SPECIFIC DEVELOPMENTAL DISORDERS OF SPEECH AND LANGUAGE
Disorders of speech and language are common, affecting 3–5 per cent of children, and it is important to identify them early so that appropriate therapy can be given.
There are a variety of factors needed for the development of normal speech: reasonable-quality hearing, the ability to understand what is being said, the ability to process what has been said, and the ability to form and verbalize a response.
If any one part of this process is faulty, then a speech or language disorder may occur.
For example, if a child is unable to understand spoken words as well as expected, they have a receptive language disorder. There is often a family history of speech problems.
- Specific speech articulation disorder is found in 2 per cent of 6–7 year olds, falling to 0.5 per cent of teenagers. These children have difficulty in using appropriate speech sounds, especially in substituting one sound for another.
- Expressive language disorder occurs when there is a delay in the ability to use spoken language appropriately, in the context of normal language comprehension.
- Receptive language disorder is a reduced ability to understand language. It is often associated with expressive disorders, but alone is relatively uncommon.
Speech and language disorders are more frequent in children with ADHD, oppositional defiance disorder, and conduct disorders. Approximately half resolve completely by adulthood, whilst the rest tend to improve to varying extents.
Any child with a suspected speech disorder should be referred to a speech and language therapist. Treatment should start with psychoeducation, but speech therapy should be offered when the disorder starts to interfere with the child’s everyday life, and is usually after 3 years of age.
It is done in the child’s usual environment (e.g. school) as this has proved more effective than the structured therapy sessions used for other conditions.
Specific reading disorder (dyslexia)
The child’s reading age is significantly (two standard deviations) below the level expected from age and IQ and this is not due solely to inadequate education or poor vision. Writing and spelling are also impaired but the rest of development is normal. Compared with children with general backwardness at school, those with specific reading disorder are more often boys (2:1) and are more likely to have minor neurological abnormalities; they are less likely to come from disadvantaged families. By late adolescence, 25 per cent have caught up with their peers, but the rest have varying degrees of persisting difficulty with reading and spelling. The child may need special help with reading at school.
Stammering is a disturbance of the rhythm and fluency of speech. It may take the form of repetitions of syllables or words, or of pauses in the production of speech. Stammering is four times more frequent in boys than girls and usually resolves by mid-childhood.
Treatment is usually with speech therapy, but the long-term effects of this are currently unknown.
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