Speech and Language Disorders: A Guide to ICD-11 Classification
Understanding Speech and Language Disorders: A Guide to ICD-11 Classification
Speech and language disorders are prevalent neurodevelopmental conditions that can have a profound impact on a child's ability to communicate and interact with others. The recent introduction of new clinical criteria and classifications for speech and language disorders in the ICD-11 represents a significant step forward in the field. These changes are aimed at enhancing the accuracy of diagnosis and the quality of care provided to individuals with these conditions.
6A01 Developmental Speech and Language Disorders
The ICD-11 classifies developmental speech or language disorders as conditions that arise during the developmental period and are characterized by difficulties in understanding or producing speech and language. These difficulties are beyond the expected limits of normal variation for age and level of intellectual functioning. Importantly, the observed speech and language problems are not attributable to regional, social, or cultural/ethnic language variations, nor are they fully explained by anatomical or neurological abnormalities.
Subtypes of Developmental Speech and Language Disorders
The ICD-11 further delineates specific subtypes of developmental speech and language disorders, including:
6A01.0 Developmental Speech Sound Disorder
Characterized by difficulties in the acquisition, production, and perception of speech, resulting in errors of pronunciation that significantly affect communication.
http://id.who.int/icd/entity/551966778 Developmental speech sound disorder is characterized by difficulties in the acquisition, production, and perception of speech that result in errors of pronunciation, either in number or types of speech errors made or the overall quality of speech production, that are outside the limits of normal variation expected for age and level of intellectual functioning and result in reduced intelligibility and significantly affect communication. The errors in pronunciation arise during the early developmental period and cannot be explained by social, cultural, and other environmental variations (e.g., regional dialects). The speech errors are not fully explained by a hearing impairment or a structural or neurological abnormality.
6A01.1 Developmental Speech Fluency Disorder
Marked by disruptions in the normal rhythmic flow and rate of speech, leading to significant impairment in various areas of functioning
http://id.who.int/icd/entity/654956298 Developmental speech fluency disorder is characterized by frequent or pervasive disruption of the normal rhythmic flow and rate of speech characterized by repetitions and prolongations in sounds, syllables, words, and phrases, as well as blocking and word avoidance or substitutions. The speech dysfluency is persistent over time. The onset of speech dysfluency occurs during the developmental period, and speech fluency is markedly below what would be expected for age. Speech dysfluency results in significant impairment in social communication, personal, family, social, educational, occupational, or other important areas of functioning. The speech dysfluency is not better accounted for by a Disorder of Intellectual Development, a Disease of the Nervous System, a sensory impairment, or a structural abnormality, or other speech or voice disorder.
6A01.2 Developmental Language Disorder
Involves persistent deficits in the acquisition, understanding, production, or use of language, causing significant limitations in the individual’s ability to communicate.
http://id.who.int/icd/entity/862918022 Developmental language disorder is characterized by persistent deficits in the acquisition, understanding, production, or use of language (spoken or signed), that arise during the developmental period, typically during early childhood, and cause significant limitations in the individual’s ability to communicate. The individual’s ability to understand, produce, or use language is markedly below what would be expected given the individual’s age. The language deficits are not explained by another neurodevelopmental disorder or a sensory impairment or neurological condition, including the effects of brain injury or infection.
6A01.20 Developmental Language Disorder with Impairment of Receptive and Expressive Language
http://id.who.int/icd/entity/822134099 Developmental language disorder with impairment of receptive and expressive language is characterized by persistent difficulties in the acquisition, understanding, production, and use of language that arise during the developmental period, typically during early childhood, and cause significant limitations in the individual’s ability to communicate. The ability to understand spoken or signed language (i.e., receptive language) is markedly below the expected level given the individual’s age and level of intellectual functioning and is accompanied by persistent impairment in the ability to produce and use spoken or signed language (i.e., expressive language).
6A01.21 Developmental Language Disorder with Impairment of Mainly Expressive Language
http://id.who.int/icd/entity/1169003948 Developmental language disorder with impairment of mainly expressive language is characterized by persistent difficulties in the acquisition, production, and use of language that arise during the developmental period, typically during early childhood, and cause significant limitations in the individual’s ability to communicate. The ability to produce and use spoken or signed language (i.e., expressive language) is markedly below the expected level given the individual’s age and level of intellectual functioning, but the ability to understand spoken or signed language (i.e., receptive language) is relatively intact.
6A01.22 Developmental Language Disorder with Impairment of Mainly Pragmatic Language
http://id.who.int/icd/entity/854708918 Developmental language disorder with impairment of mainly pragmatic language is characterized by persistent and marked difficulties with the understanding and use of language in social contexts, for example making inferences, understanding verbal humor, and resolving ambiguous meaning. These difficulties arise during the developmental period, typically during early childhood, and cause significant limitations in the individual’s ability to communicate. Pragmatic language abilities are markedly below the expected level given the individual’s age and level of intellectual functioning, but the other components of receptive and expressive language are relatively intact. This qualifier should not be used if the pragmatic language impairment is better explained by Autism Spectrum Disorder or by impairments in other components of receptive or expressive language.
6A01.23 Developmental language disorder, with other specified language impairment
http://id.who.int/icd/entity/1144287315 Developmental language disorder with other specified language impairment is characterised by persistent difficulties in the acquisition, understanding, production or use of language (spoken or signed), that arise during the developmental period and cause significant limitations in the individual’s ability to communicate. The pattern of specific deficits in language abilities is not adequately captured by any of the other developmental language disorder categories.
Differential Diagnosis of Speech and Language Disorders
Distinguishing between speech and language disorders can be challenging, as both conditions can present with similar symptoms. Speech disorders refer to difficulties in producing speech sounds, while language disorders refer to difficulties in understanding or using language. The ICD-11 criteria for speech and language disorders provide a valuable framework for accurate diagnosis and timely intervention in infants and pre-school children.
Conclusion
The ICD-11 classification of speech and language disorders reflects a more comprehensive and nuanced approach to the classification and assessment of these conditions, aiming to improve the accuracy of diagnosis and the quality of care provided to individuals with these conditions. Speech therapists, pediatricians, and other healthcare professionals play a critical role in the early identification and management of these conditions, using the ICD-11 criteria and recommended assessments to provide accurate diagnosis and timely intervention in infants and pre-school children.