Communication Disorders in Children

Many school-age children have a voice problem, most often hoarseness. The cause is often chronic overuse of the voice and/or speaking too loudly. The most common corresponding anatomic abnormality is vocal fold (cord) nodules. Other laryngeal lesions or endocrine abnormalities may also contribute. Hearing loss can contribute by impairing the ability to sense voice volume and thus modulate voice force. Nodules usually resolve with voice therapy and only rarely require surgery.

For a discussion of hearing disorders, see Hearing Impairment in Children.

About 5% of children age 3 to 17 in the United States have a speech disorder that lasted for a week or longer during the past 12 months (2). In speech disorders, speech production is impaired. Speech disorders include the following:

• Hypernasal voice quality: Hypernasality is typically caused by a cleft palate or other structural abnormality that prevents normal closure of the soft palate with the pharyngeal wall (velopharyngeal insufficiency).

• Stuttering: Developmental stuttering, the usual form of stuttering, typically begins between age 2 years and 5 years and is more common among boys. The etiology of stuttering is unknown, but family clustering is common. Neurologic disorders (eg, stroke, traumatic brain injury) may also cause stuttering.

• Articulation disorders: Most children with disordered articulation have no detectable physical cause. Secondary dysarthria can result from neurologic disorders that impair innervation or coordination of speech muscles. Because swallowing muscles are also usually affected, dysphagia may be noticed before dysarthria is detected. Hearing disorders and structural abnormalities (eg, of the tongue, lip, or palate) can also impair articulation.

Speech therapy is helpful in many primary speech disorders. Children who have anatomic abnormalities that cause velopharyngeal insufficiency generally require surgery as well as speech therapy.

About 7% of otherwise healthy children have difficulty with language comprehension or expression (called specific language impairment) (2). Boys are more often affected, and genetic factors probably contribute.

Alternatively, language problems can develop secondary to another disorder (eg, traumatic brain injury, intellectual disability, hearing loss, neglect or abuse, autism spectrum disorder, attention-deficit/hyperactivity disorder).

Children may benefit from language therapy. Some children with specific language impairment recover spontaneously.

1. 1. Black LI, Vahratian A, Hoffman HJ. Communication Disorders and Use of Intervention Services Among Children Aged 3-17 Years: United States, 2012. NCHS Data Brief. 2015;(205):1-8.

2. 2. National Institute on Deafness and Other Communication Disorders: Quick Statistics About Voice, Speech, Language. 2024. Accessed January 3, 2025.