Communication Disorders

By Diamond, Elena Lilles | National Association of School Psychologists. Communique, December 2016 | Go to article overview

Communication Disorders


Diamond, Elena Lilles, National Association of School Psychologists. Communique


Communication disorders include language disorder, speech sound disorder, social (pragmatic) communication disorder, childhood-onset fluency disorder (stuttering), and other specified and unspecified communication disorders (American Psychiatric Association [APA], 2013a). This group of neurodevelopmental disorders is characterized by deficits in language, speech, and communication. The degree of impairment from these disorders can range from mild to severe. Language delays are quite common, occurring in approximately 10% to 15% of children under the age of 3, and 3% to 7% of school-age children (APA, 2000). Communication disorders in children can negatively impact academic achievement (Lindsay, 2011) and social development (Murphy, Faulkner, & Farley, 2014). Therefore, communication disorders are of particular interest to school psychologists and mental health practitioners in school settings.

CHANGES FROM DSM-IV-TR AND RATiONALE FOR THE CHANGES

Several changes were made during the revision of the DSM-IV-TR to the DSM-5 regarding communication disorders (See Table 1 for brief overview). First, with the restructuring of the DSM, the category of Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence was eliminated, and communication disorders can now be found in the Neurodevelopmental Disorders section. Of note, a criterion for onset during the early developmental period was added to each of the communication disorders now found in the DSM-5.

A second notable change involves the combination of DSM-IV-TR expressive and mixed receptiveexpressive language disorders that form the new DSM-5 language disorder. The DSM-5 language disorder is identified by "persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign language, or other) due to deficits in comprehension or production" (APA, 2013a, p. 42). Expressive ability refers to the production of verbal or nonverbal communication, and receptive ability refers to the capacity to receive and comprehend verbal or nonverbal communications. Notably, deficits in both receptive and expressive language are not required for this diagnosis (e.g., expressive language maybe impaired while receptive language is within normal limits).

Childhood-onset fluency disorder (stuttering), formerly named stuttering, and the speech sound disorder, formerly named phonological disorder, both gained new titles but remain largely unchanged in their diagnostic criteria. Again, a criterion for onset during the early developmental period was added to both of these disorders; however, later-onset cases of fluency disorder can be diagnosed, and receive a different diagnostic code (307.0 [F98.5]; APA, 2013a).

Much of the discussion regarding communication disorder changes in the DSM-5 surround the launch of a new clinical diagnosis: social (pragmatic) communication disorder. This diagnosis is intended for children who do not meet criteria for autism spectrum disorder, but who exhibit social communication and pragmatic language impairments (APA, 2013a). Diagnostic criteria include persistent difficulties in both verbal and nonverbal social communication, including challenges adjusting communication patterns to fit within the context of the listener, difficulties following conversational rules, and impairment in the ability to make inferences or understand nonliteral or ambiguous language (APA, 2013a). It is important to rule out autism spectrum disorder when diagnosing social (pragmatic) communication disorder, and a diagnosis of social communication disorder should only be made if a developmental history fails to reveal evidence of restricted/repetitive patterns of behavior, interests, or activities (APA, 2013a). Furthermore, some individuals previously diagnosed with pervasive developmental disorder (DSM-IV-TR) may meet the criteria for social communication disorder (APA, 2013b; Kim et al., 2014).

It should also be noted that unspecified communication disorder (previously communication disorder not otherwise specified) offers a broader definition compared to its DSM-IV-TR counterpart. …

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