Unspecified Communication Disorder DSM-5 307.9 (F80.9)

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DSM-5 Category: Neurodevelopmental Disorder

Introduction

Unspecified Communication Disorder (UCD) is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), diagnosis assigned to individuals who are experiencing symptoms of a Communication Disorder. This diagnostic category applies to a clinical presentations in which symptoms of a communication disorder are present, but do not meet a sufficient number of the diagnostic criteria for a communication disorder to warrant a more specific diagnosis. The symptoms have a significant impact on social, occupational/educational/interpersonal, or other critical areas of functioning. The UCD diagnostic category is used when “ the clinician chooses not to specify the reason that the criteria are not met for communication disorder or for a specific neurodevelopmental disorder” and can includes a clinical picture in which there is insufficient data to render a more specific diagnosis (American Psychiatric Association, 2013). It is noted by Nichols (2013) that Unspecified diagnostic codes are appropriate when the clinician requires a consult, as they do not have the skill-level to specify a diagnosis, or when further evaluation is needed.

A Communication disorder can be broadly defined, and may have multiple presentations involving difficulties with reception, production, processing, or comprehension, of verbal or written communication. It can be defined in terms of severity from mild to profound, may be first apparent in childhood, with genetic etiology, or acquired through environmental influences at any point in development (American Speech-Language-Hearing Association, 2014).

Symptoms of Unspecified Communication Disorder

According to the DSM-5, (American Psychiatric Association, 2013), there are four subtypes of Communication Disorders specified:

  • Language Disorder
  • Speech Sound Disorder
  • Childhood Onset Fluency Disorder (Stuttering)
  • Social (Pragmatic) Communication Disorder

Symptoms of UCD do not fulfill the required diagnostic criteria for any one of the above disorders, (American Psychiatric Association, 2013), but the UCD diagnosis is applied when the clinician suspects a Communication disorder is present. An example would be a child who exhibits a transient stutter while anxious, which is leading to peer abuse, and further anxiety about attending school.

Risk Factors for Unspecified Communication Disorder

The DSM-5 does not specify risk factors for UCD (American Psychiatric Association, 2013). The risk factors are diverse, as the causality of Communication disorders are varied. It is noted that there is a correlation with productive language deficits in children and maternal gestational diabetes (Krakowiak, Walker, C.K., Baker, Ozonoff, Hansen, and Hertz-Picciotto, 2012), however causality is uncertain.

Onset of Unspecified Communication Disorder

The DSM-5 does not specify the age of onset of UCD. Communication disorders are part of the neurodevelopmental disorder spectrum, so the typical age of onset will be early childhood (American Psychiatric Association, 2013).

Differential Diagnosis in Unspecified Communication Disorder

There are multiple diagnostic rule-outs to consider in UCD. Some are normal variations in language, which the clinician must take care not to pathologize. As with all DSM-5 disorders, the basic criteria of at least some degree of functional impairment in a major life area, and distress must be exhibited. Others are conditions that are comorbid with Communication disorders include:

  • Normal variations in language: There are normal variations in language that can be linked to one’s accent, based on geographic location or origin. (American Speech-Language-Hearing Association, 2014). Words in one language are filtered through another, and pronounced differently according to regional norms. For example, in Northern Vermont, the word Time is often pronounced with an “Oy” sound in the middle, due to filtering through French, whereas in neighboring upstate New York State, the same word is pronounced with an “Eye” sound. Contractions specific to a region may also be employed. A common affirmative in New England is “Ah-yep”, meaning, Ah, Yes.
  • Hearing or other sensory impairment: Hearing impairment is a possible rule-out for a communication disorder, as are other sensory or motor deficits than can interfere with productive or receptive speech.
  • Intellectual disability (Intellectual developmental disorder): A delay in productive speech or difficulty comprehending receptive speech can be an expression of an intellectual disability.
  • Neurological disorders: A Communication disorder can develop due to neurological disorders, including epilepsy syndrome.
  • TBI (Traumatic Brain injury): Acquired deficits in productive or receptive speech can result from a TBI effecting Broca’s or Wernicke’s areas, respectively. This would not be classified as a Communication disorder, as it is not of a neurodevelopmental nature.
  • Structural deficits: Productive Speech can be impaired due to maxilla -facial structural defects, such a cleft palate.
  • Dysarthria: Productive Speech impairment can be attributed to a motor disorder, such as CP (Cerebral Palsy).
  • Selective mutism: Children- as well as adults or older teens- may not speak under certain circumstances secondary to anxiety, angry refusal to communicate, or as a deliberate passive-aggressive behavior.
  • Medication side effects: Impairment of productive speech can be attributed to a side effect of a medication, as can difficulty comprehending receptive speech due to medication induced cognitive impairment.
  • Adult-onset dysfluencies: If the onset of a productive speech disorder occurs during or after the teen years, is diagnosable as an Adult-onset communication disorder, rather than a neurodevelopmental disorder.
  • Tourette’s disorder: Gille de Tourette’s syndrome involves phonic tics that are of a different quality than the diagnostic features of a communication disorder (American Psychiatric Association, 2013).
  • Attention-Deficit/Hyperactivity Disorder: AD/HD may manifest as problems in communication due to inattentiveness. The causality is complex, in that a child may have AD/HD independent of symptoms of any type of communication disorder, including UCD. AD/HD is part of the spectrum of neurodevelopmental disorders associated with Communication disorders, AD/HD is also identified as being causal, or as an exacerbating factor in communication disorders, due to impaired or delayed acquisition of reading and writing skills (St. Pourcain, Mandy, Heron, Golding, Smith, and Skuse, 2011)
  • Social anxiety disorder (social phobia): The diagnostic features of social communication disorder overlap with the symptoms of social anxiety disorder, but are differentiated in that there is no history of normal social communication in the former (American Psychiatric Association, 2013).

Treatment of Unspecified Communication Disorder

The DSM-5 does not specify treatment methods for UCD (American Psychiatric Association, 2013). UCD can be treated with speech therapy if the symptoms are indicative of productive speech impairment. Depending on the severity of the symptoms, or later diagnostic clarity of a more serious disorder and the degree of impairment, psycho-education for the family may be beneficial. More in-depth family therapy may be needed, as there can be considerable stressors associated with a special needs child.

Prognosis of Unspecified Communication Disorder

The DSM-5 does not specify the prognosis for UCD (American Psychiatric Association, 2013). The prognosis will depend on a more clarified diagnosis, or if the etiology of a difficult to categorize Communication Disorder can be determined. The impact of comorbid conditions will also determine prognosis. It is noted that LD’s (Language Disorders) are specifically predictive of various forms of psychopathology from childhood to young adulthood (Toppelberg, 2014). Disruption in the normal development of communication is associated with the neurodevelopmental disorders spectrum, of which communication disorders are integral. Profound difficulties with communication can have a pervasive impact on development. Communication is critical to a child’s development into a healthy, functioning adult, particularly in the areas of:

  • Cognitive-intellectual development and later academic and occupational achievement.
  • Social- Emotional development and interpersonal relationships.
  • General ability to adapt to the environment and situations.

Academic achievement is dependent mostly on the ability to read the written word, view and comprehend images, and hear and comprehend speech. The ability to communicate understanding and knowledge is also fundamental to learning. The inability to perform these tasks can limit an appreciation of the world around one, future employment opportunities, socialization, and negatively affect self-esteem, diminish self-respect, and lead to inadequacy, frustration, and depression. Proper diagnosis and treatment can prevent a multitude of problems later in life.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Edition). Washington, DC.

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations [Relevant Paper]. Retrieved November 1, 2014 from www.asha.org/policy.

Krakowiak, P., Walker, C.K., Bremer, A.A., Baker, A.S., Ozonoff, S., Hansen, R.L., and Hertz-Picciotto, I. (2012). Maternal Metabolic Conditions and Risk for Autism and Other Neurodevelopmental Disorders. Pediatrics.129 (5). 1121 -1128. doi: 10.1542/peds.2011-2583.

Nichols, J.C. (2013). ICD -10: Specified or Unspecified. Health Data Consulting. Retrieved October 16, 2014 from http://humanservices.arkansas.gov/director/Documents/Unspecified%20Codes%20.%20Dr.%20Nichs.pdf

St. Pourcain, B., Mandy, W.P., Heron, J., Golding, J., Smith, G.D., and Skuse, D.H. (2011). Links Between Co-occurring Social-Communication and Hyperactive-Inattentive Trait Trajectories. Journal of the American Academy of Child & Adolescent Psychiatry. 50, (9). 892–902.e5 DOI: 10.1016/j.jaac.2011.05.015

Toppelberg, C.O. (2014). Do Language Disorders in Childhood Seal the Mental Health Fate of Grownups? Journal Of The American Academy Of Child & Adolescent Psychiatry. 1050 www.jaacap.org 53. (10).


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