Expressive language disorder is a childhood onset disorder, marked by a difficulty in expressing and communicating ideas clearly. Children with expressive language disorder might have a limited vocabulary, express themselves simplistically, and have difficulty making conversation.
From the moment of birth, we’re all sponges for language, soaking up every word we hear and absorbing written content far before we understand we’re doing so. Though everyone develops at a different pace, when a child exhibits major speech delays or trouble with vocabulary acquisition, the symptoms may indicate a language disorder.
Symptoms of expressive language disorder usually appear before the age of four, though they may not be highly noticeable until slightly later.
Though this disorder is called “language disorder” in the DSM 5, it’s more commonly known as expressive language disorder.
Language disorders fall into two main categories, namely “expressive” and “receptive.” Receptive language disorders indicate an issue with information intake: that is, in understanding, reading, or processing written or spoken language.
By contrast, expressive language disorder refers to an impairment or delay in terms of expressing ideas and thoughts, whether orally or in writing. Children with expressive language disorders often have typical IQ levels and can understand and process both written and spoken content at average levels (or higher), but they have trouble communicating their own ideas.
Children with expressive language disorder may also have symptoms of receptive language impairments, but it’s important to note that they don’t always appear in tandem. In other words, expressive language disorder refers to difficulty in producing language, rather than consuming or processing it.
Expressive language disorder, like many other language impairments, is fairly common. About 1 in 20 kids (5 percent of the population) experiences symptoms of a language disorder.
Expressive language disorder is more common in boys than girls, with some estimates suggesting that boys are five times likelier than girls to be diagnosed with the disorder.
Though research is ongoing, there’s no single known cause of expressive language disorder. There is a genetic link, however: About 20 to 40 percent of children with family histories of language disorders will have symptoms of speech or language impairment.
It’s common for hearing loss or impairment to cause delays in language acquisition, especially reduced vocabulary and pronunciation issues. Disorders such as autism and global intellectual delays can cause symptoms of language disorder, but they don’t have to be (and are often not) related.
Additionally, trauma such as central nervous system damage (“aphasia”) or traumatic brain injuries (TBIs) can lead to symptoms of a language disorder.
When language disorder symptoms appear after a period of typical development or after a traumatic incident, the disorder is referred to as “acquired.” Language disorders are referred to as “developmental” when the cause of the impairment is unknown or present from birth.
If you suspect your child might have expressive language disorder, you should watch out for the following signs and symptoms:
The DSM 5 defines language disorder as characterized by the following symptoms:
Language disorders are often tricky to parse, as it can be difficult to pinpoint the exact source(s) of a given delay or impairment. These are some of the most common conditions that are confused with or mistaken for expressive language disorder.
A diagnosis of an intellectual developmental disorder indicates a below-average level of intelligence. Children with expressive language disorder, meanwhile, usually have typical or above-average cognitive function and IQ levels.
Though both may manifest in speech and language impairments, expressive language disorder refers specifically to a difficulty with self-expression, rather than with understanding spoken or written language.
Dyslexia is commonly understood as a receptive or mixed expressive-receptive language disorder, and usually involves problems with writing, spelling, and reading, as well as phonological processing (i.e., understanding the sound of words and making meaningful connections between them).
People with dyslexia often also have trouble with organization and memory. While children with expressive language disorder might also have trouble remembering words, they don’t always (or even usually) have trouble reading or taking in written or spoken information. They also generally don’t have issues with organization or memory as a whole; that is, their memory issues are usually related specifically to self-expression and their own use of words.
Learning and/or cognitive disabilities, such as autism and Down syndrome, can produce developmental speech and language impairments.
Acquired speech and language impairments can sometimes be caused by hearing loss or damage to the central nervous system.
Expressive language disorder is generally understood as a childhood onset disorder. Most patients will exhibit symptoms in toddlerhood or early childhood.
Usually, when adults exhibit symptoms of speech and language impairment, barring an undiagnosed long-term case, the problem is due to hearing loss, dementia, or a neurological issue such as a brain injury or degenerative disorder.
Tom’s mother is noticing some particular patterns in her son’s speech and behavior and is starting to worry. Though he appears to understand what’s going on around him and to respond to stories, directions, and questions appropriately, he doesn’t respond verbally in kind. He loves to have his mom or dad read to him, but when they ask him what the story was about, he can’t describe it adequately and has trouble expressing what he liked about it.
When Tom tries to tell stories, he trails off or can’t seem to find the words he wants to express what he’d like to. He often uses one word or familiar phrases to communicate rather than speaking in full sentences. He uses incorrect verb tenses and leaves out important words, especially pronouns.
Instead of asking for his favorite snack by name, Tom asks his mom for “that stuff,” and rather than picking out a particular toy car at the store by describing it, he seems to get frustrated and finally calls it a “thing.” Tom’s teacher reports that he is much quieter than other students in class, and when she asks him questions, he repeats them back to her verbatim instead of answering them himself.
The good news is that expressive language disorder is highly treatable. Most children with expressive language disorder eventually recover and develop typical or above-average language skills as they age.
It’s key for parents not to blame themselves for their child’s symptoms, and not to display judgment or disappointment towards their child’s communication difficulties. Every child develops differently. And remember that the key to developing better communication is more communication: Keep talking, keep reading, and keep searching for the best treatment for your child, and you’re likely to see a favorable outcome.
Early intervention in cases of language disorders is key, not only to ensure full recovery from or management of symptoms, but also to rule out any other medical troubles. These could include neurological disorders or injuries or problems with hearing.
If you’re noticing symptoms of expressive language disorder, the first step is usually to approach your child’s pediatrician or an audiologist for an audiogram. Hearing loss can cause difficulty with proper pronunciation and with developing a rich vocabulary. Any hearing impairments should be ruled out first before your child is tested for expressive language disorder.
Once a diagnosis of language disorder is established, speech-language therapy is the gold standard for treatment.
Expressive language disorder is usually not treated with medications. If the language delays are due to an external health complication or disorder, such as autism or a traumatic brain injury, then medications that help to manage the symptoms of those conditions might be prescribed.
Most children with expressive language disorder eventually develop typical language skills by high school. The best way to help your child develop their communication skills is to encourage reading and engage them in regular conversation. Private literacy tutors or in-school aides or teaching assistants can also provide ideas for writing and communication exercises to complete at home, as well as workbooks, videos, and other resources for home use.
Whether a language disorder is developmental or acquired, early intervention is key when dealing with and managing symptoms. If you or your child is struggling with symptoms of a language disorder, don’t be afraid to seek help from a physician or your child’s school.
Speech-language therapy is virtually always covered in cases of acquired impairments, especially those caused by trauma. While speech-language therapy for developmental language disorders is sometimes covered by insurance, there are often caps on benefits. However, if your family has a Flexible Spending Account (FSA) or Health Savings Account (HSA), speech-language therapy is covered under those payment plans.
You can often find affordable options for speech-language therapy through your child’s school, especially special education programs, and through group therapy sessions (rather than private). If your child is very young, usually under three years old, you might qualify for free speech-language therapy through your state’s Early Intervention program.
The most common, and most effective, treatment for expressive language disorder is to work with a speech-language pathologist (SLP), usually one-on-one. You can find a competent SLP by asking for a referral from your pediatrician. You can also approach a school guidance counselor or special education teacher or administrator for a referral.
You can also search for a certified, trained SLP in your area through the American Speech-Language-Hearing Association (ASHA).
When you’re choosing a speech-language pathologist to treat your child’s (or your) expressive language disorder, it’s key to select a clinician with whom you and your child feel comfortable.
Pay attention to the specific treatment plan your potential therapist outlines. Does it cater specifically to your child’s age, stage, and needs? Does he or she give clear explanations for why they think a particular mode of therapy would be most beneficial?
It can also be beneficial to look for speech-language pathologists who undertake continuing education throughout their careers and who are well-accustomed to various kinds of language disorders and therapies, so they can be flexible if the need arises.
It’s important to make sure a potential SLP is a good fit for both you and your child. You can ask the following questions to advocate for the best treatment for your child:
There are a number of resources dedicated to helping individuals with expressive language disorder and their families. Here are some of the most widely used and effective books, websites, organizations, and support groups devoted to expressive language disorder.
Discovering symptoms of expressive language disorder in your child can be worrying. But with early intervention and treatment, as well as patience, symptoms of expressive language disorder can be effectively managed and even disappear over time.
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