Language and Speech Disorders
Developmental Articulation Disorder
The essential feature of this disorder is a consistent failure to make correct
articulations of speech sounds, at the developmentally appropriate age, that is
not due to a Pervasive Developmental Disorder, Mental Retardation, impairment
of the oral speech mechanism, or neuralgic, intellectual, or hearing impairments.
The disorder is manifested by frequent misarticulations, substitutions, or
omissions of speech sounds, giving the impression of "baby talk."
The speech sounds that are most frequently misarticulated are those
acquired later in the developmental sequence (r, sh, th, f, z, I, and ch); but in
more severe cases or in younger children, sounds such as b, m, t, d, n, and h
may be mispronounced. One or many speech sounds may be affected, but vowel
sounds are not among them.
There is a considerable range in the severity of the disturbance. The child's
speech may be completely intelligible, partially intelligible, or unintelligible.
Associated features. Other Specific Developmental Disorders are commonly
present, including: Developmental Expressive Language Disorder,
Developmental Receptive Language Disorder, Developmental Reading Disorder,
and Developmental Coordination Disorder. Functional Enuresis may also be
present.
A delay in reaching speech milestones (such as "first word" and "first
sentence") has been reported in some children with Developmental Articulation
Disorder, but most children with this disorder begin speaking at the appropriate
age.
Age at onset. In severe cases, the disorder is recognized at about age three.
In less severe cases, the disorder may not be apparent until age six.
Course. With speech therapy, complete recovery occurs in virtually all cases
In milder cases, spontaneous recovery may occur before the age of eight
years.
Prevalence. A conservative estimate is that approximately 10% of children
below age eight, and approximately 5% of children aged eight years or older,
have the disorder.
Familial pattern The disorder is more common among first-degree biologic
relatives than in the general population.
Differential diagnosis. Misarticulations caused by physical abnormalities can
be ruled out by physical examination: if there is a hearing impairment,
audiometric testing will reveal an abnormality; with dysarthria or apraxia, there
will be muscular weaknesses, oral mechanism defects, or a neuralgic disorder,
and there may be problems with chewing or sucking, drooling, and rate of
speech.
In Mental Retardation there is a general impairment in intellectual functioning that
is not present in Developmental Articulation Disorder. In Pervasive
Developmental Disorders there are pervasive behavioral abnormalities not
present in Developmental Articulation Disorder.
(Diagnostic Criteria for Developmental Articulation Disorder)
A. Consistent failure to use developmentally expected speech sounds. For
example, in a three-year-old, failure to articulate p, b, and t, and in a
six-year-old, failure to articulate r, sh, th, f, z, and L.
B. Not due to a Pervasive Developmental Disorder, Mental Retardation,
defect in hearing acuity, disorders of the oral speech mechanism, or a
neuralgic disorder.
Developmental Expressive Language Disorder
The essential feature of this disorder is marked impairment in the development of
expressive language that is not explainable by Mental Retardation or inadequate
schooling and that is not due to a Pervasive Developmental Disorder, hearing
impairment, or a neuralgic disorder. The diagnosis is made only if this impairment
significantly interferes with academic achievement or with activities of daily living
that require the expression Of verbal (or sign) language.
The linguistic features of Developmental Expressive Language Disorder are
varied arid depend on the severity of the disorder and the age of the child.
Nonlinguistic functioning, however, is usually within normal limits. Among the
expressive language limitations that may be present are: limited size of
vocabulary, difficulty acquiring new words, vocabulary errors (such as
substitutions, circumlocutions, overgeneralizations or jargon), shortened
sentences, simplified grammatical structures, limited varieties of grammatical
structures (such as verb forms), limited varieties of sentence types (such as
imperatives, questions, etc.), omissions of critical parts of sentences, unusual
word order, tangential responses, and slow rate of language development
(speech beginning late, and advancement through stages of language
development progressing slowly).
Associated Features. Developmental Articulation Disorder is often present. In
older children, school and learning problems (particularly in tasks involving
perceptual or sequencing skills) may be present. A history of delay in reaching
some motor milestones, Developmental Coordination Disorder, and Functional
Enuresis are not uncommon. Emotional problems, social withdrawal, and
behavioral difficulties may be present.
Age at onset. Severe forms usually occur before age three and are easily
recognized. Less severe forms may not occur until early adolescence, when
language ordinarily becomes more complex.
Course. For a young child with mild Developmental Expressive Language
Disorder, the prognosis is very good. As many as 50% of the children with this
disorder may spontaneously catch up in their expressive language abilities
before they reach school age and thus not require any specialized help. In more
severe cases, recovery is slower; but most children with Developmental
Expressive Language Disorder not complicated by Developmental Receptive
Language Disorder do acquire normal language abilities by late
adolescence.
Prevalence. Estimates range from 3% to 10% of school-age children.
Familial pattern. It appears that the disorder is more likely to occur in people
who have a family history of Developmental Articulation Disorder or other
Specific Developmental Disorders.
Differential diagnosis. In Mental Retardation there may be impaired language
functioning, but it is associated with the general impairment in intellectual
functioning. Impaired hearing may also produce abnormal expressive language
functioning, and should be ruled out by audiometric testing. In Pervasive
Developmental Disorders, in which expressive language impairment may be
present, there is little or no attempt to communicate nonverbally (e.g., through
gestures). Elective Mutism involves limited expressive output that may mimic
Developmental Expressive Language Disorder, but upon formal testing,
comprehension is found to be within normal limits. Acquired aphasia is
distinguished from Developmental Expressive Language Disorder by a history of
onset associated with head trauma, seizures, or EEG abnormalities, or by "hard"
neuralgic signs such as hemiplegia.
(Diagnostic Criteria For Developmental Expressive Language Disorder)
A. The score obtained from a standardized measure of expressive language
is substantially below that obtained from a standardized measure of
nonverbal intellectual capacity (as determined by an individually
administered lQ test).
B. The disturbance in (A) significantly interferes with academic achievement
or activities of daily living requiring the expression of verbal (or sign)
language. This may be evidenced in severe cases by use of a markedly
limited vocabulary, by speaking only in simple sentences, or by speaking
only in the present tense. In less severe cases, there may be hesitations or
errors in recalling certain words, or errors in the production of long or
complex sentences.
C. Not due to a Pervasive Developmental Disorder, detect in hearing acuity,
or a neuralgic disorder (aphasia).
Developmental Receptive Language Disorder
The essential feature of this disorder is marked impairment in the development of
language comprehension that is not explainable by Mental Retardation or
inadequate schooling and that is not due to a Pervasive Developmental Disorder,
hearing impairment, or neuralgic disorder. The diagnosis is made only if this
impairment significantly interferes with academic achievement or with activities of
daily living that require comprehension of verbal (or sign) language.
The comprehension deficit varies depending on the severity of the disorder
and the age of the child. In mild cases there may be only difficulties in
understanding particular types of words (such as spatial terms) or statements (for
example, complex if-then" sentences). In more severe cases, there may be
multiple disabilities, including an inability to understand basic vocabulary or
simple sentences, and deficits in various areas of auditory processing (e.g.,
discrimination of sounds, association of sounds and symbols storage, recall, and
sequencing)
Associated features. Developmental Articulation Disorder, Developmental
Expressive Language Disorder, and Academic Skills Disorders are often present.
Less commonly present are Functional Enuresis, Developmental Coordination
Disorder, Attention-deficit Hyperactivity Disorder, EEG abnormalities, and other
social and behavioral problems.
Age at onset. The disorder typically appears before the age of four years.
Severe forms of the disorder are apparent by age two; mild forms of the disorder,
however, may not be evident until the child is seven (second grade) or older,
when language ordinarily becomes more complex.
Course. Although many children with Developmental Receptive Language
Disorder do eventually acquire normal language abilities, some of the more
severely affected do not.
Prevalence. Estimates range from 3% to 10% of school-age children.
Familial pattern. No information.
Differential diagnosis. Mental Retardation involves impaired language
comprehension that is commensurate with the general impairment in intellectual
functioning. Hearing impairment, identified by audiometric testing, may also
produce abnormal functioning in language comprehension. In Pervasive
Developmental Disorders, when there is impairment in language
comprehension, there are usually few or no attempts to communicate nonverbally
(eg, through gestures) and little or no imaginary play. Elective Mutism involves
limited expressive output that may suggest Developmental Receptive Language
Disorder, but upon formal testing, comprehension is found to he within normal
limits. Acquired aphasia is distinguished from Developmental Receptive
Language Disorder by a history of onset associated with head trauma, seizures,
or EEG abnormalities, or by "hard" neuralgic signs such as hemiplegia.
(Diagnostic Criteria For Developmental Receptive Language Disorder
A. The score obtained from a standardized measure of receptive language is
substantially below that obtained from a standardized measure of nonverbal
intellectual capacity (as determined by an individually administered lQ
test).
B. The disturbance in (A) significantly interferes with academic achievement
or activities of daily living requiring the comprehension of verbal (or sign)
language. This may be manifested in more severe cases by an inability to
under-stand simple words or sentences. In less severe cases, there may
be difficulty in understanding only certain types of words, such as spatial
terms, or an inability to comprehend longer or more complex
statements.
C. Not due to a Pervasive Developmental Disorder, detect in hearing acuity, or
a neuralgic disorder (aphasia).
Motor Skills Disorder
Developmental Coordination Disorder
The essential feature of this disorder is a marked impairment in the development
of
motor coordination that is not explainable by Mental Retardation and that is not
due to
a known physical disorder. The diagnosis is made only if this impairment
significantly
interferes with academic achievement or with activities of daily living.
The manifestations of this disorder vary with age and development: young
children exhibit clumsiness and delays in developmental motor milestones
(including tying shoelaces, buttoning shirts, and zipping pants); older children
display difficulties with the motor aspects of puzzle assembly, model-building,
playing ball, and printing or handwriting.
Associated features. Commonly associated problems include delays in other
nonmotor milestones, Developmental Articulation Disorder, and Developmental
Receptive and Expressive Language Disorders.
Age at onset. Recognition of the disorder usually occurs when the child first
attempts such tasks as running, holding a knife and fork, or buttoning
clothes.
Course. the course is variable. In some cases, lack of coordination
continues through adolescence and adulthood.
Prevalence. Prevalence has been estimated to be as high as 6% for children
in the age range of 5-11 years.
Familial pattern. No information.
Differential diagnosis. In specific neuralgic disorders that may be
associated
with problems in coordination (e.g., cerebral palsy, progressive lesions of the
cerebellum), there is definite neural damage and abnormal findings on
conventional neuralgic examination. In Attention-deficit Hyperactivity Disorder,
there may be falling, bumping into things, or knocking things over because of
distractibility and impulsiveness. In Mental Retardation, there may be delays in
motor milestones, but these are associated with the general impairment in
intellectual functioning. Similarly, in Pervasive Developmental Disorders, an
abnormal gait and delays in motor milestones are part of a marked and pervasive
history of abnormal development.
(Diagnostic Criteria For Developmental Coordination Disorder)
A. The person's performance in daily activities requiring motor coordination is
markedly below the expected level, given the person's chronological age
and intellectual capacity. This may be manifested by marked delays in
achieving motor milestones (walking, crawling, sitting), dropping things,
"clumsiness," poor performance in sports, or poor handwriting.
B. The disturbance in (A) significantly interferes with academic achievement
or activities of daily living.
C. Not due to a known physical disorder, such as cerebral palsy, hemiplegia
or muscular dystrophy.
Specific Developmental Disorder Not otherwise Specified
Disorders in the development of language, speech, academic, and motor skills
that do not meet the criteria for a Specific Developmental Disorder. Examples
include aphasia with epilepsy acquired in childhood ("Landau syndrome") and
specific developmental difficulties in spelling.
OTHER DEVELOPMENTAL DISORDERS
Developmental Disorder Not otherwise Specified
Disorders in development that do not meet the criteria for either Mental
Retardation or
a Pervasive or a Specific Developmental Disorder.
DISRUPTIVE BEHAVIOR DISORDERS
This subclass of disorders is characterized by behavior that is socially disruptive
and is often more distressing to others than to the people with the disorders. The
subclass includes Attention-deficit Hyperactivity Disorder, Oppositional Defiant
Disorder, and Conduct Disorder. Studies have indicated that in both clinic and
community samples, the symptoms of these disorders covary to a high degree. In
the literature the behaviors that these disorders encompass have been referred
to as "externalizing" symptoms.
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Developmental Articulation Disorder
The essential feature of this disorder is a consistent failure to make correct articulations of speech sounds, at the developmentally appropriate age, that is not due to a Pervasive Developmental Disorder, Mental Retardation, impairment of the oral speech mechanism, or neuralgic, intellectual, or hearing impairments. The disorder is manifested by frequent misarticulations, substitutions, or omissions of speech sounds, giving the impression of "baby talk."
The speech sounds that are most frequently misarticulated are those acquired later in the developmental sequence (r, sh, th, f, z, I, and ch); but in more severe cases or in younger children, sounds such as b, m, t, d, n, and h may be mispronounced. One or many speech sounds may be affected, but vowel sounds are not among them.
There is a considerable range in the severity of the disturbance. The child's speech may be completely intelligible, partially intelligible, or unintelligible.
Associated features. Other Specific Developmental Disorders are commonly present, including: Developmental Expressive Language Disorder, Developmental Receptive Language Disorder, Developmental Reading Disorder, and Developmental Coordination Disorder. Functional Enuresis may also be present.
A delay in reaching speech milestones (such as "first word" and "first sentence") has been reported in some children with Developmental Articulation Disorder, but most children with this disorder begin speaking at the appropriate age.
Age at onset. In severe cases, the disorder is recognized at about age three. In less severe cases, the disorder may not be apparent until age six.
Course. With speech therapy, complete recovery occurs in virtually all cases In milder cases, spontaneous recovery may occur before the age of eight years.
Prevalence. A conservative estimate is that approximately 10% of children below age eight, and approximately 5% of children aged eight years or older, have the disorder.
Familial pattern The disorder is more common among first-degree biologic relatives than in the general population.
Differential diagnosis. Misarticulations caused by physical abnormalities can be ruled out by physical examination: if there is a hearing impairment, audiometric testing will reveal an abnormality; with dysarthria or apraxia, there will be muscular weaknesses, oral mechanism defects, or a neuralgic disorder, and there may be problems with chewing or sucking, drooling, and rate of speech.
In Mental Retardation there is a general impairment in intellectual functioning that is not present in Developmental Articulation Disorder. In Pervasive Developmental Disorders there are pervasive behavioral abnormalities not present in Developmental Articulation Disorder.
(Diagnostic Criteria for Developmental Articulation Disorder)
A. Consistent failure to use developmentally expected speech sounds. For example, in a three-year-old, failure to articulate p, b, and t, and in a six-year-old, failure to articulate r, sh, th, f, z, and L.
B. Not due to a Pervasive Developmental Disorder, Mental Retardation, defect in hearing acuity, disorders of the oral speech mechanism, or a neuralgic disorder.
Developmental Expressive Language Disorder
The essential feature of this disorder is marked impairment in the development of expressive language that is not explainable by Mental Retardation or inadequate schooling and that is not due to a Pervasive Developmental Disorder, hearing impairment, or a neuralgic disorder. The diagnosis is made only if this impairment significantly interferes with academic achievement or with activities of daily living that require the expression Of verbal (or sign) language.
The linguistic features of Developmental Expressive Language Disorder are varied arid depend on the severity of the disorder and the age of the child. Nonlinguistic functioning, however, is usually within normal limits. Among the expressive language limitations that may be present are: limited size of vocabulary, difficulty acquiring new words, vocabulary errors (such as substitutions, circumlocutions, overgeneralizations or jargon), shortened sentences, simplified grammatical structures, limited varieties of grammatical structures (such as verb forms), limited varieties of sentence types (such as imperatives, questions, etc.), omissions of critical parts of sentences, unusual word order, tangential responses, and slow rate of language development (speech beginning late, and advancement through stages of language development progressing slowly).
Associated Features. Developmental Articulation Disorder is often present. In older children, school and learning problems (particularly in tasks involving perceptual or sequencing skills) may be present. A history of delay in reaching some motor milestones, Developmental Coordination Disorder, and Functional Enuresis are not uncommon. Emotional problems, social withdrawal, and behavioral difficulties may be present.
Age at onset. Severe forms usually occur before age three and are easily recognized. Less severe forms may not occur until early adolescence, when language ordinarily becomes more complex.
Course. For a young child with mild Developmental Expressive Language Disorder, the prognosis is very good. As many as 50% of the children with this disorder may spontaneously catch up in their expressive language abilities before they reach school age and thus not require any specialized help. In more severe cases, recovery is slower; but most children with Developmental Expressive Language Disorder not complicated by Developmental Receptive Language Disorder do acquire normal language abilities by late adolescence.
Prevalence. Estimates range from 3% to 10% of school-age children.
Familial pattern. It appears that the disorder is more likely to occur in people who have a family history of Developmental Articulation Disorder or other Specific Developmental Disorders.
Differential diagnosis. In Mental Retardation there may be impaired language functioning, but it is associated with the general impairment in intellectual functioning. Impaired hearing may also produce abnormal expressive language functioning, and should be ruled out by audiometric testing. In Pervasive Developmental Disorders, in which expressive language impairment may be present, there is little or no attempt to communicate nonverbally (e.g., through gestures). Elective Mutism involves limited expressive output that may mimic Developmental Expressive Language Disorder, but upon formal testing, comprehension is found to be within normal limits. Acquired aphasia is distinguished from Developmental Expressive Language Disorder by a history of onset associated with head trauma, seizures, or EEG abnormalities, or by "hard" neuralgic signs such as hemiplegia.
(Diagnostic Criteria For Developmental Expressive Language Disorder)
A. The score obtained from a standardized measure of expressive language is substantially below that obtained from a standardized measure of nonverbal intellectual capacity (as determined by an individually administered lQ test).
B. The disturbance in (A) significantly interferes with academic achievement or activities of daily living requiring the expression of verbal (or sign) language. This may be evidenced in severe cases by use of a markedly limited vocabulary, by speaking only in simple sentences, or by speaking only in the present tense. In less severe cases, there may be hesitations or errors in recalling certain words, or errors in the production of long or complex sentences.
C. Not due to a Pervasive Developmental Disorder, detect in hearing acuity, or a neuralgic disorder (aphasia).
Developmental Receptive Language Disorder
The essential feature of this disorder is marked impairment in the development of language comprehension that is not explainable by Mental Retardation or inadequate schooling and that is not due to a Pervasive Developmental Disorder, hearing impairment, or neuralgic disorder. The diagnosis is made only if this impairment significantly interferes with academic achievement or with activities of daily living that require comprehension of verbal (or sign) language.
The comprehension deficit varies depending on the severity of the disorder and the age of the child. In mild cases there may be only difficulties in understanding particular types of words (such as spatial terms) or statements (for example, complex if-then" sentences). In more severe cases, there may be multiple disabilities, including an inability to understand basic vocabulary or simple sentences, and deficits in various areas of auditory processing (e.g., discrimination of sounds, association of sounds and symbols storage, recall, and sequencing)
Associated features. Developmental Articulation Disorder, Developmental Expressive Language Disorder, and Academic Skills Disorders are often present. Less commonly present are Functional Enuresis, Developmental Coordination Disorder, Attention-deficit Hyperactivity Disorder, EEG abnormalities, and other social and behavioral problems.
Age at onset. The disorder typically appears before the age of four years. Severe forms of the disorder are apparent by age two; mild forms of the disorder, however, may not be evident until the child is seven (second grade) or older, when language ordinarily becomes more complex.
Course. Although many children with Developmental Receptive Language Disorder do eventually acquire normal language abilities, some of the more severely affected do not.
Prevalence. Estimates range from 3% to 10% of school-age children.
Familial pattern. No information.
Differential diagnosis. Mental Retardation involves impaired language comprehension that is commensurate with the general impairment in intellectual functioning. Hearing impairment, identified by audiometric testing, may also produce abnormal functioning in language comprehension. In Pervasive Developmental Disorders, when there is impairment in language comprehension, there are usually few or no attempts to communicate nonverbally (eg, through gestures) and little or no imaginary play. Elective Mutism involves limited expressive output that may suggest Developmental Receptive Language Disorder, but upon formal testing, comprehension is found to he within normal limits. Acquired aphasia is distinguished from Developmental Receptive Language Disorder by a history of onset associated with head trauma, seizures, or EEG abnormalities, or by "hard" neuralgic signs such as hemiplegia.
(Diagnostic Criteria For Developmental Receptive Language Disorder
A. The score obtained from a standardized measure of receptive language is substantially below that obtained from a standardized measure of nonverbal intellectual capacity (as determined by an individually administered lQ test).
B. The disturbance in (A) significantly interferes with academic achievement or activities of daily living requiring the comprehension of verbal (or sign) language. This may be manifested in more severe cases by an inability to under-stand simple words or sentences. In less severe cases, there may be difficulty in understanding only certain types of words, such as spatial terms, or an inability to comprehend longer or more complex statements.
C. Not due to a Pervasive Developmental Disorder, detect in hearing acuity, or a neuralgic disorder (aphasia).
Motor Skills Disorder
Developmental Coordination Disorder
The essential feature of this disorder is a marked impairment in the development of motor coordination that is not explainable by Mental Retardation and that is not due to a known physical disorder. The diagnosis is made only if this impairment significantly interferes with academic achievement or with activities of daily living.
The manifestations of this disorder vary with age and development: young children exhibit clumsiness and delays in developmental motor milestones (including tying shoelaces, buttoning shirts, and zipping pants); older children display difficulties with the motor aspects of puzzle assembly, model-building, playing ball, and printing or handwriting.
Associated features. Commonly associated problems include delays in other nonmotor milestones, Developmental Articulation Disorder, and Developmental Receptive and Expressive Language Disorders.
Age at onset. Recognition of the disorder usually occurs when the child first attempts such tasks as running, holding a knife and fork, or buttoning clothes.
Course. the course is variable. In some cases, lack of coordination continues through adolescence and adulthood.
Prevalence. Prevalence has been estimated to be as high as 6% for children in the age range of 5-11 years.
Familial pattern. No information.
Differential diagnosis. In specific neuralgic disorders that may be associated with problems in coordination (e.g., cerebral palsy, progressive lesions of the cerebellum), there is definite neural damage and abnormal findings on conventional neuralgic examination. In Attention-deficit Hyperactivity Disorder, there may be falling, bumping into things, or knocking things over because of distractibility and impulsiveness. In Mental Retardation, there may be delays in motor milestones, but these are associated with the general impairment in intellectual functioning. Similarly, in Pervasive Developmental Disorders, an abnormal gait and delays in motor milestones are part of a marked and pervasive history of abnormal development.
(Diagnostic Criteria For Developmental Coordination Disorder)
A. The person's performance in daily activities requiring motor coordination is markedly below the expected level, given the person's chronological age and intellectual capacity. This may be manifested by marked delays in achieving motor milestones (walking, crawling, sitting), dropping things, "clumsiness," poor performance in sports, or poor handwriting.
B. The disturbance in (A) significantly interferes with academic achievement or activities of daily living.
C. Not due to a known physical disorder, such as cerebral palsy, hemiplegia or muscular dystrophy.
Specific Developmental Disorder Not otherwise Specified
Disorders in the development of language, speech, academic, and motor skills that do not meet the criteria for a Specific Developmental Disorder. Examples include aphasia with epilepsy acquired in childhood ("Landau syndrome") and specific developmental difficulties in spelling.
OTHER DEVELOPMENTAL DISORDERS
Developmental Disorder Not otherwise Specified
Disorders in development that do not meet the criteria for either Mental Retardation or a Pervasive or a Specific Developmental Disorder.
DISRUPTIVE BEHAVIOR DISORDERS
This subclass of disorders is characterized by behavior that is socially disruptive and is often more distressing to others than to the people with the disorders. The subclass includes Attention-deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder. Studies have indicated that in both clinic and community samples, the symptoms of these disorders covary to a high degree. In the literature the behaviors that these disorders encompass have been referred to as "externalizing" symptoms.