Imagine being able to understand words but unable to express them yourself. Or imagine not even being able to understand the words in the first place! This can be very frustrating and isolating for a child.
In this article, we will explore the types of language disorders that can cause these phenomena in children: receptive language disorder, expressive language disorder, and mixed receptive-expressive language disorder.
What is Receptive-Expressive Language Disorder?
Receptive language disorder, or language comprehension deficit, is when a child cannot understand what they hear or read.
On the other hand, an expressive language disorder is when a child has trouble speaking, writing, and expressing their thoughts and feelings.
When a child has both of these disorders, it is called mixed receptive-expressive language disorder or receptive-expressive language impairment (RELI). This means the child’s ability to both understand and produce speech is affected. Research shows that approximately 2% to 4% of five-year-olds suffer from mixed receptive-expressive language disorder.
Symptoms
A child affected by mixed receptive-expressive language disorder can exhibit some of the following symptoms:
Giving the impression they aren’t listening when you speak to them
Seem uninterested when books are read to them
Trouble understanding the meaning of words
Trouble understanding complicated sentences
Has a hard time learning new words
Difficulty answering questions
Trouble identifying objects
Difficulty understanding concepts and ideas
Difficulty following long or complicated verbal instructions
Difficulty finding the right word or using the wrong words
Grammar mistakes
Using short, simple sentences
Mixing up past, present, and future tenses
Struggling to add new vocabulary words
Have trouble being clear with what they want to say
Have trouble conveying a story or relaying information
Difficulty starting or holding conversations
Difficulty using and understanding others' gestures, facial expressions, and posture
Have trouble asking questions
Difficulty singing songs
Children diagnosed with mixed receptive-expressive language disorder can suffer from these symptoms to any degree, with symptoms ranging from mild to severe. This type of disorder can have symptoms that vary among children; so it is important to note that while one child may exhibit certain symptoms, another may experience a whole other range of symptoms.
For the disorder to be classified as mixed receptive-expressive language disorder, the symptoms should not be attributed to sensory deficits, neurological conditions, environmental deprivation, nonverbal intellectual deficits, or psychiatric impairments.
Causes
It is important to keep in mind that having this disorder does not necessarily have anything to do with intelligence. Some people are born with more skills than others, and the child simply is unable to communicate at the level of other kids his or her age.
Research involving SPECT measurements of brain blood flow has found that these children do not exhibit left hemisphere activation in phonemic discrimination tasks. Phonemic discrimination refers to the process of differentiating between sounds that sound similar but have different frequencies, durations, and/or intensities.
Associated with developmental disorders
What causes a lack of left hemisphere activation in children? Well, most children with mixed-expressive language disorder are more likely to suffer from developmental disorders.
If the child has a language disorder that does not seem to be caused by a physical disability, intellectual disability, or environmental factors, this can be considered a developmental language disorder (DLD). This term is used interchangeably with specific language impairment (SLI), language delay, expressive-receptive language disorder, or developmental dysphasia.
DLD will typically run in the family and commonly occurs with other diagnoses like Attention Deficit Hyperactivity Disorder (ADHD) and other learning disorders.
Possible contributing factors
However, there are more possible contributing factors that could have led to the acquisition of the disorder. And sometimes the cause is not known or can come from a combination of factors.
Here are the possible causes of this disorder in children:
Seizures
Stroke
Traumatic head injury
Family history
The child has little practice hearing the language spoken in their daily life
Aphasia: This is an acquired language disorder that happened due to brain injury, infection, tumors, or a degenerative brain disorder. Those with aphasia will have difficulty with language formulation. There are many types of aphasia and will have different issues depending on what part of the brain was affected.
Developmental and cognitive disorders such as autism spectrum disorder or Down syndrome
Hearing impairment or hearing loss
Vision impairment
Attention disorders
Developmental issues beginning from birth
Medical issues
Finding the Right Diagnosis
Unfortunately, language disorders are frequently misdiagnosed. Sometimes the child is mistaken as “lazy” or ill-behaved. As with any disorder, the proper treatment cannot start without the right diagnosis.
It starts with the caregivers. Speech and language development follows a certain basic trajectory. Parents should be on the lookout for certain age-appropriate milestones when it comes to language. Experts provide a timeline that represents the most common times for children to start talking and understanding language.
The timeline should always be represented as a range because there isn’t an exact age when children will start talking. After all, some children may experience a receptive language delay or expressive language delay and are simply found to be “late talkers”. They eventually grow to have no long-term language issues. Fortunately, they are able to catch up with other peers the child’s age, but they may simply have a limited vocabulary.
Signs of Receptive and Expressive Language Disorders
Parents, teachers, and physicians should be on the lookout for these early signs of a language disorder. Here are the most common warning signs the child may have an expressive language disorder:
1 year, 3 months: The child only has a vocabulary of fewer than three words. He or she will use mostly vowel sounds when vocalizing.
1 year, 6 months: The child doesn’t say “Mama”, or “Dada”, or call anyone by their name.
2 years: The child only has a vocabulary of fewer than 25 words. He or she doesn’t exclaim when delighted or surprised by something.
2 years, 6 months: The child does not use two-word sentences, for instance, will not combine a noun and a verb. He or she is often very hard to understand.
3 years: The child has a vocabulary of fewer than 200 words. He or she has trouble asking for objects by their names. When spoken to or asked a question, he or she will repeat the words that were spoken.
Older than 3 years: The child’s speech varies from their peers. He or she will often use words wrong or use words that are related instead.
And here are the warning signs the child may have a receptive language disorder:
1 year, 3 months: The child doesn’t acknowledge when their name is called.
1 year, 6 months: The child has difficulty following simple directions like “Pick up your toy.”
2 years: The child seems disinterested when being read to.
2 years, 6 months: The child doesn’t answer questions verbally, or even nod/shake their head in response to the question.
3 years: The child has difficulty following simple two-step directions like “Pick up your toy and put it in the toy box.” He or she may also have difficulty playing or participating in groups with others. The child may also forget the names of people he or she knows well or may confuse the name with a different one.
Some early signals can be present in either of the two language disorders we’ve mentioned. Keep in mind children can suffer from the mixed receptive-expressive language disorder.
Here are some possible early warning signs that can be present in young children with either receptive or expressive language disorder:
The child was able to say one or two words at the normal developmental age but did not expand his or her vocabulary past that point.
After 18 months old, the child will gesture or point instead of vocalizing with speech.
The child does not attempt to imitate their parent’s sounds or words.
Even though the child has an understanding of language when at home, he or she is unable to understand the language when out of the house.
Parents should be aware that even though this list can help identify if the child has a communication disorder, only having one or two signs from this list doesn’t mean the child has the disorder. That is why they must visit a pediatric doctor, or speech-language pathologist (SLP), or attend a Rite Care Program to get an accurate diagnosis.
We recommend an SLP who is certified by the American Speech-Language-Hearing Association (ASHA), which means that they adhere to rigid standards in the diagnosis and treatment of these issues.
Treatment Options
Early intervention is key. When a child is diagnosed with a receptive language disorder, expressive language disorder, or mixed receptive-expressive language disorder, he or she will need a treatment plan to overcome these language difficulties.
The treatment options that are best for the child should be facilitated by a licensed SLP. Here are the most common options used by children suffering from these disorders:
Speech-language therapy: Speech-language therapy can be done on a one-on-one basis or in a group format, depending on what your child needs. For speech therapy, especially to aid in articulation, it can be more effective to get sessions with a language therapist on an individual basis.
A speech therapist can use playful methods to relax the child and enable them to open up and communicate. These methods could include toys, books, objects, or pictures that can help with receptive language skills, expressive language skills, and language development. They may also have activities to do or can practice asking and answering questions with the child.
Home exercises: There are exercises that caregivers can do at home to encourage language growth in the child. The caregiver can practice naming items with the child, explain new concepts in different ways, play Simon says, or put together an obstacle course.
Other options include playing the feely bag game with an emphasis on guessing the item, describing its characteristics, and answering questions about it. It is also beneficial to look at picture books with the child, ask them questions about the pictures, and help them guess what might happen next.
Caregivers can also help improve communication skills by encouraging various ways of saying things. For example, the caregiver could come up with wacky or nonsensical ways to say things to get the child’s brain patterns going in different directions. This will encourage a different response from them, and hopefully more forms of expression.
Language intervention programs: These are typically school-based programs that can focus on auditory skills as well as other language issues.
Special education classes: In the US, if a child has a confirmed diagnosis of a speech and language disorder, they are eligible for special education classes. This is provided under the Individuals with Disabilities Act (IDEA).
Teacher’s aide support: Those with severe impairment can benefit from the support of a teacher’s aide.
Psychologist: If the child exhibits behavioral problems, it can be beneficial to schedule an appointment with a licensed child psychologist to help resolve these issues.
When it comes to language disorders, there is no “one size fits all” model. How well the child progresses in treatment will depend on various factors, but it is evident that each child has his or her own unique set of challenges. These challenges must be dealt with on an ongoing consistent basis, through a process built on compassion and patience under the care of a licensed SLP.
Some children can overcome these difficulties, while others may deal with lifelong symptoms. And even if these issues are resolved, children with early language delays are more at risk for having difficulties with things like phonological awareness, reading, and writing throughout their lives.
Those with mixed receptive-expressive language disorder are likely to have long-term effects on language development, literacy, behavior, social development, and even mental health problems. It is our goal to set these children up with the highest success they can have on their journey.
Providing Language Tools for Future Success
Receptive language disorder is when a child has trouble comprehending language. Expressive language disorder is when a child has trouble communicating language. Mixed receptive-expressive language disorder is when both are present in the child.
A child’s language ability is one of the most important tools for his or her future success. That is why here at the California Scottish Rite Foundation are dedicated to helping these children learn how to use these tools to ensure a better future. And we could surely use your help. Donate today!