Types of Communication Disorders

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Communication disorders (CD) are associated with difficulties in processing verbal and nonverbal communication skills. This includes impairments in either language comprehension, speech, hearing, social cues, facial expressions, gestures, or emotional perception.

Moreover, these verbal and nonverbal cues were not developed during childhood, as normally expected.

Symptoms of CDs usually lie on a spectrum of severity, in which impairments can be mild or more profound. CDs may be a result of other conditions or act as the primary disorder. They also tend to coexist with each other, in which an individual is diagnosed with multiple types of CDs.

Symptoms

There are various types of CDs. Although they are different, most share common impairments in verbal and non-verbal communication, displaying difficulties in the following areas:

  • Language comprehension
  • Speech
  • Hearing 
  • Social cues
  • Facial expressions
  • Gestures 
  • Emotional perception

Causes

There is no definitive cause of CDs, however, some possible causes are listed below:

  • Developmental disorders, such as cerebral palsy (CP) can cause delays in communication and social skills.
  • Hearing impairments are a common symptom of CDs, but can also be a cause of a CD. According to a recent study that involved children with CDs, hearing impairments were found to have the highest prevalence of potential causes.
  • Speech delay is another impairment that can produce barriers in communication, triggering the development of CDs.
  • Language difficulties are a symptom of CDs but could also potentially be a cause.
  • Intellectual disabilities are neurodevelopmental disorders that often accompany CDs but could also be the cause of the CD. This is often difficult to determine since both conditions have overlapping symptoms so it is challenging to identify which disorder onset first.

Types

Below you will find the different types of communication disorders:

Social Communication Disorder

Social communication disorder (SCD) or pragmatic disorder, consists of impairments with verbal and nonverbal cues specifically involved in social interaction. SCD does not impact language comprehensions, such as grammar or punctuation.

Individuals who appear to have SCD, experiences difficulties in the following areas of social communication:

  • Pragmatics, which is interpreting your surroundings to discern the meaning of linguistic context.
  • Conceptualizing sentences that are indirect or nonliteral, such as “metaphors, humor, and aphorisms."
  • Verbal communication due to a lack of understanding of social cues and behaviors, like not always knowing when or how to greet people or interjecting during a conversation before the appropriate time. 
  • Nonverbal communication, such as gestures, eye contact, and facial expressions can also be difficult to comprehend for those with SCD. 
  • Understanding emotions, those with SCD have trouble expressing their own emotions and depicting others or the emotional context of a situation.

Language Disorders

Language disorders (LD) consist of difficulties in perceptualizing language, whether it be vocalized, written, or in the formate of symbols. Individuals will most likely find it challenging to produce content that involves:

  • Syntax
  • Semantics 
  • Phonology (sound system)
  • Morphology (word system)
  • Pragmatics 

LDs are very similar to SCD, but require an individual to also experience issues in “word knowledge, grammar, and discourse.” Since these disorders have overlapping qualities, LDs are often included in studies that appear to be strictly directed towards SCD.

This can produce confusion in understanding the differences between these two disorders and developing concrete diagnostic criteria, which can cause difficulties in diagnosing and educating individuals about both disorders.

Speech Disorders

Speech disorders usually involve an individual experiencing challenges with articulating words fluently. There are 3 different types of speech disorders, such as:

  • Articulation disorder: Difficulties in producing clear and articulate speech, which can create challenges in social communication along with impacting how an individual retains knowledge.
  • Fluency Disorder or Childhood-Onset Fluency Disorder: This is when the flow or rhythm of speech is inconsistent or disrupted, which is also considered “stuttering.” Difficulties in fluency could be related to behavioral issues.
  • Voice disorder: Displaying abnormalities with “vocal quality” or pitch, whether this is in the form of unnecessary loudness, unusual speech duration, or an absence of speech. Such abnormalities could be acknowledged as inappropriate social behavior.

Hearing Disorders (Auditory Processing)

Hearing disorders derive from disturbances to the auditory system which impacts how one interprets “auditory information,” as well as speech and/or language. Those who experience impairments with hearing are considered to be either deaf or hard of hearing.

Diagnosis

For an individual to be diagnosed with a CD they must meet the diagnostic criteria stated in The Diagnostic Statistical Manual of Mental Disorder-5 (DSM-5) and other mental health classification books.

SCD was the most recent CD included in these diagnostic books, mostly because of the changes made to ASD diagnostic criteria which meant some individuals no longer met ASD criteria but symptoms now align with criteria for SCD.

DSM-5 Diagnostic Criteria for Social Communication Disorder

According to the DSM-5, an individual meets the criteria for SCD if they display the following symptoms:

Social issues in verbal and nonverbal communication regarding:

  • Greetings
  • Transitions in conversations, depending on the setting
  • Social rules during a conversation, like waiting until it’s your turn to speak
  • Comprehending indirect contact

Symptoms have been present since childhood and create difficulties in:

  • Functioning
  • Communication and social engagement
  • Academic or occupational performance
  • Relationships

The final criterion is that an individual must not meet the criteria for autism spectrum disorder.

Comorbidities

There are instances in which CDs can be present along with neurodevelopmental disorders. The DSM-5, however, explains that although there are many similarities, CDs cannot coexist with Autism Spectrum Disorder (ASD), since social and communication impairments are already criteria for ASD.

Those with ASD specifically share common challenges with social cues as individuals who are diagnosed with SCD.

Although there are similarities, individuals with SCD only display difficulties with specific verbal and nonverbal cues, unlike ASD in which other criteria must be met in order to be diagnosed. 

SCD is most commonly paired with neurodevelopmental disorders like attention-deficit/hyperactivity disorder (ADHD) and conduct disorder.

CDs Are Mostly Diagnosed in Children

CDs can be diagnosed in both adults and children. Most research on social impairment, however, has mostly been studied in toddlers, kids, and adolescents.

CDs are often acknowledged during childhood, in which the child can receive therapy to help in developing communication and social skills.

Once an adult, it can be more difficult to discover and treat, since these impairments are no longer developmental concerns, but social habits that interfere with communication and societal norms.

Assessing Communication Disorders

It can be difficult for experts to assess social and communication impairments in individuals because these impairments are only present during genuine social interactions.

There is not much research explaining how to assess CDs in adults, but there is information provided on how to assess in children.

Reports

Since it can be difficult for a therapist or practitioner to examine a child’s usual interaction during social settings, reports from parents and teachers are the next best thing.

Parents and teachers assess the child’s communication and social cues during daily interactions and report the behavior to the clinician.

Both parents and teachers follow a checklist suited for children ages 4 to 17 to evaluate social interaction.

The clinician will rate the child’s conversational and communication skills. This type of assessment can be difficult to gain concrete definitive data because it does take time and patience. Parents and teachers must also be consistent in collecting the data.

Observations

Examiners conduct “structured observations” by creating a setting in which they can provoke social interaction to observe the child’s responses and reactions.

They also observe both verbal and nonverbal communication between the child and adults. They analyze how the child converses, asks questions, and responds to questions. Examiners additionally examine facial expressions, gestures, and eye movements.

During these sessions, they are able to evaluate any social impairments that may be present. After doing so, practitioners can determine a necessary treatment plan. It is possible for this assessment to not be as effective, especially in young children, because they are interacting with adults that are unfamiliar to them.

Assessments

Clinicians use certain assessment measures to assess a child's pragmatic skills, by asking them to identify and interpret specific factors of stories and express these narratives coherently. These measures explore how the individual interprets indirect or figurative language; such as metaphors, humor, and idioms.

Some clinicians and researchers have concerns about these measures not being able to assess social and communication impairments successfully because the interaction is not genuine.

Treatment

Treatment for SCD would usually involve therapy sessions focused on developing social and communication skills that help enhance the understanding of social rules during conversations and social engagement.

These sessions also expand one’s knowledge of words and aid in the processing of understanding linguistics, concepts, and story-telling. Most interventions seek to develop metapragmatic awareness (MPA) which is “the ability to identify explicitly and reflect upon pragmatic rules (MP explicitation).”

Speech-language therapists facilitate these sessions, in which they also work on developing phonology and monopoly language acquisition. This helps individuals expand their speech and written language skills. 

Therapy Interventions

There are not many studies that evaluate therapy intervention for CDs, but a particular study that reviewed speech and language intervention in children with SCD expressed that therapists usually conduct a series of 20 sessions.

They also use parent and teacher reports, narrative observations, and assessments, to aid in progress. 

Although speech-language therapy appears to be effective at the conclusion of sessions, there are concerns that as the child continues to age and enter different stages of life, brief sessions just may not be enough. As research on CDs continues to expand, further treatment options must be explored to offer definitive treatment plans throughout the child’s development and possible treatment for adults who were not diagnosed as children. 

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8 Sources
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