6.1: Definitions of Communication Disorders

The Individuals with Disabilities Education Act (IDEA) defines a speech or language impairment as the following:

Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance (Individuals With Disabilities Education Act, Part B, Subpart A § 300.8(c)(11)(2004)).

This definition is used to determine whether a student with a communication disorder is eligible for special education and related services. However, many professionals also use the following definitions from the ASHA. ASHA provides the following more detailed definition of communication disorder.

A communication disorder is an impairment in the ability to receive, send, process, and comprehend concepts or verbal, nonverbal and graphic symbol systems. A communication disorder may be evident in the processes of hearing, language, and/or speech. A communication disorder may range in severity from mild to profound. It may be developmental or acquired. Individuals may demonstrate one or any combination of communication disorders. A communication disorder may result in a primary disability, or it may be secondary to other disabilities (ASHA, 1993).

ASHA also provides detailed definitions of the different types of communication disorders, including speech disorders, language disorders, and central auditory processing disorders.

A speech disorder is an impairment of the articulation of speech sounds, fluency and/or voice.

• An articulation disorder is the atypical production of speech sounds characterized by substitutions, omissions, additions or distortions that may interfere with intelligibility.
• A fluency disorder is an interruption in the flow of speaking characterized by atypical rate, rhythm, and repetitions in sounds, syllables, words, and phrases. This may be accompanied by excessive tension, struggle behavior, and secondary mannerisms.
• A voice disorder is characterized by the abnormal production and/or absences of vocal quality, pitch, loudness, resonance, and/or duration, which is inappropriate for an individual’s age and/or sex.

A language disorder is impaired comprehension and/or use of spoken, written and/or other symbol systems. The disorder may involve (1) the form of language (phonology, morphology, syntax), (2) the content of language (semantics), and/or (3) the function of language in communication (pragmatics) in any combination.

• Form of Language
  • Phonology is the sound system of a language and the rules that govern the sound combinations.
  • Morphology is the system that governs the structure of words and the construction of word forms.
  • Syntax is the system governing the order and combination of words to form sentences, and the relationships among the elements within a sentence.
• Content of Language
  • Semantics is the system that governs the meanings of words and sentences.
• Function of Language
  • Pragmatics is the system that combines the above language components in functional and socially appropriate communication.

Central auditory processing disorders (CAPD) are deficits in the information processing of audible signals not attributed to impaired peripheral hearing sensitivity or intellectual impairment. This information processing involves perceptual, cognitive, and linguistic functions that, with appropriate interaction, result in effective receptive communication of auditorily presented stimuli. Specifically, CAPD refers to limitations in the ongoing transmission, analysis, organization, transformation, elaboration, storage, retrieval, and use of information contained in audible signals. CAPD may involve the listener’s active and passive (e.g., conscious and unconscious, mediated and unmediated, controlled and automatic) ability to do the following:

• attend, discriminate, and identify acoustic signals;
• transform and continuously transmit information through both the peripheral and central nervous systems;
• filter, sort, and combine information at appropriate perceptual and conceptual levels;
• store and retrieve information efficiently; restore, organize, and use retrieved information;
• segment and decode acoustic stimuli using phonological, semantic, syntactic, and pragmatic knowledge; and
• attach meaning to a stream of acoustic signals through use of linguistic and nonlinguistic contexts (ASHA, 1993).

Finally, ASHA differentiates a communication disorder from communication variations including communication difference/dialect and augmentative/alternative communication.

Communication difference/dialect is a variation of a symbol system used by a group of individuals that reflects and is determined by shared regional, social, or cultural/ethnic factors. A regional, social, or cultural/ethnic variation of a symbol system should not be considered a disorder of speech or language.

Augmentative/alternative communication systems attempt to compensate and facilitate, temporarily or permanently, for the impairment and disability patterns of individuals with severe expressive and/ or language comprehension disorders. Augmentative/alternative communication may be required for individuals demonstrating impairments in gestural, spoken, and/or written modalities (ASHA, 1993).

APA Definition

In addition, the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association includes disorders of communication which include language disorder, speech sound disorder, childhood-onset fluency disorder (stuttering), social (pragmatic) communication disorders, and unspecified communication disorders. The diagnostic criteria for each are included below.

Language Disorder

1. 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 that include the following:
   1. Reduced vocabulary (word knowledge and use).
   2. Limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology).
   3. Impairments in discourse (ability to use vocabulary and connect sentences to explain or describe a topic or series of events or have a conversation).
2. Language abilities are substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication, social participation, academic achievement, or occupational performance, individually or in any combination.
3. Onset of symptoms is in the early developmental period.
4. The difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition and are not better explained by intellectual developmental disorder (intellectual disability) or global developmental delay (DSM-5-TR, 2022, p. 47).

Speech Sound Disorder

1. Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication or messages.
2. The disturbance causes limitation in effective communication that interferes with social participation, academic achievement, or occupational performance, individually or in any combination.
3. Onset of symptoms in the early developmental period.
4. The difficulties are not attributable to congenital or acquired conditions, such as cerebral palsy, cleft palate, deafness or hearing loss, traumatic brain injury, or other medical or neurological conditions (DSM-5-TR, 2022, p. 50).

Childhood-Onset Fluency Disorder (Stuttering)

1. Disturbances in the normal fluency and time patterning of speech that are inappropriate for the individual’s age and language skills, persist over time, and are characterized by frequent and marked occurrences of one (or more) of the following:
   1. Sound and syllable repetitions.
   2. Sound prolongations of consonants as well as vowels.
   3. Broken words (e.g., pauses within a word).
   4. Audible or silent blocking (filled or unfilled pauses in speech).
   5. Circumlocutions (word substitutions to avoid problematic words).
   6. Words produced with an excess of physical tension.
   7. Monosyllabic whole-word repetitions (e.g., “I-I-I-I see him”).
2. The disturbance causes anxiety about speaking or limitations in effective communication, social participation, or academic or occupational performance, individually or in any combination.
3. The onset of symptoms is in the early developmental period.
4. The disturbance is not attributable to a speech-motor or sensory deficit, disfluency associated with neurological insult (e.g., stroke, tumor, trauma), or another medical condition and is not better explained by another mental disorder (DSM-5-TR, 2022, p. 51-52).

Social (Pragmatic) Communication Disorder

1. Persistent difficulties in the social use of verbal and nonverbal communication as manifest by all of the following:
   1. Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
   2. Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding the use of overly formal language.
   3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
   4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral and ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).
2. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
3. The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).
4. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual developmental disorder (intellectual disability), global developmental delay, or another mental disorder (DSM-5-TR, 2022, p. 54).

The Illinois Definition of Speech or Language Impairment

Speech or Language Impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance (ISBE, 2022).

Activity \(\PageIndex{1}\): Compare and Contrast

Directions: Compare and contrast the IDEA, ASHA, APA, and Illinois definitions of communication disorders. Consider the differences and similarities between diagnostic criteria.

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 Individuals With Disabilities Education Act, Part B, Subpart A § 300.8(c)(11)(2004).

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations [Relevant Paper]. https://www.asha.org/policy/rp1993-00208/

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed. Text Revision). https://doi.org/10.1176/appi.books.9780890425596

Illinois State Board of Education. (2022, October 7). Special education disability areas. https://www.isbe.net/Pages/Special-Education-Disability-Areas.aspx