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Language disorder in children refers to problems with either:
- Getting their meaning or message across to others (expressive language disorder), or
- Understanding the message coming from others (receptive language disorder)
Some children only have an expressive language disorder. Others have a mixed receptive-expressive language disorder, meaning that they have symptoms of both conditions.
Children with language disorders are able to produce sounds, and their speech can be understood.
Alternative NamesDevelopmental aphasia; Developmental dysphasia; Delayed language; Specific developmental language disorder; SLI; Communication disorder - language disorder
Causes, incidence, and risk factorsFor most infants and children, language develops naturally beginning at birth. To develop language, a child must be able to hear, see, understand, and remember. Children must also have the physical ability to form speech.
Up to 1 out of every 20 children has symptoms of a language disorder. When the cause is unknown, it is called a developmental language disorder.
Problems with receptive language skills usually begin before age 4. Some mixed language disorders are caused by a brain injury, and these are sometimes misdiagnosed as developmental disorders.
Language disorders may occur in children with other developmental problems, autistic spectrum disorders, hearing loss, and learning disabilities. A language disorder may also be caused by damage to the central nervous system, which is called aphasia.
Language disorders are rarely caused by a lack of intelligence.
Language disorders are different than delayed language. With delayed language, the child develops speech and language in the same way as other children, but later. In language disorders, speech and language do not develop normally. The child may have some language skills, but not others. Or, the way in which these skills develop will be different than usual.
SymptomsA child with language disorder may have one or two of the symptoms listed below, or many of the symptoms. Symptoms can range from mild to severe.
Children with a receptive language disorder have difficulty understanding langugae. They may have:
- A hard time understanding what other people have said
- Problems following directions that are spoken to them
- Problems organizing their thoughts
Children with an expressive language disorder have problems using language to express what they are thinking or need. These children may:
- Have a hard time putting words together into sentences, or their sentences may be simple and short and the word order may be off
- Have difficulty finding the right words when talking, and often use placeholder words such as "um"
- Have a vocabulary that is below the level of other children the same age
- Leave words out of sentences when talking
- Use certain phrases over and over again, and repeat (echo) parts or all of questions
- Use tenses (past, present, future) improperly
Because of their language problems, these children may have difficulty in social settings. At times, language disorders may be part of the cause of severe behavioral problems.
Signs and testsA medical history may reveal that the child has close relatives who have also had speech and language problems.
Any child suspected of having this disorder can have standardized receptive and expressive language tests. A speech and language therapist or neuropsychologist will administer these tests.
An audiogramshould also be done to rule out deafness, which is one of the most common causes of language problems.
TreatmentSpeech and language therapy is the best approach to treating this type of language disorder.
Psychological therapy (psychotherapy, counseling, or cognitive behavioral therapy) is also recommended because of the possibility of related emotional or behavioral problems.
Expectations (prognosis)The outcome varies based on the cause. Brain injury or other structural problems generally have a poor outcome, in which the child will have long-term problems with language. Other, more reversible causes can be treated effectively.
Many children who have language problems during the preschool years will also have some language problems or learning difficulty later in childhood. They may also have reading disorders.
ComplicationsDifficulty understanding and using language can cause problems with social interaction and the ability to function independently as an adult.
Reading may be a problem.
Depression, anxiety, and other emotional or behavioral problems may complicate language disorders.
Calling your health care providerParents who are concerned that their child's speech or language is delayed should see their primary care provider. Ask about getting a referral to a speech and language therapist.
Children who are diagnosed with this condition may need to be seen by a neurologist or children's developmental specialist to determine if the cause can be treated.
Call your child's health care provider if you see the following signs that your child does not understand language well:
- At 15 months, does not look or point at 5 to 10 people or objects when they are named by a parent or caregiver
- At 18 months, does not follow simple directions, such as "get your coat"
- At 24 months, is not able to point to a picture or a part of the body when it is named
- At 30 months, does not respond out loud or by nodding or shaking the head and asking questions
- At 36 months, does not follow 2-step directions, and does not understand action words
Also call if you notice these signs that your child does not use or express language well:
- At 15 months, is not using three words
- At 18 months, is not saying, "Mama," "Dada," or other names
- At 24 months, is not using at least 25 words
- At 30 months, is not using two-word phrases, including phrases that include both a noun and a verb
- At 36 months, does not have at least a 200-word vocabulary, is not asking for items by name, exactly repeats questions spoken by others, language has regressed (become worse), or is not using complete sentences
- At 48 months, often uses words incorrectly or uses a similar or related word instead of the correct word
Lyon GR, Shaywitz SE, Shaywitz BA. Specific language and learning disabilities. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 32.
Sharp HM, Hillenbrand K. Speech and language development and disorders in children. Pediatr Clin North Am. 2008;55:1159-1173.
Simms MD. Language disorders in children: classification and clinical syndromes. Pediatr Clin North Am. 2007;54:437-467.
Reviewed ByReview Date: 06/29/2010
Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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When was specific language impairment discovered?
Specific Language Impairment (SLI) was formally recognized as a distinct language disorder in the 1970s. Researchers began to study children with language difficulties who demonstrated normal intelligence and no other obvious reason for their language impairments. This has led to a better understanding of SLI and the development of interventions to support affected individuals.
Expressive language disorder - developmental?
DefinitionDevelopmental expressive language disorder is a condition in which a child has lower than normal ability in vocabulary, producing complex sentences, and remembering words. However, children with this disorder may have the normal language skills needed to understand verbal or written communication.Alternative NamesLanguage disorder - expressiveCauses, incidence, and risk factorsApproximately 3 - 10% of all school-age children have expressive language disorder. It is a pretty common issue in children.The causes of this disorder are not well understood. Damage to the cerebrum of the brain and malnutrition may cause some cases. Genetic factors may also be involved.SymptomsBelow-average vocabulary skillsImproper use of tenses (past, present, future)Problems making complex sentencesProblems remembering wordsSigns and testsStandardized expressive language and nonverbal intellectual tests should be conducted if an expressive language disorder is suspected. Testing for other learning disabilities may also be needed.TreatmentLanguage therapy is the best method to treat this type of disorder. The goal of this therapy is to increase the number of phrases a child can use. This is done by using block-building techniques and speech therapy.Expectations (prognosis)How much the child recovers depends on the severity of the disorder. With reversible factors, such as vitamin deficiencies, there may be nearly full recovery.Children who do not have any other developmental or motor coordination problems have the best outlook (prognosis). Often, such children have a family history of delays in language milestones, but eventually catch up.ComplicationsLearning problemsLow self-esteemSocial problemsCalling your health care providerIf you are concerned about a child's language development, have the child tested.PreventionGood nutrition during pregnancy and early childhood and prenatal care may help. Other methods of prevention are unknown.ReferencesSimms MD. Language disorders in children: classification and clinical syndromes. Pediatr Clin North Am. 2007;54(3):437-467.
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When was specific language impairment discovered?
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Mixed receptive-expressive language disorder?
DefinitionMixed receptive-expressive language disorder is a language disability that causes impairment of both the understanding and the expression of language.Causes, incidence, and risk factorsThree to five percent of all children have either receptive or expressive language disorder, or both. These children have difficulty understanding speech (language receptivity) and using language (language expression). The cause is unknown, but there may be genetic factors, and malnutrition may play a role.Problems with receptive language skills usually begin before the age of four. Some mixed language disorders are caused by brain injury, and these are sometimes misdiagnosed as developmental disorders.SymptomsProblems with language comprehensionProblems with language expressionSpeech contains many articulation errorsDifficulty recalling early sight or sound memoriesSigns and testsStandardized receptive and expressive language tests can be given to any child suspected of having this disorder. An audiogram should also be given to rule out the possibility of deafness, as it is one of the most common causes of language problems.All children diagnosed with this condition should be seen by a neurologist or developmental pediatric specialist to determine if the cause can be reversed.TreatmentSpeech and language therapy are the best approach to this type of language disorder. Psychotherapy is also recommended because of the possibility of associated emotional or behavioral problems.Expectations (prognosis)The outcome varies based on the underlying cause. Brain injury or other structural pathology is generally associated with a poor outcome with chronic deficiencies in language, while other, more reversible causes can be treated effectively.ComplicationsDifficulty understanding and using language can cause problems with social interaction and ability to function independently as an adult.Calling your health care providerParents who are concerned about their child's acquisition of language should have the child tested. Early intervention will provide the best possible outcome.
Expressive language disorder - developmental?
DefinitionDevelopmental expressive language disorder is a condition in which a child has lower than normal ability in vocabulary, producing complex sentences, and remembering words. However, children with this disorder may have the normal language skills needed to understand verbal or written communication.Alternative NamesLanguage disorder - expressiveCauses, incidence, and risk factorsApproximately 3 - 10% of all school-age children have expressive language disorder. It is a pretty common issue in children.The causes of this disorder are not well understood. Damage to the cerebrum of the brain and malnutrition may cause some cases. Genetic factors may also be involved.SymptomsBelow-average vocabulary skillsImproper use of tenses (past, present, future)Problems making complex sentencesProblems remembering wordsSigns and testsStandardized expressive language and nonverbal intellectual tests should be conducted if an expressive language disorder is suspected. Testing for other learning disabilities may also be needed.TreatmentLanguage therapy is the best method to treat this type of disorder. The goal of this therapy is to increase the number of phrases a child can use. This is done by using block-building techniques and speech therapy.Expectations (prognosis)How much the child recovers depends on the severity of the disorder. With reversible factors, such as vitamin deficiencies, there may be nearly full recovery.Children who do not have any other developmental or motor coordination problems have the best outlook (prognosis). Often, such children have a family history of delays in language milestones, but eventually catch up.ComplicationsLearning problemsLow self-esteemSocial problemsCalling your health care providerIf you are concerned about a child's language development, have the child tested.PreventionGood nutrition during pregnancy and early childhood and prenatal care may help. Other methods of prevention are unknown.ReferencesSimms MD. Language disorders in children: classification and clinical syndromes. Pediatr Clin North Am. 2007;54(3):437-467.
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