There are a number of things in the differential diagnosis of language disorder. It certainly can be a normal developmental variation that resolves as the child ages. Sensory impairment can affect the ability to produce or comprehend language. Individuals with intellectual disability will have language deficits that are a part of their overall intellectual dysfunction. Neurological disorders, like epilepsy, can interfere with language development. Language can certainly regress in a younger child, which may represent a neurological disorder or autism spectrum disorder, which doesn’t always manifest itself until after the age of three-four years of age.
SPEECH SOUND DISORDER (PREVIOUSLY PHONOLOGICAL DISORDER OR 315.39) The clarity of a child’s speech is crucial to the ability to interact socially, express intentions, and have normal occupational and educational success. It also affects self-image and selfconfidence. This disorder was called phonological disorder in the DSM-IV and includes children who have difficulties producing intelligible speech that interferes with communication, resulting in functional impairment and personal distress. The disorder represents the inability to clearly speak phonemes (the basic units of speech). These can be omitted, distorted, added, or changed in ways that make the speaker difficult to understand. The child may drop the beginning sound or ending sound of a phoneme, or may have a lisp (which is also included as part of this disorder). The complete intelligibility of a child’s speech is achieved over the course of a decade after birth with nearly all intelligibility coming by the age of 4 years. Only half of all speech is intelligible by the age of 2 years. Deficits that fall outside of these parameters in the absence of another sensorimotor problem may indicate speech sound disorder. There are four criteria for this disorder, according to the DSM-V. These include the following: A. Persistence of unintelligible speech that consists of phoneme omission, addition, substitution, or distortion that adversely affects verbal communication. B. Difficulties with academic performance, social participation, and/or occupational performance because of the speech defect.
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