication assessments may be conducted within the context of a play situation so as to help keep these children at ease. Older children may simply be presented with tests or be interviewed by an examiner knowledgeable about speech pathology. A variety of testing tools may be used during an assessment. The Illinois Test of Psycholinguistic Abilities (ITPA), is a good example of this sort of test. The ITPA is designed to measure how well children between the ages of 4 and 8 acquire and use language. It measures 12 language functions including Visual Association (the ability to recognize and associate objects with words), Verbal Expression (the ability to express information using spoken language), and Auditory Sequential Memory (the ability to recall information, such as a sequence of numbers or the letters of the alphabet, in the proper order).
Beyond a child's raw performance on speech tests, assessors will frequently consult with teachers to help them round out their appreciation of the child's functional deficits. Teachers are also a good source of information about how children are progressing after they have been diagnosed and started in speech therapy. You may want to speak with your health care professional about how best to obtain information from your child's teacher regarding his or her learning progress in the classroom setting.