Communication disorders: language, speech sound, stuttering and social communication

Disorder

Problems understanding or using words, making speech sounds, speaking smoothly, or using language socially. Hearing is always checked first.

Updated Nov 13, 2026

Key points

Any child with delayed or unclear speech needs a hearing assessment, because hearing loss, for example from otitis media, can interfere with language development.
Language disorder is a problem with words, grammar and discourse (understanding, expressing or both); speech sound disorder is a problem with producing sounds clearly.
Stuttering usually starts between ages 2 and 6, is two to three times more common in boys, and about three in four children recover.
Social (pragmatic) communication disorder: trouble using language socially without restricted, repetitive behaviors; if those behaviors are present, think autism.
Not saying at least 2 words by the first birthday needs evaluation, and a loss of language skills may call for an evaluation for autism.
Learning more than one language does not cause developmental language disorder, which affects every language a child speaks.

What it is

DSM-5 groups four neurodevelopmental communication disorders: language disorder, speech sound disorder, childhood-onset fluency disorder (stuttering) and social (pragmatic) communication disorder. Together, communication disorders affect about 8 in 100 children and start in early childhood. Language disorder can also affect reading and writing, and identifying and treating it early is ideal.

Key facts

Developmental language disorder affects about 1 in 14 kindergarten children, is not explained by hearing loss or autism, and often follows a history of late talking.
Stuttering shows as repeated sounds, syllables or words, stretched sounds and blocks; rapid eye blinks or lip tremors can accompany it.
Singing, reading or speaking in unison can briefly reduce stuttering, while speaking before a group or on the telephone can make it worse.
Factors used to predict whether stuttering will persist include a family history, stuttering for 6 months or more, and other speech or language problems.
Structural causes such as cleft palate produce a nasal voice and usually need surgery as well as speech therapy.

Telling the communication problems apart

Condition	Core problem	Distinguishing clue
Hearing loss	Child cannot hear speech well enough to learn it	Abnormal hearing test; may follow otitis media
Language disorder	Vocabulary, sentence building and understanding are behind age	Not explained by hearing loss or autism
Speech sound disorder	Sounds are left out, swapped or distorted	Language content is normal; only intelligibility suffers
Structural speech problem (cleft palate)	Hypernasal voice	Cleft palate or another structural problem; needs surgery plus therapy
Childhood-onset fluency disorder (stuttering)	Repetitions, prolongations and blocks	Knows what to say but the flow breaks; anxiety about speaking
Social (pragmatic) communication disorder	Trouble with greetings, turn-taking, adapting to the listener and non-literal meaning	No restricted interests or repetitive behaviors
Autism spectrum disorder	Social communication deficits	Restricted, repetitive behaviors and interests are also present

Clinical notes

Refer to a speech-language pathologist when a language problem is suspected and check hearing; identifying and treating children early is ideal.
For young children who stutter, therapy often teaches parents ways to support their child's fluent speech.
Older children and adults learn techniques such as speaking more slowly and regulating breathing, and therapy also addresses anxiety about speaking.
No medicine is approved for stuttering; parents can help by speaking in a slightly slowed, relaxed way and by not finishing the child's sentences.
Watch children with language disorder for reading and writing difficulties, which it can also cause, and support them at school.

Test yourself

Think of the answer, then tap the question to see it.

What must be tested in every child with a speech or language delay?

Hearing, because hearing loss, for example from otitis media, can interfere with language development.

How does social (pragmatic) communication disorder differ from autism?

Both involve trouble using language socially, but social communication disorder lacks the restricted, repetitive behaviors and interests required for autism.

At what age does developmental stuttering usually begin, and how often does it resolve?

Usually between ages 2 and 6; about three in four children recover.

Which features raise the risk that stuttering will persist?

A family history of stuttering, stuttering that lasts 6 months or more, and other speech or language problems.

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← All of behavioral science

Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: Communication Disorders in Children (MSD Manual Professional Edition, 2025); What Is Stuttering? Diagnosis & Treatment (National Institute on Deafness and Other Communication Disorders (NIDCD), 2017); Developmental Language Disorder (National Institute on Deafness and Other Communication Disorders (NIDCD), 2023); Social (pragmatic) communication disorder: a research review of this new DSM-5 diagnostic category (Journal of Neurodevelopmental Disorders (PubMed Central), 2014).

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