Course and Natural History - Childhood Disorders: Communication Disorders

Course and Natural History

Expressive and Mixed Receptive-expressive Language Disorders

Contrary to some popular beliefs, language disorders do not usu-ally spontaneously resolve. In general, the course of these dis-orders is lengthy, and the more severe disorders are usually the more persistent. Language disorders of the developmental type generally appear gradually early in life, while those secondary to other medical illnesses tend to occur more precipitously and at any age. In the case of Expressive Language Disorder, DSM-IV-TR reports that most children with this condition acquire more or less normal language abilities by late adolescence, but that subtle deficits may persist. In the case of Mixed Receptive-expressive

Language Disorders only a minority of children are free of com-munication problems in adulthood. Even when their communica-tion skills seem grossly normal, subtle deficits may persist, and they may experience educational difficulties. The prognosis for individuals with acquired language disorders often depends upon the severity of injury or illness, as well as their premorbid state.

Phonation Disorder

The course of Phonation Disorder is much more encouraging than those of other communication disorders. Milder cases may not be discovered until the child starts school. These cases often recover spontaneously, especially if the child does not encounter adverse psychosocial consequences because of his speech. Severe cases associated with anatomic malformations may at times require surgical intervention. Between these two extremes are children who gradually improve, often to the point of total remission, and whose improvement may be accelerated by speech therapy.

Stuttering

Stuttering usually appears in early childhood, at as early as two years of age and frequently around five, with a typically gradual onset. A study by Yairi et al. (1993) suggested that often early-ap-pearing stuttering takes on a moderate to severe form. Children are generally not aware of this condition in themselves until it is pointed out to them by others. The disorder can wax and wane during childhood. By early adolescence, it abates spontaneously in some cases, and from 60 to 80% of individuals eventually re-cover totally or to a major extent. DSM-IV-TR asserts that spon-taneous recovery typically occurs before the age of 16. Stuttering may persist into adulthood, often leading to adverse social and occupational consequences.