Chapter 9
Speech and Language Disorders in the Home, School, and Community
Chapter Overview
The acquisition of speech and language is so natural that we may not truly appreciate the complexity and power of
human oral communication unless or until something goes wrong. In the United States, about 10% of the population
have speech, language, or hearing problems. Some may be surprised that this many people have communication
disorders. When we consider how much language knowledge the child must acquire, how quickly she acquires it,
Learning Outcomes
• Differentiate between normal and disordered speech and language.
• Contrast the interrelationships of speech and language and their impact on
learning.
• Describe the causes, contributing factors, and types of communication disorders.
• Discuss the characteristics of several speech disorders.
Key Terms and Concepts
• Prevalence, p. 364
• Incidence, p. 364
• Definitions of speech disorders: p. 366–367
• Low vision, p. 376
• Legally blind, p. 376
• Developmental disability, p. 377
• Intellectual disability, p. 377
• Autism spectrum disorder, p. 379
• Traumatic brain injury, p. 381
• Cerebrovascular accident, p. 382
• Learning disability, p. 382
• Dyslexia, p .383
• Specific language impairment, p. 383
• Neurogenic stuttering, p. 388
• Psychogenic stuttering, p. 388
• Cluttering, p. 389
Points of Emphasis
1. We live in an age in which we depend on our communication skills far more than in ages past.
2. When speech, language, and hearing problems occur, they pose significant challenges for individuals, their
families, and society.
3. Communication disorders are estimated to affect from 5% to 10% of the population and are among the most
common disabilities in the United States.
4. As we consider communication disorders, you should keep in mind that we often cannot determine a single
cause of a problem. In most cases, a combination of factors is responsible.
5. The World Health Organization (WHO) developed the International Classification of Functioning, Disability and
Health (ICF), which is a classification system that helps practitioners to assess a person’s disability and its effect
6. One of the most widely used definitions of disordered speech is offered by Van Riper and Erickson (1996) and it
focuses on three key aspects of communication abnormality: conspicuous, unintelligible and unpleasant.
8. An organic disorder is one that is caused by a demonstrable pathology of an organ system.
9. There are many ways in which the environment plays a role in the prevalence of communication disorders.
a. These include: prenatal environmental factors, prematurity, low birth weight, hypoxic/anoxic events,
10. Hearing loss is a common physical condition and there are three types of hearing loss: conductive, sensorineural
and mixed.
11. A person with low vision (visual acuity 20/70) has some functional use of sight ranging from a moderate to
severe impairment. A person is deemed legally blind when visual acuity is 20/200 or less in the better eye, or has
a 20-degree visual field.
a. Children who have low vision or blindness face challenges in language development during the first few
years, but with support from others the potential for normal language development is high.
12. Developmental disability is a broad term used when the disability occurs prior to the age of 22 years. Children
who have developmental disabilities often have speech and language problems.
a. There is no dispute that a connection exists between intellectual disability and language impairment, and
that the severity of language impairment is correlated with the degree of intellectual disability.
i) Intellectual disability occurs when a person has significant limitations in intelligence, as determined by
13. The DSM-5 defines autism spectrum disorder (ASD) as having five primary characteristics: (1) social
communication and interaction deficits (expressive and/or receptive); (2) repetitive or restricted patterns of
behavior; (3) onset of symptoms in early childhood; (4) significant impairment in functioning in contextual
situations; (5) other developmental disorders do not explain the disturbances.
a. In 2012, the CDC found that 1 in 88 children had autism in the United States and it was five times more
common in boys than in girls.
b. The cause of autism has not been established.
14. A sudden trauma to the brain that causes injury is called traumatic brain injury (TBI).
a. Causes include concussions, vehicular accidents, falls, domestic violence, childhood physical abuse, and
15. A cerebrovascular accident (CVA), commonly called a stroke, may result in mild to serious motor, speech, and
language problems. Children who sustain brain injury are far more likely to recover language abilities as
compared to adults, although there are factors besides age.
16. A learning disability is a general term that is used to designate difficulties in acquiring spoken language, written
language, and mathematical skills.
a. Learning disabilities are not the result of sensory, intellectual, or emotional disorders and they are not due to
environmental factors, such as inappropriate instruction or cultural influences.
18. Specific language impairment (SLI) is a term used to categorize a language disorder that is not accompanied by
deficits in hearing, intelligence, neurological functions, or motor function.
19. The term phonological disorder is used to describe children who not only have speech errors on the surface, but
whose errors indicate an underlying disorder in establishing and using the appropriate rules for sounds and their
20. When a child does not speak clearly as compared to others at or near his age, it can be a sign that speech
acquisition is delayed. There are many factors that should be considered in determining what causes delay in any
particular child.
21. There are many causes of voice disorders, and experts classify them in various ways. Four categories of voice
problems, summarized by Boone and colleagues, include organic voice disorders, neurogenic voice disorders,
psychogenic voice disorders and muscle tension dysphonia.
b. Another category that is also related to behavior is called psychogenic voice disorders.
c. There are numerous types of organic voice disorders in which the physical structures involved in phonation
22. There are common denominators among fluency disorders, but it is important to differentiate among them
because they are not simply variations of the same disorder. They have different etiologies and different
symptoms.
a. Any disorder characterized by hesitation, repetition of speech segments, or prolongation of sounds that
impedes the forward flow of speech is a fluency disorder.
b. Developmental stutterers, or simply stutterers with no qualifying adjectives, are individuals who are normal
neurologically and who do not have serious psychological problems.
iv) Most experts believe that the prognosis for the adult stutterer is not good.
c. Neurogenic stuttering begins after an individual suffers damage to the central nervous system and may or
may not have a history of stuttering.
d. The onset of psychogenic stuttering tends to be sudden and appears to be associated with a specific,
identifiable psychological trauma. The person with psychogenic stuttering tends to stutter in all
communicative situations, does not develop secondary behaviors and is essentially detached from her
stuttering.
Discussion Topics
• Open the discussion up to the class and prompt them to share about the communication disorders they may have
experienced personally, or those they have observed in family members or friends. In what ways has the
disorder shaped their lives?
• What three main characteristics do Van Riper and Erickson use to differentiate normal speech and language
from disordered speech and language? How do these compare and contrast to the ICF developed by WHO?
Encourage students to share out which they feel could be used to more appropriately define a communication
disorder.
• Discuss the difference between functional and organic disorders. Why is this differentiation important?
• What is the role of amplification and sign language in the acquisition of language for children who have hearing
loss?
• What role should parents and other family members play in the diagnosis and treatment of a child’s
communication disorder?
• Summarize the four main categories of voice disorders. Imagine that you have a temporary voice disorder
caused from misusing your voice at a sporting event. How would this problem affect your daily activities?
• How should people respond to people who stutter when they are producing mild moments of stuttering? Severe
moments of stuttering?
• Based on the differences among developmental stuttering, neurogenic stuttering, and psychogenic stuttering,
how should treatment be altered for each of these problems?
• What guidelines should speech-language clinicians follow so that they accurately differentiate between
stuttering and cluttering?
Suggested Activities
• Select one speech or language disorder discussed in the chapter and role play that you have this disorder. Using
Van Riper and Erickson’s definition of disordered speech, write a paragraph for each of the three characteristics
discussing how it would make you feel and what situations would be difficult for you. How does this compare
to ICF developed by WHO for the specific disorder you selected?
• Establish as many specific criteria as possible for determining voice disorders and fluency disorders.
• Find 5-10 definitions of stuttering. Critique each one, identifying its strengths and weaknesses. Using what you
learn from your analyses of these definitions, write one of your own.
• Interview an adult with a moderate to severe communication disorder to learn how his/her communication
difficulties have affected his/her life, what he/she has done to try to deal with these difficulties, and how these
problems affect his/her perceptions about the future, personally and vocationally.
• Observe a classroom (preschool, elementary, middle, or high school). Consider the curriculum being taught.
What might be challenging for a child with SLI and for a child with a learning disability? How might you
modify the curriculum to make it accessible for these children?
Assignment Suggestions
• Video Example 9.1 (p. 366): Jackson is 21 months old and uses mostly single words. Although two-word
utterances are scare in his repertoire, they are expected between 20 and 26 months. Watch the video to see
Jackson’s mother express her concerns about her son’s limited expressive vocabulary and two-word
combinations. She discusses his medical history as one factor that might relate to his language development and
the strategies she is using to increase his language skills.
• Video Example 9.2 (p. 367): Watch the student in this video work with her speech-language pathologist to
request objects using her high-technology assistive device. When the student strings picture icons together and
presses play, she is able to hear her sentence. Practice creating requests will eventually lead to spontaneous
verbal participation through the use of the device in the classroom.
• Video Example 9.4 (p. 385): Watch the video of a first-grader practicing speech sounds in syllables with
her
speech–language pathologist. Down syndrome
results in low muscle tone, so precision of articulation is
impaired. Children with Down syndrome
also have at least some degree of intellectual
disability, which has
an effect on language development in addition to the acquisition of speech.
• Readers may assess their understanding by completing these brief, self-check quizzes:
o 9.1 (p. 368): characteristics of communication disorders
o 9.3 (p. 384): causes, contributing factors, and types of language disorders
o 9.4 (p. 389): speech disorders
• Chapter Review 9.1 (p. 391)
Websites to Explore
• The website for the Autism Support Network offers support, resources and information about autism for parents
and professionals.
• The Dyslexia Help website from the University of Michigan shares the role of the SLP in working with dyslexia
on a page titled “The Role of the Speech–Language Pathologist.”
• Judith Maginnis Kuster from Minnesota State University shares her class resources for stuttering and many
other speech and language disorders. Stuttering resources can be found on Judith Kuster’s website through
MNSU titled “The Stuttering Homepage.” Additional resources can be found on through MNSU titled
“Examples of Materials that Can Be Adapted for Therapy.”