III. INTRODUCTION TO PRACTICE
THERAPISTS
communication disorders [Mary Guerrero Rodríguez] I. Expressive language disorder.
II. Language disorder Mixed receptive-expressive.
III. Phonological disorder.
IV. Stuttering.
-selective mutism.
1) expressive language disorder.
1.1. Diagnostic Features
Criteria for diagnosis.
The essential feature of this disorder is a deficiency in expressive language development. Expressive language scores were below those obtained in the nonverbal intellectual capacity and receptive language. The difficulties can seem both verbally and in gesture.
These difficulties interfere with academic or occupational achievement or social communication. Symptoms do not meet the criteria for language disorder Mixed receptive-expressive, or pervasive developmental disorder. In case of mental retardation, motor or sensory deficit of speech, or environmental deprivation, poor language are superior to those usually associated with such problems.
linguistic features of the disorder vary depending on the severity and age of the child.
These features include: quantitatively limited speech, a limited range of vocabulary, difficulty acquiring new words, errors or evocative vocabulary words, sentences too short, simplified grammar, limited varieties of grammatical structures, limited varieties time phrases, omissions of critical parts of sentences, use of an unusual order of words and delayed speech development.
The operation linguistic and comprehension skills of language are usually within normal limits. This disorder can be acquired or progressive. In the acquired type occurs expressive language impairment after a period of normal development as a result of a neurological disease or medical condition. In the evolutionary rate exists expressive language impairment of unknown origin. Children with this disorder usually begin his speech later and progress more slowly than usual in the development of expressive language.
1.2. Symptoms and associated disorders.
- The most common is a phonological disorder.
-disorder can also be seen in the influence and development of language (abnormally fast rate, erratic rhythm of speech and changes in the structure of language). -When
expressive language disorder is acquired additional difficulties are common speech, including abnormalities of the joint motor, phonological errors, slow speech, syllable repetitions and patterns of intonation and accentuation monotonous.
-In children the disorder is usually associated with certain learning and school problems. There may also be a slight alteration of receptive verbal skills.
-are frequent delays in reaching some motor milestones of development, a developmental coordination disorder and enuresis.
-also associated social withdrawal and some mental disorders such as attention deficit disorder with hyperactivity.
"It may be accompanied by EEG abnormalities, abnormal findings on neuroimaging techniques, dysarthric or apraxic behavior and other neurological disorders.
1.3. Symptoms depend on culture and gender.
For the assessment of communication skills should take into account the language and cultural context of the subject, mostly bilingual.
expressive language disorder developmental type is more common in males than in females.
1.4. Prevalence.
estimated 3-5% of children can be affected by a disorder of expressive language evolutionary. The acquired type is less common.
1.5. Course.
The developmental type is usually identified by 3 years of age, although milder forms may not appear until adolescence.
Their evolution is variable. About half of children with this disorder seem to overcome it, while the other half will have lasting problems.
At the end of adolescence, most children acquire language skills a more or less normal, although subtle deficits may persist.
acquired type disorder due to brain injuries, head trauma or stroke can occur at any age and its onset is sudden.
The evolution and prognosis are related with the severity and location of brain pathology, as well as the child's age and developmental level of the existing language in the time it was acquired disorder.
Clinical improvement of language skills can be rapid and complete, or otherwise may be incomplete recovery or a progressive.
1.6.
familiar pattern of expressive language disorder developmental type is more likely in individuals with a family history of communication disorders or learning. Not so in the acquired type.
1.7. Differential Diagnosis
expressive language disorder does not present receptive language disorders which distinguishes the disorder Mixed receptive-expressive language.
expressive language disorder is not diagnosed cases of autism or other pervasive developmental disorder. Autism is distinguished from the expressive language disorders, receptive and expressive communication anomalies and the presence of a qualitative impairment in social interaction and behavior patterns restricted repetitive and stereotyped.
The development of receptive and expressive language may be affected by mental retardation, impaired hearing or other sensory deficit, motor deficit or speech severe environmental deprivation. The
Children with expressive language delays due to environmental deprivation may experience rapid improvements once solved the environmental problems. In the disorder of written expression there is an alteration of writing skills. If there are deficits in oral expression, may be appropriate to provide an additional diagnosis of expressive language disorder.
Selective mutism production involves a limited expressive language disorder can resemble an expressive or mixed receptive language disorder, expressive close observation is needed to determine the presence of normal language.
acquired aphasia associated with a medical condition is usually transient childhood. The diagnosis of expressive language disorder is appropriate only if the language disturbance persists beyond the acute period of recovery.
1.8. Value of Diagnostic Criteria for Research CIE_10
Diagnostic Criteria for Research of ICD-10 proposed specific breakpoints for expressive language scores: two standard deviations below the expected level and a standard deviation below the CI nonverbal. Furthermore, unlike DSM-IV, the diagnosis can be established if any deterioration of neurological, sensory or physical affects directly the use of spoken or if mental retardation.
2) expressive language disorder Mixed receptive-
2.1. Diagnostic Features
Criteria for diagnosis.
disorder mixed expressive-receptive language is an alteration of both receptive language development. The scores of receptive and expressive language are below those of nonverbal intellectual capacity. Difficulties may occur in both verbal and gestural communications.
The language difficulties interfere with academic or occupational achievement or social communication.
Symptoms do not meet the criteria for a disorder Pervasive development.
If mental retardation, motor or sensory deficit of speech, or environmental deprivation of language deficiencies in excess of those usually associated with these problems. If a motor or sensory deficit or a neurological disease speaking, should be coded on Axis III.
Those affected by this disorder experience the difficulties associated with an expressive language disorder and problems with receptive language development (eg, difficulty understanding words, phrases, or particular types of words). In severe cases it may be noted multiple alterations, including the inability to understand the basic vocabulary and simple sentences, as well as deficits in auditory processing areas. Since
expressive language development in children is based on the acquisition of receptive skills, never seen a pure receptive language disorder.
disorder mixed receptive-expressive language can be acquired or developmental.
The acquired type occurs involvement of receptive and expressive language after a period of normal development as a result of a neurological disease or medical condition.
In the developmental type there is an alteration of receptive and expressive language that is not associated with any neurological involvement of known origin. It is characterized by a slow rate of language development.
2.2. Symptoms and related disorders
- The linguistic features of this disorder are similar to those of expressive language disorder. The lack of understanding is the primary feature that differentiates this expressive language disorder, it can vary depending on the severity of the condition and age of the child.
- Alterations of language comprehension may be less evident than those involved in language production.
- It may seem that the child is confused or not paying attention when spoken to (you can follow instructions incorrectly or not following at all, or inadequate responses to shear asks you questions and may be exceptionally quiet or very talkative).
- The conversation skills such as respect for shifts are usually very poor or inadequate.
-deficits are common in different areas of sensory processing of information, especially in auditory temporal processing.
"It is also characteristic of the difficulty to produce smooth and rapid movement sequences. Are common phonological disorders, learning disorders and speech perception deficits and impaired memory.
-also associated, attention deficit disorder with hyperactivity, developmental disorder coordination and enuresis.
- Language Disorder Mixed Receptive-Expressive may be associated with EEG abnormalities.
"There is a form of language disorder Mixed receptive-expressive strength of starts around 3-9 years of age and is accompanied by seizures, being known as Landau-Kleffner syndrome.
2.3. Symptoms depend on culture and gender.
For the assessment of communication skills should take into account the language and cultural context of the subject, especially in bilinguals.
developmental type disorder is more prevalent in men than in women.
2.4. The prevalence
estimated that the disorder mixed expressive-receptive language developmental type can occur in 3% of school-age children, but is less common than expressive language. The Landau-Kleffner syndrome and other forms of acquired type of disorder are rare.
2.5. Course.
Typically, this developmental type disorder is detected before 4 years of age. Severe forms can appear to age 2. The lighter may not be recognized until the child enters school where comprehension deficits become more evident.
language disorder Mixed receptive-expressive type acquired due to brain injuries, head trauma or stroke, can occur at any age.
The acquired type characteristic of Landau-Kleffner syndrome usually occurs between 3 and 9 years old.
Many children with language disorder Mixed receptive-expressive eventually acquire a normal language skills. In language disorder Mixed receptive-expressive acquired type, course and prognosis are related to the severity, location of brain pathology, as well as the child's age and level of language development in the time was acquired disorder. Sometimes the clinical improvement of language skills is complete, while in other cases there may be an incomplete recovery or a progressive. Children with more severe forms tend to develop learning disorder.
2.6.
-familiar pattern of evolution type of the disorder is more common among first-degree biological relatives of those suffering from the disorder in the general population.
"No evidence of familial incidence in the acquired type of this disorder.
2.7. Differential Diagnosis
disorder mixed receptive-expressive language receptive language disorders presented which distinguishes the expressive language disorder.
language disorder Mixed receptive-expressive not diagnosed cases of autism or other pervasive development.
The development of receptive and expressive language may be affected by mental retardation, impaired hearing or other sensory deficit, motor deficit or speech severe environmental deprivation.
Children with expressive language delays due to environmental deprivation may experience rapid improvements once solved the environmental problems. In the disorder of written expression there is an alteration of writing skills. If there are deficits in oral expression, may be appropriate to provide an additional diagnosis of expressive language disorder.
Selective mutism involves a limited expressive production can resemble expressive language disorder or a disorder Mixed receptive-expressive language, in some cases requires a medical history and careful observation to determine the presence of normal language.
acquired aphasia associated with a medical condition is usually transient childhood. The diagnosis of mixed disorder is appropriate only if the language disturbance persists beyond the acute period of recovery.
2.8. Relationship Research Criteria of ICD-10
In ICD-10 this condition is called receptive language disorder and deviations mentioned only in understanding the language and also Unlike the DSM-IV, the diagnosis can not be established if any deterioration of neurological, sensory or physical use directly affects receptive language or if mental retardation.
3) Phonological Disorder.
3.1. Diagnostic Features
Criteria for the diagnosis
The key feature is a failure to use speech sounds appropriate for age developmentally and language of the subject. Errors can involve the production, use, performance or organization of sounds. The deficiencies in the production of speech sounds interfere with academic occupational, or social communication. If mental retardation, motor or sensory deficit of speech, or environmental deprivation, poor speech are higher than those usually associated with these problems. If a motor or sensory deficit or a neurological disease speaking, should be coded on Axis III.
phonological disorder include an inability to correctly produce speech sounds and phonological problems that involve such cognitive deficit in linguistic categorization of speech sounds. The severity ranges from very little or no effect on speech intelligibility to speech completely unintelligible.
most frequently sounds are poorly articulated acquisition later in development (l, r, s, z, ch) but in younger subjects and affected more serious may be affected consonants and vowels early development. The lisp is particularly common.
phonological disorder may involve errors of selection and arrangement of sounds in syllables and words. 3.1 SYMPTOMS
and related disorders can be associated with hearing impairment, deficits of oral peripheral mechanism of speech, neurological disorders, cognitive disabilities or psychosocial problems. It is estimated that 2.5% of preschool children with disorders phonological unknown origin are classified as functional or evolutionary. May have delayed onset of speech.
3.2. Culture-bound symptoms and sex
Developmental assessments of communication skills should take into account the cultural and linguistic context of the subject, especially in bilinguals. Phonological disorder is more prevalent in males.
3.3. Prevalence.
Approximately 2-3% of children between 6 and 7 years old has a phonological disorder of moderate to severe, although the prevalence of milder forms is superior. The prevalence drops to 0.5% 17 years of age.
3.4. Course.
In severe phonological disorder, the child's language may be relatively unintelligible even to family members. The course of the disorder varies depending on its severity and associated causes. In mild presentations of unknown cause spontaneous recovery usually occurs.
3.5. Familiar pattern.
has demonstrated the existence of family history.
3.6. Differential diagnosis.
speech difficulties may be associated with mental retardation, hearing impairment or other sensory deficit, motor deficit or deprivation speech serious environmental. If deficiencies in speech are higher than those associated with these problems can be diagnosed phonological disorder.
problems limited to the rhythm of speech or voice is not included in the phonological disorder and are diagnosed as stuttering or communication disorder not otherwise specified.
3.7. Relationship with Research Diagnostic Criteria of ICD-10.
ICD-10 proposes that the ability to articulate a word is two standard deviations below the expected level and a standard deviation below the nonverbal IQ to make this diagnosis. In addition, it can not be established if any deterioration of neurological, sensory or physical use directly affects receptive language or if mental retardation.
4) Stuttering
4.1. Diagnostic Features
Criteria for the diagnosis
The essential feature of stuttering is a disorder of the normal fluency and temporal structure of speech, which is inappropriate for the subject's age. It is characterized by frequent repetitions or prolongations of sounds or syllables. Also note: interjections, fragmented words, audible or silent blocking, circumlocutions, words produced with an excess of physical tension and repetition of words monosilábicas. La alteración de la fluidez interfiere el rendimiento académico o laboral, o la comunicación social. Si hay un déficit sensorial o motor del habla, las deficiencias del habla son superiores a las asociadas usualmente a estos problemas. Si hay un déficit sensorial o motor del habla o una enfermedad neurológica, se codificarán también en el Eje III. La intensidad del trastorno varía en función de las situaciones y a menudo es más grave cuando se produce una presión especial para comunicar. El tartamudeo suele no producirse durante una lectura oral, cantando o hablando a objetos animados o animales.
4.2. Síntomas y trastornos asociados
En su inicio el sujeto puede no be aware of the problem.
You can try to avoid stuttering by linguistic mechanisms (eg, altering the rate of speech, avoiding certain words ...).
can be accompanied by certain movements such as blinking, tremors of the face, etc. Stress and anxiety exacerbate stuttering.
Stuttering can produce an alteration of social activity. In people with stuttering, phonological disorder and expressive language disorder are common.
4.3. Prevalence
stuttering prevalence in prepubertal children is 1% and down 0.8% in adolescence. The male to female ratio is about 3:1.
4.4. Course
The onset of the disorder typically occurs between 2 and 7 years of age, almost always manifests before age 10. The onset is usually insidious and gradually begins gradually is becoming a chronic problem. The disorder progresses and changes in the flow of speech is becoming more frequent and stuttering occurs in relation to significant words or phrases. When the child becomes aware mechanisms may appear to avoid disruption of the flow, observed emotional responses. Over 80% recover, and up to 60% do so spontaneously. Usually. Recovery occurs before 16 years of age.
4.5. Some familiar pattern
studies provide evidence for the existence of a genetic factor in the etiology of stuttering. The presence of a phonological disorder or a disorder of expressive language developmental type, or a family history of both, increases the likelihood of stuttering. In the case of males who stutter, about 10% of their daughters and 20% of their children.
4.6.
differential diagnosis of speech difficulties may be associated with a hearing impairment or other sensory deficit or motor speech deficits. Stuttering anomalies should be distinguished from normal verbal fluency that occur frequently in young children include repetitions of words in sentences, incomplete sentences, interjections ...
4.7. Relationship to Diagnostic Criteria for Research of ICD-10
research diagnostic criteria of ICD-10 are based on a minimum of 3 months to determine the clinical significance of stuttering.
5) communication disorder not otherwise specified.
These communication disorders who do not meet the criteria of any specific communication disorder, such as a voice disorder. Selective mutism
Diagnostic Features
feature essence of selective mutism is the persistent failure to speak in specific social situations despite speaking in other situations.
The disturbance interferes with educational or occupational achievement or social communication. The disturbance must last for at least 1 month and may not coincide with the first month of school.
not diagnosed if the subject's inability to speak is due solely to a lack of fluency in the language required in the social situation, or whether the disorder is best explained by the pregnancy itself a communication disorder, or if it appears in the course of a pervasive developmental disorder, schizophrenia or other psychotic disorder.
Children affected by this disorder can communicate through gestures, movements or shaking of the head, pulling or pushing, or by vocalizations monosyllabic, short, monotonous, or in an altered voice.
Associated Features and Disorders Associated with selective mutism
find excessive shyness, fear of pregnancy, social isolation and social withdrawal, negativism, temper tantrums or oppositional or controlling behavior, especially at home. Although usually have normal language skills, may be associated with a communication disorder or a disease that causes abnormalities in the joint. Also may have anxiety disorders, mental retardation, hospitalization, social phobia or stress psychosocial impairment. Symptoms
dependent on culture and gender
The behavior of immigrant children tend not to use the speech of his new country can not be diagnosed as selective mutism.
This disorder is more common in women than in men. Prevalence
is a rare and infrequent. Course
usually begins before age 5. The alteration usually lasts a few months, but sometimes persists and can last several years even
. Differential Diagnosis
should be distinguished from the communication disorders and that these speech impaired not limited to a specific social situation. Immigrant children if he persists in refusing to use the new language will not be diagnosed if selective mutism.
Individuals with pervasive developmental disorder, schizophrenia or other psychotic disorder or severe mental retardation may experience communication problems. However, the selective mutism is diagnosed only in children with proven ability to speak in certain social situations (at home).
