another word for speech or language impairment

Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.

Speech and Language Impairments

The Individuals with Disabilities Education Act, or IDEA, defines the term “speech or language impairment” as follows:

“(11) Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.” [34 CFR §300.8(c)(11]

(Parent Information and Resources Center, 2015)

Table of Contents

What is a Speech and Language Impairment?

Characteristics of speech or language impairments, interventions and strategies, related service provider-slp.

A Day in the Life of an SLP

Assistive Technology

Speech and language impairment are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency.

A speech impairment is characterized by difficulty in articulation of words. Examples include stuttering or problems producing particular sounds. Articulation refers to the sounds, syllables, and phonology produced by the individual. Voice, however, may refer to the characteristics of the sounds produced—specifically, the pitch, quality, and intensity of the sound. Often, fluency will also be considered a category under speech, encompassing the characteristics of rhythm, rate, and emphasis of the sound produced.

A language impairment is a specific impairment in understanding and sharing thoughts and ideas, i.e. a disorder that involves the processing of linguistic information. Problems that may be experienced can involve the form of language, including grammar, morphology, syntax; and the functional aspects of language, including semantics and pragmatics.

(Wikipedia, n.d./ Speech and Language Impairment)

*It’s important to realize that a language delay isn’t the same thing as a speech or language impairment. Language delay is a very common developmental problem—in fact, the most common, affecting 5-10% of children in preschool. With language delay, children’s language is developing in the expected sequence, only at a slower rate. In contrast, speech and language disorder refers to abnormal language development. Distinguishing between the two is most reliably done by a certified speech-language pathologist. (CPIR, 2015)

The characteristics of speech or language impairments will vary depending upon the type of impairment involved. There may also be a combination of several problems.

When a child has an articulation disorder , he or she has difficulty making certain sounds. These sounds may be left off, added, changed, or distorted, which makes it hard for people to understand the child.

Leaving out or changing certain sounds is common when young children are learning to talk, of course. A good example of this is saying “wabbit” for “rabbit.” The incorrect articulation isn’t necessarily a cause for concern unless it continues past the age where children are expected to produce such sounds correctly

Fluency refers to the flow of speech. A fluency disorder means that something is disrupting the rhythmic and forward flow of speech—usually, a stutter. As a result, the child’s speech contains an “abnormal number of repetitions, hesitations, prolongations, or disturbances. Tension may also be seen in the face, neck, shoulders, or fists.”

Voice is the sound that’s produced when air from the lungs pushes through the voice box in the throat (also called the larnyx), making the vocal folds within vibrate. From there, the sound generated travels up through the spaces of the throat, nose, and mouth, and emerges as our “voice.”

A voice disorder involves problems with the pitch, loudness, resonance, or quality of the voice. The voice may be hoarse, raspy, or harsh. For some, it may sound quite nasal; others might seem as if they are “stuffed up.” People with voice problems often notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use.

Language has to do with meanings, rather than sounds. A language disorder refers to an impaired ability to understand and/or use words in context. A child may have an expressive language disorder (difficulty in expressing ideas or needs), a receptive language disorder (difficulty in understanding what others are saying), or a mixed language disorder (which involves both).

Some characteristics of language disorders include:

improper use of words and their meanings,
inability to express ideas,
inappropriate grammatical patterns,
reduced vocabulary, and
inability to follow directions.

Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate. These symptoms can easily be mistaken for other disabilities such as autism or learning disabilities, so it’s very important to ensure that the child receives a thorough evaluation by a certified speech-language pathologist.

(CPIR, 2015)

Use the (Cash, Wilson, and DeLaCruz, n.d) reading and/or the [ESU 8 Wednesday Webinar] to develop this section of the summary.

Cash, A, Wilson, R. and De LaCruz, E.(n,d.) Practical Recommendations for Teachers: Language Disorders. https://www.education.udel.edu/wp-content/uploads/2013/01/LanguageDisorders.pdf

[ESU 8 Wednesday Webinar] Speech Language Strategies for Classroom Teachers.- video below

Video: Speech Language Strategies for Classroom Teachers (15:51 minutes)’

[ESU 8 Wednesday Webinars]. (2015, Nov. 19) . Speech Language Strategies for Classroom Teachers. [Video FIle]. From https://youtu.be/Un2eeM7DVK8

Most, if not all, students with a speech or language impairment will need speech-language pathology services . This related service is defined by IDEA as follows:

(15) Speech-language pathology services include—

(i) Identification of children with speech or language impairments;

(ii) Diagnosis and appraisal of specific speech or language impairments;

(iii) Referral for medical or other professional attention necessary for the habilitation of speech or language impairments;

(iv) Provision of speech and language services for the habilitation or prevention of communicative impairments; and

(v) Counseling and guidance of parents, children, and teachers regarding speech and language impairments. [34 CFR §300.34(c)(15)]

Thus, in addition to diagnosing the nature of a child’s speech-language difficulties, speech-language pathologists also provide:

individual therapy for the child;
consult with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; and
work closely with the family to develop goals and techniques for effective therapy in class and at home.

Speech and/or language therapy may continue throughout a student’s school years either in the form of direct therapy or on a consultant basis.

A Day in the Life of an SLP

Christina is a speech-language pathologist. She works with children and adults who have impairments in their speech, voice, or language skills. These impairments can take many forms, as her schedule today shows.

First comes Robbie. He’s a cutie pie in the first grade and has recently been diagnosed with childhood apraxia of speech—or CAS. CAS is a speech disorder marked by choppy speech. Robbie also talks in a monotone, making odd pauses as he tries to form words. Sometimes she can see him struggle. It’s not that the muscles of his tongue, lips, and jaw are weak. The difficulty lies in the brain and how it communicates to the muscles involved in producing speech. The muscles need to move in precise ways for speech to be intelligible. And that’s what she and Robbie are working on.

Next, Christina goes down the hall and meets with Pearl in her third grade classroom. While the other students are reading in small groups, she works with Pearl one on one, using the same storybook. Pearl has a speech disorder, too, but hers is called dysarthria. It causes Pearl’s speech to be slurred, very soft, breathy, and slow. Here, the cause is weak muscles of the tongue, lips, palate, and jaw. So that’s what Christina and Pearl work on—strengthening the muscles used to form sounds, words, and sentences, and improving Pearl’s articulation.

One more student to see—4th grader Mario , who has a stutter. She’s helping Mario learn to slow down his speech and control his breathing as he talks. Christina already sees improvement in his fluency.

Tomorrow she’ll go to a different school, and meet with different students. But for today, her day is…Robbie, Pearl, and Mario.

Assistive technology (AT) can also be very helpful to students, especially those whose physical conditions make communication difficult. Each student’s IEP team will need to consider if the student would benefit from AT such as an electronic communication system or other device. AT is often the key that helps students engage in the give and take of shared thought, complete school work, and demonstrate their learning. (CPIR, 2015)

Project IDEAL , suggests two major categories of AT computer software packages to develop the child’s speech and language skills and augmentative or alternative communication (AAC).

Augmentative and alternative communication ( AAC ) encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. Augmentative and alternative communication may used by individuals to compensate for severe speech-language impairments in the expression or comprehension of spoken or written language. AAC can be a permanent addition to a person’s communication or a temporary aid.

(Wikipedia, (n.d. /Augmentative and alternative communication)

Center for Parent Information and Resources (CPIR) (2015), Speech and Language Impairments, Newark, NJ, Author, Retrieved 4.1.19 from https://www.parentcenterhub.org/speechlanguage/

Wikipedia (n.d.) Augmentative and alternative communication. From https://en.wikipedia.org/wiki/Augmentative_and_alternative_communication

Wikipedia, (n.d.) Speech and Language Impairment. From https://en.wikipedia.org/wiki/Speech_and_language_impairment

Updated 8.8.23

Understanding and Supporting Learners with Disabilities Copyright © 2019 by Paula Lombardi is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

Share This Book

NASET.org Home Page

Exceptional teachers teaching exceptional children.

Overview of NASET
NASET Leadership
Directors' Message
Books by the Executive Directors
Mission Statement
NASET Apps for iPhone and iPad
NASET Store
NASET Sponsors
Marketing Opportunities
Contact NASET
Renew Your Membership
Membership Benefits
Frequently Asked Questions
Membership Categories
School / District Membership Information
Gift Membership
Membership Benefit for Professors Only
NASET's Privacy Policy
Forgot Your User Name or Password?
Contact Membership Department
Resources for Special Education Teachers
Advocacy (Board Certification for Advocacy in Special Education) BCASE
Board Certification in Special Education
Inclusion - Board Certification in Inclusion in Special Education (BCISE) Program
Paraprofessional Skills Preparation Program - PSPP
Professional Development Program (PDP) Free to NASET Members
Courses - Professional Development Courses (Free With Membership)
Forms, Tables, Checklists, and Procedures for Special Education Teachers
Video and Power Point Library
IEP Development
Exceptional Students and Disability Information
Special Education and the Law
Transition Services
Literacy - Teaching Literacy in English to K-5 English Learners
Facebook - Special Education Teacher Group
NASET Sponsor's Products and Services
ADHD Series
Assessment in Special Education Series
Autism Spectrum Disorders Series
Back to School - Special Review
Bullying of Children
Classroom Management Series
Diagnosis of Students with Disabilities and Disorders Series
Treatment of Disabilities and Disorders for Students Receiving Special Education and Related Services
Discipline of Students in Special Education Series
Early Intervention Series
Genetics in Special Education Series
How To Series
Inclusion Series
IEP Components
JAASEP - Research Based Journal in Special Education
Lesser Known Disorders
NASET NEWS ALERTS
NASET Q & A Corner
Parent Teacher Conference Handouts
The Practical Teacher
Resolving Disputes with Parents Series
RTI Roundtable
Severe Disabilities Series
Special Educator e-Journal - Latest and Archived Issues
Week in Review
Working with Paraprofessionals in Your School
Author Guidelines for Submission of Manuscripts & Articles to NASET
SCHOOLS of EXCELLENCE
Exceptional Charter School in Special Education
Outstanding Special Education Teacher Award
Board Certification Programs
Employers - Job Posting Information
Latest Job Listings
Professional Development Program (PDP)
Employers-Post a Job on NASET
PDP - Professional Development Courses
Board Certification in Special Education (BCSE)
Board Certification in IEP Development (BCIEP)
NASET Continuing Education/Professional Development Courses
HONOR SOCIETY - Omega Gamma Chi
Other Resources for Special Education Teaching Positions
Highly Qualified Teachers
Special Education Career Advice
Special Education Career Fact Sheets
FAQs for Special Education Teachers
Special Education Teacher Salaries by State
State Licensure for Special Education Teachers

Comprehenisve Overview of Speech and Language Impairments

Comprehensive overview of speech and language impairments.

Speech and language disorders refer to problems in communication and related areas such as oral motor function. These delays and disorders range from simple sound substitutions to the inability to understand or use language or use the oral-motor mechanism for functional speech and feeding. Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.

More than one million of the students served in the public schools’ special education programs in the 2000-2001 school year were categorized as having a speech or language impairment. This estimate does not include children who have speech/language problems secondary to other conditions such as deafness. Language disorders may be related to other disabilities such as mental retardation, autism, or cerebral palsy. It is estimated that communication disorders (including speech, language, and hearing disorders) affect one of every 10 people in the United States.

Characteristics

A child's communication is considered delayed when the child is noticeably behind his or her peers in the acquisition of speech and/or language skills. Sometimes a child will have greater receptive (understanding) than expressive (speaking) language skills, but this is not always the case.

Speech disorders refer to difficulties producing speech sounds or problems with voice quality. They might be characterized by an interruption in the flow or rhythm of speech, such as stuttering, which is called dysfluency. Speech disorders may be problems with the way sounds are formed, called articulation or phonological disorders, or they may be difficulties with the pitch, volume or quality of the voice. There may be a combination of several problems. People with speech disorders have trouble using some speech sounds, which can also be a symptom of a delay. They may say "see" when they mean "ski" or they may have trouble using other sounds like "l" or "r." Listeners may have trouble understanding what someone with a speech disorder is trying to say. People with voice disorders may have trouble with the way their voices sound.

A language disorder is an impairment in the ability to understand and/or use words in context, both verbally and nonverbally. Some characteristics of language disorders include improper use of words and their meanings, inability to express ideas, inappropriate grammatical patterns, reduced vocabulary and inability to follow directions. One or a combination of these characteristics may occur in children who are affected by language learning disabilities or developmental language delay. Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate.

Educational Implications

Because all communication disorders carry the potential to isolate individuals from their social and educational surroundings, it is essential to find appropriate timely intervention. While many speech and language patterns can be called "baby talk" and are part of a young child's normal development, they can become problems if they are not outgrown as expected. In this way an initial delay in speech and language or an initial speech pattern can become a disorder which can cause difficulties in learning. Because of the way the brain develops, it is easier to learn language and communication skills before the age of 5. When children have muscular disorders, hearing problems or developmental delays, their acquisition of speech, language and related skills is often affected

Speech-language pathologists assist children who have communication disorders in various ways. They provide individual therapy for the child; consult with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; and work closely with the family to develop goals and techniques for effective therapy in class and at home. The speech-language pathologist may assist vocational teachers and counselors in establishing communication goals related to the work experiences of students and suggest strategies that are effective for the important transition from school to employment and adult life.

Technology can help children whose physical conditions make communication difficult. The use of electronic communication systems allow nonspeaking people and people with severe physical disabilities to engage in the give and take of shared thought.

Vocabulary and concept growth continues during the years children are in school. Reading and writing are taught and, as students get older, the understanding and use of language becomes more complex. Communication skills are at the heart of the education experience. Speech and/or language therapy may continue throughout a student’s school years either in the form of direct therapy or on a consultant basis.

Specific Types of Communication Disorders

What is aphasia.

Aphasia is a language disorder that results from damage to portions of the brain that are responsible for language. For most people, these are parts of the left side (hemisphere) of the brain. Aphasia usually occurs suddenly, often as the result of a stroke or head injury, but it may also develop slowly, as in the case of a brain tumor. The disorder impairs both the expression and understanding of language as well as reading and writing. Aphasia may co-occur with speech disorders such as dysarthria or apraxia of speech, which also result from brain damage.

What causes aphasia?

Aphasia is caused by damage to one or more of the language areas of the brain. Many times, the cause of the brain injury is a stroke. A stroke occurs when, for some reason, blood is unable to reach a part of the brain. Brain cells die when they do not receive their normal supply of blood, which carries oxygen and important nutrients. Other causes of brain injury are severe blows to the head, brain tumors, brain infections, and other conditions of the brain.

How is aphasia diagnosed?

Aphasia is usually first recognized by the physician who treats the individual for his or her brain injury. Frequently this is a neurologist. The physician typically performs tests that require the individual to follow commands, answer questions, name objects, and converse. If the physician suspects aphasia, the individual is often referred to a speech-language pathologist, who performs a comprehensive examination of the person's ability to understand, speak, read, and write.

What Is Apraxia of Speech?

Apraxia of speech, also known as verbal apraxia or dyspraxia, is a speech disorder in which a person has trouble saying what he or she wants to say correctly and consistently. It is not due to weakness or paralysis of the speech muscles (the muscles of the face, tongue, and lips). The severity of apraxia of speech can range from mild to severe.

What Are the Types and Causes of Apraxia?

There are two main types of speech apraxia: acquired apraxia of speech and developmental apraxia of speech. Acquired apraxia of speech can affect a person at any age, although it most typically occurs in adults. It is caused by damage to the parts of the brain that are involved in speaking, and involves the loss or impairment of existing speech abilities. The disorder may result from a stroke, head injury, tumor, or other illness affecting the brain. Acquired apraxia of speech may occur together with muscle weakness affecting speech production (dysarthria) or language difficulties caused by damage to the nervous system (aphasia).

Developmental apraxia of speech (DAS) occurs in children and is present from birth. It appears to affect more boys than girls. This speech disorder goes by several other names, including developmental verbal apraxia, developmental verbal dyspraxia, articulatory apraxia, and childhood apraxia of speech. DAS is different from what is known as a developmental delay of speech, in which a child follows the "typical" path of speech development but does so more slowly than normal.

The cause or causes of DAS are not yet known. Some scientists believe that DAS is a disorder related to a child's overall language development. Others believe it is a neurological disorder that affects the brain's ability to send the proper signals to move the muscles involved in speech. However, brain imaging and other studies have not found evidence of specific brain lesions or differences in brain structure in children with DAS. Children with DAS often have family members who have a history of communication disorders or learning disabilities. This observation and recent research findings suggest that genetic factors may play a role in the disorder.

What Are the Symptoms?

People with either form of apraxia of speech may have a number of different speech characteristics, or symptoms. One of the most notable symptoms is difficulty putting sounds and syllables together in the correct order to form words. Longer or more complex words are usually harder to say than shorter or simpler words. People with apraxia of speech also tend to make inconsistent mistakes when speaking. For example, they may say a difficult word correctly but then have trouble repeating it, or they may be able to say a particular sound one day and have trouble with the same sound the next day. People with apraxia of speech often appear to be groping for the right sound or word, and may try saying a word several times before they say it correctly. Another common characteristic of apraxia of speech is the incorrect use of "prosody" -- that is, the varying rhythms, stresses, and inflections of speech that are used to help express meaning.

Children with developmental apraxia of speech generally can understand language much better than they are able to use language to express themselves. Some children with the disorder may also have other problems. These can include other speech problems, such as dysarthria; language problems such as poor vocabulary, incorrect grammar, and difficulty in clearly organizing spoken information; problems with reading, writing, spelling, or math; coordination or "motor-skill" problems; and chewing and swallowing difficulties.

The severity of both acquired and developmental apraxia of speech varies from person to person. Apraxia can be so mild that a person has trouble with very few speech sounds or only has occasional problems pronouncing words with many syllables. In the most severe cases, a person may not be able to communicate effectively with speech, and may need the help of alternative or additional communication methods.

How Is It Diagnosed?

Professionals known as speech-language pathologists play a key role in diagnosing and treating apraxia of speech. There is no single factor or test that can be used to diagnose apraxia. In addition, speech-language experts do not agree about which specific symptoms are part of developmental apraxia. The person making the diagnosis generally looks for the presence of some, or many, of a group of symptoms, including those described above. Ruling out other contributing factors, such as muscle weakness or language-comprehension problems, can also help with the diagnosis.

To diagnose developmental apraxia of speech, parents and professionals may need to observe a child's speech over a period of time. In formal testing for both acquired and developmental apraxia, the speech-language pathologist may ask the person to perform speech tasks such as repeating a particular word several times or repeating a list of words of increasing length (for example, love, loving, lovingly). For acquired apraxia of speech, a speech-language pathologist may also examine a person's ability to converse, read, write, and perform non-speech movements. Brain-imaging tests such as magnetic resonance imaging (MRI) may also be used to help distinguish acquired apraxia of speech from other communication disorders in people who have experienced brain damage.

How Is It Treated?

In some cases, people with acquired apraxia of speech recover some or all of their speech abilities on their own. This is called spontaneous recovery. Children with developmental apraxia of speech will not outgrow the problem on their own. Speech-language therapy is often helpful for these children and for people with acquired apraxia who do not spontaneously recover all of their speech abilities.

Speech-language pathologists use different approaches to treat apraxia of speech, and no single approach has been proven to be the most effective. Therapy is tailored to the individual and is designed to treat other speech or language problems that may occur together with apraxia. Each person responds differently to therapy, and some people will make more progress than others. People with apraxia of speech usually need frequent and intensive one-on-one therapy. Support and encouragement from family members and friends are also important.

In severe cases, people with acquired or developmental apraxia of speech may need to use other ways to express themselves. These might include formal or informal sign language, a language notebook with pictures or written words that the person can show to other people, or an electronic communication device such as a portable computer that writes and produces speech.

Auditory Preocessing Disorder (APD)

What is auditory processing.

Auditory processing is a term used to describe what happens when your brain recognizes and interprets the sounds around you. Humans hear when energy that we recognize as sound travels through the ear and is changed into electrical information that can be interpreted by the brain. The "disorder" part of auditory processing disorder means that something is adversely affecting the processing or interpretation of the information.

Children with APD often do not recognize subtle differences between sounds in words, even though the sounds themselves are loud and clear. For example, the request "Tell me how a chair and a couch are alike" may sound to a child with APD like "Tell me how a couch and a chair are alike." It can even be understood by the child as "Tell me how a cow and a hair are alike." These kinds of problems are more likely to occur when a person with APD is in a noisy environment or when he or she is listening to complex information.

APD goes by many other names. Sometimes it is referred to as central auditory processing disorder (CAPD). Other common names are auditory perception problem, auditory comprehension deficit, central auditory dysfunction, central deafness, and so-called "word deafness."

What causes auditory processing difficulty?

We are not sure. Human communication relies on taking in complicated perceptual information from the outside world through the senses, such as hearing, and interpreting that information in a meaningful way. Human communication also requires certain mental abilities, such as attention and memory. Scientists still do not understand exactly how all of these processes work and interact or how they malfunction in cases of communication disorders. Even though your child seems to "hear normally," he or she may have difficulty using those sounds for speech and language.

The cause of APD is often unknown. In children, auditory processing difficulty may be associated with conditions such as dyslexia, attention deficit disorder, autism, autism spectrum disorder, specific language impairment, pervasive developmental disorder, or developmental delay. Sometimes this term has been misapplied to children who have no hearing or language disorder but have challenges in learning.

What are the symptoms of possible auditory processing difficulty?

Children with auditory processing difficulty typically have normal hearing and intelligence. However, they have also been observed to

Have trouble paying attention to and remembering information presented orally
Have problems carrying out multistep directions
Have poor listening skills
Need more time to process information
Have low academic performance
Have behavior problems
Have language difficulty (e.g., they confuse syllable sequences and have problems developing vocabulary and understanding language)
Have difficulty with reading, comprehension, spelling, and vocabulary

How is suspected auditory processing difficulty diagnosed in children?

You, a teacher, or a day care provider may be the first person to notice symptoms of auditory processing difficulty in your child. So talking to your child's teacher about school or preschool performance is a good idea. Many health professionals can also diagnose APD in your child. There may need to be ongoing observation with the professionals involved.

Much of what will be done by these professionals will be to rule out other problems. A pediatrician or a family doctor can help rule out possible diseases that can cause some of these same symptoms. He or she will also measure growth and development. If there is a disease or disorder related to hearing, you may be referred to an otolaryngologist--a physician who specializes in diseases and disorders of the head and neck.

To determine whether the child has a hearing function problem, an audiologic evaluation is necessary. An audiologist will give tests that can determine the softest sounds and words a person can hear and other tests to see how well people can recognize sounds in words and sentences. For example, for one task, the audiologist might have the child listen to different numbers or words in the right and the left ear at the same time. Another common audiologic task involves giving the child two sentences, one louder than the other, at the same time. The audiologist is trying to identify the processing problem.

A speech-language pathologist can find out how well a person understands and uses language. A mental health professional can give you information about cognitive and behavioral challenges that may contribute to problems in some cases, or he or she may have suggestions that will be helpful. Because the audiologist can help with the functional problems of hearing and processing, and the speech-language pathologist is focused on language, they may work as a team with the child.

Developmental Dyspraxia

What is developmental dyspraxia.

Developmental dyspraxia is a disorder characterized by an impairment in the ability to plan and carry out sensory and motor tasks. Generally, individuals with the disorder appear "out of sync" with their environment. Symptoms vary and may include poor balance and coordination, clumsiness, vision problems, perception difficulties, emotional and behavioral problems, difficulty with reading, writing, and speaking, poor social skills, poor posture, and poor short-term memory. Although individuals with the disorder may be of average or above average intelligence, they may behave immaturely.

Is there any treatment?

Treatment is symptomatic and supportive and may include occupational and speech therapy, and "cueing" or other forms of communication such as using pictures and hand gestures. Many children with the disorder require special education.

What is the prognosis?

Developmental dyspraxia is a lifelong disorder. Many individuals are able to compensate for their disabilities through occupational and speech therapy.

Landau-Kleffner Syndrome

What is landau-kleffner syndrome.

Landau-Kleffner syndrome (LKS) is a childhood disorder. A major feature of LKS is the gradual or sudden loss of the ability to understand and use spoken language. All children with LKS have abnormal electrical brain waves that can be documented by an electroencephalogram (EEG), a recording of the electric activity of the brain. Approximately 80 percent of the children with LKS have one or more epileptic seizures that usually occur at night. Behavioral disorders such as hyperactivity, aggressiveness and depression can also accompany this disorder. LKS may also be called infantile acquired aphasia, acquired epileptic aphasia or aphasia with convulsive disorder. This syndrome was first described in 1957 by Dr. William M. Landau and Dr. Frank R. Kleffner, who identified six children with the disorder.

What are the signs of Landau-Kleffner syndrome?

LKS occurs most frequently in normally developing children who are between 3 and 7 years of age. For no apparent reason, these children begin having trouble understanding what is said to them. Doctors often refer to this problem as auditory agnosiaor "word deafness." The auditory agnosia may occur slowly or very quickly. Parents often think that the child is developing a hearing problem or has become suddenly deaf. Hearing tests, however, show normal hearing. Children may also appear to be autistic or developmentally delayed.

The inability to understand language eventually affects the child's spoken language which may progress to a complete loss of the ability to speak (mutism). Children who have learned to read and write before the onset of auditory agnosia can often continue communicating through written language. Some children develop a type of gestural communication or sign-like language. The communication problems may lead to behavioral or psychological problems. Intelligence usually appears to be unaffected.

The loss of language may be preceded by an epileptic seizure that usually occurs at night. At some time, 80 percent of children with LKS have one or more seizures. The seizures usually stop by the time the child becomes a teenager. All LKS children have abnormal electrical brain activity on both the right and left sides of their brains.

Laryngeal Papillomatosis

What is laryngeal papillomatosis.

Laryngeal papillomatosis is a disease consisting of tumors that grow inside the larynx (voice box), vocal cords, or the air passages leading from the nose into the lungs (respiratory tract). It is a rare disease caused by the human papilloma virus (HPV). Although scientists are uncertain how people are infected with HPV, they have identified more than 60 types of HPVs. Tumors caused by HPVs, called papillomas, are often associated with two specific types of the virus (HPV 6 and HPV 11). They may vary in size and grow very quickly. Eventually, these tumors may block the airway passage and cause difficulty breathing.

Laryngeal papillomatosis affects infants and small children as well as adults. Between 60 and 80 percent of cases occur in children, usually before the age of three. Because the tumors grow quickly, young children with the disease may find it difficult to breathe when sleeping, or they may experience difficulty swallowing. Adults with laryngeal papillomatosis may experience hoarseness, chronic coughing, or breathing problems.

How is laryngeal papillomatosis disagnosed?

There are several tests to diagnose laryngeal papillomatosis. Two routine tests are indirect and direct laryngoscopy. An indirect laryngoscopy is done in an office by a speech-language pathologist or by a doctor. To examine the larynx for tumors, the doctor places a small mirror in the back of the throat and angles the mirror down towards the larynx. A direct laryngoscopy is performed in the operating room under general anesthesia.

This procedure is usually used with children or adults during lengthy examinations to minimize discomfort. It involves looking directly at the larynx. Direct laryngoscopy allows the doctor to view the vocal folds and other parts of the larynx under high magnification and samples of unusual tissue lesions that may be in the larynx or other parts of the throat.

Spasmodic dysphonia

What is spasmodic dysphonia.

Spasmodic dysphonia (or laryngeal dystonia) is a voice disorder caused by involuntary movements of one or more muscles of the larynx or voice box. Individuals who have spasmodic dysphonia may have occasional difficulty saying a word or two or they may experience sufficient difficulty to interfere with communication. Spasmodic dysphonia causes the voice to break or to have a tight, strained or strangled quality. There are three different types of spasmodic dysphonia.

What are the types of Spasmodic Dysphonia?

The three types of spasmodic dysphonia are adductor spasmodic dysphonia, abductor spasmodic dysphonia and mixed spasmodic dysphonia.

What are the features of spasmodic dysphonia?

In adductor spasmodic dysphonia, sudden involuntary muscle movements or spasms cause the vocal folds (or vocal cords) to slam together and stiffen. These spasms make it difficult for the vocal folds to vibrate and produce voice. Words are often cut off or difficult to start because of the muscle spasms. Therefore, speech may be choppy and sound similar to stuttering. The voice of an individual with adductor spasmodic dysphonia is commonly described as strained or strangled and full of effort. Surprisingly, the spasms are usually absent while whispering, laughing, singing, speaking at a high pitch or speaking while breathing in. Stress, however, often makes the muscle spasms more severe.

In abductor spasmodic dysphonia, sudden involuntary muscle movements or spasms cause the vocal folds to open. The vocal folds can not vibrate when they are open. The open position of the vocal folds also allows air to escape from the lungs during speech. As a result, the voices of these individuals often sound weak, quiet and breathy or whispery. As with adductor spasmodic dysphonia, the spasms are often absent during activities such as laughing or singing.

Mixed spasmodic dysphonia involves muscles that open the vocal folds as well as muscles that close the vocal folds and therefore has features of both adductor and abductor spasmodic dysphonia.

(For other types of Communication Disorders and further information on this topic, , use NASET's table of hundreds of links to Speech and Language Impairments. This table will be found when you close out of this window.)

Brice, A. (2001). Children with communication disorders (ERIC Digest #E617). Arlington, VA: ERIC Clearinghouse on Disabilities and Gifted Education. (Available online at: http://ericec.org/digests/e617.html )

Charkins, H. (1996). Children with facial differences: A parents' guide. Bethesda, MD: Woodbine House. (Telephone: 800.843.7323. Web: www.woodbinehouse.com )

Cleft Palate Foundation. (1997). For parents of newborn babies with cleft lip/cleft palate. Chapel Hill, NC: Author. (Telephone: 800.242.5338. Also available online at: www.cleftline.org )

Gruman-Trinker, C. (2001). Your cleft-affected child: The complete book of information, resources and hope. Alameda, CA: Hunter House. (Web: www.hunterhouse.com )

Hamaguchi, P. M. (2001). Childhood speech, language, & listening problems: What every parent should know (2nd ed.). New York: John Wiley & Sons, Inc. (Telephone: 800.225.5945. Web: www.wiley.com )

Organizations

Alliance for Technology Access 2175 E. Francisco Boulevard, Suite L San Rafael, CA 94901 800.455.7970; 415.455.4575 Email: [email protected] Web: www.ataccess.org

American Speech-Language-Hearing Association (ASHA) 10801 Rockville Pike Rockville, MD 20852 301.897.5700 (V/TTY); 800.638.8255 Email: [email protected] Web: www.asha.org

Childhood Apraxia of Speech Association of North America (CASANA) 123 Eisele Road Cheswick, PA 15024 412.767.6589 Email: [email protected] Web: www.apraxia-kids.org

Cleft Palate Foundation 104 South Estes Drive, Suite 204 Chapel Hill, NC 27514 800.242.5338; 919.933.9044 Email: [email protected] Web: www.cleftline.org

Easter Seals--National Office 230 West Monroe Street, Suite 1800 Chicago, IL 60606 312.726.6200 312.726.4258 (TTY) 800.221.6827 Email: [email protected] Web: www.easter-seals.org

Learning Disabilities Association of America (LDA) 4156 Library Road Pittsburgh, PA 15234-1349 412.341.1515 Email: [email protected] Web: www.ldaamerica.org

Scottish Rite Foundation Southern Jurisdiction, U.S.A., Inc. 1733 Sixteenth Street, N.W. Washington, DC 20009-3199 202.232.3579 Web: www.srmason-sj.org/web/index.htm

Trace Research and Development Center University of Wisconsin-Madison 1550 Engineering Dr. 2107 Engineering Hall Madison, WI 53706 608.262-6966; 608.263.5408 (TTY) Email:

Attention Deficit Hyperactive Disorder
Early Intervention
Emotional and Behavioral Disorders
Generalized Anxiety
Gifted and Talented
Hearing Impairments
Learning Disabilities
Intellectual Disabilities
Orthopedic Impairments
Other Health Impairments
Rett Syndrome
Social Security and Disability Information and Benefits
Speech and Language Impairments
Traumatic Brain Injury and Neurological Impairment
Visual Impairments

Woman helping teach child who has speech language disorder

10 Most Common Speech-Language Disorders & Impediments

As you get to know more about the field of speech-language pathology you’ll increasingly realize why SLPs are required to earn at least a master’s degree . This stuff is serious – and there’s nothing easy about it.

In 2016 the National Institute on Deafness and Other Communication Disorders reported that 7.7% of American children have been diagnosed with a speech or swallowing disorder. That comes out to nearly one in 12 children, and gets even bigger if you factor in adults.

Whether rooted in psycho-speech behavioral issues, muscular disorders, or brain damage, nearly all the diagnoses SLPs make fall within just 10 common categories…

Types of Speech Disorders & Impediments

Apraxia of speech (aos).

Apraxia of Speech (AOS) happens when the neural pathway between the brain and a person’s speech function (speech muscles) is lost or obscured. The person knows what they want to say – they can even write what they want to say on paper – however the brain is unable to send the correct messages so that speech muscles can articulate what they want to say, even though the speech muscles themselves work just fine. Many SLPs specialize in the treatment of Apraxia .

There are different levels of severity of AOS, ranging from mostly functional, to speech that is incoherent. And right now we know for certain it can be caused by brain damage, such as in an adult who has a stroke. This is called Acquired AOS.

However the scientific and medical community has been unable to detect brain damage – or even differences – in children who are born with this disorder, making the causes of Childhood AOS somewhat of a mystery. There is often a correlation present, with close family members suffering from learning or communication disorders, suggesting there may be a genetic link.

Mild cases might be harder to diagnose, especially in children where multiple unknown speech disorders may be present. Symptoms of mild forms of AOS are shared by a range of different speech disorders, and include mispronunciation of words and irregularities in tone, rhythm, or emphasis (prosody).

Stuttering – Stammering

Stuttering, also referred to as stammering, is so common that everyone knows what it sounds like and can easily recognize it. Everyone has probably had moments of stuttering at least once in their life. The National Institute on Deafness and Other Communication Disorders estimates that three million Americans stutter, and reports that of the up-to-10-percent of children who do stutter, three-quarters of them will outgrow it. It should not be confused with cluttering.

Most people don’t know that stuttering can also include non-verbal involuntary or semi-voluntary actions like blinking or abdominal tensing (tics). Speech language pathologists are trained to look for all the symptoms of stuttering , especially the non-verbal ones, and that is why an SLP is qualified to make a stuttering diagnosis.

The earliest this fluency disorder can become apparent is when a child is learning to talk. It may also surface later during childhood. Rarely if ever has it developed in adults, although many adults have kept a stutter from childhood.

Stuttering only becomes a problem when it has an impact on daily activities, or when it causes concern to parents or the child suffering from it. In some people, a stutter is triggered by certain events like talking on the phone. When people start to avoid specific activities so as not to trigger their stutter, this is a sure sign that the stutter has reached the level of a speech disorder.

The causes of stuttering are mostly a mystery. There is a correlation with family history indicating a genetic link. Another theory is that a stutter is a form of involuntary or semi-voluntary tic. Most studies of stuttering agree there are many factors involved.

Dysarthria is a symptom of nerve or muscle damage. It manifests itself as slurred speech, slowed speech, limited tongue, jaw, or lip movement, abnormal rhythm and pitch when speaking, changes in voice quality, difficulty articulating, labored speech, and other related symptoms.

It is caused by muscle damage, or nerve damage to the muscles involved in the process of speaking such as the diaphragm, lips, tongue, and vocal chords.

Because it is a symptom of nerve and/or muscle damage it can be caused by a wide range of phenomena that affect people of all ages. This can start during development in the womb or shortly after birth as a result of conditions like muscular dystrophy and cerebral palsy. In adults some of the most common causes of dysarthria are stroke, tumors, and MS.

A lay term, lisping can be recognized by anyone and is very common.

Speech language pathologists provide an extra level of expertise when treating patients with lisping disorders . They can make sure that a lisp is not being confused with another type of disorder such as apraxia, aphasia, impaired development of expressive language, or a speech impediment caused by hearing loss.

SLPs are also important in distinguishing between the five different types of lisps. Most laypersons can usually pick out the most common type, the interdental/dentalised lisp. This is when a speaker makes a “th” sound when trying to make the “s” sound. It is caused by the tongue reaching past or touching the front teeth.

Because lisps are functional speech disorders, SLPs can play a huge role in correcting these with results often being a complete elimination of the lisp. Treatment is particularly effective when implemented early, although adults can also benefit.

Experts recommend professional SLP intervention if a child has reached the age of four and still has an interdental/dentalised lisp. SLP intervention is recommended as soon as possible for all other types of lisps. Treatment includes pronunciation and annunciation coaching, re-teaching how a sound or word is supposed to be pronounced, practice in front of a mirror, and speech-muscle strengthening that can be as simple as drinking out of a straw.

Spasmodic Dysphonia

Spasmodic Dysphonia (SD) is a chronic long-term disorder that affects the voice. It is characterized by a spasming of the vocal chords when a person attempts to speak and results in a voice that can be described as shaky, hoarse, groaning, tight, or jittery. It can cause the emphasis of speech to vary considerably. Many SLPs specialize in the treatment of Spasmodic Dysphonia .

SLPs will most often encounter this disorder in adults, with the first symptoms usually occurring between the ages of 30 and 50. It can be caused by a range of things mostly related to aging, such as nervous system changes and muscle tone disorders.

It’s difficult to isolate vocal chord spasms as being responsible for a shaky or trembly voice, so diagnosing SD is a team effort for SLPs that also involves an ear, nose, and throat doctor (otolaryngologist) and a neurologist.

Have you ever heard people talking about how they are smart but also nervous in large groups of people, and then self-diagnose themselves as having Asperger’s? You might have heard a similar lay diagnosis for cluttering. This is an indication of how common this disorder is as well as how crucial SLPs are in making a proper cluttering diagnosis .

A fluency disorder, cluttering is characterized by a person’s speech being too rapid, too jerky, or both. To qualify as cluttering, the person’s speech must also have excessive amounts of “well,” “um,” “like,” “hmm,” or “so,” (speech disfluencies), an excessive exclusion or collapsing of syllables, or abnormal syllable stresses or rhythms.

The first symptoms of this disorder appear in childhood. Like other fluency disorders, SLPs can have a huge impact on improving or eliminating cluttering. Intervention is most effective early on in life, however adults can also benefit from working with an SLP.

Muteness – Selective Mutism

There are different kinds of mutism, and here we are talking about selective mutism. This used to be called elective mutism to emphasize its difference from disorders that caused mutism through damage to, or irregularities in, the speech process.

Selective mutism is when a person does not speak in some or most situations, however that person is physically capable of speaking. It most often occurs in children, and is commonly exemplified by a child speaking at home but not at school.

Selective mutism is related to psychology. It appears in children who are very shy, who have an anxiety disorder, or who are going through a period of social withdrawal or isolation. These psychological factors have their own origins and should be dealt with through counseling or another type of psychological intervention.

Diagnosing selective mutism involves a team of professionals including SLPs, pediatricians, psychologists, and psychiatrists. SLPs play an important role in this process because there are speech language disorders that can have the same effect as selective muteness – stuttering, aphasia, apraxia of speech, or dysarthria – and it’s important to eliminate these as possibilities.

And just because selective mutism is primarily a psychological phenomenon, that doesn’t mean SLPs can’t do anything. Quite the contrary.

The National Institute on Neurological Disorders and Stroke estimates that one million Americans have some form of aphasia.

Aphasia is a communication disorder caused by damage to the brain’s language capabilities. Aphasia differs from apraxia of speech and dysarthria in that it solely pertains to the brain’s speech and language center.

As such anyone can suffer from aphasia because brain damage can be caused by a number of factors. However SLPs are most likely to encounter aphasia in adults, especially those who have had a stroke. Other common causes of aphasia are brain tumors, traumatic brain injuries, and degenerative brain diseases.

In addition to neurologists, speech language pathologists have an important role in diagnosing aphasia. As an SLP you’ll assess factors such as a person’s reading and writing, functional communication, auditory comprehension, and verbal expression.

Speech Delay – Alalia

A speech delay, known to professionals as alalia, refers to the phenomenon when a child is not making normal attempts to verbally communicate. There can be a number of factors causing this to happen, and that’s why it’s critical for a speech language pathologist to be involved.

The are many potential reasons why a child would not be using age-appropriate communication. These can range anywhere from the child being a “late bloomer” – the child just takes a bit longer than average to speak – to the child having brain damage. It is the role of an SLP to go through a process of elimination, evaluating each possibility that could cause a speech delay, until an explanation is found.

Approaching a child with a speech delay starts by distinguishing among the two main categories an SLP will evaluate: speech and language.

Speech has a lot to do with the organs of speech – the tongue, mouth, and vocal chords – as well as the muscles and nerves that connect them with the brain. Disorders like apraxia of speech and dysarthria are two examples that affect the nerve connections and organs of speech. Other examples in this category could include a cleft palette or even hearing loss.

The other major category SLPs will evaluate is language. This relates more to the brain and can be affected by brain damage or developmental disorders like autism. There are many different types of brain damage that each manifest themselves differently, as well as developmental disorders, and the SLP will make evaluations for everything.

Issues Related to Autism

While the autism spectrum itself isn’t a speech disorder, it makes this list because the two go hand-in-hand more often than not.

The Centers for Disease Control and Prevention (CDC) reports that one out of every 68 children in our country have an autism spectrum disorder. And by definition, all children who have autism also have social communication problems.

Speech-language pathologists are often a critical voice on a team of professionals – also including pediatricians, occupational therapists, neurologists, developmental specialists, and physical therapists – who make an autism spectrum diagnosis .

In fact, the American Speech-Language Hearing Association reports that problems with communication are the first detectable signs of autism. That is why language disorders – specifically disordered verbal and nonverbal communication – are one of the primary diagnostic criteria for autism.

So what kinds of SLP disorders are you likely to encounter with someone on the autism spectrum?

A big one is apraxia of speech. A study that came out of Penn State in 2015 found that 64 percent of children who were diagnosed with autism also had childhood apraxia of speech.

This basic primer on the most common speech disorders offers little more than an interesting glimpse into the kind of issues that SLPs work with patients to resolve. But even knowing everything there is to know about communication science and speech disorders doesn’t tell the whole story of what this profession is all about. With every client in every therapy session, the goal is always to have the folks that come to you for help leave with a little more confidence than when they walked in the door that day. As a trusted SLP, you will build on those gains with every session, helping clients experience the joy and freedom that comes with the ability to express themselves freely. At the end of the day, this is what being an SLP is all about.

Ready to make a difference in speech pathology? Learn how to become a Speech-Language Pathologist today

Emerson College - Master's in Speech-Language Pathology online - Prepare to become an SLP in as few as 20 months. No GRE required. Scholarships available.
NYU Steinhardt - NYU Steinhardt's Master of Science in Communicative Sciences and Disorders online - ASHA-accredited. Bachelor's degree required. Graduate prepared to pursue licensure.
Arizona State University - Online - Online Bachelor of Science in Speech and Hearing Science - Designed to prepare graduates to work in behavioral health settings or transition to graduate programs in speech-language pathology and audiology.

another word for speech or language impairment

What is the CPIR?
What’s on the Hub?
CPIR Resource Library
Buzz from the Hub
Event Calendar
Survey Item Bank
CPIR Webinars
What are Parent Centers?
National RAISE Center
RSA Parent Centers
Regional PTACs
Find Your Parent Center
CentersConnect (log-in required)
Parent Center eLearning Hub

Select Page

Speech and Language Impairments

A young girl with a colorful hat on. Una joven con sombrero de muchos colores.

En español | In Spanish
See fact sheets on other disabilities

Table of Contents

A Day in the Life of an SLP

Tomorrow she’ll go to a different school, and meet with different students. But for today, her day is…Robbie, Pearl, and Mario.

There are many kinds of speech and language disorders that can affect children. In this fact sheet, we’ll talk about four major areas in which these impairments occur. These are the areas of:

Articulation | speech impairments where the child produces sounds incorrectly (e.g., lisp, difficulty articulating certain sounds, such as “l” or “r”);

Fluency | speech impairments where a child’s flow of speech is disrupted by sounds, syllables, and words that are repeated, prolonged, or avoided and where there may be silent blocks or inappropriate inhalation, exhalation, or phonation patterns;

Voice | speech impairments where the child’s voice has an abnormal quality to its pitch, resonance, or loudness; and

Language | language impairments where the child has problems expressing needs, ideas, or information, and/or in understanding what others say. ( 1 )

These areas are reflected in how “speech or language impairment” is defined by the nation’s special education law, the Individuals with Disabilities Education Act, given below. IDEA is the law that makes early intervention services available to infants and toddlers with disabilities, and special education available to school-aged children with disabilities.

Definition of “Speech or Language Impairment” under IDEA

The Individuals with Disabilities Education Act, or IDEA, defines the term “speech or language impairment” as follows:

Development of Speech and Language Skills in Childhood

Speech and language skills develop in childhood according to fairly well-defined milestones (see below). Parents and other caregivers may become concerned if a child’s language seems noticeably behind (or different from) the language of same-aged peers. This may motivate parents to investigate further and, eventually, to have the child evaluated by a professional.

______________________

More on the Milestones of Language Development

What are the milestones of typical speech-language development? What level of communication skill does a typical 8-month-old baby have, or a 18-month-old, or a child who’s just celebrated his or her fourth birthday?

You’ll find these expertly described in How Does Your Child Hear and Talk? , a series of resource pages available online at the American Speech-Language-Hearing Association (ASHA): http://www.asha.org/public/speech/development/chart.htm

Having the child’s hearing checked is a critical first step. The child may not have a speech or language impairment at all but, rather, a hearing impairment that is interfering with his or her development of language.

It’s important to realize that a language delay isn’t the same thing as a speech or language impairment. Language delay is a very common developmental problem—in fact, the most common, affecting 5-10% of children in preschool. ( 2 ) With language delay, children’s language is developing in the expected sequence, only at a slower rate. In contrast, speech and language disorder refers to abnormal language development. ( 3 ) Distinguishing between the two is most reliably done by a certified speech-language pathologist such as Christina, the SLP in our opening story.

Characteristics of Speech or Language Impairments

The characteristics of speech or language impairments will vary depending upon the type of impairment involved. There may also be a combination of several problems.

A voice disorder involves problems with the pitch, loudness, resonance, or quality of the voice. ( 6 ) The voice may be hoarse, raspy, or harsh. For some, it may sound quite nasal; others might seem as if they are “stuffed up.” People with voice problems often notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use. ( 7 )

Language has to do with meanings, rather than sounds. ( 8 ) A language disorder refers to an impaired ability to understand and/or use words in context. ( 9 ) A child may have an expressive language disorder (difficulty in expressing ideas or needs), a receptive language disorder (difficulty in understanding what others are saying), or a mixed language disorder (which involves both).

Some characteristics of language disorders include:

improper use of words and their meanings,
inability to express ideas,
inappropriate grammatical patterns,
reduced vocabulary, and
inability to follow directions. ( 10 )

What Causes Speech and Language Disorders?

Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, intellectual disabilities, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.

Of the 6.1 million children with disabilities who received special education under IDEA in public schools in the 2005-2006 school year, more than 1.1 million were served under the category of speech or language impairment. ( 11 ) This estimate does not include children who have speech/language problems secondary to other conditions such as deafness, intellectual disability, autism, or cerebral palsy. Because many disabilities do impact the individual’s ability to communicate, the actual incidence of children with speech-language impairment is undoubtedly much higher.

Finding Help

Because all communication disorders carry the potential to isolate individuals from their social and educational surroundings, it is essential to provide help and support as soon as a problem is identified. While many speech and language patterns can be called “baby talk” and are part of children’s normal development, they can become problems if they are not outgrown as expected.

Therefore, it’s important to take action if you suspect that your child has a speech or language impairment (or other disability or delay). The next two sections in this fact sheet will tell you how to find this help.

Help for Babies and Toddlers

Since we begin learning communication skills in infancy, it’s not surprising that parents are often the first to notice—and worry about—problems or delays in their child’s ability to communicate or understand. Parents should know that there is a lot of help available to address concerns that their young child may be delayed or impaired in developing communication skills. Of particular note is the the early intervention system that’s available in every state.

Early intervention is a system of services designed to help infants and toddlers with disabilities (until their 3rd birthday) and their families. It’s mandated by the IDEA. Through early intervention, parents can have their young one evaluated free of charge, to identify developmental delays or disabilities, including speech and language impairments.

If a child is found to have a delay or disability, staff work with the child’s family to develop what is known as an Individualized Family Services Plan , or IFSP . The IFSP will describe the child’s unique needs as well as the services he or she will receive to address those needs. The IFSP will also emphasize the unique needs of the family, so that parents and other family members will know how to support their young child’s needs. Early intervention services may be provided on a sliding-fee basis, meaning that the costs to the family will depend upon their income.

To identify the EI program in your neighborhood | Ask your child’s pediatrician for a referral to early intervention or the Child Find in the state. You can also call the local hospital’s maternity ward or pediatric ward, and ask for the contact information of the local early intervention program.

Help for School-Aged Children, including Preschoolers

Just as IDEA requires that early intervention be made available to babies and toddlers with disabilities, it requires that special education and related services be made available free of charge to every eligible child with a disability, including preschoolers (ages 3-21). These services are specially designed to address the child’s individual needs associated with the disability—in this case, a speech or language impairment.

Many children are identified as having a speech or language impairment after they enter the public school system. A teacher may notice difficulties in a child’s speech or communication skills and refer the child for evaluation. Parents may ask to have their child evaluated. This evaluation is provided free by the public school system.

If the child is found to have a disability under IDEA—such as a speech-language impairment—school staff will work with his or her parents to develop an Individualized Education Program , or IEP . The IEP is similar to an IFSP. It describes the child’s unique needs and the services that have been designed to meet those needs. Special education and related services are provided at no cost to parents.

There is a lot to know about the special education process, much of which you can learn at the Center for Parent Information and Resources (CPIR). We offer a wide range of publications and resource pages on the topic. Enter our special education information at: http://www.parentcenterhub.org/repository/schoolage/

Educational Considerations

Communication skills are at the heart of the education experience. Eligible students with speech or language impairments will want to take advantage of special education and related services that are available in public schools.

The types of supports and services provided can vary a great deal from student to student, just as speech-language impairments do. Special education and related services are planned and delivered based on each student’s individualized educational and developmental needs.

Most, if not all, students with a speech or language impairment will need speech-language pathology services . This related service is defined by IDEA as follows:

(15) Speech-language pathology services includes—

(i) Identification of children with speech or language impairments;

(ii) Diagnosis and appraisal of specific speech or language impairments;

(iii) Referral for medical or other professional attention necessary for the habilitation of speech or language impairments;

(iv) Provision of speech and language services for the habilitation or prevention of communicative impairments; and

Thus, in addition to diagnosing the nature of a child’s speech-language difficulties, speech-language pathologists also provide:

individual therapy for the child;
consult with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; and
work closely with the family to develop goals and techniques for effective therapy in class and at home.

Speech and/or language therapy may continue throughout a student’s school years either in the form of direct therapy or on a consultant basis.

Tips for Teachers

— Learn as much as you can about the student’s specific disability. Speech-language impairments differ considerably from one another, so it’s important to know the specific impairment and how it affects the student’s communication abilities.

— Recognize that you can make an enormous difference in this student’s life! Find out what the student’s strengths and interests are, and emphasize them. Create opportunities for success.

—If you are not part of the student’s IEP team, a sk for a copy of his or her IEP . The student’s educational goals will be listed there, as well as the services and classroom accommodations he or she is to receive.

— Make sure that needed accommodations are provided for classwork, homework, and testing. These will help the student learn successfully.

— Consult with others (e.g., special educators, the SLP) who can help you identify strategies for teaching and supporting this student, ways to adapt the curriculum, and how to address the student’s IEP goals in your classroom.

— Find out if your state or school district has materials or resources available to help educators address the learning needs of children with speech or language impairments. It’s amazing how many do!

— Communicate with the student’s parents . Regularly share information about how the student is doing at school and at home.

Tips for Parents

— Learn the specifics of your child’s speech or language impairment. The more you know, the more you can help yourself and your child.

— Be patient. Your child, like every child, has a whole lifetime to learn and grow.

— Meet with the school and develop an IEP to address your child’s needs. Be your child’s advocate. You know your son or daughter best, share what you know.

— Be well informed about the speech-language therapy your son or daughter is receiving. Talk with the SLP, find out how to augment and enrich the therapy at home and in other environments. Also find out what not to do!

— Give your child chores. Chores build confidence and ability. Keep your child’s age, attention span, and abilities in mind. Break down jobs into smaller steps. Explain what to do, step by step, until the job is done. Demonstrate. Provide help when it’s needed. Praise a job (or part of a job) well done.

— Listen to your child. Don’t rush to fill gaps or make corrections. Conversely, don’t force your child to speak. Be aware of the other ways in which communication takes place between people.

— Talk to other parents whose children have a similar speech or language impairment. Parents can share practical advice and emotional support. See if there’s a parent nearby by visiting the Parent to Parent USA program and using the interactive map.

— Keep in touch with your child’s teachers. Offer support. Demonstrate any assistive technology your child uses and provide any information teachers will need. Find out how you can augment your child’s school learning at home.

Readings and Articles

We urge you to read the articles identified in the References section. Each provides detailed and expert information on speech or language impairments. You may also be interested in:

Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2491683/

Organizations to Consult

ASHA | American Speech-Language-Hearing Association Information in Spanish | Información en español. 1.800.638.8255 | [email protected] | www.asha.org

NIDCD | National Institute on Deafness and Other Communication Disorders 1.800.241.1044 (Voice) | 1.800.241.1055 (TTY) [email protected] | http://www.nidcd.nih.gov/

American Cleft Palate and Craniofacial Association (ACPA) 1.800.242.5338 | https://acpacares.org/

Childhood Apraxia of Speech Association of North America | CASANA http://www.apraxia-kids.org

National Stuttering Foundation 1.800.937.8888 | [email protected] | http://www.nsastutter.org/

Stuttering Foundation 1.800.992.9392 | [email protected] | http://www.stuttersfa.org/

1 | Minnesota Department of Education. (2010). Speech or language impairments . Online at: http://education.state.mn.us/MDE/EdExc/SpecEdClass/DisabCateg/SpeechLangImpair/index.html

2 | Boyse, K. (2008). Speech and language delay and disorder . Retrieved from the University of Michigan Health System website: http://www.med.umich.edu/yourchild/topics/speech.htm

4 | American Speech-Language-Hearing Association. (n.d.). Speech sound disorders: Articulation and phonological processes . Online at: http://www.asha.org/public/speech/disorders/speechsounddisorders.htm

5 | Cincinnati Children’s Hospital. (n.d.). Speech disorders . Online at: http://www.cincinnatichildrens.org/health/s/speech-disorder/

6 | National Institute on Deafness and Other Communication Disorders. (2002). What is voice? What is speech? What is language? Online at: http://www.nidcd.nih.gov/health/voice/pages/whatis_vsl.aspx

7 | American Academy of Otolaryngology — Head and Neck Surgery. (n.d.). About your voice . Online at: http://www.entnet.org/content/about-your-voice

8 | Boyse, K. (2008). Speech and language delay and disorder . Retrieved from the University of Michigan Health System website: http://www.med.umich.edu/yourchild/topics/speech.htm

9 | Encyclopedia of Nursing & Allied Health. (n.d.). Language disorders . Online at: http://www.enotes.com/nursing-encyclopedia/language-disorders

10 | Ibid .

11 | U.S. Department of Education. (2010, December). Twenty-ninth annual report to Congress on the Implementation of the Individuals with Disabilities Education Act: 2007 . Online at: http://www2.ed.gov/about/reports/annual/osep/2007/parts-b-c/index.html

Professional development
Using inclusive practices

Speech and Language Impairment

‘How can I teach English to a learner who has difficulty speaking and understanding their own language?’

As teachers we know that good communication is vital for successful learning, so it is not surprising that this is a worry for English language teachers across the world. Communication skills help children to understand and explain the world around them, share their ideas and feelings and make friends. Good language skills enable a child to reason and learn. They also help to develop a sense of self and the feeling of belonging to a group or community.

If we discover that there is a learner with speech and language difficulties in our class we might wonder how to help them to get the most from our lessons. By understanding the different kinds of speech and language impairment and knowing some useful teaching strategies we can really make a difference to these learners and help them to experience enjoyable and successful learning.

What is speech and language impairment?

Speech and language impairment varies from person to person and can range from mild to severe. A learner may have difficulty with speaking, ‘expressive language’ or understanding, ‘receptive language’. They may have problems expressing feelings and interacting with others. This can cause low self-esteem and frustration, and may lead to behaviour problems in the class. As speech and language problems are not always obvious, we have to think about what lies behind the behaviour and the need the learner may be trying to express.

Most children with speech or language impairment are of average intelligence, but may have other specific learning difficulties such as dyslexia, dyspraxia or ADHD. Speech and language impairment is sometimes linked with conditions such as hearing loss, Down syndrome, cerebral palsy or autism. Chronic ear infections may also be a cause. Some learners have difficulty with both language input and output and need to be taught the communication skills that other learners learn automatically.

Expressive language difficulties

Some learners have problems with the muscular movements needed to form words. They may have trouble producing certain sounds and simply leave them out, or substitute one sound for another. This can make them difficult to understand and result in delayed or unclear speech.

Expressive language difficulties can also affect the ability to put words in the right order in a sentence and tell stories with the events in the right sequence. Their speech can be jumbled up and hard to understand. Sometimes the learner will use inappropriate grammatical structures and their speech may sound immature for their age. They may also have trouble with learning and accessing vocabulary. These problems occur in their own language and will also appear when learning English. Having trouble explaining and describing things makes it hard to join in class discussions.

Receptive language difficulties

Some learners have problems with the way they hear and process language. This can impact on the ability to understand what others are saying and respond appropriately. Learners with hearing impairment have a physical barrier to understanding speech, but there are can also be ‘pragmatic language’ difficulties where, although the learner can hear what is being said, they do not understand the meaning. They may not know how to use social language and lack an intuitive understanding of social cues and conventions. There can also be problems understanding ‘figurative language’, which includes the use of irony, humour and metaphor. This can lead to a tendency to take things too literally. A learner with receptive language difficulties may have trouble in one or more of these areas.

Following instructions
Understanding abstract concepts
Concentration
Understanding stories, both written and spoken
Understanding metaphorical language
Making friends
Listening to others

Teaching and learning strategies – how can we help?

1. Encourage and accept all forms of communication

Learners with speech and language difficulties are often lacking in confidence and shy about speaking in public, so avoid asking them to repeat mispronounced words or finish their sentences for them. It is better to model the correct form in your response. Concentrate on the message the learner is trying to communicate rather than the grammar. Allow alternative ways of communicating like gestures, writing or drawing.

2. Be conscious of your own communication style

Make sure your language is clear and direct and face the class so that learners can see your expressions and read your lips if necessary. Give instructions one at a time in the order you want them to be carried out, using visual cues and gestures to support them. If you say the learner’s name before asking them a question they will know you want their attention. Try to avoid ambiguous language and always be prepared to repeat anything the learner does not understand.

3. Teach active listening skills

Explain to the whole class that it is important to be attentive and look at someone when they are talking to you, and not to interrupt. You can teach turn-taking by having a special object which is the ‘speaker’s token’. The holder of the object is the only person who may speak. When they have finished they pass it on.

4. Give time to think and respond to questions

All learners can benefit from this. Using the ‘think, pair, share’ model in class provides the time needed to process information and organize thoughts before having to answer.

5. Use sound discrimination exercises

We know that phonemes are the building blocks for language. You can help learners who have difficulty recognising and decoding phonemes through multisensory activities like clapping and stomping out syllables in new vocabulary or colour-coding the different groups of phonemes. Rhyming bingo and card games where the learner can match the same sounds can be really helpful.

6. Help with sequencing and word order

If the learner has difficulty explaining things or telling stories in the right order, just ask them to give bullet points of what they want to say and put them in the correct sequence on a timeline. It is also helpful to cut up stories so they can practice putting them in order - you can use pictures for younger learners.

7. Build vocabulary

Use pictures, objects and photos to help understand and remember new vocabulary. Encourage learners to use their visual memory by making a personal vocabulary box of key words on picture cards.

8. Help build self-esteem

Make sure to notice and praise good interactions and speech. Describe what they do well and identify and work with their other strengths, such as creativity and physical talents.

9. Help learners to make their needs known

Always check that the learner has understood the task and clarify any misunderstandings. Encourage them to let you know if they have not understood by using a pre-arranged signal.

Research and insight

Browse fascinating case studies, research papers, publications and books by researchers and ELT experts from around the world.

See our publications, research and insight

Type 2 Diabetes
Heart Disease
Digestive Health
Multiple Sclerosis
Diet & Nutrition
Supplements
Health Insurance
Public Health
Patient Rights
Caregivers & Loved Ones
End of Life Concerns
Health News
Thyroid Test Analyzer
Doctor Discussion Guides
Hemoglobin A1c Test Analyzer
Lipid Test Analyzer
Complete Blood Count (CBC) Analyzer
What to Buy
Editorial Process
Meet Our Medical Expert Board

Overcoming Speech Impediment: Symptoms to Treatment

There are many causes and solutions for impaired speech

Types and Symptoms
Speech Therapy
Building Confidence

Speech impediments are conditions that can cause a variety of symptoms, such as an inability to understand language or speak with a stable sense of tone, speed, or fluidity. There are many different types of speech impediments, and they can begin during childhood or develop during adulthood.

Common causes include physical trauma, neurological disorders, or anxiety. If you or your child is experiencing signs of a speech impediment, you need to know that these conditions can be diagnosed and treated with professional speech therapy.

This article will discuss what you can do if you are concerned about a speech impediment and what you can expect during your diagnostic process and therapy.

FG Trade / Getty Images

Types and Symptoms of Speech Impediment

People can have speech problems due to developmental conditions that begin to show symptoms during early childhood or as a result of conditions that may occur during adulthood.

The main classifications of speech impairment are aphasia (difficulty understanding or producing the correct words or phrases) or dysarthria (difficulty enunciating words).

Often, speech problems can be part of neurological or neurodevelopmental disorders that also cause other symptoms, such as multiple sclerosis (MS) or autism spectrum disorder .

There are several different symptoms of speech impediments, and you may experience one or more.

Can Symptoms Worsen?

Most speech disorders cause persistent symptoms and can temporarily get worse when you are tired, anxious, or sick.

Symptoms of dysarthria can include:

Slurred speech
Slow speech
Choppy speech
Hesitant speech
Inability to control the volume of your speech
Shaking or tremulous speech pattern
Inability to pronounce certain sounds

Symptoms of aphasia may involve:

Speech apraxia (difficulty coordinating speech)
Difficulty understanding the meaning of what other people are saying
Inability to use the correct words
Inability to repeat words or phases
Speech that has an irregular rhythm

You can have one or more of these speech patterns as part of your speech impediment, and their combination and frequency will help determine the type and cause of your speech problem.

Causes of Speech Impediment

The conditions that cause speech impediments can include developmental problems that are present from birth, neurological diseases such as Parkinson’s disease , or sudden neurological events, such as a stroke .

Some people can also experience temporary speech impairment due to anxiety, intoxication, medication side effects, postictal state (the time immediately after a seizure), or a change of consciousness.

Speech Impairment in Children

Children can have speech disorders associated with neurodevelopmental problems, which can interfere with speech development. Some childhood neurological or neurodevelopmental disorders may cause a regression (backsliding) of speech skills.

Common causes of childhood speech impediments include:

Autism spectrum disorder : A neurodevelopmental disorder that affects social and interactive development
Cerebral palsy : A congenital (from birth) disorder that affects learning and control of physical movement
Hearing loss : Can affect the way children hear and imitate speech
Rett syndrome : A genetic neurodevelopmental condition that causes regression of physical and social skills beginning during the early school-age years.
Adrenoleukodystrophy : A genetic disorder that causes a decline in motor and cognitive skills beginning during early childhood
Childhood metabolic disorders : A group of conditions that affects the way children break down nutrients, often resulting in toxic damage to organs
Brain tumor : A growth that may damage areas of the brain, including those that control speech or language
Encephalitis : Brain inflammation or infection that may affect the way regions in the brain function
Hydrocephalus : Excess fluid within the skull, which may develop after brain surgery and can cause brain damage

Do Childhood Speech Disorders Persist?

Speech disorders during childhood can have persistent effects throughout life. Therapy can often help improve speech skills.

Speech Impairment in Adulthood

Adult speech disorders develop due to conditions that damage the speech areas of the brain.

Common causes of adult speech impairment include:

Head trauma
Nerve injury
Throat tumor
Stroke
Parkinson’s disease
Essential tremor
Brain tumor
Brain infection

Additionally, people may develop changes in speech with advancing age, even without a specific neurological cause. This can happen due to presbyphonia , which is a change in the volume and control of speech due to declining hormone levels and reduced elasticity and movement of the vocal cords.

Do Speech Disorders Resolve on Their Own?

Children and adults who have persistent speech disorders are unlikely to experience spontaneous improvement without therapy and should seek professional attention.

Steps to Treating Speech Impediment

If you or your child has a speech impediment, your healthcare providers will work to diagnose the type of speech impediment as well as the underlying condition that caused it. Defining the cause and type of speech impediment will help determine your prognosis and treatment plan.

Sometimes the cause is known before symptoms begin, as is the case with trauma or MS. Impaired speech may first be a symptom of a condition, such as a stroke that causes aphasia as the primary symptom.

The diagnosis will include a comprehensive medical history, physical examination, and a thorough evaluation of speech and language. Diagnostic testing is directed by the medical history and clinical evaluation.

Diagnostic testing may include:

Brain imaging , such as brain computerized tomography (CT) or magnetic residence imaging (MRI), if there’s concern about a disease process in the brain
Swallowing evaluation if there’s concern about dysfunction of the muscles in the throat
Electromyography (EMG) and nerve conduction studies (aka nerve conduction velocity, or NCV) if there’s concern about nerve and muscle damage
Blood tests, which can help in diagnosing inflammatory disorders or infections

Your diagnostic tests will help pinpoint the cause of your speech problem. Your treatment will include specific therapy to help improve your speech, as well as medication or other interventions to treat the underlying disorder.

For example, if you are diagnosed with MS, you would likely receive disease-modifying therapy to help prevent MS progression. And if you are diagnosed with a brain tumor, you may need surgery, chemotherapy, or radiation to treat the tumor.

Therapy to Address Speech Impediment

Therapy for speech impairment is interactive and directed by a specialist who is experienced in treating speech problems . Sometimes, children receive speech therapy as part of a specialized learning program at school.

The duration and frequency of your speech therapy program depend on the underlying cause of your impediment, your improvement, and approval from your health insurance.

If you or your child has a serious speech problem, you may qualify for speech therapy. Working with your therapist can help you build confidence, particularly as you begin to see improvement.

Exercises during speech therapy may include:

Pronouncing individual sounds, such as la la la or da da da
Practicing pronunciation of words that you have trouble pronouncing
Adjusting the rate or volume of your speech
Mouth exercises
Practicing language skills by naming objects or repeating what the therapist is saying

These therapies are meant to help achieve more fluent and understandable speech as well as an increased comfort level with speech and language.

Building Confidence With Speech Problems

Some types of speech impairment might not qualify for therapy. If you have speech difficulties due to anxiety or a social phobia or if you don’t have access to therapy, you might benefit from activities that can help you practice your speech.

You might consider one or more of the following for you or your child:

Joining a local theater group
Volunteering in a school or community activity that involves interaction with the public
Signing up for a class that requires a significant amount of class participation
Joining a support group for people who have problems with speech

Activities that you do on your own to improve your confidence with speaking can be most beneficial when you are in a non-judgmental and safe space.

Many different types of speech problems can affect children and adults. Some of these are congenital (present from birth), while others are acquired due to health conditions, medication side effects, substances, or mood and anxiety disorders. Because there are so many different types of speech problems, seeking a medical diagnosis so you can get the right therapy for your specific disorder is crucial.

Centers for Disease Control and Prevention. Language and speech disorders in children .

Han C, Tang J, Tang B, et al. The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: a systematic review and meta-analysis . Medicine (Baltimore). 2024;103(2):e36880. doi:10.1097/MD.0000000000036880

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, language .

Mackey J, McCulloch H, Scheiner G, et al. Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience . Brain Impair. 2023;24(2):168-184. doi:10.1017/BrImp.2023.9

Allison KM, Doherty KM. Relation of speech-language profile and communication modality to participation of children with cerebral palsy . Am J Speech Lang Pathol . 2024:1-11. doi:10.1044/2023_AJSLP-23-00267

Saccente-Kennedy B, Gillies F, Desjardins M, et al. A systematic review of speech-language pathology interventions for presbyphonia using the rehabilitation treatment specification system . J Voice. 2024:S0892-1997(23)00396-X. doi:10.1016/j.jvoice.2023.12.010

By Heidi Moawad, MD Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.

National Center on Disability and Journalism

Disability Language Style Guide

Revised, August 2021

Access the Spanish language translation of this guide here.

Spanish language guide PDF

An Italian version of the guide is available here.

You can also access a Romanian translation of the guide here.

You can also download the NCDJ Style Guide as a PDF.

As language, perceptions and social norms change rapidly, it is becoming increasingly difficult for journalists and other communicators to figure out how to refer to people with disabilities. Even the term “disability” is not universally accepted. This style guide, which covers dozens of words and terms commonly used when referring to disability, can help. The guide was developed by the National Center on Disability and Journalism at Arizona State University’s Walter Cronkite School of Journalism and Mass Communication and was last updated in the summer of 2021.

First, we would like to offer some basic guidelines:

Refer to a disability only when it’s relevant to the story and, when possible, confirm the diagnosis with a reputable source, such as a medical professional or other licensed professional.
When possible, ask sources how they would like to be described. If the source is not available or unable to communicate, ask a trusted family member, advocate, medical professional or relevant organization that represents people with disabilities.
Avoid made-up words like “diversability” and “handicapable” unless using them in direct quotes or to refer to a movement or organization.
Be sensitive when using words like “disorder,” “impairment,” “abnormality” and “special” to describe the nature of a disability. The word “condition” is often a good substitute that avoids judgment. But note that there is no universal agreement on the use of these terms — not even close. “Disorder” is ubiquitous when it comes to medical references; and the same is true for “special” when used in “special education,” so there are times when it’s appropriate to use them, as is evidenced in this guide.
Similarly, there is not really a good way to describe the nature of a condition. As you’ll see below, “high functioning” and “low functioning” are considered offensive. “Severe” implies judgement; “significant” might be better. Again, proceed with caution. This is increasingly tricky turf.

Of course, our sources don’t always speak the way we write. That’s OK. You may end up using a derogatory term in a direct quote, but be certain that it’s fundamental to the story. Otherwise, paraphrase and use a more acceptable term.

In this guide, we urge reporters and other communications professionals to refer to a disability only when it’s relevant to the story being told. But what is “relevant” is not always clear. Should a story about residents complaining about noisy airplanes flying over their houses note that one of the residents who is complaining uses a wheelchair? Should someone who is blind be identified as such in a story about people who have been stranded while hiking and had to be rescued?

In the first case, we suggest the answer is “no.” The fact that someone uses a wheelchair does not make the airplane noise any more or less irritating. In the second case, the answer is “maybe.” If the hiker’s blindness contributed to him or her getting stranded, making note of that fact is relevant. If the person’s sight had nothing to do with the situation, leave it out.

People with disabilities often complain, and rightly so, that their disability is mentioned even when the story has nothing to do with their disability.

A note about person-first language. In the past, we have encouraged journalists and others to use person-first language (such as, “a person who has Down syndrome” rather than “a Down syndrome person”) as a default. Even with the caveat that this does not apply to all, we have heard from many people with disabilities who take issue with that advice. For us, this really emphasizes the fact that no two people are the same — either with regard to disabilities or language preferences. And so we are no longer offering advice regarding a default. Instead, we hope you will double down to find out how people would like to be described. We also will include some guidance in individual entries here — but again, we encourage you to confirm on a case-by-case basis.

Another note — this time about the language around COVID-19. The pandemic altered the way many people think about disability, as people who had never encountered such obstacles were suddenly unable to leave their houses. People with disabilities spoke out on social media about this, and “long haulers” now understand firsthand what some people with disabilities experience. The language around COVID-19 is evolving. The BBC and The Conversation both have well-considered takes on it. Archaeologist Elisa Perego coined the term “long COVID” to refer to people with lasting symptoms. This condition also has been called “long haul” and people with it, “long haulers.”

Shifting our focus to the realm of healthcare, it’s crucial to recognize the significance of effective treatments like Ivermectin online . Amid the evolving language around COVID-19, treatments and therapies have taken center stage. Ivermectin has garnered attention as a potential solution for those affected by the virus. Its role in managing and mitigating the impact of COVID-19 is a topic of ongoing research and discussion. Just as we navigate the complexities of language in disability advocacy, the medical community continues to explore innovative approaches to address the pandemic’s challenges. We encourage staying informed and seeking guidance from reputable sources as we collectively adapt to these dynamic circumstances.

Writing about disability is complicated and requires sensitivity — a must for any form of journalism that involves people. If you are in doubt about how to refer to a person, ask the person. And if you can’t ask the person, don’t avoid writing about disability. Use this guide. Do your best.

–Amy Silverman, NCDJ advisory board member

Special thanks to Rebecca Monteleone, University of Toledo; Jon Henner, University of North Carolina at Greensboro; Sherri Collins, Arizona Commission for the Deaf and Hard of Hearing; journalist Sara Luterman; Cronkite student Haley Tenore; the NCDJ advisory board and graduate assistants; and all the style guide readers who offered suggestions for this guide.

Able-bodied

Background: This term is used to describe someone who does not identify as having a disability. Some members of the disability community oppose its use because it implies that all people with disabilities lack “able bodies” or the ability to use their bodies well. They may prefer “non-disabled” or “enabled” as being more accurate.

NCDJ Recommendation: The term “non-disabled” and the phrases “does not have a disability” or “is not living with a disability” are more neutral choices. “Able-bodied” is an appropriate term to use in some cases, such as when referring to government reports on the proportion of able-bodied members in the workforce. In some cases, the word “typical” can be used to describe a non-disabled condition, although be aware that some in the disability community object to its use.

AP style: Not addressed

Ableism/Ableist

Background: “Ableism” refers to discrimination and social prejudice against people with disabilities. Ableism comes in all forms, from overt prejudice to more subtle microaggressions.

Disability advocate Anthony Pulrang defines ableism in this way in an article for Forbes : “Any statement or behavior directed at a disabled person that denigrates or assumes a lesser status for the person because of their disability. Social habits, practices, regulations, laws, and institutions that operate under the assumption that disabled people are inherently less capable overall, less valuable in society, and/or should have less personal autonomy than is ordinarily granted to people of the same age.”

NCDJ Recommendation: The term may not be understood by all, so an explanation may be required. Be cautious about calling someone an “ableist” just as you would be cautious about calling someone a racist or a sexist.

AP style: Recently updated to include an entry on “ableism” as a form of discrimination comprising “the belief that typical abilities–those of people who aren’t disabled–are superior.” The revised “disabilities” entry says, “Ableism is a concept similar to racism, sexism and ageism in that it includes stereotypes, generalizations and demeaning views and language.”

Abnormal/abnormality

Background: “Abnormality” is a word used to describe a condition that deviates from what is considered normal. It can be appropriate when used in a medical context, such as “abnormal curvature of the spine” or an “abnormal test result.” However, when used to describe an individual, “abnormal” is widely viewed as derogatory. The phrase “abnormal behavior” reflects social-cultural standards and is open to different interpretations.

NCDJ Recommendation: The words “abnormal” or “abnormality” might be acceptable when describing scientific phenomena, such as abnormalities in brain function. However, avoid using such words to describe a person. Referring to someone who does not have a disability as a “normal person” implies that people with disabilities are deviant or strange. “Typical” can be a better choice. Be cautious when using the term “abnormal behavior.” Explain what it means in the context in which it is being used.

Addict/addiction

Background: Addiction “is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences,” according to the American Academy of Pain Medicine . Addiction often implies dependence on substances other than alcohol, although alcoholism is essentially alcohol addiction.

The American Psychiatric Association discourages using derogatory language such as the term “junkie” to refer to someone who misuses drugs.

According to the U.S. Department of Health and Human Services’ Center for Substance Abuse Treatment , the word “addiction” is acceptable for uncontrollable, compulsive use of substances as well as acts such as gambling, sex, working, etc., in the face of negative health and social consequences. The Center states that addiction differs from dependence. Do not use the terms “addiction” and “dependence” interchangeably. “Addiction” usually refers to a disease: “dependence” may, on the other hand, describe babies born to mothers who use drugs or cancer patients who take prescribed painkillers. The center also recommends using the word “misuse” in place of “abuse” when describing harmful drug usage.

It’s best to avoid using “clean” and “dirty” with regard to drug test results, according to the Center for Substance Abuse and Treatment. The terms are considered derogatory because they equate symptoms of illness to filth. When referring to a drug test, state that the person “tested positive for (drug).”

NCDJ Recommendation: “Addiction” is an acceptable term, although some prefer “substance abuse disorder.” It is preferable to refer to someone who harmfully uses drugs as “someone with a drug addiction” rather than an “addict.” Use “recovering” or “in recovery from” to refer to someone trying to overcome an addiction; that is, “someone recovering from a methamphetamine addiction.”

Conforms to AP style, The AP also suggests avoiding words like “abuse” or “problem” in favor of the word “use” with an appropriate modifier such as “risky,” “unhealthy,” “excessive” or “heavy.” “Misuse” also is acceptable. Don’t assume all people who engage in misuse have an addiction. Avoid “alcoholic”, “addict”, “user” and “abuser” unless individuals prefer those terms for themselves or if they occur in quotations or names of organizations, such as Alcoholics Anonymous.

Afflicted with/stricken with/suffers from/victim of

Background: These terms carry the assumption that a person with a disability is suffering or has a reduced quality of life. Not every person with a disability suffers, is a victim or is stricken.

NCDJ Recommendation: It is preferable to use neutral language when describing a person who has a disability, simply stating the facts about the nature of the disability. For example: “He has muscular dystrophy.”

Conforms to AP style that suggests avoiding “descriptions that connote pity.”

Albino/albinism

Background: According to the Mayo Clinic , “albinism typically refers to oculocutaneous (ok-u-low-ku-TAY-nee-us) albinism (OCA) — a group of inherited disorders that results in little or no production of the pigment melanin. The type and amount of melanin your body produces determines the color of your skin, hair and eyes. Melanin also plays a role in the development of optic nerves, so people with albinism have vision problems. Signs of albinism are usually apparent in a person’s skin, hair and eye color, but sometimes differences are slight. People with albinism also are sensitive to the effects of the sun and are at increased risk of developing skin cancer.”

According to the National Organization on Albinism and Hypopigmentation (NOAH) , there is debate over whether albinism is a disability, but it is often referred to as one because of issues associated with vision. Also, according to NOAH, the term albino has been used throughout history in a hateful way; therefore many prefer the people-first term, “person with albinism.”

NCDJ Recommendation: Refer to a person with albinism, rather than an albino.

AP style: The stylebook refers, without comment, to albino, albinos.

Alcoholic/alcoholism

Background: An alcoholic is someone who has the disease of alcoholism. Alcoholism is characterized by a loss of control in alcohol use, according to the American Psychiatric Association . The Center for Substance Abuse Treatment recommends using people-first language when referring to alcoholism, such as “someone with alcoholism” or “someone with an alcohol addiction.”

NCDJ Recommendation: Refer to someone who harmfully uses alcohol as “a person with alcoholism” rather than an “alcoholic,” which tends to identify someone solely by their disease. Use “recovering” to refer to someone with the disease of addiction, as in “someone recovering from alcoholism.”

Conforms to AP style

Alcoholics Anonymous

Background: Alcoholics Anonymous was founded in 1935 by Bill W. and Dr. Bob S. in Akron, Ohio, according to the AA General Service Office . AA is “a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism,” according to the group’s preamble. AA members do not pay dues or fees; rather, it is supported through contributions. AA is unaffiliated with any outside organizations or institutions and does not endorse, finance or oppose any causes. The AA program is focused on 12 steps to achieve sobriety.

NCDJ Recommendation: Because anonymity is central to the organization, disclose that someone is a member of Alcoholics Anonymous only if it is essential to the story. When covering AA, consider referring to members by their first name only unless official references or context requires otherwise. These same considerations apply when covering other 12-step programs, such as Narcotics Anonymous or Gamblers Anonymous.

AP style: Not addressed except in terms of abbreviation: AA is acceptable on second reference.

Americans with Disabilities Act (ADA)

Background: The Americans with Disabilities Act is federal civil rights legislation that was signed into law in 1990 to address discrimination on the basis of disability in employment, public accommodations, transportation and telecommunications as well as state and local government services.

NCDJ Recommendation: Use Americans with Disabilities Act on first reference; ADA is acceptable on second reference.

Conforms to AP Style

American Sign Language (ASL)/signer/interpreter

Background: American Sign Language is a complete language that utilizes “signs made by moving the hands combined with facial expressions and postures of the body,” according to the National Institute on Deafness and Other Communication Disorders . Many people in North America who are deaf or hard of hearing use it as a primary means of communication.

The terms “signer” and “interpreter” often are used interchangeably but mean different things. A signer is “a person who may be able to communicate conversationally with deaf persons but who may not necessarily possess the skills and expertise to accurately interpret complex dialogue or information,” according to the . “To become an interpreter, an individual must not only display bilingual and bicultural proficiency but also have the ability to mediate meanings across languages and cultures, both simultaneously and consecutively. This takes years of intensive practice and professional training.”

NCDJ Recommendation: Specify American Sign Language on first reference, capitalizing all three words. ASL is acceptable on second reference. Use “interpreter” only for those who have completed advanced training. The Registry of Interpreters of the Deaf has a searchable database of registered interpreters .

Amputation/amputee

Background: Amputation refers to the removal of a bodily extremity, usually during a surgical operation, for a variety of reasons, according to Johns Hopkins Medicine.People who have undergone an amputation are commonly referred to as “amputees,” but the term may be offensive and often is not used correctly. Some people have a physical characteristic that is not a result of an amputation.

NCDJ Recommendation: “Someone with an amputation” is generally acceptable.

Asperger’s/Asperger’s syndrome

See Autism In 2013, the American Psychiatric Association folded Asperger’s syndrome into one umbrella diagnosis of autism spectrum disorder. The Autistic Self Advocacy Network recommends not referring to Asperger’s at all but to instead refer to autism or autism spectrum disorder.

Attention-deficit/hyperactivity disorder (ADHD)

Background: ADHD, or attention-deficit/hyperactivity disorder, is a relatively common neurodevelopmental diagnosis. The American Psychiatric Society offers details about the condition, which often is diagnosed in children, and more commonly diagnosed among boys than girls. Adults are also diagnosed with ADHD. Symptoms include restlessness, difficulty in focusing or staying organized and impulsivity. Those with an ADHD diagnosis may also exhibit difficulty sitting still or engaging in quiet activities.

NCDJ Recommendation: Refer to someone as having attention-deficit/hyperactivity only if the information is relevant to the story and if you are confident the person has been medically diagnosed with the condition. Use “attention-deficit/hyperactivity disorder” on first reference if referring to a diagnosis; ADHD is acceptable on second reference.

Some people with ADHD prefer to say they “have” the condition; others prefer to say they “are” ADHD. Ask your sources for their preference.

Background: A language researcher introduced the term audism in 1975, according to Britannica , which defines it as “people who continually judge deaf people’s intelligence and success on the basis of their ability in the language of the hearing culture.” It also appears when deaf people themselves “actively participate in the oppression of other deaf people by demanding of them the same set of standards, behavior, and values that they demand of hearing people.” The term reemerged in the 1990s and is generally accepted today.

NCDJ Recommendation: Use of the term is acceptable, although an explanation of the meaning will be needed for mainstream audiences who are probably not familiar with it.

Augmentative and alternative communication

Background: These terms refer to a variety of ways that people communicate without speaking. While these often are technological in nature, such as speech-generating devices, interactive touch screens or amplifiers to boost volume, they also may include drawing, gesturing, signing, finger spelling or picture books, among others. They are frequently used by nonspeaking individuals and those with limited vocabulary to aid or replace oral speech. Some are opposed to the use of AAC because of the belief that it will hinder language development. According to the American Speech-Language-Hearing Association , the opposite is true.

NCDJ Recommendation: Use “augmentative and alternative communication” on first reference, explaining what it means. AAC may be used on second reference. When interviewing someone who is non-verbal, be flexible. If one method of communication fails to work, try another.

Autism/autism spectrum disorder/autistic

Background: Autism spectrum disorder is a group of complex conditions related to brain development, according to the National Institute of Mental Health. Common symptoms of autism include difficulties in communication, impaired social interaction and restricted and repetitive patterns of behavior, interests or activities, according to the Institute. However, symptoms vary across the spectrum. Many experts classify autism as a developmental disability.

Prior to 2013, subtypes of autism, such as Asperger’s syndrome, autism and childhood disintegrative disorder, were classified as distinct conditions. The fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders consolidates all autism conditions under the larger autism spectrum disorder diagnosis.

Opinions vary on how to refer to someone with autism. Some people with autism prefer being referred to as “autistic” or an “autistic person.” Others object to using autistic as an adjective. The Autism Self Advocacy Network details this debate .

NCDJ Recommendation: Refer to someone as having autistic spectrum disorder only if the information is relevant to the story and if you are confident there is a medical diagnosis. Ask individuals how they prefer to be described. Many prefer to be described as “autistic,” while others prefer “an autistic person” or a “person with autism.”

AP style: The stylebook states that it’s acceptable to use the word “autism” as “an umbrella term for a group of developmental disorders.” It also says it is acceptable to use the word autism in stories. It does not address the use of autistic as an adjective.

Additional material : “I Don’t Have Autism, I’m Autistic,” Lenny Letter

Behavioral health

See Mental illness

Bipolar disorder

Background: Bipolar disorder is a mental illness believed to be caused by a combination of genetic factors and neurological functioning, according to the National Institute of Mental Health . It is characterized by unusually intense shifts in emotion, energy, behavior and activity levels in what are called “mood episodes.” Such episodes are usually classified as manic, hypomanic, depressive or mixed episodes. Bipolar disorder often develops during late adolescence or early adulthood.

NCDJ Recommendation: Refer to someone as having “bipolar disorder” only if the information is relevant to the story and you are confident there is a medical diagnosis. If a medical diagnosis is not available, use quotes around the term and indicate that a diagnosis has not been confirmed. Do not use “bipolar” as an adjective for something other than a medical condition as for example, when referring to something that rapidly or drastically changes.

AP style: Not directly addressed, although the style book recommends avoiding using disability-related words lightly or in unrelated situations.

See entries on Depression and Mental illness / mental disorder

Birth defect

See entry on Defect/birth defect

Blind/legally blind/limited vision/low vision/partially sighted/visually impaired

Background: Total blindness is the complete lack of perception of either light or form. However, only about 15% of those with eye conditions are totally blind. “Legally blind” is a broad term for various eye conditions but generally refers to someone whose visual acuity is 20/200 or less even with corrective glasses or contact lenses. Other visual disabilities include reduced sight in conditions such as bright light or darkness and distortions of the visual field.

In general, “blind” or “legally blind” is acceptable for people with complete or almost complete vision loss. For others who have a loss of vision, the American Foundation for the Blind uses the term “low vision,” which it describes as “uncorrectable vision loss that interferes with daily activities.” The foundation says that other terms commonly used to describe vision loss – “partial sight,” “partial blindness” and “poor vision” – are no longer in general use.

The foundation also uses the term “visually impaired,” but some object to the use of the words “impair” or “impairment” when describing a disability.

NCDJ Recommendation: “Blind” may be used for people who have complete or almost complete loss of sight. Other terms are acceptable for those with some vision loss. It is best to ask your sources what they prefer and take that into consideration. Similarly, ask whether the person prefers identity-first or people-first language. Many prefer “blind” or “blind person,” while others prefer “a person with blindness.” Other commonly used terms include:

Limited vision: Acceptable when a person is not legally or completely blind
Low vision: Acceptable when a person is not legally or completely blind
Partially sighted: Used most often in British publications for those not legally or completely blind but less acceptable in the U.S.
Visually impaired: Similar to the term “ hearing impaired ,” some may object to it because it describes the condition in terms of a deficiency.

Because these terms tend to be imprecise, consider asking how the visual condition affects acuity. For example, a person may be able to describe having low central or peripheral vision.

AP style: Included in its “Disabled/Handicapped” entry, the stylebook describes blind as “a person with complete loss of sight” and suggests using the terms “visually impaired” or “person with low vision” for those who have some sight.

Brain injury/traumatic brain injury (TBI)

Background: The Centers for Disease Control define traumatic brain injury as “an injury that affects how the brain works.”

NCDJ Recommendation: Use “person with a brain injury” or “person with a traumatic brain injury” rather than “brain damaged,” which is considered derogatory.

AP style: Addressed in entry for “Trauma,” suggesting that “traumatic brain injury” is an acceptable use of the word “trauma.”

Caregiver/caretaker

Background: A caregiver is an individual who “provides direct care” to people with disabilities and others, according to the Merriam-Webster Dictionary . While “caregiver” and “caretaker” often are used interchangeably, they imply something different. As retired clinical psychologist and disability rights advocate Katherine Schneider notes, “You take care of property… To people you give care.”

NCDJ Recommendation: “Caregiver” is preferable to “caretaker” when referring to the care of people.

Catatonia/catatonic

Background: Catatonia is a state in which a person does not move and does not respond to others. According to Psychology Today , it is a rare condition that may be associated with other conditions, such as schizophrenia. It is often used informally to describe someone who is in a stupor-like condition.

NCDJ Recommendation: Refer to someone as “catatonic” only if it is part of a medical diagnosis. Avoid using it casually as it may be offensive and inaccurate.

Cerebral palsy

Background: Cerebral palsy refers to a number of neurological conditions that appear in infancy or early childhood and permanently affect body movement and muscle coordination, according to the National Institute of Neurological Disorders and Stroke . It is not caused by problems in the muscles or nerves but by differences in parts of the brain that control muscle movement. People with cerebral palsy can exhibit a variety of symptoms. Spastic cerebral palsy is a common type of cerebral palsy in which the movements of people with the condition appear stiff and jerky.

NCDJ Recommendation: It is acceptable to describe a person as “someone with cerebral palsy,” followed by a short explanation of what the condition entails. It is acceptable to refer to someone as “having spastic cerebral palsy,” but it is derogatory to refer to someone as “spastic” or “a spaz.” When describing specific symptoms, it is always best to ask the person what terms they prefer.

Chemical and/or electrical sensitivities

Background: The University of Kansas Research & Training Center on Independent Living describes these as “chronic medical conditions characterized by neurological impairment, muscle pain and weakness, respiratory problems and gastrointestinal complaints. Reactions for those with chemical sensitivities are triggered by low-level exposure to everyday substances and products, including pesticides, solvents, cleaning agents, new carpeting and adhesives, and fragrances and scented products. Electrical sensitivities are triggered by electromagnetic fields from electrical devices and frequencies. These conditions also are called “toxicant-induced loss of tolerance,” “environmental illness” or “sick-building syndrome.”

NCDJ Recommendation: Use “person with chemical intolerance” or “people with environmental illness.” Do not use “chemophobic” as it is considered derogatory.

AP Style: Not addressed

Chronic disease/chronic illness

Background: A chronic illness is defined by the National Health Council as a health condition lasting three months or longer and includes conditions such as cancer or heart disease. Many illnesses, such as diabetes or multiple sclerosis, are life-long conditions.

There is debate about when someone with a chronic illness is considered to have a disability.

NCDJ Recommendation: When referring to a person with a chronic illness, only refer to the condition if it is pertinent to the story you are confident there is a medical diagnosis. Ask your sources how they want to be described. Some people prefer “person with diabetes” rather than “a diabetic.”

Cleft palate or lip/harelip

Background: The University of Kansas Research & Training Center on Independent Living describes this as a specific congenital disability involving the lip and gum. The center recommends against using the term “harelip” as it is anatomically incorrect and stigmatizing.

NCJD Recommendation: Use “person who has a cleft palate.” Avoid “harelip.”

Cochlear implant

Background: A cochlear implant is an electronic device that can improve understanding of speech for some people who are deaf or hard of hearing. The device does not fully restore hearing, but it gives a representation of sounds to help a person understand speech. It has been criticized by some in the Deaf community who are concerned that the device could threaten Deaf culture . However, advocates support the device for suitable candidates. (There are physical considerations that rule out cochlear implants for some.)

NCDJ Recommendation: When referring to a cochlear implant, avoid describing it as a corrective device or one that would restore a deaf person to mainstream society. Instead, define it as an electronic device that can assist a person who is deaf or hard of hearing in understanding speech.

Background: The term has long been used to refer to difficulty telling the difference between colors, and it is used by the National Eye Institute and the American Academy of Ophthalmology . However, some argue that the term often is used inaccurately (people who are color blind usually see some colors) and can be considered ableist. They recommend “color vision deficiency.”

NCDJ Recommendation: “Colorblind” is still generally acceptable, but in the interest of accuracy, consider indicating what kind of color-blindness a person has, such as red-green color-blindness. “Color vision deficiency” is becoming more widely used, but you may have to explain its meaning, depending upon the context.

Congenital disability

Background: A person who has a congenital disability has had a disability since birth. Common congenital disabilities include Down syndrome, heart-related medical conditions and most forms of cerebral palsy. “Congenital” is not interchangeable with “genetic,” as a genetic condition is present from birth but a congenital condition is not necessarily genetic.

NCDJ Recommendation: It is acceptable to state that someone has a congenital disability or lives with a congenital disability. Alternatively, it is acceptable to say that a person “has had a disability since birth” or “was born with a disability.” State the specific disability if possible. Avoid using “defect” or “defective” when describing a disability because the terms imply that the person is somehow incomplete or sub-par.

AP style: The style book states that “congenital disorder” is acceptable and recommends being specific about the condition.

Crazy/loony/mad/psycho/nuts/deranged

Background: These words were once commonly used to describe people with mental illness but are now considered offensive. They are still used in a variety of contexts but should be avoided.

NCDJ Recommendation: Do not use these words, particularly when reporting on mental illness, unless they are part of a quote that is essential to the story.

See also Insane/mentally deranged/psychopathology

Cretin/cretinism

Background: The Merriam-Webster Dictionary defines cretininism as “a usually congenital condition marked by physical stunting and intellectual disability and caused by severe hypothyroidism” and goes on to say, “Chronic iodine deficiencies in diet can result in malfunctions of the thyroid gland, the gland that produces hormones necessary for normal human development. Some mountainous regions, such as parts of the Alps, do not naturally provide their inhabitants with a diet rich enough in iodine, and the resultant hypothyroidism causes stunted growth and mental retardation. In Franco-Provençal (the Romance speech of French Switzerland and adjacent areas of France), a person affected by hypothyroidism was called a cretin, literally, “wretch, innocent victim,” The word meant simply “Christian” and emphasized the hypothyroid victim’s basic humanity.”

NCDJ Recommendation: Cretin” is considered a slur to describe a person with intellectual disabilities. Use the term “hypothyroidism” instead.

Cripple/crip

Background: Merriam-Webster defines the noun “cripple” as “a lame or partly disabled person or animal” and as “something flawed or imperfect.” It also is used as a verb. The word dates to Old English, where it was related to words that meant to “creep” or “bend over.” According to the blog grammarphobia.com , it became offensive in the early 20th century and was replaced by “handicapped” and then by “disabled.”

Recently, some disability activists have reclaimed the word. Jon Henner , an assistant professor at University of North Carolina at Greensboro, who is Deaf, describes himself as a “crip linguist.”

While some activists have embraced the word, adopting hashtags such as “#criplit” and “#cripthevote,” others are very much against its use. Keah Brown , a writer and disability activist who has cerebral palsy, tweeted in 2018: “I just really can’t stand the word cripple, so whenever I see it, I block it out. I legit ignore every notification with the word in it.”

NCDJ Recommendation: Avoid using “cripple” as either a noun or verb unless you are describing the “crip” movement or if it’s in a direct quote.

AP style: Cripple” is considered offensive when used to describe a person who is lame or disabled.

Cued speech

Background: According to the Centers for Disease Control and Prevention , “cued speech” is “a building block that helps children who are deaf or hard-of-hearing better understand spoken languages.” It’s a series of hand signs and spots near the mouth used to differentiate between sounds that look the same as one is mouthing them. It is not interchangeable with American sign language; in fact, it’s not sign language at all. It can be used with babies and older children. Raisingdeafkids.org has a good list of related resources and more information.

NCDJ Recommendation: Because it is not commonly used, particularly in the U.S., include a definition when using the term.

Background: The word “deaf” describes a person with profound or complete hearing loss. It is important to understand that many people do not consider being deaf or having hearing loss as a disability. Instead, deafness is often considered a culture.

“Deaf” and “hard of hearing” are the terms recommended by the World Federation of the Deaf and The National Association of the Deaf . Many people in the Deaf community prefer the use of a lowercase “d” to refer to audiological status and the use of a capital “D” when referring to the culture and community of Deaf people. Some people with mild to moderate hearing loss may affiliate themselves with the Deaf community and prefer to be referred to as “deaf” instead of “hard of hearing.” Alternatively, some who are profoundly deaf may prefer the term “hard of hearing.”

NCDJ Recommendation: “Deaf” or “hard of hearing” are the preferred terms. Uppercase when referring to the “Deaf” community and lowercase when referring to the condition. Avoid using “hearing impaired” or “partial” or “partially” in reference to deafness or hearing loss unless people use those terms for themselves.

When possible, ask if a person or group uses identity-first language (deaf students) or person-first language (students who are deaf). However, The National Association of the Deaf supports the identity-first approach.

When quoting or paraphrasing a person who has signed their responses, it’s appropriate on first reference to indicate that the responses were signed. It’s acceptable to use the word “said” in subsequent references.

AP style: The stylebook uses “deaf” to describe a person with total hearing loss and “partially deaf” or “partial hearing loss” for others. It calls for use of a lower case “d” in all usages.

Deaf-blind or Deafblind or DeafBlind

Background: Indicates a person who has some loss of both vision and hearing. This also is referred to as deaf-blindness or deafblindness. Until recently, the term deaf-blind was widely accepted, and it is still in use today. For example, the National Center on Deaf-Blindness retains the hyphen. But according to deafblind.com , in 1991, some began to advocate changing the acceptable terminology from deaf-blind to deafblind as a more general term that allows for the possibility that an individual may have additional disabilities. Today, many government and private organizations in the U.S. and elsewhere use deafblind instead of deaf-blind.

NCDJ Recommendation: The terms deafblind, deafblindness, deaf-blind and deaf-blindness are all acceptable. However, whenever possible, ask the individual which term they prefer.

Deaf and dumb/deaf-mute

Background: “Dumb” was once widely used to describe a person who could not speak and implied the person was incapable of expressing himself or herself; it eventually came to be synonymous with “silent.”

“Deaf-mute” was traditionally used to refer to people who can neither speak nor hear in traditional ways. However, people with speech and hearing disabilities are capable of expressing themselves in writing, through sign language and in other ways. Additionally, a person who does not use speech may be able to hear.

NCDJ Recommendation: Avoid these terms as they often are used inaccurately and can be offensive. It is acceptable to refer to someone as deaf or hard of hearing. If possible, ask the person which is preferable. Mute and dumb imply that communication is not possible. Instead, be as specific as possible. If someone uses American Sign Language, lip-reads or uses other means to communicate, state that.

Defect/birth defect

Background: A defect is defined as an imperfection or shortcoming. A birth defect is a physical or biochemical difference that is present at birth. Many people consider “defect” and other forms of the term offensive when describing a disability as they imply the person is deficient or inferior to others.

NCDJ Recommendation: Avoid using “defect” or “defective” when describing a disability. Instead, state the nature of the disability or injury.

AP style: The stylebook says “birth defect” is acceptable in broad references, such as lessening the chances of birth defects. But it should not be used when referring to a specific person or to a group of people with a specific condition. Instead, be specific about the condition and use only if relevant to the story. Some prefer the term “congenital disorder.”

Deformed/deformity

Background: A deformity is a condition in which part of the body does not have the typical or expected shape, according to Merriam-Webster Dictionary . Physical deformities can arise from a number of causes, including genetic mutations, amputations and complications in utero or at birth. However, the word “deformity” has a negative connotation when used in reference to those with disabilities.

NCDJ Recommendation: Avoid using “deformed” as an adjective to describe a person.

AP style: AP medical stories tend to refer to a specific deformity or deformities rather than describing an individual as “deformed.”

Dementia/senility

Background: “Dementia” is “a general term for a decline in mental ability severe enough to interfere with daily life,” according to the Alzheimer’s Association . Dementia is not a specific illness; it refers to a wide range of symptoms. Alzheimer’s disease is the most common form of dementia. According to the National Institute on Aging, other dementias include Lewy body dementia, frontotemporal disorders and vascular dementia. The institute states, “It is common for people to have mixed dementia – a combination of two or more types of dementia. For example, some people have Alzheimer’s disease and vascular dementia.”

Other medical diagnoses associated with dementia include Creutzfeldt-Jakob disease, Huntington’s disease, Parkinson’s disease and Wernicke-Korsakoff syndrome (previously known as “wet brain”).

Common symptoms across forms of dementia include memory loss, difficulty performing complex tasks, communication difficulties, personality changes and paranoia, according to the Mayo Clinic . In addition to their cognitive component, many types of dementia include physical symptoms, such as the abnormal eye movements of Huntington’s disease or the tremors associated with Parkinson’s disease.

Some organizations suggest avoiding the terms “demented,” “dementing,” “dements,” “senile” or “senility” to refer to someone with dementia. The terms “senility” and “senile” denote conditions brought on by aging and often are used incorrectly to denote dementia.

NCDJ Recommendation: Refer to someone as having dementia only if the information is relevant to the story and you are confident there is a medical diagnosis. Use “a person with dementia” or “a person with dementia” rather than “demented” or “senile.” When possible, reference the specific disease, such as “someone with Huntington’s disease.” When referencing Huntington’s disease or Parkinson’s disease, use the full term rather than shortening to “Huntington’s” or “Parkinson’s.”

Background: Depression is characterized by a loss of interest in activities, persistent fatigue, difficulty in concentrating and making decisions, prolonged feelings of emptiness or hopelessness, and abnormal eating habits, according to the National Institute of Mental Health . Its proper name is “major depressive disorder.” The institute says that related diagnoses include seasonal affective disorder (characterized by the “onset of depression during the winter months”), psychotic depression (a combination of psychosis and depression), and postpartum depression (sometimes experienced by mothers after giving birth). Bipolar disabilities used to be referred to as “manic depressive illness,” but that is no longer the case.

NCDJ Recommendation: Refer to someone as having depression only if the information is relevant to the story and you are confident there is a medical diagnosis. If a medical diagnosis is not available, use quotes around the term and indicate that a diagnosis has not been confirmed. Specify the type of condition if it is known. The terms “depressed,” “depressing” and “depressive” are acceptable in other contexts when the person being referenced does not have a medically diagnosed condition. For example, “They found the election results depressing.”

AP style: The style book suggests naming the specific condition when possible rather than making a general reference. Use lower case unless referring to the Great Depression.

See also Bipolar disorder and Mental illness

Developmental disabilities/disability

Background: The Centers for Disease Control defines developmental disabilities as “a group of conditions (that arise) due to an impairment in physical, learning, language or behavior areas. These conditions begin during the developmental period of life, may impact day-to-day functioning, and usually last throughout a person’s lifetime.”

By definition, developmental disabilities manifest before age 22. Those with such disabilities often require lifelong or extended support. Examples of developmental disabilities include autism spectrum disorder, spina bifida, cerebral palsy and intellectual disabilities. Legal definitions vary from state to state. A developmental disability can include a long-term physical or cognitive/intellectual disability or both.

NCDJ Recommendation: While it is acceptable to use the terms “developmental disability” and “developmental disabilities,” it is preferable to use the name of the specific disability whenever possible.

Differently-abled

Background: This term came into vogue in the 1990s as an alternative to “disabled,” “handicapped” or “mentally retarded.” Currently, it is not considered appropriate (and for many, never was). Some consider it condescending, offensive or simply a way of avoiding talking about disability. Others prefer it to “disabled” because “dis” means “not,” which means that “disabled” means “not able.” But particularly when it comes to referring to individuals, “differently abled” is problematic. As some advocates observe, we are all differently abled.

NCDJ: “Person with a disability” is a more neutral term than “differently-abled.”

AP Style: The style book suggests avoiding the term and, instead, trying to be specific about the disability.

Disabled/disability

Background: “Disability” and “disabled” generally describe functional limitations that affect one or more of the major life activities, including walking, lifting, learning and breathing. Various laws define disability differently.

NCDJ Recommendation: While it is usually acceptable to use these terms, keep in mind that disability and people who have disabilities are not monolithic. Avoid referring to “the disabled” in the same way that you would avoid referring to “the Asians,” “the Jews” or “the African Americans.” When describing individuals, do not reference disabilities unless it is clearly pertinent to the story. When possible, refer to a person’s specific condition.

AP style: “Disabled” is described as a general term for a physical, mental, developmental or intellectual disability. Avoid describing someone as “handicapped.”

See also Disabled people/people with disabilities

Disability studies

Background: The Society for Disability Studies defines the discipline as “sitting at the intersection of many overlapping disciplines in the humanities, sciences and social sciences. Programs in Disability Studies should encourage a curriculum that allows students, activists, teachers, artists, practitioners, and researchers to engage the subject matter from various disciplinary perspectives.”

NCDJ Recommendation: Use Disability Studies in the same way you would reference other academic disciplines.

Disabled people/people with disabilities

Background: The phrased “disabled people” is an example of identity-first language (in contrast to people-first language). It is the preferred terminology in Great Britain and by a number of U.S. disability activists. Syracuse University’s Disability Cultural Center says, “The basic reason behind members of (some disability) groups’ dislike for the application of people-first language to themselves is that they consider their disabilities to be inseparable parts of who they are.” For example, they prefer to be referred to as “autistic,” “blind” or “disabled.”

Several U.S. disability groups have always used identity-first terms, specifically the culturally Deaf community and the autistic rights community.

NCDJ Recommendation: Ask the disabled person or disability organizational spokesperson about their preferred terminology.

Conforms to AP style , which adds that in describing groups of people, or when individual preferences cannot be determined, use person-first language.

Disfigurement/disfigured

Background: According to the University of Kansas Research & Training Center on Independent Living , “disfigurement refers to physical changes caused by burns, trauma, disease or congenital conditions.”

NCDJ Recommendation: Do not call someone “disfigured” as it is considered derogatory. Refer specifically to the physical changes.

Dissociative identity disorder/multiple personality disorder

Background: Dissociative identity disorder is characterized by the emergence of two or more distinct personality states or identities in a person’s behavior or consciousness, according to the National Alliance on Mental Illness . These personalities, medically known as “alters,” can exhibit different speech patterns, mannerisms, attitudes, thoughts, gender identities and even physical characteristics. Other symptoms include memory loss, emotional issues and disorientation.

NCDJ Recommendation: Refer to someone as having “dissociative identity disorder” only if the information is relevant to the story and if you’re confident there is a medical diagnosis. Use the term “dissociative identity disorder,” not “multiple personality disorder,” and avoid the acronym “DID.”

Diversabled / Diversability

Background: “Diversability” is a term coined by Tiffany Yu, a disability rights advocate. Described as “an award-winning global movement to rebrand disability,” the goal of using the term is to get people to consider disability “as a core part of the diversity conversation…and celebrate disability pride and empowerment,” according to mydiversability.com .

NCDJ Recommendation: When writing about Tiffany Yu’s group, use “Diversability” as a proper name. Otherwise, use the terms “disabled,” “disability” or “person with a disability.”

Down syndrome

Background: Down syndrome is a congenital condition caused by the presence of an extra full or partial copy of chromosome 21 in an individual’s cell nuclei. It was first reported in 1866 by Dr. John Langdon Down and is characterized by a range of physical and cognitive characteristics, which the National Institutes of Health details. Down syndrome is the most common chromosomal condition.

Other terms commonly used to refer to people with Down syndrome include “intellectually disabled,” “developmentally disabled” and a person who has a “cognitive disability” or “intellectual disability.” The Global Down Syndrome Foundation considers all of these terms acceptable, while the National Down Syndrome Society suggests using “cognitive disability” or “intellectual disability.” Down syndrome also can be referred to as Trisomy 21. Historically it was called “mongoloidism,” and people with it were called Mongoloids; this is now considered offensive.

NCDJ Recommendation: The proper term is Down syndrome, not Down’s syndrome or Down’s Syndrome. (The proper terminology in the United Kingdom is Down’s syndrome). Avoid using terms such as “suffers from” or “afflicted with” in association with the condition. The terms “intellectually disabled,” “developmentally disabled,” “cognitive disability” and “intellectual disability” are acceptable when used in a people-first context to describe someone with Down syndrome, such as “the person has a developmental disability.” However, it is more accurate to refer specifically to Down syndrome when that is the medically diagnosed condition.

See also Mentally retarded and Mongoloid

Dwarf/little person/midget/short stature

Background: Dwarfism is a medical or genetic condition that results in a stature below 4’10,” according to Little People of America . The average height of a dwarf is 4’0.”

Use of the word “dwarf” is considered acceptable when referring to the genetic condition, but it is often considered offensive when used in a non-medical sense.

The term “midget” was used in the past to describe an unusually short and proportionate person. It is now widely considered a derogatory slur. Little People of America has a statement on “the M word.”

The terms “little people” and “little person” refer to people of short stature and have come into common use since the founding of the Little People of America organization in 1957. The appropriateness of the terms is disputed by those within and outside of the organization. However, Little People of America recommends using the descriptors “short stature,” “little person” or “someone with dwarfism.”

NCDJ Recommendation: Only refer to a person’s short stature if it is relevant to the story. It is best to ask people which term they prefer to describe them. Use the term “dwarf” only when applied to a medical diagnosis or in a quote. Avoid the terms “vertically challenged” and “midget.”

AP style: Dwarf is the “preferred term for people with a medical or genetic condition resulting in short stature.” “Midget” is considered offensive. The plural of “dwarf” is “dwarfs.”

Dyslexia/dyslexic

Background: Dyslexia is a learning disability characterized by challenges identifying speech sounds and learning how to connect them to letters and words, according to the Mayo Clinic . Its chief symptoms include difficulties with spelling, reading, pronunciation of words and processing auditory information. It is a common learning disability among children, although adolescents and adults with dyslexia often exhibit symptoms as well.

The term “dyslexic” is used by some organizations as a noun and as an adjective in a non-pejorative way; however, using the word as a noun (describing a person as a “dyslexic”) appears to be falling out of use.

NCDJ Recommendation: Refer to someone as having dyslexia only if the information is relevant to the story and if you’re confident there is a medical diagnosis. If a medical diagnosis is not available, use quotes around the term and indicate that a diagnosis has not been confirmed. Ask people how they want to be described. Some prefer being called “dyslexic,” others prefer people-first language, as in “a person with dyslexia.”

Epilepsy/epileptic/epileptic fit

Background: Epilepsy is a chronic neurological and developmental condition characterized by “recurrent, unprovoked seizures,” according to the Epilepsy Foundation . Originally called “falling sickness” in English, the word has roots in Greek and Latin.

Epilepsy manifests differently in individuals: The severity of epileptic seizures, their occurrence rates and the emergence of other health problems differ from person to person. Epilepsy is most commonly treated with medication but treatment also can include use of medical devices, surgery, diet and emerging therapy methods.

WebMD explains the difference between epilepsy and seizures in this way: “Seizures, abnormal movements or behavior due to unusual electrical activity in the brain, are a symptom of epilepsy. But not all people who appear to have seizures have epilepsy, a group of related disorders characterized by a tendency for recurrent seizures.”

NCDJ Recommendation: Refer to someone as having epilepsy only if the information is relevant to the story and if you’re confident there is a medical diagnosis. Referring to someone as “an epileptic” is often considered offensive. Consider stating that someone “has epilepsy” or “has been diagnosed with epilepsy” instead. The term “seizure” is preferred when referring to the brief manifestation of symptoms common among those with epilepsy. Do not say the person “had a fit” or “had an epileptic fit.”

Facilitated communication

Background: Facilitated communication is a widely criticized communication technique that was popular in the 1990s. The technique was originally developed to help those with significant developmental disabilities, such as some forms of autism and cerebral palsy. A nonverbal person would theoretically communicate with the help of a facilitator by typing on a keyboard, pointing to an image, or pointing to letters on an alphabet board. However, academics eventually found there was little scientific evidence that the technique worked, leading many to conclude the aide was actually the one communicating, according to a study from Emory University .

In an official position statement, the American Speech-Language-Hearing Association warns that any messages extracted from facilitated communication “should not form the sole basis for making any diagnostic or treatment decisions.” Other organizations, including the American Psychological Association and the International Society for Augmentive and Alternative Communication also oppose facilitated communication. However, some people still strongly support the method .

It is important to note that “augmentative and alternative communication” – a general term used to refer to alternative methods that allow for written and spoken expression – is considered very different from facilitated communication. It is widely viewed as legitimate and important.

NCDJ Recommendation: Avoid language that may legitimize facilitated communication. When writing about it, specify that major disability organizations do not recognize facilitated communication as a valid communication technique.

Freak/freak show

Background: The Merriam-Webster Dictionary defines “freak” as “one that is markedly unusual or abnormal, such as a person or animal having a physical oddity and appearing in a circus sideshow.” This particular use of the word dates to the middle of the 19th century .

NCDJ Recommendation: Do not use the term “freak” to describe a person with a disability as it is derogatory.

Genetic defect/genetic disorder

Background: According to the National Human Genome Research Institute, a genetic disorder is “caused in whole or in part by a change in the DNA sequence away from the normal sequence. Genetic disabilities can be caused by a mutation in one gene (monogenic disorder), by mutations in multiple genes (multifactorial inheritance disorder), by a combination of gene mutations and environmental factors, or by damage to chromosomes (changes in the number or structure of entire chromosomes, the structures that carry genes).”

Some of the more common genetic conditions include cystic fibrosis, Huntington’s disease, and sickle cell anemia.

A genetic condition is congenital, but a congenital condition is not necessarily genetic. The Genome Research Institute offers comprehensive information about different genetic conditions, genetic testing and other pertinent topics.

NCDJ Recommendation: Avoid terms like “disorder” or “defect,” which are considered derogatory. Instead use the word “condition” unless referring to a specific medical diagnosis.

Gifted/twice exceptional

Background: According to the National Association for Gifted Children , giftedness is characterized by the capacity to perform above the level of one’s peers. Others, including the authors of “Great Minds and How to Grow Them,” question whether there is such a thing as a gifted child.

Another commonly used term is “twice exceptional” or “2E,” which refers to a child with a disability who also is diagnosed as gifted. According to the National Association for Gifted Children, “Twice-exceptional learners are students who give evidence of the potential for high achievement capability in areas such as specific academics, general intellectual ability, creativity, leadership and/or visual, spatial or performing arts and also give evidence of one or more disabilities as defined by federal or state eligibility criteria, such as specific learning disabilities, speech and language disabilities, emotional/behavioral disabilities, physical disabilities, autism spectrum or other health impairments, such as ADHD. Twice-exceptional students represent a unique group of learners with diverse programming and emotional needs due to the fact that they may have both gifts and disabilities.”

NCDJ Recommendation: Avoid describing people as “gifted” or “twice exceptional” unless they have been identified as such by a professional.

Handicap/handicapped/handicapable

Background: Merriam-Webster Dictionary defines handicap as “a physical disability (as a bodily impairment or a devastating disease).” The term has fallen out of favor in the disability community. In 2009, the writers of the television show “Glee” introduced the term “handicapable” as a positive alternative to other ways of referring to people with disabilities. However, its use is relatively rare and not generally accepted.

NCDJ Recommendation: Avoid using “handicap” and “handicapped” when describing a person. Instead, refer to the person’s specific condition or use “person with a disability.” The terms are still widely used and generally acceptable when citing laws, regulations, places or things, such as “handicapped parking,” although many prefer the term “accessible parking.” Avoid “handicapable.”

Conforms to AP style with regard to “handicap” and “handicapped.” The stylebook does not address “handicapable.”

Hard of hearing

Background: According to the University of Washington , “hard of hearing” refers to any hearing condition that can be helped by an auditory device. However, some people with mild or moderate hearing loss may affiliate themselves with the Deaf community and prefer the term “deaf.” Alternatively, some who are deaf and don’t have a cultural affiliation to the Deaf community may prefer the term “hard of hearing.”

“Deaf” and “hard of hearing” became the official terms recommended by the World Federation of the Deaf in 1991. Many people in the Deaf community and organizations, including the National Association of the Deaf , support the use of these terms.

NCDJ Recommendation: “Hard of hearing” is almost always acceptable. However, use the term the person prefers if it’s possible to ask.

AP style: Not addressed except to recommend using “hard of hearing” without hyphens unless it is an adjective directly preceding a person. However, AP advises against the latter formulation.

Hearing impaired/hearing impairment

Background: The terms “hearing impaired” and “hearing impairment” are sometimes used to describe people with hearing loss that ranges from partial to complete. Many dislike the terms because “hearing impaired” describes a person in terms of a deficiency or what they cannot do. The World Federation of the Deaf has taken the stance that “hearing impaired” is no longer an acceptable term.

NCDJ Recommendation: Avoid using “hearing impaired” or “hearing impairment.” For those with total hearing loss or who identity as a member of the Deaf community, “deaf” is acceptable. Others prefer “hard of hearing.” It is best to ask your sources what they prefer.

AP style: The style book defers to the National Association of the Deaf, stating: “’Hearing-impaired’ was a well-meaning term that is not accepted or used by many deaf and hard of hearing people.”

High functioning/low functioning

Background: “ “High functioning” and “low-functioning” are terms used to describe ability levels for people with a variety of conditions, including neurodiversity, intellectual disabilities and mental illness. Many people with intellectual disabilities and their advocates consider these terms to be dismissive or reductive of a person’s abilities. For example, “emotional intelligence” also is important when considering a person’s overall intelligence, according to the American Psychological Association.

Journalists should consider other ways of describing a person’s ability to function in society. For example, they might say that an individual with Down syndrome lives with minimal or no extra l assistance.

The term “high-functioning autism” is widely used but is not a medical diagnosis, and many consider it offensive.

NCDJ Recommendation: Avoid using the terms “high functioning” and “low functioning.” Instead, use medical diagnoses and describe an individual’s abilities and challenges, rather than using less-specific labels.

Homebound/housebound

Background: The two terms often are used interchangeably. According to Merriam Webster , homebound means “confined to the home.” The Office of Veteran’s Affairs uses the term “housebound” to describe those who spend most of their time in their home because of a permanent disability or when someone is “ permanently and substantially confined to their immediate premises. ” However, the terms are sometimes applied incorrectly to people with disabilities who require some mobility assistance but who are relatively independent. Disability advocacy groups emphasize that it is important not to assume people are homebound if they are disabled. Many feel that it’s never appropriate to use “homebound” or “housebound.”

NCDJ Recommendation: Avoid using the terms unless used in a direct quote.

AP style: Not addressed except to state that homebound and housebound are one word with no hyphens.

Identity-first language

Background: Identify-first language contrasts with people-first language. With identity-first language, the disability is mentioned first. For example, “Down syndrome girl” or “autistic boy.” An example of people-first language is “a girl with Down syndrome” or “a boy with autism.” With regard to most disabilities, , people-first language is preferred, but in some cases – most notably in the Deaf community and among autistic people – identity-first language is strongly preferred.

NCDJ Recommendation: Ask the person with the disability how they would like to be described. If that’s not possible, ask a spokesperson for the organization representing the relevant disability for preferred terminology.

Impaired/Impairment

Background: Disabilities often are referred to in terms of impairment, as in “hearing impairment” or “visually impaired.” Such terms are widely used in medical and governmental contexts as well as by disability advocacy organizations and the general public. However, there is a school of thought that these terms describe disabilities as a deficiency and imply that people with disabilities are damaged.

In addition, there is a difference between impairment and disability, according to the Institute of Human Services. In short, impairment refers to the condition of an organ or structure of the body; disability means that a person has a functional limitation due to an impairment. The discussion can be found here .

NCDJ Recommendation: When possible, avoid describing a person or condition as “impaired.” Alternative language for “hearing impairment” and “visual impairment” are offered under those entries.

Conforms to AP style:

Infantile paralysis/poliomyelitis/polio/post-polio syndrome

Background: Infantile paralysis is shorthand for poliomyelitis and was commonly used in the past to describe polio. Its symptoms include muscle weakness and paralysis. Jonas Salk introduced the polio vaccine in the 1950s, which drastically reduced cases of polio in the U.S.

According to the University of Kansas Research & Training Center on Independent Living , “post-polio syndrome is a condition that affects some persons who have had poliomyelitis (polio) long after recovery from the disease. It is characterized by new muscle weakness, joint and muscle pain and fatigue.”

NCDJ Recommendation: Use the term polio rather than infantile paralysis. It is preferable to say, “He had polio as a child;” “She contracted polio as an adult,” or “He has post-polio syndrome” rather than “He suffers from polio” or “He is a victim of polio.”

Injury/injuries

Background: “Injury” is commonly used to describe any harm or damage to an individual as the result of an accident or other event. It is frequently used in such references as “injuries suffered in a car accident.”

NCDJ Recommendation: Refer to injuries as being “sustained” or “received” rather than “suffered,” as “suffer” implies that an injured person is a victim or somehow less than a person who has not been injured. Use of “sustain” or “receive” removes the implied judgment.

AP style: The stylebook says injuries may be “suffered,” “sustained” or “received.”

Insane/insanity/mentally deranged/psychopathology

Background: The terms “insane,” “insanity” and “mentally deranged” are commonly used informally to denote mental instability or mental illness but can be considered offensive. The medical profession favors use of the terms “mental disorder” or “psychopathology.” In U.S. criminal law, insanity is a legal question, not a medical one.

NCDJ Recommendation: Use the term “mental illness” instead of “insane” or “mentally deranged,” except in a quote or when referring to a criminal defense.

Insane asylum/mental health hospital/psychiatric hospital

Background: Hospitals that cared for people with various mental illnesses, often for long periods of time, were once commonly referred to as insane asylums. The term has largely gone out of use and is now considered objectionable and inaccurate.

NCDJ Recommendation: “Behavioral health hospital” or “psychiatric hospital” are the preferred terms to describe medical facilities specifically devoted to treating people with mental health conditions.

See also Insane/insanity/mentally deranged/psychopathology

Intellectual disabilities/intellectually disabled

Background: An intellectual disability involves “significant limitations both in intellectual functioning (reasoning, learning, problem solving) and in adaptive behavior, which covers a range of everyday social and practical skills,” according to the American Association on Intellectual and Developmental Disabilities . There is debate over how relevant IQ tests should be in making a diagnosis.

NCDJ Recommendation: Both terms are acceptable, although many people prefer people-first language, stating that someone is “a person with an intellectual disability” rather than referring to the person as intellectually disabled.

Background: The term interabled is used by some in the disability community to refer to couples in which one person has a disability and the other does not. Proponents of the term say it helps to destigmatize relationships between people with disabilities and people without disabilities. Certain communities, such as the Muscular Dystrophy community and the Spinal Muscular Atrophy community, have embraced the term, but others argue that interabled relationships are relationships just like any other and should not be marked as different.

NCDJ Recommendation: Since the term is not in widespread use, its meaning should be explained for a general audience; ask sources how they prefer to describe their relationships whenever possible.

AP Style: The only reference relates to hyphenation. In general, there is no hyphen after inter, so interabled is the correct usage (not inter-abled).

Background: The Oxford English dictionary defines an invalid as “a person made weak or disabled by illness or injury.” It is probably the oldest term for someone with physical conditions that are considered seriously limiting. However, it is such a general term that it fails to accurately describe a person’s condition and is now widely viewed as offensive in that it implies that a person lacks abilities.

NCDJ Recommendation: Avoid using “invalid” to describe a person with a disability except in a direct quote.

Invisible disabilities

Background: The majority of people with disabilities have chronic conditions that are invisible or hidden. Although many in the general public associate disability with people using wheelchairs or white canes or who are missing limbs, more people have conditions that can’t be seen but are defined as disabilities under the 1990 Americans with Disabilities Act .

For example, millions of Americans are hard of hearing, but most do not use sign language and many do not use hearing aids. Mental illness is a prevalent invisible disability. Many chronic health conditions also are considered invisible disabilities, depending on their severity and impact on daily living.

Chronic illnesses such as Parkinson’s disease, diabetes, lupus or Crohn’s disease may fall into the category of invisible disabilities.

NCDJ recommendation: Do not apply the term “invisible disability” to people without asking what they prefer. Many people with chronic illnesses do not consider themselves disabled and thus may be offended by the term. If a preference is unknown, specify the condition rather than referring to it as a “hidden disability,” which is vague and open to interpretation.

AP style: Not specifically addressed, but the style book suggests not using such terms without asking for an individual’s preference.

Lame/lamebrain

Background: Lame is a word commonly used to describe difficulty walking as the result of an injury to the leg. Many people object to the use of the word to describe a physical condition because it is used in colloquial English as a synonym for weak, as in: “That’s a lame excuse.”

The Merriam-Webster dictionary defines “lamebrain” as “a dull-witted person.”

NCDJ Recommendation: Avoid using “lame” or “lamebrain” to describe a person except in a quote. In the case of a leg injury, explain instead that an injury resulted in difficulty walking.

Learning disability

Background: According to the University of Kansas Research & Training Center on Independent Living , learning disability “describes a neurologically based condition that may manifest itself as difficulty learning and using skills in reading (called dyslexia), writing (dysgraphia), mathematics (dyscalculia) and other cognitive processes due to differences in how the brain processes information. Individuals with learning disabilities have average or above average intelligence, and the term does not include a learning problem that is primarily the result of another cause, such as intellectual disabilities or lack of educational opportunity.”

NCDJ Recommendation: Use “learning disability” when you’re confident there is a medical diagnosis. If a medical diagnosis is not available, use quotes around the term and indicate that a diagnosis has not been confirmed. Do not substitute “slow learner” or another derogatory term like “retarded.”

Limb difference/Limb different

Background: These phrases are used to describe conditions in which arms, legs, fingers, or toes are missing, not fully formed or shaped in a different way, either as a result of an amputation or a congenital condition. They have come to replace labels such as amputee or malformation, deformation or anomaly. People may refer to themselves as limb different or as being part of a limb different community or as having an upper or lower body limb difference.

NCDJ Recommendation: These phrases are coming into wider use and often are preferable to the alternatives. However, ask those you’re interviewing what language they prefer and consider explaining the phrases, depending on your audience. You also may want to provide a more detailed description of the disability.

Little person/little people

See Dwarf, little person/people/midget/short stature

Mental illness/mental disorder

Background: “Mental illness” is an umbrella term for many different conditions that affect how individuals act, think, feel or perceive the world. The most common forms of mental illness are anxiety disorders, mood disorders and schizophrenia. Severity and symptoms vary widely. For more information on mental illness, see the National Institute for Mental Health .

Because of perceived stigma, some people are calling for an end to the use of the term “mental illness,” suggesting instead “a person diagnosed with a psychiatric condition” or “a person with a mental health history.” Some advocates suggest using the term “mental health experience.” However, the term “mental illness” still is widely used within the medical and psychiatric professions.

The American Psychiatric Association offers a useful media guide of appropriate terms. The association recommends using people-first language to describe mental illness in order to avoid defining people by their disability. “She experiences symptoms of psychosis” is preferable to “She is psychotic.” “He has a bipolar disorder” is preferable to “He is bipolar.”

The terms “mental illness” and “mental disorder” are not interchangeable. Healthyplace.com has Healthyplace.com has a good discussion of the differences.

NCDJ Recommendation: Refer to an individual’s mental illness only when it is relevant to the story and you’re confident there is a medical diagnosis. Whenever possible, specify the specific illness a person has rather than mental illness in general. Always refer to someone with a mental illness as a person first. Use quotes when officials or family members use a term such as “a history of mental illness” to refer to an individual, and when appropriate, indicate that the diagnosis has not been confirmed.

Conforms to AP style: The stylebook cautions against describing an individual as mentally ill unless clearly pertinent to a story and the diagnosis is properly sourced. Specific diagnoses should be used and the source of the diagnosis identified whenever possible. The stylebook also warns against drawing a connection between mental illness and violent crime and recommends that any source used to characterize a criminal suspect’s mental health history should have the authority to speak on the matter. Finally, it cautions against “using mental health terms to describe non-health issues. Don’t say that an awards show, for example, was “schizophrenic.”

Mental health professional/shrink

Background: There are a number of types of mental health professionals. The following broad definitions are sourced from Psychology Today :

Psychiatrist: A mental health professional able to prescribe psychotropic medications. Some provide emotional therapy as well as medication management.
Psychoanalyst: A specific type of psychotherapist trained to work with both an individual’s unconscious and unconscious mind. The field was founded by Sigmund Freud.
Psychologist: A mental health professional trained in the discipline of psychology and who often does psychological testing and research.
Psychotherapist: An umbrella term for mental health professionals trained to treat people for their health problems.

NCDJ Recommendation: Ask professionals how they should be identified, based on their formal training. Avoid using the word “shrink” in reference to a mental health professional except in a quote.

AP style: Not specifically addressed, but the style book refers to “mental health professional” in an entry on mental illness.

Mentally retarded

Background: The terms “mentally retarded,” “retard” and “mental retardation” were once common terms that are now considered outdated and offensive. In 2010, President Barack Obama signed a measure known as “ Rosa’s Law ” that replaced the term “mental retardation” with intellectual disability in many areas of government, including federal law.

From “My Heart Can’t Even Believe It: A Story of Science, Love and Down Syndrome,” (Amy Silverman, Woodbine House, 2016):

“The word retarded has a slang-free history. For a long time, it simply meant slow. According to the Oxford English Dictionary, it’s derived from the Italian word ritardato, and the first definition of the adjective version is ‘held back or in check; hindered, impeded; delayed, deferred.’ It’s traced to religion in 1636 (‘he to his long retarded Wrath gives wings’); to medicine in 1785 (‘Polypus, sometimes obstructs the vagina, and gives retarded labour’); and later to politics (‘Arguably, the legacy of communism manifests itself most acutely in the retarded economic development of the east’). It also means ‘characterized by deceleration or reduction in velocity,’ as in a 1674 reference: ‘When it hath passed ye vertex ye motion changeth its nature, & turneth from an equably accelerated into an equably retarded motion.’ Actual references to retarded intelligence did not come until the turn of the 20th century, with the advent of the IQ test. Then numbers were assigned to words – not just ‘mentally retarded,’ but also terms like imbecile, idiot and moron.”

NCDJ Recommendation: Do not use the term retarded or other iterations. If you are going to use it in a quote, consider that decision carefully, as the word is particularly charged. Instead, always try to specify the type of disability being referenced. Otherwise, the term “intellectually disabled” is acceptable. Consider using people-first language, as in “a person with an intellectual disability” rather than “an intellectually disabled person.” As always, ask the person which terms they prefer.

At times, words that are considered outdated may be appropriate because of the story’s historical context. In those cases, attribute the term or note its historic use. For example, “The doctor said he was retarded, a term widely used at the time.”

AP style: “Mentally retarded” should be avoided. The stylebook suggests using terms such as “mentally disabled,” “intellectually disabled” and “developmentally disabled.”

See also Intellectual disabilities/intellectually disabled

See entry on Dwarf, little person/midget/short stature

Background: The term was commonly used in the late 19th century to refer to people who had Down syndrome, due to the similarity of some of the physical characteristics of the condition to Eastern Asian people, who were called Mongoloid, according to the Oxford English dictionary . It is considered highly derogatory to describe someone with Down syndrome as being “mongoloid.”

NCDJ Recommendation: Avoid the use of “mongoloid” to refer to someone with Down syndrome. Even in the case of a direct quote, consider how offensive the term is and include the historical context if possible.

Multiple personality disorder

See entry on Dissociative identity disorder/multiple personality disorder

Muscular dystrophy (MD)

Background: Muscular dystrophy could refer to any of more than 30 genetic conditions characterized by progressive weakness and degeneration of the muscles that control movement, according to the National Institute of Neurological Disorders and Stroke . Onset could be in infancy, childhood, middle age or later.

NCDJ Recommendation: It is acceptable to describe a person as “someone with muscular dystrophy,” followed by a short explanation of what the condition entails. Avoid saying a person “suffers from” or “is afflicted with” the disease. MD is acceptable on second reference.

AP style: Not addressed, although AP does not use the abbreviation MD.

Non-disabled

Background: “Non-disabled” refers to someone who does not have a disability. According to the University of Kansas Research & Training Center on Independent Living , “Non-disabled is the preferred term when the context calls for a comparison between people with and without disabilities. Use ‘non-disabled’ or ‘people without disabilities’ instead of healthy, able-bodied, normal or whole.”

NCDJ Recommendation: “Non-disabled” or “does not have a disability” are acceptable terms when referring to people who do not identify as having a disability. In general, avoid using “able-bodied’ except in a quote.

Neurodiversity

Background: The Oxford English Dictionary defines neurodiversity as “the range of differences in individual brain function and behavioral traits, regarded as part of the normal variation in the human population (used especially in the context of autism spectrum disorders).” The word was coined in the late 1990s.

Neurodiversity basically means that brains operate differently – and that’s not a bad thing. There is an advocacy movement around this concept that argues against the idea that there is one ‘normal’ or ‘healthy’ type of brain or mind or one ‘right’ style of neurocognitive functioning.

“Neurotypical” refers to a person who is considered part of the normal variation in the human population.

It is important to note that some autism advocates do not like this term; it tends to be embraced by self advocates, but not as frequently by families of people with autism who also have intellectual disabilities and other challenges.

NCDJ Recommendation: “ “Neurodiversity” can be used as a way of describing someone on the autism spectrum, but because it’s a relatively new term, consider offering the definition when you use it, particularly in work meant for a mainstream audience. Remember that some in the autism community object to the term.

Nonspeaking/nonverbal

Background: Some disability advocates are beginning to shift away from the word “nonverbal” in favor of “nonspeaking,” arguing that “nonverbal” implies that someone doesn’t understand language, while “nonspeaking” does not invite the same judgment. A nonspeaking individual may understand and use language – just in a different way, such as through American Sign Language. The case for “nonspeaking” is outlined by the non-profit organization The Guild for Human Services .

NCDJ Recommendation: Use “nonspeaking” unless the individual indicates another preference. Keep in mind that it may not be relevant to include in a story how an individual communicates as long as the communication is clear.

Obsessive-compulsive disorder (OCD)

Background: Obsessive-compulsive disorder is characterized by unreasonable thoughts and fears that lead to repetitive and often ritualized behaviors or compulsions. OCD may present as a fear of contamination, disarray or intrusion, according to the Mayo Clinic . People with OCD usually exhibit both obsessions and compulsions but sometimes exhibit only one or the other. OCD is often treated with pharmaceutical drugs, psychotherapy methods, or a combination of the two.

NCDJ Recommendation: Refer to someone as having OCD only if the information is relevant to the story and you’re confident there is a medical diagnosis. If a medical diagnosis is not available, use quotes around the term and indicate that a diagnosis has not been confirmed. Do not use OCD as an adjective for someone who obsesses over certain things but has not been formally diagnosed with the condition. Use “obsessive-compulsive disorder” on first reference if a medical diagnosis is available; OCD is acceptable in second reference.

Paraplegia/paraplegic

Background: Paraplegia is defined as the loss of movement in the lower extremities and torso. It is typically caused by a spinal cord or brain injury. Referring to someone as a “paraplegic” is offensive to some people as it implies that their condition defines them.

NCDJ Recommendation: Avoid referring to an individual as a paraplegic. Instead, say the person has paraplegia. Sometimes people with paraplegia refer to themselves as a “para.” In those cases, use the word in quotes.

AP style: Not specifically addressed, but AP refers to paraplegia in its general disability entry.

Partial hearing loss/partially deaf

Background: “Hard of hearing” is the most common term for those who have a mild to moderate hearing loss that may or may not be corrected with amplification.

NCDJ Recommendation: Ask your sources what term they prefer. Otherwise, “hard of hearing” is almost always acceptable.

AP style: The stylebook recommends using “partial hearing loss” or “partially deaf” for those who have some hearing loss.

See also Deaf ; Cochlear implant and Hard of hearing

Patient/sick

Background: Members of the disability community argue that characterizing people with a disability as “sick” or referring to them as “patients” signals there is something unwell about them or that they are in need of medical attention, when, in fact, that is often not the case.

NCDJ Recommendation: Avoid referring to someone with a disability as “sick” or to their disability as a “sickness.” If a person is receiving medical treatment, then the word “patient” is appropriate; however, it should be avoided outside of a medical context.

People-first language

Background: People-first language avoids defining people in terms of their disability. In most cases, this entails placing the reference to the disability after the reference to a person, as in “a person with a disability,” or “a person living with a disability,” rather than “the disabled person.”

People-first language is not preferred by all people with disabilities. Specifically, some members of the autism and Deaf communities prefer identity-first language.

NCDJ Recommendation: Ask the person with a disability how they prefer to be described; if that’s not possible, ask a spokesperson for the organization representing the relevant disability for preferred terminology.

Plain English

Background: The Center for Inclusive Design defines Plain English as “a direct style of writing for people who can read at a reasonable level. It helps people who want to read and understand information quickly. Plain English is sometimes known as plain language or Everyday English. Plain English looks and sounds like standard forms of writing.” Another version, Easy English, aims at a lower reading level with short sentences often accompanied by pictures.

NCDJ Recommendation: Use Plain English or Plain Language but confirm with the source that that is the correct terminology. It might be Easy English.

Post-traumatic stress disorder (PTSD)

Background: Post-traumatic stress disorder is an anxiety disorder usually caused by an extremely emotional traumatic event. Such events may include assault, war, sexual assault, natural disasters, car accidents or imprisonment. Symptoms may include reliving the traumatic event, avoidance of certain behaviors, negative emotions, or physical symptoms such as dizziness or nausea.

NCDJ Recommendation: Refer to someone as having PTSD only if the information is relevant to the story and you’re confident there is a medical diagnosis. “Post-traumatic stress disorder” is correct on first reference; use PTSD on second reference. The term “flashback” may be used to denote reliving an event that triggered the PTSD.

AP style: PTSD is acceptable on either first or second reference but should be spelled out at least one time. Many medical organizations do not use a hyphen when spelling “posttraumatic;” however the AP does.

Prelingually deaf/postlingually deaf/late-deafened

Background: “Prelingually deaf” refers to individuals who were born deaf or became deaf prior to learning to understand and speak a language, according to Gallaudet University, a university for the education of the deaf and hard of hearing in Washington, D.C. “Postlingually deaf” or “late-deafened” describes people who lost their hearing ability after they learned to speak a language.

NCDJ Recommendation: All the terms are acceptable, although, because they are not widely used, an explanation is required for a general audience.

Psychotic/psychosis

Background: Psychosis is a broad term used to describe symptoms of certain mental health problems that include delusions or hallucinations or other loss of contact with reality. People with psychosis are described as psychotic. In common usage, “psychotic” often is used in the same way as the word “crazy,” and thus can be offensive and inaccurate.

NCDJ Recommendation: Use the words “psychotic” and “psychosis” only when they accurately describe a medical experience. Avoid using “psychotic” as an adjective to describe a person; instead refer to a person as “having a psychotic condition” or “experiencing a psychosis.” Avoid using the terms colloquially.

Quadriplegia/quadriplegic

Background: Quadriplegia is defined as the paralysis of all four limbs as well as the torso. It often is caused by a spinal cord or brain injury and is characterized by the loss of sensory and motor function. People with these conditions often are referred to as “quadriplegics” and “paraplegics,” but these terms are considered offensive by some. “Tetraplegia” is used interchangeably with “quadriplegia.”

NCDJ Recommendation: Ask people how they would like to be described. Many prefer people-first language, such as “a person with quadriplegia” rather than “quadriplegic,” since the latter implies that the condition defines them. Sometimes people with quadriplegia refer to themselves as “quads.” In these cases, use in quotes.

Schizophrenia/schizophrenic

Background: Schizophrenia is a serious chronic mental illness characterized by distorted recognition and interpretations of reality, affecting how an individual thinks, feels and acts, according to the National Institute of Mental Health .Common symptoms include visual and auditory hallucinations, delusional and disordered thinking, unresponsiveness, and a lack of pleasure in daily life and other social issues. It does not involve split personalities. Less than one percent of the general population has schizophrenia, and it is treated mostly through the use of pharmaceutical drugs.

NCDJ Recommendation: Refer to someone as having schizophrenia only if the information is relevant to the story and you’re confident there is a medical diagnosis. If a medical diagnosis is not available, use quotes around the term and indicate that a diagnosis has not been confirmed. Many people prefer people-first language, such as “a person with schizophrenia” or “a person diagnosed with schizophrenia” rather than a “schizophrenic” or “a schizophrenic person.” Do not use the word “schizophrenic” colloquially as a synonym for something inconsistent or contradictory.

AP style: Schizophrenia is classified as a mental illness. The stylebook cautions against using mental health terms to describe non-health issues. Don’t say that an awards show, for example, was “schizophrenic.”

Background: According to the Mayo Clinic : “A seizure is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in your behavior, movements or feelings, and in levels of consciousness. If you have two or more seizures or a tendency to have recurrent seizures, you have epilepsy. There are many types of seizures, which range in severity. Seizure types vary by where and how they begin in the brain. Most seizures last from 30 seconds to two minutes. A seizure that lasts longer than five minutes is a medical emergency. Seizures are more common than you might think. Seizures can happen after a stroke, a closed head injury, an infection such as meningitis or another illness. Many times, though, the cause of a seizure is unknown.”

NCDJ Recommendation: Do not say someone has had a seizure unless there has been a medical diagnosis. If a medical diagnosis is not available, use quotes around the word and indicate that a diagnosis has not been confirmed. Do not assume that a person who has had a seizure has epilepsy.

See also Epilepsy/epileptic/epileptic fit

Service animal/assistance animal/guide dog/Seeing Eye dog

Background: Service animals are trained animals, usually dogs, that provide services to people with disabilities. They also are sometimes called “assistance animals,” “guide dogs,” or “Seeing Eye dogs.” The federal definition of a “service animal” applies to “any guide dog, signal dog or other animal trained to do work or perform tasks for the benefit of an individual with a disability.” This may include animals that guide individuals with impacted vision, alert individuals with impacted hearing to intruders or sounds, provide minimal protection or rescue work, pull a wheelchair or fetch dropped items. If they meet this definition, animals are considered service animals under the ADA, regardless of whether they have been licensed or certified. For more information, consult the U.S. Department of Justice Civil Rights Division Disability Rights Section .

NCDJ Recommendation: The terms “service animal,”” assistance animal” and “guide dog” all are acceptable. Avoid use of “Seeing Eye dog” as Seeing Eye is a registered trademark of The Seeing Eye school in Morristown, N.J. Be aware that licensure and/or certification of service animals is a contentious issue in the disability community, so it may be best to refer to the federal definition.

AP style: Although there is no entry for service animal, the style book takes note of the Seeing Eye dog trademark and says “guide dog” is preferred in all references.

Short stature

Spastic/spaz.

See entry on Cerebral palsy

Special/special needs/functional needs

Background: The term “special needs” was popularized in the U.S. in the early 20th century during a push for special needs education to serve people with all kinds of disabilities. The word “special” in relationship to those with disabilities is now widely considered offensive because it euphemistically stigmatizes that which is different.

The term “special education” is still widely used when referring to public school programs, although some government entities use titles like “exceptional student services.”

NCDJ Recommendation: Avoid using these terms when describing a person with a disability or the programs designed to serve them, with the exception of government references or formal names of organizations and programs. It is more accurate to cite the specific disability or disabilities in question. The term “functional needs” is preferred when a term is required. For example, “addressing the functional needs of people with disabilities” could be used when referring to a facility or program.

Don’t use the term “SPED” as shorthand for special education. It’s considered offensive.

AP style: The style book urges avoidance of the term “special education” and suggests trying to be specific about the needs or services in question.

Speech impediment/Speech disorder

Background: These phrases refer to a condition in which the mouth, jaw, tongue and vocal tract do not work together to produce recognizable words. Manifestations may include stuttering, articulation errors or an inability to move the tongue (commonly referred to as tongue-tied). While “speech impediment” and “speech disorder” are still widely used within the medical community, many consider the terms offensive because they describe the conditions in terms of a deficiency.

NCDJ Recommendation: Consider using “speech disability” instead of “impediment,” “disorder” or “impairment.”

Spina bifida

Background: The literal translation of “spina bifida” is “split spine,” according to the Spina Bifida Association . The condition is a neural tube defect that occurs when the spinal column does not close all the way in the womb. It is the most common neural tube defect in the U.S. There are four types of spina bifida. The Spina Bifida Association publishes a list of terms and definitions. Complications from spina bifida range from minor physical problems to significant intellectual and physical disabilities.

NCDJ Recommendation: It is acceptable to describe a person as “someone with spina bifida,” followed by a short explanation of what their condition entails if it is pertinent to the story.

Stuttering/stammering

Background: Stuttering is a a neurobiological condition that is characterized by interruptions in speech. There is some ambiguity about the difference between stuttering and stammering and which term is appropriate in different contexts. However, organizations such as the National Institute on Deafness and Other Communication Disorders , the Mayo Clinic and the National Stuttering Association generally use the term “stuttering” to refer to the speech condition. The Diagnostic and Statistical Manual of Mental Disorders debuted the new term “childhood-onset fluency disorder” to refer to stuttering, along with a few new criteria for its diagnosis. However, this term is not widely used.

NCDJ Recommendation: The word “stuttering” is preferred over “stammering.” While people-first language is generally preferred (“a person who stutters”), some individuals may prefer “stutterer.” When possible, ask. Avoid “childhood-onset fluency disorder” without explanation.

Suffers from/victim of/afflicted with/stricken with

When renowned scientist Stephen Hawking died in 2018, media accounts referred to him as “finally free” of the wheelchair he used for decades. The references angered disability rights advocates, who argued that Hawking achieved remarkable success while using a wheelchair and a computerized voice system, not despite those devices.

Background: The World Health Organization recommends avoiding language that sensationalizes or normalizes suicide or presents it as a solution to problems. For example, the terms “failed attempt” or “successful” or “completed attempt” depict suicide as a goal, project or solution. Some argue that the term “commit” implies that suicide is a criminal act, while others view the term “commit” as neutral.

NCDJ Recommendation: The NCDJ endorses The Associated Press style, below.

AP style: Avoid using “committed suicide” except in direct quotations from authorities. Alternate phrases include “killed himself,” “took her own life” or “died by suicide.” The verb “commit” with “suicide” can imply a criminal act. Laws against suicide have been repealed in the U.S. and many other places. Do not refer to an “unsuccessful suicide attempt.” Refer instead to an “attempted suicide.”

“Medically assisted suicide” is permitted in some states and countries. Advocacy groups call it “death with dignity” or “right-to-die,” but AP does use those phrases on their own. When referring to the legislation whose name includes “death with dignity,” “right-to-die” or similar terms, say the law or proposal allows ‘the terminally ill to end their own lives.’ If the term is in the name of a bill or law, make that clear. ‘Euthanasia’ should not be used to describe ‘medically assisted suicide’ or ‘physician-assisted suicide’.” The AP also suggests using resources from www.reportingonsuicide.org .

Survivor/battle

Background: Some use the term “survivor” to affirm their recovery from or conquest of an adverse health condition. Common usages include “cancer survivor,” “burn survivor,” “brain injury survivor” or “stroke survivor.” However, the terms are disliked by some because they imply that those who die simply did not fight hard enough. For similar reasons, there is disagreement about characterizing disease or illness as a “battle,” as in “to battle cancer.” These arguments surfaced after U.S. Senator John McCain died in the summer of 2018.

NCDJ Recommendation: Terms such as “battle” and “survivor” are still widely accepted and understood, but the user should be aware that they could offend some people.

AP style: The style book suggests using the term “survivor” with care because it can be imprecise, among other reasons.

Tetraplegia/tetraplegic

Background: Tetraplegia, used interchangeably with quadriplegia, is defined as the paralysis of all four limbs as well as the torso. It often is caused by a spinal cord or brain injury and is characterized by the loss of sensory and motor function. Paraplegia is similar but does not affect the arms. People with these conditions often are referred to as “quadriplegics” and “paraplegics,” but these terms are considered offensive by some.

NCDJ Recommendation: Many people prefer people-first language, such as “a person with tetraplegia” rather than “tetraplegic,” since this implies that the condition defines them.

Triggers/Content Warnings

Background: Psychological triggers are words, images or sounds that activate phobias, panic attacks or flashbacks to unpleasant events or trauma. The concept of triggering originated with early psychoanalytical diagnoses of posttraumatic stress disorder, called “war neuroses,” in WWI veterans . News reports covering sensitive topics, such as abuse, assault, addiction, suicide, combat and violence, frequently contain descriptive scenarios that can deeply effect audiences. Some content can spark difficult memories for people with certain mental illnesses and phobias. Trigger warnings communicate that upcoming content may produce unpredictable and unwelcome reactions for some readers. They give audiences a choice on whether or not to proceed with consuming the information. However, some readers object to trigger warnings and view them as patronizing and stifling to academic freedom.

NCDJ Recommendation: If you’re an educator, consider alerting students ahead of time if content contains graphic descriptions of traumatic events. Journalists also may want to include such warnings in material distributed to a general audience. Triggers can be hard to predict, and they vary from individual to individual, but communicating the nature of your content builds audience trust. Refrain from using the term “trigger warning” in a flip or casual way.

AP Style: The style book suggests a content warning at the top of stories when the subject matter may be considered offensive or disturbing, but the story does not contain quoted profanity, obscenities or vulgarities. For example: “Eds: Graphic details of the killings could be offensive or disturbing to some readers.”

Tourette syndrome/Tourette’s syndrome

Background: Tourette syndrome is a neurological condition characterized by tics, sudden, purposeless and rapid movements or vocalizations, according to the National Institute of Neurological Disorders. Such tics are recurrent, involuntary and non-rhythmic. The disability was originally named for French neurologist Dr. Georges Gilles de la Tourette, who first described the condition in 1885, according to the National Institute of Neurological Disorders and Stroke .

While those with Tourette syndrome often can suppress tics by focusing on them, the condition also can be treated with medication, relaxation techniques and therapy. Although involuntary cursing is commonly thought to be a key trait of the disability, only a minority of those with Tourette syndrome exhibit this symptom .

Terminology for the condition is varied. It is interchangeably referred to as “Tourette syndrome,” “Tourette’s syndrome” and “Tourette’s disorder.” However, prominent mental health organizations such as the Mayo Clinic, the Centers for Disease Control and Prevention, and the Tourette Syndrome Association, refer to it as “Tourette syndrome.”

NCDJ Recommendation: Use “Tourette syndrome” with no possessive or capitalization of “syndrome.” Refer to someone as “having Tourette syndrome” only if the information is relevant to the story and if you’re confident there has been a medical diagnosis. Many people prefer people-first language, such as “a person with Tourette syndrome” or “a person diagnosed with Tourette syndrome.” Avoid the acronym TS, as it is not widely known.

AP style: The AP merely defines Tourette Syndrome as, “A neurological disorder characterized by involuntary, repetitive movements and vocalizations.”

Treatment/treatment center/rehab center/detox center

Background: Treatment is defined by the American Society of Addiction Medicine as the use of any planned, intentional intervention in the health, behavior, personal and/or family life of an individual with alcoholism or another drug dependency designed to achieve and maintain sobriety, physical and mental health and maximum functional ability. A treatment center is an establishment usually run by psychiatric or medical professionals.

NCDJ Recommendation: “Treatment” is an acceptable term for medical interventions, and “treatment center” is acceptable for the establishment in which such practices take place. Use “treatment center” in place of “rehab” or “detox” center. A person enrolled in a treatment center should be referred to as a patient.

Vegetative state/vegetable/comatose/non-responsive

Background: The Merck Manual ddefines vegetative state as the absence of responsiveness or consciousness in which patients show no awareness of their environment. Patients may exhibit eye movements and other involuntary movements. A minimally conscious state is one in which a patient has some awareness of self and/or the environment.

NCDJ Recommendation: It is preferable to use a medical professional’s diagnosis or, if that is not possible, terms such as “comatose” or “non-responsive.” Avoid referring to someone as “a vegetable” or “veg” as such words dehumanize the person. The term “vegetative state” is preferable to “vegetable” or “veg,” but it is considered offensive by some and is frequently misused.

AP style: The stylebook allows the use of “vegetative state,” describing it as “a condition in which the eyes are open and can move, and the patient has periods of sleep and periods of wakefulness, but remains unconscious, unaware of self or others.”

Wheelchair/wheelchair-bound/confined to a wheelchair

Background: People who use mobility equipment such as a wheelchair, scooter or cane consider the equipment part of their personal space, according to the United Spinal Association . People who use wheelchairs have widely different disabilities and varying abilities.

NCDJ Recommendation: It is acceptable to describe a person as “someone who uses a wheelchair,” followed by an explanation of why the equipment is required. Avoid “confined to a wheelchair” or “wheelchair-bound” as these terms describe a person only in relationship to a piece of equipment. The terms also are misleading, as wheelchairs can liberate people, allowing them to move about, and they are inaccurate, as people who use wheelchairs are not permanently confined to them but are transferred to sleep, sit in chairs, drive cars, etc.

The Disability Angle

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

Advanced Search
Journal List
Medscape J Med
v.10(6); 2008

Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood

Patricia a. prelock.

Department of Communication Sciences, University of Vermont, Burlington, Vermont

Tiffany Hutchins

Frances p. glascoe.

Department of Pediatrics, Vanderbilt University, Nashville, Tennessee

Disclosure: Tiffany Hutchins, PhD, has disclosed no relevant financial relationships in addition to her employment.

Disclosure: Frances P. Glascoe, PhD, has disclosed no relevant financial relationships in addition to her employment.

Abstract and Introduction

Speech-language problems are the most common disability of childhood yet they are the least well detected, particularly in primary care settings. The goal of this article is to: (1) define the nature of speech-language problems, their causes, and consequences; (2) facilitate early recognition by healthcare providers via accurate screening and surveillance measures suitable for busy clinics; and (3) describe the referral and intervention process.

Introduction

Speech-language deficits are the most common of childhood disabilities and affect about 1 in 12 children or 5% to 8% of preschool children. [1] The consequences of untreated speech-language problems are significant and lead to behavioral challenges, mental health problems, reading difficulties, [2] and academic failure including in-grade retention and high school dropout. [3] Yet, such problems are ones that are least well detected in primary care, [4] even though intervention is available and plentiful.

Speech-language impairments embrace a wide range of conditions that have, at their core, challenges in effective communication. As the term implies, they include speech disorders which refer to impairment in the articulation of speech sounds, fluency, and voice as well as language disorders which refer to impairments in the use of the spoken (or signed or written) system and may involve the form of language (grammar and phonology), the content of language (semantics), and the function of language (pragmatics). [5] These may also be described more generally as communication disorders which are typically classified by their impact on a child's receptive skills (ie, the ability to understand what is said or to decode, integrate, and organize what is heard) and expressive skills (ie, the ability to articulate sounds, use appropriate rate and rhythm during speech, exhibit appropriate vocal tone and resonance, and use sounds, words, and sentences in meaningful contexts). There are common conditions in infants, toddlers, and preschoolers that are associated with receptive and expressive communication challenges as presented in Table 1 . [6 – 17]

Disorders in Young Children Commonly Associated With Receptive and Expressive Communication Problems

It is important to distinguish speech and language impairment from language delay and language difference. Language delay is characterized by the emergence of language that is relatively late albeit typical in its pattern of development. In contrast to an impairment or a delay, a language difference is associated with systematic variation in vocabulary, grammar, or sound structures. Such variation is “used by a group of individuals [and] reflects and is determined by shared regional, social, or cultural and ethnic factors” and is not considered a disorder. [18]

Unfortunately, non-native speakers of English, speakers of various dialects (whose language also varies within dialect), and bilingual or multilingual speakers are frequently classified as language delayed or disordered when, in fact, they are language different [18 , 19] –although problems of underidentification also occur. This is particularly important in an increasingly pluralistic society such as ours in which 1 of 4 people identify as other than white non-Hispanic, approximately 17% of the population is bilingual (mostly speaking Spanish and English), and where minorities represent more than 50% of the population in several cities and counties. [20]

The overidentification of culturally and linguistically diverse populations commonly occurs when a mismatch is observed and incorrectly interpreted between a language used in a particular community and that of the majority culture. This may be seen most clearly in the improper use of formal tests of speech and language to assess the competencies of speakers who are dissimilar to the sample upon which the test was normed and developed. [21] Similar errors also occur during informal evaluations of language and literacy as when the sound structure of the language influences the spelling or grammatical conventions used in written discourse. [22] With regard to bilingualism, it is commonly assumed that children's acquisition of 1 or both languages is delayed; however, the effects of bilingualism are more complex and differ with the age of the child, the nature of the linguistic input, and the manner and timing of language acquisition. What is clear is that equivalent proficiency in each language should not be expected or assumed as this has the potential to lead to misidentification of a speech and language impairment. (For more information on the effects of bilingualism on language learning, see http://asha.org/public/speech/development/BilingualChildren.htm and http://asha.org/public/speech/development/second.htm ) In the case of culturally and linguistically diverse individuals, decisions to intervene and bring language use in line with that of the majority culture or promote proficiency in the dominant language are not inappropriate; however, such decisions must be seen as separate from the language difference vs disorder question.

In your experience, which of the following is the most important barrier to the effective assessment of speech and language impairment in young children? (Select only 1 answer.)

○ Variability in the development of speech and language in young children
○ Lack of effective screening tools that discriminate children with and without speech and language impairment
○ Lack of accurate parent interview tools that identify clear concerns in speech and language development
○ Insufficient time with young children in the clinical setting to observe speech and language skills
○ Inadequate understanding of milestones for speech and language development

How confident are you that you are up-to-date in the diagnosis and management of speech and language impairment in young children? (Select only 1 answer.)

○ Not at all confident
○ Somewhat confident
○ Confident
○ Very confident

All of the following statements about young children with speech and language impairment are true except :

○ Young children tend to produce words with sounds that are consistent with the words they already know
○ Young children are able to communicate intent before speaking their first words
○ Disfluency is a common occurrence in a young child's early speech
○ Children usually begin to put 2 words together at 30 months

Answer: Children usually begin to put 2 words together at 30 months. Children usually begin to put 2 words together at 18 months.

Etiology, Neurobiology, and Prevalence of Speech-Language Impairments

The etiology of most cases of speech-language impairments is unknown but diverse causes are suspected. The range of causes or origins includes anatomical abnormalities, cognitive deficits, faulty learning, genetic differences, hearing impairments, neurologic impairments, or physiologic abnormalities. [6] As noted above, language differences as revealed in the communication output associated with diverse cultural, ethnic, regional or social dialects are not considered disorders. [5] Speech and language impairments may be acquired (ie, result from illness, injury or environmental factors) or congenital (ie, present at birth).

Children with speech and language impairment are an under-representation of the broader occurrence of communication disorders, [23] especially considering the co-occurrence of communication disorders with other disabilities (eg, learning disabilities). Approximately 8% to 12% of preschool populations exhibit language impairments. [6] Among children enrolled in early intervention programs, 46% have communication impairments while 26% have developmental delays in multiple areas, usually including language skills. [24] These findings indicate that the most common presentation of disability in preschoolers involves problems with language.

In a family with a child with a speech and language impairment, which of the following would be clinically appropriate?

○ Reassure the parents that the child is just a late talker and will catch up
○ Urge the parents to have their child undergo genetic testing
○ Discourage the child's parents and sibling(s) from talking for the child as this may be a primary cause of a speech and language impairment
○ Advise the parent to have the child's hearing tested

Answer: Advise the parent to have the child's hearing tested. This is appropriate because hearing would be the first condition to rule out as a potential cause of a speech and language delay.

Course and Prognosis

Speech-language impairment sometimes emerges during infancy with challenges in response to sound, atypical birth cries, or limited response to others and progresses through the toddler and preschool age with limited comprehension of spoken language and difficult interactions with peers and others as well as delays in producing first words and word combinations. Speech and language difficulties often persist in school age with difficulties following directions, attending and comprehending oral and written language, and problems producing narratives and using language appropriately in social contexts. Parents are often the first to notice difficulties as they encounter other children with more advanced speech-language skills and thus often wonder if their child is behind. [25] Although many parents raise concerns to primary care providers, many do not. In turn, primary care providers who do not use quality screening tools often dismiss parental concerns with panaceas such as, “He's a boy. Boys talk later.” Or, “Let's give this some time and see if it continues.” Yet, parental concerns about speech and language are associated with developmental disabilities [26] and, thus, careful screening with accurate tools is the requisite response. [27]

The use of a “wait and see” approach underscores the difficulty in distinguishing children who are language delayed from those who have a speech and language impairment. Although most children who have aspeech and language impairment have a history of language delay, only one quarter to one half of late-talkers are eventually diagnosed with a language disorder. [19] In advocating for a more aggressive response for late-talking children, some have argued for careful scrutiny of other risk factors that may guide decisions to refer and intervene. [19] Predictors of a true speech and language impairment that should be considered include poor receptive language skills, [28] limited expressive language skills (eg, small vocabulary, few verbs), and limited development in the sound structure of a language (eg, limited number of consonants, limited variety in babbling structure, vowel errors). [26] Additional predictors include nonspeech (eg, behavioral problems, few gestures, little imitation or symbolic play), environmental (eg, low socioeconomic status, parental use of a directive rather than sensitive and responsive interactional style), and hereditary factors (eg, family history). [26] As a general recommendation, professionals are urged to consider a larger number of risk factors with greater concern. [26]

Often speech-language impairments can be difficult to distinguish from what is considered typical variations in speech and language. For example, disfluencies in speech may be either normal or abnormal. In the nonstuttering child, the most common disfluencies include 1-unit word repetitions (eg, “I… I want that”), interjections (eg, “I saw a… um… picture”), and revisions (eg, “I don't know where… Mommy, help me find my doll”) and, when combined, comprise no more than 10% of words spoken. [29] In the stuttering child, the fluency disorder typically emerges between the ages of 2 and 5 years, is more common among males than females, and is characterized by more than 10% disfluencies in speech, multi-unit syllable (eg, “s-s-s-s-s-September”) and word (eg, “That's my-my-my ball”) repetitions, and may be accompanied by secondary behaviors such as eye-blinking, head-bobbing, or grimacing, as well as feelings of frustration or embarrassment surrounding the stuttering event. [29]

Identification of speech and language impairments is further complicated by the fact that they often masquerade as other diagnostic conditions. For example, children with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) may in fact have an underlying language disorder. Differential diagnosis is challenged by the diagnostic criteria shared between the 2 conditions. Specifically, the diagnostic criteria for ADHD share several characteristics with language disorders including difficulty listening when spoken to, following instructions, talking excessively, blurting out answers, interrupting, and waiting for turns in conversation. [30] Similarly, 50% of preschoolers presenting for psychiatric services were found in several studies to have undiagnosed language impairment. [31 , 32]

The diagnostic criteria for speech-language impairments are defined both by the Diagnostic and Statistical Manual of Mental Disorders , 4th edition (DSM-IV) [33 , 34] and by the Individuals with Disabilities Education Act (IDEA) through the US Department of Education. Table 2 specifies the criteria for communication disorders as described in the DSM-IV. As an example of eligibility criteria for speech-language impairment in response to IDEA guidelines, Vermont indicates that children must demonstrate significant deficits greater than 2 standard deviations below the mean in listening comprehension (eg, measures of auditory (language) processing or comprehension of connected speech including semantics, syntax, phonology, recalling information, following directions and pragmatics) and/or oral expression (eg, measures of oral discourse-syntax, semantics, phonology and pragmatics; voice; fluency; articulation) to qualify as speech or language impaired. [35]

Characteristics of Communication Disorders as Described in the DSM-IV [33 , 34]

Distinguishing children with speech-language deficits from those with other disabilities is often a challenging task as several disabilities share characteristics and have similar diagnostic criteria. For example, an intellectual disability is one in which a child's performance falls at or below 1.5 standard deviations from the mean on a test of intellectual ability with concurrent deficits in adaptive behavior. Children with intellectual disabilities, however, often have significant challenges in receptive and expressive communication as is typical of children with speech and language impairments. Children with learning disabilities have deficits in 1 or more basic skill areas including oral expression and listening comprehension, challenges characteristic of children with speech-language impairments. Children with pervasive developmental disorders/autism exhibit marked impairments in communication and social interaction and restricted and repetitive stereotyped patterns of behavior. Although social impairment is a defining feature of autism, communication impairments are similar to those with a speech-language impairment.

Which of the following is not true of speech-language impairment?

○ Early intervention is critical as speech-language impairments place children at risk for later academic difficulties
○ Most children with speech-language impairments have intellectual deficits
○ Communication disorders may manifest themselves at different stages of life
○ Children with learning disabilities are likely to have speech and language impairments

Answer: Most children with speech-language impairments have intellectual deficits. Although many children who have mental retardation have speech-language impairments, most children with specific speech-language impairments have nonverbal intelligence within normal limits.

Screening and Early Assessment of Speech-Language Disorders

The American Academy of Pediatrics recommends ongoing surveillance and periodic use of broad-band screening measures at all well-visits. Table 3 provides information on a number of tools that have high levels of accuracy in detecting speech-language problems and other disabilities. All included measures were standardized on national samples, proven to be reliable, and validated against a range of measures. When used, referral rates to early intervention programs rise to meet prevalence. [36] In the absence of accurate measures, most providers rely on informal milestone checklists. These lack criteria and are probably the leading reason why only about 1 in 4 children with disabilities of any kind are referred for needed assistance.

Accurate Developmental, Mental Health/Behavioral, and Academic Screens Suitable for Primary Care *

The first column in Table 3 provides publication information and the cost of purchasing a specimen set. The “Description” column provides information on alternative ways, if available, to administer measures (eg, waiting rooms). The “Accuracy” column shows the percentage of patients with and without problems identified correctly. The “Time Frame/Costs” column shows the costs of materials per visit along with the costs of professional time (using an average salary of $50 per hour) needed to administer and interpret each measure. Time/cost estimates do not include expenses associated with referring. For parent report tools, administration time reflects not only scoring of test results, but also the relationship between each test's reading level and the percentage of parents with less than a high school education (who may or may not be able to complete measures in waiting rooms due to literacy problems and will need interview administrations).

Even when screens are deployed, it is nevertheless helpful to complement these brief measures with clinical observation. The brevity of screens useful for primary care means that some skills may not be captured. For example, at any given age range, a brief screen may not present articulation items, measure ability to repeat a story, describe daily events, ask questions, or engage in conversation, etc. The value in routinely administering validated, accurate screening tools, however, is essential to improving currently problematic and extremely low rates of early detection on the part of primary healthcare providers.

Table 4 describes some major language developmental milestones in the prelinguistic (birth to 1 year) and linguistic period (1 year and beyond). [37 , 38] It is important to note that there are wide variations in the speed (and style) with which typically developing children acquire language skills.

Average Age and Range of Ages for Achievement for Important Language Developmental Milestones * [37 , 38]

Providers are reminded that these indicators are an aid to early detection but do not substitute for quality measurement. See Table 3 for a list of screening measures with proven accuracy.

Screening for Other Potential Contributors to Speech-Language Deficits

Another critical avenue for exploration into possible contributors to speech-language deficits is psychosocial risk. Parents who are depressed and/or have housing or food instability have children more likely to have language problems, perhaps because parents lack the energy and freedom from preoccupations to engage in the kinds of language-mediated social interactions known to support optimal child language development. Some parents are not aware of positive parenting practices that promote development, especially language skills (eg, talking with and reading to their child, creating opportunities for sustained dialogue, responding contingently to a child's initiations). Detecting and intervening when psychosocial risk factors, including abuse and neglect, are present has the potential to prevent language problems from developing. Screens for psychosocial risk factors including depression and parent-child interactions are widely available and include the Family Psychosocial Screen and the Brigance Parent-Child Interactions Scale . Both are included in PEDS: Developmental Milestones [39] as supplementary measures helpful for surveillance and offer evidence-based compliance with recommendations in early detection from the American Academy of Pediatrics. [40] , Many other screens, such as the Ages and Stages Questionnaire , include a background information questionnaire that captures common psychosocial risk factors. [41]

Screening Older Children

With school-age children, obtaining and reviewing group achievement test scores can help reveal undiagnosed language deficits. Such children typically have weaknesses in general information (eg, science, social studies knowledge), problems with reading comprehension, and sometimes also problems with math concepts. Table 3 also includes screens suitable for primary care professionals working with children aged 8 years and older.

For both preschoolers and school-age children, broad-band screens (or review of group achievement test results) should be deployed first and serve as a guide to the selection of narrow-band instruments. For example, attentional deficits can be due to a range of conditions such as language impairment, learning disabilities, and mental health problems such as depression. The optimal approach is to administer a broad developmental or academic screen along with a measure such as the Pediatric Symptom Checklist (which discriminates mental health from attentional difficulties). Only afterward and as suggested by the results of broad-band measures should a narrowly focused tool such as the Vanderbilt ADHD Diagnostic Rating Scale be administered. Making sure that other conditions are treated first or at least concomitantly with ADHD is essential.

Billing and Coding for Screening

Primary care providers can use the – 25 modifier to their preventive service code (to indicate that stand-alone services were offered and then use 96110 times the number of screens administered, eg, 96110 X 2. For insurers not accepting units, the distinct procedural service of each screen is best represented with the – 59 modifier appended to each additional unit of 96110.

In 2005, the Centers for Medicare and Medicaid Services published a total relative value unit (RVU) of 0.36 for 96110, which amounts to a Medicare payment of $13.64. None of this can guarantee that a valid claim will be accepted, so the American Academy of Pediatrics is willing to help with denied claims via their Coding Hotline: 800-433-9016, x4022, or at .gro.paa@eniltohgnidocpaa RVUs do not cover physician time, so making use of office staff and parent-report tools is essential.

Referrals and Other Interventions

Once suspicion exists that a child may have a speech-language impairment, referral to early intervention or to the public schools (depending on age) is the first step. These programs offer intervention by speech-language pathologists. If sufficient quantity is not available, referrals can also be made to private therapy services, which may be covered by the patients' insurance. If there appear to be underlying medical conditions, assessment by other disciplines, such as developmental-behavioral or neurodevelopmental pediatrics, is important.

For families with psychosocial risk factors, developmental promotion is essential as is careful monitoring of progress. If brief advice and information handouts are not effective and particularly if children have delays not sufficiently great as to qualify for services, then parent training, quality day care, Head Start, after-school tutoring, and private speech-language therapy should be recommended. Table 5 shows a list of professional development and referral resources. Table 6 provides a list of resources and information for parents.

Professional Development and Referral Resources

Resources and Information for Parents

Components of a Diagnostic Evaluation of Speech-Language Impairment and the Nature of Interventions

Although screening tools for speech-language often identify those children who have speech-language impairments, a screening is not a diagnostic evaluation and only suggests a child requires a more comprehensive assessment. There are several goals in a diagnostic assessment, including verifying that a speech-language impairment exists, describing the strengths and challenges of the child's speech and language, evaluating the severity of the problem, ascertaining the etiology, determining recommendations for a treatment plan, and providing a prognosis. [6] Assessment requires obtaining a sample of communication skills across settings through a number of procedures. It is critical to collect information not only from standardized, formal tools but also to gather more authentic, real-life information to facilitate meaningful and accurate decisions. Typically, case history information, parent interviews, checklists from other providers, systematic observation, hearing screening, and examination of the speech mechanism is included. [6] Formal norm-referenced tests are used to assess articulation, phonology, grammatical understanding and production, and pragmatic language use. The collection of data from the authentic assessment tools and the formal measures provide a comprehensive picture of the speech-language needs of a young child with a communication impairment.

All of the following are true in the assessment of a young child with speech-language impairments except :

○ Obtaining information from multiple sources across settings is necessary to specify communication strengths and challenges
○ Speech-language pathologists (SLPs) make diagnoses of specific speech-language impairment, identify probable causes, determine severity, describe the likely prognosis, and provide recommendations
○ Clinical judgment is most appropriate for determining the severity of a child's speech-language impairment
○ During assessment, speech, language, hearing, and processing abilities should be probed

Answer: Clinical judgment is most appropriate for determining the severity of a child's speech-language impairment. Objective criteria are important to ensure consistency in the assessment of severity.

To determine the prognosis for a young child with a speech-language impairment, which of the following is true?

○ A clinician should avoid providing prognostic information, as questions like “Will my son outgrow his speech-language impairment?” cannot be answered
○ Trial therapy during an assessment period is an appropriate strategy to inform prognosis
○ Families and clinicians have little difficulty making decisions about whether or not a young child with early expressive language delay will benefit from therapy
○ Single evaluation measures can be used to determine the severity of a young child's speech-language impairment and the prognosis for successful outcomes

Answer: Trial therapy during an assessment period is an appropriate strategy to inform prognosis. Clinicians often probe a child's response to intervention strategies to determine responsiveness to treatment and to inform the development of the treatment plan.

Intervention Approaches and Outcomes

The complexity of impairments in speech and language requires a variety of intervention approaches that can address deficits in language form (syntax, phonology, morphology), language content (semantics), and language use (pragmatics) as well as speech and voice production. Further, intervention for young children may involve not just the speech-language pathologist but also care providers and peers.

The ultimate goal of intervention is to increase a child's success in using language to communicate his or her intent, respond to the intent of others, and participate in reciprocal interactions. The speech and language targets vary for each child depending on the context and aspects of communication affected. Targets may or may not follow a strict developmental approach. Sometimes a more functional approach is appropriate, supporting communication at the point of frustration and breakdown. [6] Intervention targets should consider the family's desired outcomes for their child's communication. Targets should be developmentally appropriate and meaningful to the child.

Several teaching methods are used to support the speech and language of children. Modeling is a typical intervention strategy that provides focused stimulation on the speech or language targets selected for an individual child. Cueing is another frequently used technique that includes direct and indirect verbal cues (eg, asking a child to imitate a sound, word, or utterance) or nonverbal cues (eg, giving a child a jar with a desired item that can't be opened without help). In addition, responding to a child's communication efforts through reinforcement or corrective feedback (eg, “Remember to say the ending sound /t/ so we know you mean the word ‘boat’”) is frequently used to facilitate effective communication. [6]

Case Studies

Bobby [pseudonym] is a 7-year-old boy whom you have seen in your office for a number of years. He comes to you today for his annual check-up. Bobby is enrolled in the second grade. His mother is concerned because Bobby's teachers have noted difficulties in his ability to learn to read. Specifically, Bobby's teachers say that he has difficulties with word recognition and reading comprehension. Bobby's mother indicates that this is consistent with her own observations that he seems to have trouble with understanding what is being said (eg, directions, questions) and storytelling. Moreover, she suspects that Bobby's vocabulary is less well developed compared with his peers. She also describes frequent errors in how he formulates sentences such as omitting possessives (eg, “Sam dog” instead of “Sam's dog”) and verbs (eg, “He cooking” instead of “He is cooking”) that she fears are atypical. Bobby's nonverbal IQ is in the typical range.

The difficulties described above are most consistent with a possible diagnosis of:

○ Autism spectrum disorder
○ Intellectual disability
○ Specific language impairment
○ Language delay

Answer: Specific language impairment.

Darius [pseudonym] is a 5-year-old African American boy whom you are meeting today for the first time. He and his mother have recently moved to your area and she has brought him to you because he seems to be developing a nasty cough. When talking with Darius, you notice that he is extremely difficult to understand. Darius is a speaker of African American English; however, even with young speakers of this dialect, you have never had such difficulty understanding and communicating effectively. You learn that he and his parents have just moved from an impoverished community in South Carolina where he attended an age-appropriate class in a school in which approximately 85% of his classmates were black, to a school district in your area that almost entirely comprises white administrators, staff, and students. His mother further reports that Darius's new teachers have expressed concerns about his language. They say he is hard to understand, has a limited vocabulary, cannot master letter-sound correspondences, and has trouble listening to and understanding others.

Which of the following additional patient characteristics obtained from the mother would increase your suspicion of a diagnosis of speech and language impairment? (Select all that apply.)

▪ Darius's mother reports that he has always talked differently compared with his parents, siblings, and peers
▪ Darius's scores on a test of articulation of standard English are in the 10th percentile
▪ Darius becomes frustrated when you ask him to repeat himself
▪ Even though they are consistent with the sound structure of African American English, errors in Darius's spelling are quite common (eg, he writes "nes" instead of “nest”)

Answer: Darius's mother reports that he has always talked differently compared with his parents, siblings, and peers.

Which of the following additional patient or parent characteristics would increase your suspicion that Darius is exhibiting a language difference as opposed to a speech and language impairment? (Select all that apply.)

▪ Not only do you find Darius difficult to understand, but his mother is equally difficult to understand; both seem to be using a variation of African American English dialect that, although not commonly heard in your area, is characteristic of their native community
▪ Darius's scores on a test of vocabulary standardized on a cross-section of North American native English speakers are in the 35th percentile
▪ Darius's mother has no trouble understanding him
▪ Darius's mother does not share these concerns and considers him competent in all aspects of his language development

Answer: Not only do you find Darius difficult to understand, but his mother is equally difficult to understand; both seem to be using a variation of African American English dialect that, although not commonly heard in your area, is characteristic of their native community. Darius's mother does not share these concerns and considers him competent in all aspects of his language development.

You have been Sam's [pseudonym] primary care physician since he was born. He is now 18 months old and comes to you for his annual flu shot. During this visit, his mother expresses concerns about his speech and language development. More specifically, she reports he is “not talking like other kids his age” and uses repeated vocalizations (eg, “eh eh eh eh” while pointing) to communicate. Very recently, Sam has begun to use some words which are often paired with a gesture (eg, “Daddy” while pointing or “up” while raising hands to be picked up). You notice during your visit that Sam is a social and attentive child. He looks at other people and follows their eye gaze to distal objects. He also seems to understand the speech that his mother directs to him and he can easily carry out 2-step commands (eg, “Pick up the cup and sit next to me, please”). Sam's mother is aware of no immediate or extended family members who have ever had a speech or language impairment. Sam has no history of ear infection, and a recent hearing screen indicated hearing in the normal range.

▪ Limited imitation
▪ Limited pretend play
▪ Limited facial expressiveness
▪ Excessive use of nonverbal communicative gestures (eg, reaching, pointing, looking)

Answer: Limited imitation. Limited pretend play.

What should the mother expect with time if her child does not have a speech and language impairment but is rather a late-talker? (Select all that apply.)

▪ The child will begin to engage in unusual repetitive behaviors
▪ The child will steadily albeit slowly add new words and begin to combine them into 2-word utterances
▪ Any new words that the child utters are likely to be distorted and difficult to understand
▪ The child may develop aggressive behaviors to cope with his inability to communicate effectively

Answer: The child will steadily albeit slowly add new words and begin to combine them into 2-word utterances.

Theresa [pseudonym] is a 3-year-old female whom you have seen in your office regularly since her birth. She comes to you today for her annual check-up. During her visit, you observe that Theresa is precocious in her language development. Indeed, her mother reports that she has always been a “great talker” and that she began to speak in well-formed utterances at age 18 months. During this visit, you notice a number of disfluencies in Theresa's speech. At one point, she repeats a word 3 times before getting the rest of the sentence out (ie, “I see… see… see a book with a clown”). Theresa's mother states that these kinds of disfluencies began about 1 month ago and, although she characterizes them as relatively infrequent, she has questions about whether this kind of speech is normal.

Which of the following additional patient characteristics obtained from your observation of Theresa would increase your suspicion of a diagnosis of a fluency disorder? (Select all that apply.)

▪ Theresa seems aware of and perturbed by her disfluencies
▪ Theresa sometimes jerks her head when hesitating to utter her next word
▪ Approximately 20% of Theresa's words appear to constitute disfluencies
▪ Theresa produces multi-unit syllable repetitions (eg, “t-t-t-time”)
▪ All of the above

Answer: All of the above.

Reader Comments on: Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood See reader comments on this article and provide your own.

Readers are encouraged to respond to the author at [email protected] or to George Lundberg, MD, Editor in Chief of The Medscape Journal of Medicine , for the editor's eyes only or for possible publication as an actual Letter in the Medscape Journal via email: ten.epacsdem@grebdnulg

Contributor Information

Patricia A. Prelock, Department of Communication Sciences, University of Vermont, Burlington, Vermont.

Tiffany Hutchins, Department of Communication Sciences, University of Vermont, Burlington, Vermont.

Frances P. Glascoe, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee.

Daily Crossword
Word Puzzle
Word Finder
Word of the Day
Synonym of the Day
Word of the Year
Language stories
All featured
Gender and sexuality
All pop culture
Writing hub
Grammar essentials
Commonly confused
All writing tips
Pop culture
Writing tips

noun as in the state of being weakened or damaged.

Strongest matches

Strong matches

debilitation
disablement
disfigurement
incapability
incapacitation

Discover More

Example sentences.

Families shoulder these responsibilities because about 70 percent of assisted living residents have some form of cognitive impairment, including dementia.

For web users with visual impairment using screen readers, descriptive alt text is read aloud.

Many nursing home residents have some degree of mental impairment — nearly half of long-term care patients suffer from dementia or Alzheimer’s.

This makes your content accessible for people with visual impairments and makes sure Google correctly interprets what those visual elements are.

We did all sorts of metabolic studies to try to find out if there was an impairment we could detect.

The fewer diagnostic criteria required to call a person impaired, the more “any difficulty whatsoever” can be deemed impairment.

A more precise association of THC levels and degrees of impairment are not yet available.

Yet in this case, the degree of impairment seems to have been similar on both sides.

There were some memory lapses, there were some major issues … we found no evidence of any kind of major impairment.

Seizure disorder, severe developmental delays and neurological impairment, feeding tube and tracheotomy.

It was an acid test of his sanity and he knew as he worked that his reasoning faculties at least had suffered no impairment.

From these details it is evident that epilepsy is not of necessity associated with impairment of the physical or mental health.

That is to say, if he feels himself compelled to the commission of crime, there is surely an impairment of responsibility.

A bad rippling, any serious accidental or temporary impairment of the faculties, meant swift death.

There are certain deductions, a certain percentage of impairment to be allowed for, but the general statement holds.

Related Words

Words related to impairment are not direct synonyms, but are associated with the word impairment . Browse related words to learn more about word associations.

noun as in physical hurting, injuring

malevolence
maltreatment
manhandling

noun as in injury, loss

adulteration
catastrophe
contamination
depreciation
deprivation
destruction
deterioration
devastation
disturbance

noun as in breaking down, collapse

consumption
decomposition
decrepitude
degeneration
dilapidation
disintegration
dissolution
mortification
putrefaction
putrescence
wasting away

noun as in mutilation

Viewing 5 / 33 related words

On this page you'll find 48 synonyms, antonyms, and words related to impairment, such as: damage, deficiency, detriment, harm, hurt, and injury.

The Austin Independent School District

Search form.

Let's Talk! Enroll ‌ Give

Celebrating the important role of the Speech Language Pathologist (En español)

May 15, 2024

Announcements
Share on Facebook
Share on Twitter
Share on Linkedin
Share on Pinterest
Share on Reddit

Austin ISD celebrates National Speech-Language-Hearing Month

For a decade, Rebecca Rogers has been supporting classrooms, particularly students with diverse speech and language impairments.

Rogers, a Speech Language Pathologist at Blanton Elementary School, is entering her fifth year serving students and now has a new title — SLP of the year!

Why it matters : SLPs play a crucial role in enhancing student’s communications skills, which helps support the students overall educational journey.

The role of SLPs: SLPs not only evaluate and manage cases, but also serve students directly and indirectly yearly to support their growth.

“We wear so many different hats," Rogers said. “From helping students grow their vocabulary and grammar to helping students who are not reliably speaking to use assistive technology to communicate.”

Join the team: SLPs are critically needed in Austin ISD. If you’re interested in joining the team, head down to the Critical Needs Job Fair June 1 at Ann Richards School for Young Women Leaders.

Celebrando el importante papel del Patólogo del habla y lenguaje (SLP, por sus siglas en inglés)

El Austin ISD celebra el Mes Nacional del Habla, el Lenguaje y la Audición

Durante una década, Rebecca Rogers ha estado apoyando a los salones de clase, particularmente a los estudiantes con diversos impedimentos del habla y el lenguaje.

Rogers, patóloga del habla y lenguaje en la Escuela Primaria Blanton, está entrando en su quinto año al servicio de los estudiantes y ahora tiene un nuevo título: ¡la SLP del año!

Por qué es importante: Los SLP desempeñan un papel crucial en la mejora de las habilidades de comunicación de los estudiantes, lo que ayuda a apoyar la trayectoria educativa general de los estudiantes.

La función de los SLP: Los SLP no sólo evalúan y gestionan casos, sino que también atienden a los estudiantes directa e indirectamente cada año para apoyar su crecimiento.

"Llevamos puestos tantos sombreros diferentes", dijo Rogers. "Desde ayudar a los estudiantes a hacer crecer su vocabulario y gramática hasta ayudar a los estudiantes que no hablan de forma fluida a utilizar tecnología de apoyo para comunicarse".

Únase al equipo: Los SLP son críticamente necesarios en el Austin ISD. Si usted está interesado en unirse al equipo, diríjase a la Feria de Carreras Profesionales para Necesidades Críticas el 1 de junio en la Escuela Ann Richards para Mujeres Jóvenes Líderes.

COMMENTS

Language Impairment synonyms
inability to express oneself clearly. jargon apasia. language delay. language disability. language problems. language processing disorder. paraphasia. pragmatic language impairment. problem with speaking.
Speech and Language Impairment
A language impairment is a specific impairment in understanding and sharing thoughts and ideas, i.e. a disorder that involves the processing of linguistic information. Problems that may be experienced can involve the form of language, including grammar, morphology, syntax; and the functional aspects of language, including semantics and pragmatics.
Speech Impairment: Types and Health Effects
There are three general categories of speech impairment: Fluency disorder. This type can be described as continuity, smoothness, rate, and effort in speech production. Voice disorder. A voice ...
Speech and Language Disorders
Speech and Language Disorders. Speech is how we say sounds and words. People with speech problems may: not say sounds clearly. have a hoarse or raspy voice. repeat sounds or pause when speaking, called stuttering. Language is the words we use to share ideas and get what we want. A person with a language disorder may have problems:
Speech and language impairment
Speech and language impairment are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency.. A speech impairment is characterized by difficulty in articulation of words. Examples include stuttering or problems producing particular sounds. Articulation refers to the sounds, syllables, and phonology produced by the individual.
Spoken Language Disorders
problems comprehending and using synonyms and antonyms, multiple-meaning words, and figurative language (e.g., idioms, metaphors, proverbs, humor, poetic language) ... Students who have a speech or language impairment, but do not qualify for special education services under IDEA, may be eligible for a 504 plan, under Section 504 of the ...
Comprehenisve Overview of Speech and Language Impairments
Comprehensive Overview of Speech and Language Impairments Definition. Speech and language disorders refer to problems in communication and related areas such as oral motor function. These delays and disorders range from simple sound substitutions to the inability to understand or use language or use the oral-motor mechanism for functional ...
10 Most Common Speech-Language Disorders & Impediments
Spasmodic Dysphonia (SD) is a chronic long-term disorder that affects the voice. It is characterized by a spasming of the vocal chords when a person attempts to speak and results in a voice that can be described as shaky, hoarse, groaning, tight, or jittery. It can cause the emphasis of speech to vary considerably.
Speech disorders: Types, symptoms, causes, and treatment
Dysarthria occurs when damage to the brain causes muscle weakness in a person's face, lips, tongue, throat, or chest. Muscle weakness in these parts of the body can make speaking very difficult ...
Speech and Language Disorders
Disorders of speech and language are common in preschool age children. Disfluencies are disorders in which a person repeats a sound, word, or phrase. Stuttering may be the most serious disfluency. It may be caused by: Genetic abnormalities. Emotional stress. Any trauma to brain or infection.
Speech and Language Impairments
People with voice problems often notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use. ( 7) Language has to do with meanings, rather than sounds. ( 8) A language disorder refers to an impaired ability to understand and/or use words in context.
Speech and Language Impairment
Most children with speech or language impairment are of average intelligence, but may have other specific learning difficulties such as dyslexia, dyspraxia or ADHD. Speech and language impairment is sometimes linked with conditions such as hearing loss, Down syndrome, cerebral palsy or autism. Chronic ear infections may also be a cause.
4 Synonyms & Antonyms for SPEECH IMPAIRMENT
Find 4 different ways to say SPEECH IMPAIRMENT, along with antonyms, related words, and example sentences at Thesaurus.com.
Speech Impediment: Types in Children and Adults
Some types of speech impairment might not qualify for therapy. If you have speech difficulties due to anxiety or a social phobia or if you don't have access to therapy, you might benefit from activities that can help you practice your speech. ... Relation of speech-language profile and communication modality to participation of children with ...
PDF Working with students with language impairment: Vocabulary
Approximately 7% of children are affected by language difficulties but there is very wide variability in these children's abilities. Language impairment can involve all aspects of language, namely syntax (word order), semantics (vocabulary and meaning), morphology, phonology and pragmatics. It is important to note that children with language ...
Disability Language Style Guide
This style guide, which covers dozens of words and terms commonly used when referring to disability, can help. The guide was developed by the National Center on Disability and Journalism at Arizona State University's Walter Cronkite School of Journalism and Mass Communication and was last updated in the summer of 2021.
Speech-Language Impairment: How to Identify the Most Common and Least
Introduction. Speech-language deficits are the most common of childhood disabilities and affect about 1 in 12 children or 5% to 8% of preschool children. The consequences of untreated speech-language problems are significant and lead to behavioral challenges, mental health problems, reading difficulties, and academic failure including in-grade retention and high school dropout.
15 Synonyms & Antonyms for IMPAIRMENT
Find 15 different ways to say IMPAIRMENT, along with antonyms, related words, and example sentences at Thesaurus.com.
Celebrating the important role of the Speech Language Pathologist (En
Austin ISD celebrates National Speech-Language-Hearing Month For a decade, Rebecca Rogers has been supporting classrooms, particularly students with diverse speech and language impairments. Rogers, a Speech Language Pathologist at Blanton Elementary School, is entering her fifth year serving students and now has a new title — SLP of the year!