Communication Disorder

Humans are the only species to have developed an elaborate system of speech sounds that combine to form meaningful units of language through the use of rules and procedures.¹ Communication refers to the process of transferring a message from a sender to a receiver using this language. There are two aspects to communicating effectively; expressive language involves producing speech to communicate with others, and receptive language involves understanding spoken language.

Communication Disorders defined

The term ‘communication disorder’ covers a range of problems in the areas of speech, language, and auditory processing, and affects a person’s ability to relate to others by using and understanding speech and language. Several examples of communication disorders include dyspraxia, dyslexia, aphasia and developmental phonological disorders. Some general characteristics of communication disorders include being unable to follow instructions, incomprehensible speech, overly slow speech, problems with articulation, voice, and fluency, stuttering, and difficulty in forming sentences (often saying words out of order)². Communication disorders can affect receptive language skills (difficulties understanding spoken language), expressive language skills (difficulties producing speech), or both.³ It is estimated that five percent of school-aged children have some form of speech or language disorder², most of whom are boys.

A person can be identified as having impaired speech when it is different enough from the speech of other people that it calls attention to itself, interferes with the communication process, or causes distress either to the speaker or the listener.¹ Speech disorders can be further divided into four areas: language, articulation, voice, and stuttering.⁴

A language disorder refers to impairments in the comprehension and/or development of spoken and written skills, as well as difficulties in listening.

An Articulation impairment refers to poor pronunciation and formation of sounds or words. There may be difficulties stringing sounds together, or sounds may be omitted or distorted.

A voice disorder refers to difficulties in voice quality, pitch, and loudness. Typical characteristics of voice disorders include hoarseness, breathiness, or interruptions to loudness or pitch. Stuttering refers to an interruption in the flow of speech, and includes hesitations when speaking and/or repetition of sounds and words. Stuttering may begin as a sporadic problem and progress to a chronic problem over time.

Specific types of communications disorders

Auditory Processing Disorder refers to difficulties in processing and interpreting auditory information. People with auditory processing disorder usually have normal hearing and intelligence, but may experience problems paying attention to and recalling oral information, have poor listening skills, behavioural problems, and difficulties in reading, comprehension, spelling, and vocabulary.⁵

Dyspraxia/Apraxia refers to difficulty getting the body to do what the brain is telling it to do, resulting in a disorder of skilled movements. When this disorder affects speech it is called developmental apraxia of speech, or developmental verbal dyspraxia. People with this disorder often have much better receptive language skills than expressive; they may be hard to understand, and may speak in a slow, effortful manner.⁶ They have the ability to say sounds and words, but lack the motor planning required to make the movements required to produce speech.⁷

Aphasia usually occurs as a result of brain damage, and may result in a loss of phonetic production of speech, an inability to understand speech, and an inability to repeat, hear, or read words with small variations in intonation. There are many types of aphasia, including Broca’s aphasia and Wernicke’s aphasia. People with Broca’s aphasia do not have fluent speech, and they have trouble repeating words or naming objects, and producing spontaneous speech. In contrast, people with Wernicke’s aphasia have much more fluent speech, but language is often incomprehensible and full of jargon, and language comprehension is weak.⁸

Dysfluency (stuttering) affects the flow of speech, and is characterized by an abnormally high number of stoppages in speech. When these breaks in speech occur, they are often accompanied by repetition of sounds or syllables, prolongated sounds, and periods where speech or airflow is blocked. Other indicators include eye blinking, facial grimacing, and physical movements while speaking.⁹

Developmental Phonological Disorders are a group of language disorders that refer to an inability to produce appropriate speech sounds; often one sound is substituted for another or sounds are omitted altogether.¹⁰ These disorders have also been known to affect the ability to read or spell.⁷ People with phonological disorders often are able to articulate all required speech sounds, but the impairment is in the area of learning to organize these sounds into a cohesive system to enable expressive language.⁶

The indicators of communication disorders

There are certain indicators of normal language development at various ages, and the main indicators are expressed below.^11,12

Causes of communication disorders

There are a number of causes attributed to communication disorders; such as hearing impairment, physical disability, biological causes and developmental disability. A hearing impairment, whether partial or full, can cause difficulties in the development of speech and language. Someone with a hearing impairment may ask to have questions repeated, show confusion during conversations, or display inaccurate speech sounds, such as leaving out the beginning of a word; for example, saying ‘at’ instead of ‘cat'.⁴

A physical disability such as cleft lip and palate are known to cause communication disorders, as well as disabilities such as cerebral palsy.⁴ Biological causes such as abnormal brain development, exposure to toxins during pregnancy (e.g. abused substances or lead), and genetic factors have also been identified.³

A developmental disability can also cause delays in the development of language and speech. Characteristics of people with Pervasive Developmental Disorders such as Autism or Asperger’s Disorder include severe impairment in communication skills.¹³ Other causes of communication disorders may be vocal abuse or misuse, mental retardation or emotional or psychological disorders.

The physiology of communication disorders

Communication involves producing speech as well as receiving and understanding spoken language. Children with communication disorders typically have normal hearing and possess the physical ability to produce speech sounds – their difficulties stem from the way their brain is processing information.

When a child is in the womb, the ear is the first organ to mature and become functional and after 16 weeks the child can hear all perceivable sounds in the uterine environment. There are two organs in the inner ear which are responsible for perceiving sound. The cochlea attends to all sounds in the auditory spectrum while the vestibule responds to bone-conducted sound (sound waves hitting the body and the head). The vestibule has the equally important task of regulating the position of the body. It uses knowledge of gravity and where the head is to maintain physical balance and equilibrium and also enables smooth and controlled coordination.

The third function of the vestibule is as a sensory integrator. Because the ear is the first fully matured organ, the vestibule is the primary receptor of information from every sensory system in the body. That is, the vestibule receives all sensory input and relays the information to the appropriate part of the brain. The multitude of problems experienced by children with communication disorders starts to become clearer when the role of the inner ear is explored in detail. Because the cochlea and the vestibule share some of the same anatomical components it is not uncommon for language (cochlea), motor and sensory ability (vestibule) to demonstrate parallel strengths or weaknesses.

Children with communication disorders tend to demonstrate abnormal listening patterns, due to problems in how the received sound is transmitted to the brain and interpreted for its meaning. This also helps to explain why producing speech is affected, as verbal skills are first acquired through listening to speech sounds. If this initial stage is compromised by a weak auditory system, subsequent development of any skill that relies on effective functioning of the inner ear is impeded.

How the Tomatis Method can assist those with communication disorders

French physician, Alfred Tomatis, developed the Tomatis Listening Program about 50 years ago. The development of his technique for auditory training was based on the fundamental principle that the voice produces what the ear hears – a concept referred to as the Tomatis effect. The Tomatis method relies primarily on carefully controlled sound stimulation using Mozart music and Gregorian chant. The mother’s voice is used while the child is encouraged to actively imitate or respond to what they hear. Each program is tailored to the child’s individual needs as identified through the initial assessment.

Listening assessments are undertaken every 10-15 hours throughout the program and the listening schedule is continually adjusted to reflect the client’s progress. The important thing to realize is that the Tomatis Method improves auditory processing with respect to language and the use of microphones by the mother and the child trains the reception of language signals to be achieved more effectively, both from the mother and from himself or herself.

It is difficult to generalize about the way a child will change once the Tomatis Method is administered. Children undertake the program to address different deficits or problems. The simplest way to explain what can be expected is that the child’s functioning will shift more an extreme to a more moderate position. The Tomatis Method aims to improve reception and expression of language communication – once this is underway, the indications of the progress are reflected behaviourally, emotionally, and socially. The effects of the Tomatis Method are not temporary as the program is not concerned with developing extraordinary functioning but with restoring the auditory system to a greater equilibrium.

Integrated Listening Systems (iLs)

An alternative to the Tomatis Method is Integrated Listening Systems which is a home-based sound stimulation program in combination with a movement program. The auditory stimulation is based on the same scientific rationale as the Tomatis Method, using filtration techniques which are programmed onto CDs. While iLs does not involve the complex sound modification and equipment used in Tomatis training, it remains a highly effective and convenient alternative which may be suitable for some children. Sometimes iLs is used in combination with Developmental Movement Therapy but this is generally determined at the initial assessment.

Combining the Tomatis Method with Developmental Movement Therapy (DMT)

Many children with communication disorders also suffer from neurosensory dysfunction. This is a weakness in the way sensory information from various parts of the body is integrated and transmitted to the brain¹⁴ and can manifest itself as a communication disorder. Sensory systems should not be purely thought of as abilities to hear, see, feel, smell, or taste in isolation of each other. Our senses are only useful when the connections from the organ to the brain are operating normally.¹⁵ Because the vestibule is where the initial sensory integration takes place, the Tomatis Method is often combined with a program of Developmental Movement Therapy (DMT) so that the vestibule is stimulated through both sound and sensory input.

When children are born, they emerge from the womb with primitive reflexes – physical responses that are initiated without conscious thought or intention. These reflexes allow the child to cope with the influx of new sensory information from the post-utero environment, but should soon be overtaken and inhibited by voluntary actions – these are referred to as postural reflexes or postural control. It has been found that problems with neurosensory integration may be attributed to partially uninhibited primitive reflexes. The rationale behind DMT is that sensory systems and reflexes are indivisible, and that any existing partially retained primitive reflexes can be actively inhibited by exercising the postural reflexes. Postural reflexes have the effect of maintaining and controlling posture, physical actions, and equilibrium.¹⁴

Developmental Movement Therapy involves a program of movements designed to retrace motor development as it ideally should have been experienced and has been shown to be of considerable benefit to children with communication disorders.¹⁴

References

1 Van Riper, C., & Erickson, R.L. (1996). Speech correction: An introduction to speech pathology and audiology. (9th Ed.). Boston: Allyn and Bacon.

2 Child Development Institute: Children with Communication Disorders. (www.childdevelopmentinfo.com/disorders/children_with_communication_disorders.shtml)

3 Yale Medical Group: Communication Disorders. (http://ymghealthinfo.org/content.asp?page=P02559)

4 PsychNet-UK: Speech/Communication Disorders.
(http://www.psychnet-uk.com/dsm_iv/communication_disorder.htm) Auditory processing disorder.

5 Shelley L. Velleman: Childhood Apraxia of Speech. (http://www-unix.oit.umass.edu/~velleman/cas.html)

6 Caroline Bowen: Children’s Speech Sound Disorders. (http://members.tripod.com/Caroline_Bowen/phonol-and-artic.htm)

7 Daniel H. Jacobs: Aphasia. (http://www.emedicine.com/neuro/topic437.htm)

8 Bay Area Speech and Language Services: Stuttering. (http://www.bayareaspeech.com/html/stuttering.html)

9 Medline Plus: Phonological Disorder. (http://www.nlm.nih.gov/medlineplus/ency/article/001541.htm)

10 Child Development Institute: Language Development in Children. (www.childdevelopmentinfo.com/development/language_development.shtml)

11 The Language Express PSL System: Ages and Stages. (http://www.language-express.ca/agesstages/3months.htm)

12 National Dissemination Center for Children with Disabilities: Pervasive Developmental Disorders. (http://www.nichcy.org/pubs/factshe/fs20txt.htm#define)

13 Psychology Today: Communication Disorders. (http://cms.psychologytoday.com/conditions/commdisorder.html)

14 Goddard, S. (2002). Reflexes, Learning and Behavior. Fern Ridge Press, Oregon.

15 Heartland: Sensory Integration: The Concept. (http://www.geocities.com/heartland)