Causes, Signs and Symptoms, Diagnosis, Treatment and Prognosis of Expressive Language Disorder
The two basic parts of language are expressive and receptive skills. Expressive language includes the words in our vocabulary and how we put those words together to communicate by talking, writing, and gesturing. The speech-language pathologist (SLP) will examine various parts of the child’s expressive language skills, including the form, content, and use of language. As with most speech and language disorders, some expressive language errors are considered normal in younger but not older children. For example, it would be typical for a 3-year-old child to explain, “I runned.” This is a form error called overgeneralization, because the child has applied the add -ed for past tense rule to the verb run. However, an older child should know that the past tense form of run is ran, so an SLP would be concerned if a 6-year-old made the same error.
Your young child might not meet the first expressive language milestones of speaking his first word by 12 months, two-word sentences by 2 years, or three-word sentences by 3 years. An older child might struggle with adding new vocabulary words to his book report. These problems in learning and using new words describe errors in the content of the child’s language. Finally, the way we use language varies widely within and across cultures. Making eye contact while speaking is a common courtesy in the U.S. but may be considered rude in Japan. Children usually pick up on the subtle rules of our language, called pragmatics, but some children need coaching in how to use language rules while interacting with other people.
As you can see, if your child has been diagnosed with an expressive language disorder, it will be helpful for you to learn which of the many areas of language are impaired.
The causes of impairment in one area of language (expressive) but not the other (receptive) are unknown, but we do know that various areas of the brain are involved in the way we learn and use language. It’s possible that one area has not developed on time or is impaired in some way. It’s also possible that other cognitive, or thinking, skills are impaired. For example, forming a sentence with words in the correct order involves skills like working memory, organization, and planning. Impairments in any of these cognitive skills may contribute to language disorders.
An expressive language disorder implies, by definition, that the child’s receptive language skills are normal—otherwise, the child would be diagnosed with a mixed expressive-receptive language disorder or another disorder, such as specific language impairment. With the expressive-only impairment, the child understands the language around him, but for some reason, the child is unable to clearly express himself while using that language.
One way to think about this type of disorder is to consider an extreme case: selective mutism. While mutism is related to other factors, such as anxiety or shyness, it may help to imagine a child with mutism who understands everything spoken to him. The impairment, though, is that the child with mutism cannot express himself (due to silence). In expressive language disorder, however, the child at least attempts to use language to express himself, but instead of silence, the result is impaired language.
Your child may receive one-on-one speech therapy or participate in group therapy with other children who have similar language impairments. It is also useful for young children to model new skills for each other. The child with expressive language disorder can demonstrate receptive skills, such as following directions or answering simple questions, for a child who has a mixed expressive-receptive language disorder. On the other hand, a child with better expressive language skills can model how to ask questions to peers or teachers.
Specific tools used in therapy include:
Songs & Rhymes. The rhythm of music and rhymes provide a structure for learning language by repeating phrases, remembering what comes next, and making gestures and movements to match the words.
Story Telling. Books provide consistent exposure to new concepts as they are read over and over. We will ask your child questions and encourage him to ask questions as well. Role-playing the story gives your child the chance to use the concepts and phrases from the book.
Sensory Activities. New textures and other sensations provide many opportunities for new language skills, such as describing an object that is soft vs. hard or smooth vs. rough.
Arts & Crafts. Children often express themselves better through art than words. We will talk about the artwork, ask/answer questions, and encourage your child to tell you about our crafts.
Apps & Books.
Flash cards with objects to describe attributes
Drawing apps for creating stories
Perhaps the main tool used in language therapy is language! We will “bombard” your child with new vocabulary words, questions, and experiences in order to teach concepts in ways that will keep your child engaged while learning. We encourage you to talk more with your child as well, as research suggests the more words children hear, the better their language skills will be in the future.
The prognosis of any language disorder depends greatly on the cause and severity of the disorder, the age of the child at diagnosis and treatment, and the motivation of both the child and the parent to follow through with homework and practice. The good sign with this diagnosis is that the child’s receptive language skills are not impaired; understanding language is the foundation for expressing language. As with many speech and language disorders, chances for success improve with early intervention.