Communication Disorders in Children

See Hearing Impairment in Children.

More than 6% of school-age children have a voice problem, most often hoarseness. These problems usually result from long-term overuse of the voice, speaking too loudly, or a combination.

Many children with voice problems have small nodules on the vocal cords. It is not clear how much the voice problems contribute to causing nodules or how much the nodules contribute to causing voice problems. Nodules usually resolve with voice therapy and only rarely require surgery.

In these disorders, the production of a speech sound is difficult. As a result, children are less able to communicate meaningfully. About 5% of children entering the first grade have a speech disorder. Speech disorders include the following:

• Hypernasal voice quality or speaking through the nose: This disorder may be caused by a cleft palate or other facial defect.

• Stuttering: Developmental stuttering, the usual form of stuttering, typically begins between the ages of 2 years and 5 years and is more common among boys. The cause of stuttering is unknown, but stuttering commonly runs in families. Nervous system disorders are not common causes of stuttering.

• Articulation disorders: Children with these disorders have difficulty forming sounds because controlling and coordinating the muscles used to produce speech is difficult. Most children with an articulation disorder have no detectable physical cause, but some have a nervous system disorder that impairs the coordination of muscles needed for speech. The impaired muscle coordination may also cause difficulty swallowing (dysphagia), and difficulty swallowing may become apparent before difficulty speaking. Hearing disorders and a defect of the tongue, lip, or palate can also impair articulation.

Speech therapy is helpful in many speech disorders. A cleft palate is almost always repaired surgically, but children still usually require speech therapy as well.

The ability to use, understand, or express language can be reduced in otherwise healthy children (called specific language impairment). Thus, the ability to communicate is greatly impaired, limiting educational, social, and vocational opportunities. This disorder occurs in about 5% of children and is more common among boys. Abnormal genes appear to play a role in many cases. Alternatively, language problems can develop because of another disorder, such as a brain injury, intellectual disability, hearing loss, neglect or abuse, autism, or attention-deficit/hyperactivity disorder.

Some children appear to recover on their own. Others need language therapy.