refer to difficulties with reading, spelling, and/or writing that are evidenced in a significant lag behind the individual's same-age peers. most children with these disabilities are at least of average intelligence, ruling out intellectual impairments as the causal factor. diagnostic criteria the dsm-5 and the icd-10 are both used to make specific diagnostic decisions. speech and language disorders commonly include communication issues, but also extend into various areas such as oral-motor function—sucking, swallowing, drinking, or eating. in some cases, a child's communication is delayed considerably behind his/her same-aged peers. the effects of these disorders can range from basic difficulties in the production of certain letter sounds to more comprehensive inabilities to generate (expressive) or understand (receptive) language. in most cases, the causal factors that create these speech and language difficulties are unknown. there are a wide variety of biological and environmental causal factors that can create them, ranging from drug abuse to neurological issues. for more information on causal hypotheses, refer to the section on models. developmental disorders developmental disorders tend to have a genetic origin, such as mutations of foxp2, which has been linked to developmental verbal dyspraxia and specific language impairment. some of these impairments are caused by genetics. case histories often reveal a positive family history of communication disorders. between 28% and 60% of children with a speech and language deficit have a sibling and/or parent who is also affected. down syndrome is another example of a genetic causal factor that may result in speech and/or language impairments. stuttering is a disorder that is hypothesized to have a strong genetic component as well. some speech and language impairments have environmental causes. a specific language impairment, for example, may be caused by insufficient language stimulation in the environment. if a child does not have access to an adequate role model, or is not spoken to with much frequency, the child may not develop strong language skills. furthermore, if a child has little stimulating experiences, or is not encouraged to develop speech, that child may have little incentive to speak at all and may not develop speech and language skills at an average pace. developmental disabilities such as autism and neurological disorders such as cerebral palsy may also result in impaired communicative abilities. similarly, malformation or malfunctioning of the respiratory system or speech mechanisms may result in speech impairments. for example, a cleft palate will allow too much air to pass through the nasal cavity and a cleft lip will not allow the individual to correctly form sounds that require the upper lip. the development of vocal fold nodules represents another issue of biological causation. in some cases of biological origin, medical interventions such as surgery or medication may be required. other cases may require speech therapy or behavioral training. acquired disorders acquired disorders result from brain injury, stroke or atrophy, many of these issues are included under the aphasia umbrella. brain damage, for example, may result in various forms of aphasia if critical areas of the brain such as broca's or wernicke's area are damaged by lesions or atrophy as part of a dementia. an acquired language disorder occurs after the person is injured or ill, it is neurological. one of the most commonly known acquired language disorder is aphasia. everyday activities are easily affected because of a language disorder. communication impacts how understanding the person is of this disorder. there is a sender and receiver to communication, the receiver needs to be able to understand the communication process. the receiver should also be able to understand, so that they can respond and communicate back to the sender. the person needs to be careful how the sender/ receiver interprets the messages being sent. there are 4 types of barriers to communication for the sender/receivers, process barriers, physical barriers, semantic barriers, and psychosocial barriers. process barriers are the sender and receiver of communication. physical barriers, one of the biggest and major barriers to communication, are caused by distractions. the semantic barriers of communication are the words and meaning of the words and how they are used. psychosocial barriers are the mental and emotional factors of communication. these barriers are important because of how to treat and an acquired language disorder. noise plays a big role in the communication process, by helping to interpret the message and bringing out emotions and attitude. speech and language assessment what follows are a list of frequently used measures of speech and language skills, and the age-ranges for which they are appropriate. clinical evaluation of language fundamentals – preschool (3–6 years) clinical evaluation of language fundamentals (6–21 years) macarthur communicative development inventories (0–12 months) the rossetti infant-toddler language scale (0–36 months) preschool language scale (0–6 years) expressive one-word picture vocabulary test (2–15 years) bankson-bernthal phonological process survey test (2–16 years) goldman-fristoe test of articulation 2 (2–21 years) peabody picture vocabulary test (2.5–40 years) in the united states of america under the individuals with disabilities education act (idea) 2004, the federal government has defined a speech or language impairment as "a communication disorder such as stuttering, impaired articulation, a language impairment, or a voice impairment, which adversely affects a child's learning". in order to qualify in the educational system as having a speech or language impairment, the child's speech must be either unintelligible much of the time or he/she must have been professionally diagnosed as having either a speech impairment or language delay which requires intervention. additionally, idea 2004 contains an exclusionary clause that stipulates that a speech or language impairment may not be either cultural, ethnic, bilingual, or dialectical differences in language, temporary disorders (such as those induced by dental problems), or delayed abilities in producing the most difficult linguistic sounds in a child's age range. management speech-language pathologists (slps) offer many services to children with speech or language disabilities. speech-language pathology main article: speech-language pathology speech-language pathologists (slps) may provide individual therapy for the child to assist with speech production problems such as stuttering. they may consult with the child's teacher about ways in which the child might be accommodated in the classroom, or modifications that might be made in instruction or environment. the slp can also make crucial connections with the family, and help them to establish goals and techniques to be used in the home. other service providers, such as counselors or vocational instructors may also be included in the development of goals as the child transitions into adulthood. the individual services that the child receives will depend upon the needs of that child. simpler problems of speech, such as hoarseness or vocal fatigue (voicing problems) may be solved with basic instruction on how to modulate one's voice. articulation problems could be remediated by simple practice in sound pronunciation. fluency problems may be remediated with coaching and practice under the guidance of trained professionals, and may disappear with age. however, more complicated problems, such as those accompanying autism or strokes, may require many years of one-on-one therapy with a variety of service providers. in most cases, it is imperative that the families be included in the treatment plans since they can help to implement the treatment plans. the educators are also a critical link in the implementation of the child's treatment plan. for children with language disorders, professionals often relate the treatment plans to classroom content, such as classroom textbooks or presentation assignments. the professional teaches various strategies to the child, and the child works to apply them effectively in the classroom. for success in the educational environment, it is imperative that the slp or other speech-language professional have a strong, positive rapport with the teacher(s). speech-language pathologists create plans that cater to the individual needs of the patient. if speech is not practical for a patient, the slp will work with the patient to decide upon an augmentative and alternative communication (aac) method or device to facilitate communication. they may work with other patients to help them make sounds, improve voices, or teach general communication strategies. they also work with individuals who have difficulties swallowing. in addition to offering these types of communication training services, slps also keep records of evaluation, progress, and eventual discharge of patients, and work with families to overcome and cope with communication impairments (bureau of labor statistics, 2009). in many cases, slps provide direct clinical services to individuals with communication or swallowing disorders. slps work with physicians, psychologists, and social workers to provide services in the medical domain, and collaborate with educational professionals to offer additional services for students to facilitate the educational process. thus, speech-language services may be found in schools, hospitals, outpatient clinics, and nursing homes, among other settings. the setting in which therapy is provided to the individual depends upon the age, type, and severity of the individual's impairment. an infant/toddler may engage in an early intervention program, in which services are delivered in a naturalistic environment in which the child is most comfortable—probably his/her home. if the child is school-aged, he/she may receive speech-language services at an outpatient clinic, or even at his/her home school as part of a weekly program. the type of setting in which therapy is offered depends largely upon characteristics of the individual and his/her disability. as with any professional practice that is informed by ongoing research, controversies exist in the fields that deal with speech and language disorders. one such current debate relates to the efficacy of oral motor exercises and the expectations surrounding them. according to lof, non-speech oral motor exercises (ns-ome) includes "any technique that does not require the child to produce a speech sound but is used to influence the development of speaking abilities". these sorts of exercises would include blowing, tongue push-ups, pucker-smile, tongue wags, big smile, tongue-to-nose-to-chin, cheek puffing, blowing kisses, and tongue curling, among others. lof continues, indicating that 85% of slps are currently using ns-ome. additionally, these exercises are used for dysarthria, apraxia, late talkers, structural anomalies, phonological impairments, hearing impairments, and other disorders. practitioners assume that these exercises will strengthen articulatory structures and generalize to speech acts. lof reviews 10 studies, and concludes that only one of the studies shows benefits to these exercises (it also suffered serious methodological flaws). lof ultimately concludes that the exercises employ the same structures, but are used for different functions. the ns-ome position is not without its supporters, however, and the proponents are numerous. interventions intervention services will be guided by the strengths and needs determined by the speech and language evaluation. the areas of need may be addressed individually until each one is functional; alternatively, multiple needs may be addressed simultaneously through the intervention techniques. if possible, all interventions will be geared towards the goal of developing typical communicative interaction. to this end, interventions typically follow either a preventive, remedial, or compensatory model. the preventive service model is common as an early intervention technique, especially for children whose other disorders place them at a higher risk for developing later communication problems. this model works to lessen the probability or severity of the issues that could later emerge. the remedial model is used when an individual already has a speech or language impairment that he/she wishes to have corrected. compensatory models would be used if a professional determines that it is best for the child to bypass the communication limitation; often, this relies on aac. language intervention activities are used in some therapy sessions. in these exercises, an slp or other trained professional will interact with a child by working with the child through play and other forms of interaction to talk to the child and model language use. the professional will make use of various stimuli, such as books, objects, or simple pictures to stimulate the emerging language. in these activities, the professional will model correct pronunciation, and will encourage the child to practice these skills. articulation therapy may be used during play therapy as well, but involves modeling specific aspects of language—the production of sound. the specific sounds will be modeled for the child by the professional (often the slp), and the specific processes involved in creating those sounds will be taught as well. for example, the professional might instruct the child in the placement of the tongue or lips in order to produce certain consonant sounds. technology is another avenue of intervention, and can help children whose