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Communication difficulties

communication; disability; problems; disorders; speech; language; talking; speaking; semantic; signing; stuttering; dyspraxia; autism; Asperger; syndrome; Down; intellectual; hearing; impairment; AAC; CAP; central; auditory; processing; dyslexia;

From a very early age, children learn that words, voice tone, facial expressions and gestures are all part of the messages other people give them. Children learn to express their needs through facial expressions, gestures (such as nodding and pointing) and sounds. The closer they get to school age, the clearer, and more 'adult' like the sounds become.

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When children are very young, parents understand their needs from the way they behave. If babies cry, they could be hungry, thirsty, lonely, frightened or in need of a nappy change. As they get a little older, children learn to express their needs through facial expressions, gestures (such as nodding and pointing) and sounds. Between 12-18 months of age, they begin to use words. From a very early age, children also learn to understand other people. They learn that words, voice tone, facial expressions and gestures are all part of the messages other people give them.

Some children do not develop speech as easily as others. Sometimes they do not find it easy to understand the meaning of words or gestures. These problems are examples of communication difficulties. When a child has a communication difficulty, it may be necessary to get help from teachers, speech pathologists and other professionals.

Communication difficulties are more common than you may think: 20% of four year old children have diffuculty learning language.

What is communication?

The word 'communication' is used to talk about how people share information (including their thoughts and feelings). Often when people think about communication, they think about talking and listening. However, people also send information by:

  • the tone of their voice
  • the look on their face (facial expression)
  • the way they use their hands (gestures)
  • the way they move and hold their body (body language).

Learning to understand and talk occurs gradually 

Children will typically be able to say 50 words by the time they reach 2 years. At this age they will start to put short two word sentences together. Language learning increases dramatically and by three years children are using three to four word sentences and can be easily understood by familiar adults. By four years children are communicating in four to five word sentences and can be understood by anyone.

Opportunities to practise talking and listening with adults and other children help children to develop their communication skills.

What is a communication problem?

A communication problem occurs when children have difficulty with:

  • recognising the emotions or intentions of others
  • speech sounds (saying the words clearly or correctly)
  • speaking fluently (without hesitating too much or stuttering)
  • using words and grammar (rules about word order and use)
  • putting words together to let others know what they think or want
  • understanding what others say.

Communication problems may affect a child's ability to speak (speech disorders/impairments) and/or the ability to understand and use spoken language (language disorders/impairments). Professionals talk about these as expressive and receptive communication difficulties.

Receptive communication problem

A receptive communication problem means that children have trouble understanding (or receiving) the meaning of information being given to them. There may be difficulty with understanding:

  • individual words, including words that describe things (such as big/little, all, different)
  • phrases
  • information when it is put into sentences
  • questions
  • longer instructions
  • descriptions.

Many children with receptive communication problems rely on facial expressions, tone of voice, gestures or body language to understand what they are told. They may also gain understanding from watching other people and from the use of routines.

Expressive communication or language problem

Children with an expressive communication or language problem have trouble giving (or expressing) information to other people in a way that other people can easily understand. They may have trouble learning and remembering:

  • words, such as the names of things
  • the rules of grammar and how to connect words to make sentences
  • how to use language to meet their needs (such as to ask questions, describe events, give instructions or tell a story).

Communication problems can sometimes be due to hearing problems.

Babies are offered  a hearing screening at birth. Children who are at risk of their hearing changing should have their hearing rechecked. (Have a look at Hearing and hearing loss.) If your child's hearing is at risk of changing or you think that hearing loss may be the cause of your child's communication problems, take your child to see your family doctor for a check of his or her ear health, and for a referral for a hearing check-up.

Types of communication difficulties

There are many types of communication difficulties. These include:

  • speech delay/disorder/impairment
  • language delay/disorder/impairment
  • expressive language disorder
  • receptive language disorder
  • stuttering or dysfluency
  • verbal dyspraxia (difficulty in making muscle movements that are needed for speaking clearly and quickly)
  • semantic/pragmatic disorder (this affects a child's use of language for social purposes)
  • Auditory Processing Disorder  (APD) (this affects a child's listening and understanding of language)
  • Specific learning difficulties - such as dyslexia.
  •  Sometimes, a communication difficulty will happen as part of a syndrome or disability.

Communication problems can be mild, moderate or severe.Your child's support needs will depend on the type of communication problem and how severe or complicated it is.

Causes of communication problems

Parents often want to know why their child is having difficulty learning to understand and/or talk. It can be difficult to pinpoint a particular cause.

In some cases, there are reasons for a child's communication problems that can be related to one or more of the following:

Physical factors

  • Children with low muscle tone (hypotonia) have trouble coordinating (moving) the muscles of the mouth and tongue to produce clear sounds.
  • Structural problems in the mouth, throat and nose, such as cleft palate prevent clear speech sounds.
  • Conditions that affect nerve and muscle control, such as muscular dystrophy or cerebral palsy, may make speech difficult or impossible.
  • Repeated ear infections, affecting hearing.

Syndromes or disabilities that cause delays in development

  • Some syndromes or disabilities, such as autism, affect the development of communication skills.
  • Hearing impairment may make it more difficult for children to develop speech and language. They may require extra support or specialised teaching.
  • Intellectual delay and disability  will slow the development of speech and language.
  • When we speak with each other, much of what we 'say' is actually communicated in our facial expression, hand gestures and body language. Vision impairments may reduce the amount of information that a child receives during a conversation. This can lead to communication difficulties.

Acquired brain injury

  • Acquired brain injury may damage parts of the brain that deal with communication.
  • Children with an acquired brain injury may lose the ability to speak or understand language. This loss may be temporary or permanent, depending upon the type of injury.
  • Children with an acquired brain injury may develop specific learning difficulties that make it harder to learn to organise and express their thoughts.

Communication problems can also be caused by:

  • lack of experience or stimulation
  • limited opportunities to talk with others.

What you can do

  • Parents know their children better than anyone. If you feel that your child is struggling to talk or understand what you say, speak to your doctor or local community health centre, child care, child health nurse, preschool or school staff or make an appointment with a speech pathologist.
  • Have your child's hearing and eye sight checked to make sure they are not contributing to the communication problem.
  • You can provide your child with opportunities to practise communicating with children the same age. You could visit a playgroup, kindergym or the local playground.
  • Sometimes parents and children attend early intervention programs.
  • Practise talking and listening skills with your child. Spend time playing with and reading to your child.
  • If your child could have a communication problem, you will probably be referred to a speech pathologist for a formal diagnosis. The speech pathologist will have suggestions that will help your child. You may be asked to practise specific things with your child on a regular basis.

Role of a speech pathologist

Speech pathologists work to identify which areas of talking and listening need to develop and help children develop communication skills. Depending on a child's need, a speech pathologist will concentrate on problems with:

  • speaking, including stuttering or sound formation
  • understanding
  • learning words and vocabulary
  • using language appropriately with other people
  • organising words, sounds and sentences to make a clear message.

Sometimes speech pathologists will work with drinking and eating problems, especially where these affect speech.

They may teach your child how to communicate in other ways (such as using signs) or to use an alternative or augmentative communication device, such as a communication board or computer.

A speech pathologist will talk with parents about their concerns. They will develop programs to improve a child's skills. These programs may be carried out by the speech pathologist or by parents and staff at preschool, childcare or school.

If your child has a communication problem, a speech pathologist may suggest the use of:

  • communication boards or charts
  • electronic devices, such as computers
  • symbols
  • sign language.

This may happen if your child:

  • is becoming frustrated because his speech cannot be understood
  • does not have enough muscle tone to coordinate speech
  • needs to practise the basic language skills needed for more complex thinking
  • is better at thinking in pictures than in words  
  • is confused by spoken language.

Alternative and augmentative communication (AAC)

Alternative and augmentative communication (AAC) devices help people with speech and language problems to communicate. Not all AAC devices are expensive or highly technological.

  • Alternative devices (such as communication boards, computers or voice output devices) give a child a way to communicate when no speech is present.
  • Augmentative devices (such as pictures or symbols) assist a speaking child to give a clearer message.

There is more about this on the Speech Pathology Australia site Augmentive and alternative communication 

Sign language

Signing is a way to communicate using standard hand movements. When children have speech and/or language problems, signing can help to make their message clear. For children with delayed speech development, signing can:

  • provide a way to communicate while their speech develops
  • reduce frustration and behaviour difficulties
  • help them understand the meaning of words
  • help them develop more complex thinking skills.

Courses in basic sign language are often available to parents and teachers.

There is more about this on the Better Health Channel Sign language - Auslan.

Preschool and school

There are many different types of communication difficulties. Some children with communication difficulties do not need much extra support to do well in preschool and school. Others need quite a lot.

  • Preschools and schools may be able to give your child additional help, depending upon her needs.
  • The type of speech pathology service your child receives may change when she starts preschool. It may change again when she moves from preschool to school.
  • Speech and language difficulties can be very frustrating for your child and may be the cause of behaviour problems at preschool or school.
  • Your child's teachers may develop a special program to help her to develop better communication skills.
  • In some places, school systems will have specialised programs, classes or units for children and students with communication problems.

Resources

South Australia

If you have concerns about your child's communication, you may wish to contact:

  • your child's pre-school or school teacher who may be able to refer your child to a Department of Education and Child Development (DECD) speech pathologist http://www.decd.sa.gov.au/ 
  • your local community hospital
  • your local community health centre
  • a private speech pathologist - see Speech Pathology Australia.

General

References and further reading

Speech Pathology Australia 
http://speechpathologyaustralia.org.au/ 

Raising Children Network 
http://raisingchildren.net.au/ 

Novita Children's Services 
http://www.novita.org.au/ 

Better Health Channel 
http://www.betterhealth.vic.gov.au/ 

Prepared in collaboration

with Newborn and Children's Hearing, Women's and Children's Health Network (South Australia) and the Department of Educationand Child Development Ministerial Advisory Committee on Students with Disabilities

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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