Causes, Signs and Symptoms, Diagnosis, Treatment and Prognosis of Receptive Language Disorder
The two basic parts of language are expressive and receptive skills. Receptive language refers to the words and language concepts that we understand, such as the meaning of the smile (a noun) versus smiling (an action). Receptive language forms the foundation of language from which expressive language develops; that is, your child must first understand the meanings of words, phrases, and sentences in order to use them in spoken language. When the underlying receptive language skills are impaired, your child will show signs like not following simple directions (“Show me the apple.”) nor answering age-appropriate questions (“How old are you?”).
Language concepts, such as comparatives and superlatives (big, bigger, biggest), may be difficult for the child to learn. Although not as common, it is possible for a child to have greater expressive than receptive skills; in this case, the child’s language may sound age-appropriate when speaking, but upon deeper testing of his or her specific skills, the breakdown in understanding becomes apparent, such as not knowing specific prepositions (above, below, next to, inside) or not following multi-step directions (Put the ball in the cup then close the lid on the box). The speech-language pathologist (SLP) will examine your child’s language in parts in order to tease apart the specific areas of strengths and needs. Note that it is uncommon for a child to have a receptive-only disorder with normal expressive language skills. So, when receptive language is impaired, the child will likely receive a diagnosis of mixed receptive-expressive language disorder.
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.
While specific causes of language impairment may not be easy to pinpoint, we know that various areas of the brain are involved in the way we learn and use language. During development, a child’s cognitive, or thinking, skills may be slow to develop or be impaired in some way. Such changes in the brain will lead to problems with language. 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.
According to the American Speech-Language-Hearing Association (ASHA), language disorders may be caused by any of the following:
Family history of language disorders
Birth-related issues, like premature birth, low birth weight, or trauma
Physical problems, such as hearing loss
Developmental disorders, like autism or failure-to-thrive
Exposure to teratogens (a substance that can cause a birth defect), like alcohol or drugs during pregnancy
Brain injuries or disorders, like stroke, tumors, or cerebral palsy
As a parent, your main concern may be that your child is not speaking like other children his or her age; remember that speaking is an expressive language skill. Parents often feel as though their children understand “everything” but just “won’t talk.” An expressive-only language disorder is possible, but it’s very likely that the child also has receptive language impairments. Upon testing, the SLP might identify difficulties with understanding (receptive) language as well, which many parents do not recognize prior to evaluation. These are signs to look for (compared to same-age peers):
Not following directions (1-step, 2-step, 3-step)
Not answering questions (who, what, when, where, why, how)
It is uncommon for a child to be diagnosed with a receptive-only language disorder. Receptive-only would imply that the child speaks just like peers (expressive language) but doesn’t understand his or her own language. It is more likely for your child to be diagnosed with impairments in both understanding and speaking, which is called a mixed receptive-expressive language disorder.
The SLP will also suggest a full audiological (hearing) evaluation to make sure that your child’s ears are able to hear all of the subtle differences in our speech sounds. Even a slight hearing loss caused by ear infection blockages can lead to delayed speech and language skills. A child does not need to be “deaf” in order to be affected by hearing loss.
Your child may receive one-on-one speech therapy or participate in group therapy with other children who have similar language impairments. One-on-one therapy is effective to a certain degree, but as social beings, children often learn best in the presence of other children. It is useful, though not strictly necessary, for young children to model new skills for each other. For example, a child who understands directions better than your child can demonstrate how to follow the directions.
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.
Flashcards 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 for 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. As with many speech and language disorders, chances for success improve with early intervention.