school screening - all india institute of speech and...
TRANSCRIPT
School Screening
Distribution of Communication disorders in
School Children
Communication Disorders
Prevention
Incidence & Prevalence of Communication Disorders in India
School Screening Program
Significance of School Screening
Epidemiological Data on School Screening: Current Status
School Screening Program at AIISH
Material
Participants
Procedure
Results
Conclusion
References
AIISH, MYSURU
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
1
AIISH, MYSURU
Communication Disorders
Communication is the essence of human life. It is also the most effective tool
to cope up with day-to-day living. Verbal communication is unique to
human beings and it is said to be the most efficient mode of communication.
Communication disorder is a broad term which covers different types of
disorders (Ruscello, Louis & Mason, 1991) which can be seen at the level of
comprehension or production of speech sounds (i.e. consonants and
vowels), words, phrases, or sentences (ASHA, 2006). The spectrum of
communication disorders include problems in speaking, hearing and
thinking such as voice disorders, phonological disorders, fluency disorders
(Stuttering & Cluttering), language disorders, delayed and/or arrested
speech and language development due to hearing impairment, mental
retardation and other problems. Details of the different communication
disorders are mentioned in table 1.
Table 1: Different types of communication disorders
Type of disorder Definition
Phonological/articulation
disorders
Atypical production of speech sounds characterized
by substitutions, omissions, additions or distortions
that may interfere with intelligibility (ASHA, 1982)
Fluency disorder An interruption in the flow of speaking characterized
by atypical rate, rhythm, and repetitions in sounds,
syllables, words, and phrases. This may be
accompanied by excessive tension, struggle
behaviour, and secondary mannerisms (ASHA,
1982)
Voice disorder Characterized by the abnormal production and/or
absences of vocal quality, pitch, loudness,
resonance, and/or duration, which is inappropriate
for an individual's age and/or sex (ASHA, 1982)
Cleft lip palate An opening or split in the upper lip, the roof of the
mouth (palate) or both (Mayo clinic, 2015).
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
2
AIISH, MYSURU
Prevention
Research has shown that prevention of any disorder is effective in reducing
incidence and prevalence. The World Health Organization (1998) defined
prevention as “the measures not only to prevent the occurrence of disease,
such as risk factor reduction, but also to arrest its progress and reduce its
consequences once established”. Communication disorders can be
prevented at various levels viz., primary, secondary and tertiary
prevention. According to American Speech and Hearing Association
Spoken language
disorder
Individuals with language difficulties has a unique
profile, based on his or her current level of language
functioning, as well as functioning in areas related
to language, including hearing, cognitive level, and
speech production skills (ASHA, 2011).
Mental Retardation A condition of arrested or incomplete development
of the mind, which is especially characterized by
impairment of skills manifested during the
developmental period, skills which contribute to the
overall level of intelligence, i.e. cognitive, language,
motor, and social abilities. Retardation can occur
with or without any other mental or physical
condition (ICD-10, 2015)
Cerebral palsy A disorder of movement, muscle tone or posture
that is caused by an insult to the immature,
developing brain, most often before birth
(Mayo clinic, 2013)
Autism Spectrum
Disorder
(A neuro-developmental disorder characterized by
deficits in social communication and social
interaction and the presence of restricted, repetitive
behaviours (ASHA, 1982)
Reading and writing
problems
Problems with age-appropriate reading, spelling,
and/or writing (ASHA, 1982)
Hearing disorders A hearing disorder is the result of impaired auditory
sensitivity of the physiological auditory system. A
hearing disorder may limit the development,
comprehension, production, and/or maintenance of
speech and/or language (ASHA, 1993)
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
3
AIISH, MYSURU
(1988), Primary prevention refers to the “elimination or inhibition of the
onset and development of communication disorder by altering
susceptibility or reducing exposure for susceptible persons. Whereas,
secondary prevention refers to the early detection and treatment of
communication disorders (ASHA, 1988). Tertiary prevention is defined as
the reduction of a disability by attempting to restore effective functioning
(ASHA, 1988).
Incidence and prevalence of
communication disorders in India
Communication disorders may affect social and emotional well-being,
cognition, and behaviour (Felsenfeld, McGue, & Broen, 1995; Lewis,
Freebairn, & Taylor, 2000). Prevalence is defined as the number of people
with a disease or condition in a given population at a specific time, either a
point in time or over a period of time. The prevalence of a disorder is
essential to assess the need for health services and to evaluate the problem
of disease in a population. It helps to compare the prevalence of disease in
different populations and to examine trends in disease prevalence or
severity over time. As per the country wide sample survey conducted by
Government of India in 2011, census listed hearing impairment (18.9%) as
the second leading disability and speech impairment (7.5%) as the fifth
highest disability. Males outnumbered the females in both hearing (Males-
52.8%, Females-47.2%) and speech impairment (Males-56.25%, Females-
43.8%).
In India, Sreeraj, Suma, Jayaram, Sandeep, Mahima and Shreyank (2013)
conducted a survey in rural population of India and found out that the
prevalence of individuals at risk of communication disorders was 6.07%.
Among those at risk, the prevalence of audiological and or otological
disorder was found to be 90.58% and that of speech and language disorder
was 9.42%. Among those at risk of speech and language disorder, 22.9%
were found to be at risk of mental retardation.
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
4
AIISH, MYSURU
School screening program
Screening refers to the process of identifying the presence of a problem.
There are several screening procedures, which include use of high-risk
registers, checklists, questionnaires, screening tests, etc. Through preschool
and school screening, it is feasible to identify children at risk for any speech,
language, hearing or academic problems and also detect communication
disorders in children. It is a part of secondary prevention where in the
condition is identified for any risk and then a detailed evaluation will
confirm the diagnosis in order to carry out intervention as early as possible.
Thus, preventing the deterioration or worsening of the condition. Routine
school screening programs will provide an estimate of the prevalence of
communication disorders in school aged population. The incidence and
prevalence of any disorder estimated through surveys or school screening
programs helps to evaluate the problem of a disorder in a population and
also facilitates need for appropriate clinical services to these children.
Significance of school screening
In preschool and school age children, the prevalence of communication
disorders can be high but go undetected as the population are not screened
or identified with appropriate measures. Also many of these conditions in
children may not be identified until the age of 2–3 years of age, particularly
in the absence of any medical risks or cognitive disabilities (Wetherby &
Prizant, 1996). According to an epidemiological data of World Health
Organization, the burden of hearing impairment ranges between 0.5% and
5% of every born infant (WHO, 2010). Newborn hearing screening aims on
congenital or childhood deafness and ignores acquired speech language and
hearing loss seen at later stage of life in children. Universal newborn/infant
screening program is essential not only for hearing screening but also to
check for communication disorders as a whole. In universal
newborn/infant screening programs, only screening identification of
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
5
AIISH, MYSURU
children lesser than 3 years is taking place and, however, children who are
above 3 years of age are missed out.
Epidemiological data on school screening:
Current status
Earlier studies on western population reported that prevalence of Speech-
Language and hearing disorders have broad variability in the prevalence
rates. Prevalence of communication disorders was found to be between
4.19% (De Andrade, 1997), and 13.0% (McLeod & McKinnon, 2007). The
prevalence of speech disorder was 1.06% (McKinnon, McLeod & Reilly,
2007), 4.6% (Kirkpatrick & Ward, 1984), 2.3-24.6% (Law, Boyle, Harris,
Harkness & Nye, 2000). Similarly, the prevalence of language disorders was
found to be 2.02–19% (Law, Boyle, Harris, Harkness & Nye, 2000). Several
western studies reported the prevalence of communication disorders in
school going children but the incidence and prevalence rates are lacking in
the Indian scenario.
School screening program at AIISH
Screening of school children was carried out by a professional team
comprising of a Speech-Language Pathologist, Audiologist, and an ENT
specialist. Screening was conducted in a relatively noise free environment.
The following protocol was followed for pre-school and school screening
program:
Initially ear examination was done through an Otoscope. Pure tone
audiometric screening was carried out in a quiet room at 500 Hz, 1 kHz, 2
kHz and 4 kHz, through a screening audiometer air-conduction mode. In
addition, Immittance screening (Tympnaomtery & Reflexometry) was
performed to check for any abnormality in middle ear. A Pure tone
threshold of more than 20 dB HL at any one of the frequency and or the
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
6
AIISH, MYSURU
tympanaogram of ‘B’ or ‘C’ type with absent reflex at 1 kHz was considered
as ‘fail’ criteria.
Material
Speech and Language evaluation was carried out using a protocol
developed for assessing speech and language skills in children. Table 2
shows the tools used for speech and language evaluation.
Table 2: Various assessment tools used to screen/assess speech and language
skills in children.
Name of the test Author Age
(yrs) Population Domains
Linguistic Profile Test
in Kannada
Suchithra&
Karanth
(1990, 2007);
6-15
Language
delay or
disorders
Assess receptive and
expressive language
skills
Reading Acquisition
Profile – Kannada
Prema (1997) 8-12 Children with
Learning
Disability
Meta-phonological
tests, Reading and
writing test, test for
orthographic principles
and reading
comprehension.
English language Test
for Indian Children
Bhuvaneshw
ari & Shanbal
(2010)
4-6 Children with
HI, MR, CP, PD,
etc.
Assess language
abilities of the child
using following
domains: Semantic
Knowledge,
Morphological rules and
syntactic rules
including the following
subtests: Lexical
Categories, Nouns,
verbs, generative
naming, opposites,
tenses and plurals.
Assessment checklist
for speech-language
skill
Swapna,
Jayaram,
Prema &
Geetha
(2010)
0-6 Children with
communication
disorders
Includes assessment of
receptive language and
expressive language
skills
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
7
AIISH, MYSURU
Participants
The Department of Prevention of Communication Disorders (POCD) at the
All India Institute of Speech and Hearing (AIISH), Mysore is involved in
carrying out regular school screening programs in various regions. One
such school screening program was conducted in government and private
school setup of rural and urban regions in the districts of Mysore and
Mandya, in the state of Karnataka. Twenty five schools were screened for
communication disorders between the years 2012 and 2014. The data was
analysed for 2010 school going children. Out of 2010 children, 829 children
belonged to urban region and 1181 belonged to rural region. Across
grades, 1407 children were studying in lower primary grade (≤5th grade)
and 603 children (6th& 7th grade) in upper primary grade. Across gender,
1093 were boys and 917 were girls.
Test of Articulation in
Kannada
Babu,
Rathna, &
Bettagiri
(1972);
Deepa &
Savithri
(2010)
3-6
Phonological/A
rticulation
disorders
Assesses articulation
skills in children
Early Literacy
Screening Tool
Shanbal,
Goswami,
Prathima&
Chaithra
(2011)
3-6
Children at risk
for Learning
disability
Assesses auditory
discrimination, oral
language, verbal
memory, early literacy,
phonological awareness,
reading, writing,
mathematics
Dyslexia Assessment
Profile for Indian
Children (DAPIC)
Kuppuraj&
Shanbal
(2012)
6-13 Children with
Learning
disability
Checks for reading and
writing abilities at
alphabet, word and
sentence level.
Stuttering severity
Index (SSI)
Riley (1981) 3-8
years
Children with
stuttering
Checks for dysfluencies
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
8
AIISH, MYSURU
Procedure
A prior permission was taken from the respective districts of Deputy
Director of Public Instructions (DDPI) office. All the school children were
screened for speech and language disorders if any, through the Assessment
checklist for speech-language skills (Swapna, Jayaram, Prema & Geetha,
2010) to check for speech and language skills; Early Literacy Screening Tool
(Shanbal, Goswami, Chaithra & Prathima, 2011) to check for literacy skills.
Children were screened informally through general conversation and/or
story narration to check for voice, fluency and articulation. If the child failed
in screening, further referral was made to administer an appropriate
speech and language tests on identified child to confirm the deficit. Routine
detailed diagnostic evaluations were carried out by qualified Speech-
Language Pathologists and Audiologists.
Analyses
The data was analyzed to look for prevalence of communication disorders
in school going children and the effect of regions (urban & rural), grades
(Lower primary & Upper primary) and gender (Boys & Girls). Percent of
prevalence rate was calculated and Chi-square test was used to find the
significant association between prevalence of communication disorders
across regions, grades and gender.
Results
Occurrence of communication disorders in school children
Among 2010 screened children, 14.2% were found to have communication
disorders. Among the identified group, the occurrence of language
disorders was found to be highest followed by speech disorders, hearing
disorders and multiple disorders. Table 3 and figure 1 showed distribution
of overall occurrence of communication disorders in school children.
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
9
AIISH, MYSURU
Table 3: Distribution of children who had communication disorders in school
[Total screened (N) =2010]
Communication Disorders N Occurrence rate ( %)
Language disorders 138 6.9%
Speech disorders 74 3.7%
Hearing disorders 68 3.4%
Multiple disorders 6 0.3%
Total 215 75.4
Figure 1: Distribution of communication disorders in school children
Occurrence of communication disorders across region
The occurrence of communication disorders between regions revealed a
high prevalence of language disorders, speech disorders, hearing disorders
and multiple disorders in the rural region (86.2%, 64.4%, 63.2% & 100%
respectively) compared to urban region (13.8%, 35.6% 36.8% & 0%
respectively). Results of Chi- square test indicated a significant association
[χ² (3) = 20.91, p <0.01] between regions and communication disorders
(Speech, language, hearing & multiple). Table 4 and figure 2 showed
distribution of communication disorders across regions.
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
10
AIISH, MYSURU
Table 4: Distribution of children who had communication disorders across
regions [Total screened (N) =2010]
Communication disorders
Rural Urban
N % N %
Language disorders 119 86.2 19 13.8
Speech disorders 47 64.4 26 35.6
Hearing disorders 43 63.2 25 36.8
Multiple disorders 6 100.0 0 0.0
Total 215 75.4 70 24.6
Chi square- χ² (3) =20.91 Statistical Significance -p <0.01
Figure 2: Distribution of communication disorders across regions
Occurrence of communication disorders across grades
Relatively, higher occurrence of language disorders (71.7%), speech
disorders (82.2%), hearing disorders (66.2%) and multiple disorders
(83.3%) was found in the lower primary grades than in the upper primary
grades (28.3%, 17.8%, 33.8% & 16.7% respectively). However, results of
Chi-square test revealed no significant association between grades and
communication disorders [χ² (3) =5.197, p>0.05]. Table 5 and figure 3 show
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
11
AIISH, MYSURU
distribution of communication disorders in lower primary and upper
primary grades in school going children.
Table 5: Distribution of children who had communication disorders across
grades [Total screened (N) =2010]
Communication disorders
Lower Primary Lower Primary
N % N %
Language disorders 99 71.7 39 28.3
Speech disorders 60 82.2 13 17.8
Hearing disorders 45 66.2 23 33.8
Multiple disorders 5 83.3 1 16.7
Total 209 73.3 76 26.7
Chi square- χ² (3) = 5.197 Statistical Significance- p>0.05
Figure 3: Distribution of communication disorders across grades.
Occurrence of communication disorders across gender
The results revealed a high occurrence of language disorders, speech
disorders, hearing disorders and multiple disorders in boys (63.8%, 68.5%,
61.8% & 83.3% respectively) compared to girls (17.1%, 7.1%, 8% & 2.1%
respectively). Results of Chi-square test indicated no significant association
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
12
AIISH, MYSURU
between gender and communication disorders [χ² (3) = 3.22, p>0.05]. Table
6 and figure 4 showed distribution of communication disorders (Speech,
language, hearing & multiple) between boys and girls.
Table 6: Distribution of children who had communication disorders gender
[Total screened (N) =2010]
Communication disorders
Boys Girls
N % N %
Language disorders 88 63.8 50 36.2
Speech disorders 50 68.5 23 31.5
Hearing disorders 42 61.8 26 38.2
Multiple disorders 5 83.3 1 16.7
Total 185 64.9 100 35.1
Chi square- χ² (3) = 1.68 Statistical Significance- p>0.05
Figure 4: Distribution of communication disorders across gender.
Further descriptive analysis was done to estimate the distribution of
various speech and language disorders in school children. Among the total
communication disorders, 11.44% (N=230) were found to have some form
of speech and/or language and/or multiple disorders. Table 7 shows
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
13
AIISH, MYSURU
distribution of different types of speech, language and multiple disorders in
children.
Table 7: Distribution of different types of Speech, language and multiple
disorders
Communication disorders Total
n %
Language disorders
Learning disability 100 43.5
Mental retardation 25 10.9
Specific language impairment 18 7.8
Autism spectrum disorder 2 0.9
Speech disorders
Articulation/phonological
disorders 43 18.7
Fluency disorders 25 10.9
Voice disorders 5 2.2
Childhood dysarthria 4 1.7
Hypernasality with repaired Cleft
lip & Palate 3 1.3
Multiple disorders Combination of any Speech and
language disorder 5 2.2
From Table 7, it can be inferred that children with Learning disability was
more common in school children (43.5%) among the language disorders.
Among the speech disorders, children with Articulation/ Phonological
disorders were found higher (18.7%). Other disorders like Fluency
disorders (10.9%), Mental retardation (10.9%), Specific language
impairment (7.8%), Voice disorders (2.2%), Childhood dysarthria (1.7%),
Hypernasality with repaired cleft-lip & Palate (1.3%), Autism Spectrum
Disorders (0.9%) and multiple disorders (2.2%) were also prevalent in the
study.
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
14
AIISH, MYSURU
Discussion
The present study identified the occurrence of communication disorders in
school children and the comparison across regions, grades and genders.
The results of the study revealed higher occurrence of communication
disorders in school children. Among those, the estimated occurrence of
language disorders was higher followed by speech disorders, hearing
disorders and multiple disorders. There exists a significant variation in the
prevalence of communication disorders across studies in different parts of
the world. The prevalence of communication disorders was reported 1.7%
in Australian children (Keating, Turrell & Ozanne, 2001); 12.40 to 13.04%
in Australian children (McLeod, et al, 2007); 14.4% to 18.7%in Greece
children (Okalindou & Kampanaros, 2001). In contradiction to the present
study, higher occurrence of speech impairment (2.3-24.6%) was reported
followed by language impairment (2.02–19%) (Law et al., 2000). However,
the results of the present findings cannot be compared with the existing
findings due to difference in study design. The difference in prevalence rate
among the communication disorders could be due to the difference in
methodologies used in the study, age of participants, data collection
methods such as direct assessment and/or parent/teacher report,
definition of communication disorders and its sub-groupings such as
speech and language disorders (McKinnon et al., 2007).
Between regions, the present study reported that school children who are
in rural regions exhibited higher occurrence rate compared to urban areas.
This is in consonance with the prevalence reported by Singh, Chandra,
Dayal, Chandra and Bhushan (1980); Srivastava and Khan (2008); Gad-
Allaha, Abd-Elraoufa, Abou-Elsaadb and Abd-Elwahedc (2012). Incidence
of communication disorders in rural areas is relatively more as it is not
always identified and treated accordingly (Srivastava et al., 2008) at an
earlier stage due to ignorance or lack of knowledge and lack of access to
facilities for identification and treatment of communication disorders in the
rural regions. It might also be due to lack of resources and infrastructure
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
15
AIISH, MYSURU
(Yadav, Jarhyan, Gupta & Pandav, 2009); lack of health awareness due to
various socio economic factors (Kumar, 1997); poor accessibility, non-
availability, poor utilization of rehabilitation services and also its cost-
effectiveness (Kumar, Roy & Kar, 2012).
Between grades, the results of the present study revealed that there exists
no association between communication disorders. Generally, the incidences
of communication disorders in children are reported to have reduced with
age (Keating, Turrell & Ozanne, 2000; Harasty & Reed, 1994; Craig, Hancock,
Tran, Craig, & Peters, 2002). The present data showed no significant
difference for language, hearing and multiple disorders and their
association between grades. This might be due to a smaller difference in age
between the groups. The findings of the present study can be correlated
with the fact that children at this age show greater alteration in speech
during the phases of dental exchanges and reorganization of the intraoral
space required to produce speech (Rabelo, Alves, Goulart, Frinche & Lemos
et al., 2011).
With respect to gender, in the present study, no association was seen in the
occurrence of communication disorders and gender. However, earlier
studies showed a greater rate of impairment in boys than girls with male to
female ratios ranging from 1.5 to 2.4 for speech disorders, and 0.98:1 to
2.30:1 for language disorders (McKinnon et al., 2007; Tomblin, et al., 1997).
A consensus of literature reports indicate that gender differences for
communication disorders is not a significant factor amongst all
communication disorders. For e.g., in studies of children with Learning
disability (Dhanda et al., 2013; Roth, 2004), Mental retardation (Helgason,
1964; Murphy, Yeargin-Allsopp, Decoufle, & Drews, 1995), Autism
Spectrum Disorders (Werling & Geschwind, 2013) and others reported that
though occurrence was greater in boys than girls, there was no significant
difference reported within the gender. On the other hand, those studies
who report of significant gender differences in children suggest that these
variations in general could be due to a relatively lower threshold for
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
16
AIISH, MYSURU
developing certain skills in boys indicating a difference in the genetic
predisposition of brain development for boys and girls (Lewis, 1990).
Gender differences in few of the communication disorders are attributed to
susceptibility of brain injury between males and females. For e.g. studies
have reported that among children with cerebral palsy, males are at greater
susceptibility to white matter injuries and intraventricular haemorrhage
than females, especially when children born are preterm (Reiss, Kesler,
Vohr, Duncan, Katz & Pajot et al., 2004; Johnston & Hagberg, 2007).
With respect to the distribution of different types of speech, language and
multiple disorders, the present study revealed a perceptible occurrence in
school children (11.4%). Among these, distribution of learning disability
and articulation/ phonological disorders were more widespread followed
by other disorders like Fluency disorders, Mental retardation, Specific
language impairment, Voice disorders, Childhood dysarthria, Hypernasality
with repaired cleft-lip & Palate, Autism Spectrum Disorders and multiple
disorders. A greater proportion of children associated with learning
difficulties in the present study could be due to the factors such as poorer
educational opportunities in schools, poor socioeconomic status (Emerson,
Hatton, Robertson, Roberts, Baines, Evison & Glover, 2010), and poor
access to the rehabilitative services. Generally, as children grow articulation
problems could seem to fade and disappear without treatment. More
occurrence of deprived articulation might be due to poor modelling and
reinforcement in the classroom and at home.
Conclusions
The findings of the present study showed the occurrence of communication
disorders in school going children. Among the identified children with
communication disorders, language disorders were found high compared to
speech disorders, hearing disorders and multiple disorders. Occurrence of
communication disorders was higher in rural regions than urban regions.
But no significant gender effect and grades effect was seen for any form of
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
17
AIISH, MYSURU
communication disorders. Further, it was also notices that learning
disability and articulation/phonological disorders were found to be more
common in school going children compared to other speech and language
disorders. The results indicated the need and importance of screening of
communication disorders in school going children for early identification
and primary, secondary and tertiary prevention. It can be concluded that
the disordered specific identify of the children is essential and they in turn
require special attention by continuously monitoring their speech and
language skills by the professionals in the field of communication disorders
and also for planning appropriate rehabilitation. However, such studies
should be carried out in a large scale with similar protocol to estimate the
actual incidence and prevalence rates of communication disorders in school
going children.
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
18
AIISH, MYSURU
References
American Speech-Language-Hearing Association. (1982). Language.
Retrieved from http://www.asha.org/policy/RP198200125/ #sthash.
r62sDq1V.dpuf
American Speech-Language-Hearing Association. (1988). Prevention of
communication disorders [Position Statement]. Retrieved from
www.asha.org/policy.
American Speech-Language-Hearing Association. (1993). Definitions of
communication disorders and variations. Retrieved from
www.asha.org/policy/RP198200125/#sthash.r62sDq1V.dpuf
American Speech-Language-Hearing Association. (2006). Preferred practice
patterns for the profession of speech-language pathology. Retrieved
from www.asha.org.
Babu, R. M., Rathna, N., & Bettagiri, R. (1972). Test of articulation in
Kannada. Journal of All India Institute of Speech and Hearing, 3, 7-19.
Baron-cohen, S., Knickmeyer, R. C., & Beltmone, M. K. (2007). Sex
differences in the brain: implications for explaining autism. Science,
310(5749), 819-823.
Bhuvaneshwari, B., & Shanbal, J. C. (2010). English Language Test for Indian
Children. Students Research at AIISH, Vol. VIII, 182-189.
Bzoch, K., & League, R. (1971). Receptive Expressive Emergent Language
Scale. Language Educational Division, Computer Management
Corporation, the Tree of Life Press: Gainesville, Florida.
Census of India. (2001). Disabled population by type of disability, age, sex
and type, New Delhi, Registrar general office. Retrived from http://
censusindia.gov.in/Census_And_You/disabled_population. aspx
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
19
AIISH, MYSURU
Craig, A., Hancock, K., Tran, Y., Craig, M., & Peters, K. (2002). Epidemiology
of stuttering in the community across the entire life span. Journal of
Speech, Language, and Hearing Research, 45(6), 1097–1105.
DeAndrade, C. R. F. (1997). Speech-language idiopathic disorder prevalence
in children from one to eleven years of age. Journal of Public Health,
31(5), 495–501.
Dhanda A, & Jagawat T. (2013). Prevalence and pattern of learning
disabilities in school children, Delhi Psychiatry Journal, 16(2), 386-
390.
Emerson, E., Hatton, C., Robertson, J., Roberts, H., Baines, S., Evison, F., &
Glover, G. (2011). People with Learning Disabilities in England 2011:
Services & Supports Improving Health and Lives: Learning disability
observatory.
Felsenfeld, S., McGue, M., & Broen, P. A. (1995). Familial aggregation of
phonological disorders: Results from a 28-year follow-up Journal of
Speech and Hearing Research, 38, 1091–1107.
Gad-Allaha, H., Abd-Elraoufa, S., Abou-Elsaadb, T., & Abd-Elwahedc, M.
(2012). Identification of communication disorders among Egyptian
Arabic-speaking nursery school children. Egyptian Journal of Ear,
Nose, Throat and Allied Sciences, 13(2), 83–90.
Harasty, J., & Reed, V. A. (1994). The prevalence of speech and language
impairment in two Sydney metropolitan schools. Australian Journal of
Human Communication Disorders, 22, 1–23.
Harlekhar, G. (1986). Three dimensional language acquisition test – 3DLAT
(Unpublished Master’s dissertation). All India Institute of Speech and
Hearing, University of Mysore, India.
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
20
AIISH, MYSURU
Helgason, T. (1964). Epidemiology of mental disorders in Iceland. A
psychiatric and demographic investigation of 5395 Icelanders. Acta
Psychiatrica Scandinavica, 39(S173), 7-250.
Keating, D., Turrell, G., & Ozanne, A. (2001). Childhood speech disorders:
Reported prevalence, co-morbidity and socioeconomic profile. Journal
of Paediatrics & Child Health, 37(5), 431-6.
Kirkpatrick, E., & Ward, J. (1984). Prevalence of articulation errors in New
South Wales primary school pupils. Australian Journal of Human
Communication Disorders, 12, 55–62.
Kumar, S. (1997). Deafness and its prevention: Indian scenario. Indian
Journal of Pediatrics, 64, 801–9.
Kumar, G. S., Roy, G., & Sekharkar, S. (2012). Disability and Rehabilitation
Services in India: Issues and Challenges, Journal of Family Medicine
and Primary Care, 1(1), 69–73.
Kuppuraj, S., & Shanbal, J. C. (2012). Dyslexia assessment profile in Indian
children (DAPIC). A publication of the All India Institute of Speech and
Hearing, Mysore. ISBN 978-93-81584-36-1.
Law, J., Boyle, J., Harris, F., Harkness, A., & Nye, C. (2000). Prevalence and
natural history of primary speech and language delay: Findings from a
systematic review of the literature. International Journal of Language
and Communication Disorders, 35(2), 165-188.
Lewis, B., Freebairn, L., & Taylor, H. (2000). Follow-up of children with
early expressive phonology disorders. Journal of Learning Disabilities,
33, 433–444.
Mark, A., Matharu, V., Dowswell, G., & Smith, M. (2013). The point
prevalence of otitis media with effusion in secondary school children
in Pokhara, Nepal: A cross sectional study. International Journal of
Pediatric Otorhinolaryngology, 77, 1523-1529.
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
21
AIISH, MYSURU
McKinnon, D. H., McLeod, S., & Reilly, S. (2007). The prevalence of
stuttering, voice and speech-sound disorders in primary school
students in Australia. Language, Speech, and Hearing Services in
Schools, 38(1), 5-15.
McLeod, S., & McKinnon, D. H. (2007). The prevalence of communication
disorders compared with other learning needs in 14,500 primary and
secondary school students. International Journal of Language and
Communication Disorders, 42(S1), 37-59.
Murphy, C. C., Yeargin-Allsopp, M., Decoufle, P., & Drews, C. D. (1995). The
administrative prevalence of mental retardation in 10-year-old
children in metropolitan Atlanta, 1985 through 1987. American
Journal of Public Health, 85, 319-323.
Okalidou, A., & Kampanaros, M. (2001). Teacher perceptions of
communication impairment at screening stage in preschool children
living in Patras, Greece. International Journal of Language and
Communication Disorders, 36(4), 489-502.
Prema, K. S. (1997). Reading Acquisition Profile in Kannada - RAP-K
(Unpublished doctoral thesis). All India institute of Speech and
Hearing, University of Mysore, India.
Rabelo, A. T. V., Alves, C. R. L., Goulart, L. M. F., Frinche, A. A. D., Lemos, S. M.
A., et al. (2011). Speech disorders in Belo Horizonte, Journal da
Sociedade de Fonoaudiololgia, 23(4), 344-350.
Riley, G. D. A. (1994). Stuttering Severity Instrument for children and adults.
Pro-Ed Austin, Texas.
Roth, S. C. (2004). Learning disabilities: the interaction of students and their
environments (5th ed.). Boston: Hlyn & Bacon/Pearson Education.
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
22
AIISH, MYSURU
Ruscello, D. M., St. Louis, K. O., & Mason, N. (1991). School-aged children
with phonologic disorders: Coexistence with other speech language
disorders. Journal of Speech and Hearing Research, 34(2), 236–242.
Shanbal, J. C., Goswami, S. P., Chaithra, S., & Prathima, S. (2010).
Phonological awareness skills and reading in children who are at risk
for learning disability: Role in the Indian context? Journal of All India
Institute of Speech and Hearing, 29(2), 204-214.
Silva, M. R. (2008). Alteracoesdefalaemescolares: Occorencia,
identificacaoecondutasadotadas. Compinas: In Rabelo, A. T. V., Alves,
C. R. L., Goulart, L. M. F., Frinche, A. A. D., Lemos, S. M. A., et al. (2011).
Speech disorders in Belo Horizonte, Journal da Sociedade de
Fonoaudiololgia, 23(4), 344-350.
Singh, A. P., Chandra, M. R., Dayal, D., Chandra, R., & Bhushan, V. (1980).
Prevalence of deafness in a rural population of Lucknow district.
Indian Journal of Public Health 24(1), 23-31.
Sreeraj, K., Suma, C., Jayaram, G., Sandeep, M., Mahima, G., & Shreyank, P. S.
(2013). Prevalence of communication disorders in rural population of
India. Journal of Hearing Science, 3(2), 41-49.
Srivastava, D. K., & Khan, J, A. (2008). Disability needs attention now. Indian
Journal for the Practicing Doctor, 5, 3-4.
Suchitra, M. G., & Karanth, P. (2007). Linguistic Profile Test in Kannada.
Journal of All India Institute of Speech and Hearing, 26, 68-71.
Swapna, N., Jayaram, M., Prema, K. S., & Geetha, Y. V. (2010). Development of
intervention module for preschool children with communication
disorders (Unpublished Project). AIISH Research Fund, All India
Institute of Speech and Hearing, Mysore.
Tomblin, J. B., Records, N. L., Buckwalter, P., Zhang, X., Smith, E., & O’Brien,
M. (1997). Prevalence of specific language impairment in
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru
AIISH OCCURRENCE OF COMMUNICATION DISORDERS: EPIDEMIOLOGICAL REPORT
23
AIISH, MYSURU
kindergarten children. Journal of Speech Language and Hearing
Research, 40, 1245–60.
Werling, D. M, & Geschwind, D. H. (2013). Sex differences in autism
spectrum disorders. Current Opinion in Neurology, 26(2), 146–153.
Wetherby, A., & Prizant, B. (1996). Toward earlier identification of
communication and language problems in infants and young children.
Journal of Speech Language and Hearing Research, 110–113.
World Health Organization. (1998). Facts about Deafness. Retrieved from
http://www.who.int/features/factfiles/deafness/en/
World Health Organization. (2015). The ICD-10 Classification of mental and
behavioural disorders (F00-F99). World Health Organization, Geneva.
Yadav, K., Jarhyan, P., Gupta, V., & Pandav, C. S. (2009). Revitalizing Rural
Health Care Delivery: Can Rural Health Practitioners be the Answer?
Indian Journal of Community Medicine. 34(1), 3–5.
Department of
Prevention of
Communication
Disorders,
All India Institute
of Speech &
Hearing, Mysuru