Expressive Language Disorder Diagnosis

Expressive language disorder means a child has difficulty conveying or expressing information in speech, writing, sign language or gesture. For preschool children, the impairment is not evident in the written form, since they have not started formal education.

Expressive language disorder is generally a childhood disorder. There are two types of expressive language disorder: the developmental type and the acquired type.

Developmental expressive language disorder does not have a known cause and generally appears at the time a child is learning to talk. Acquired expressive language disorder is caused by damage to the brain .

It occurs suddenly after events such as stroke or traumatic head injury. The acquired type can occur at any age.

Some children are late in reaching typical language milestones in the first three years, but eventually catch up to their peers. These children are commonly referred to as ‘late-talkers’.

Children who continue to have difficulty with verbal expression may be diagnosed with expressive language disorder or another language impairment.

Causes

There is no known cause of developmental expressive language disorder. Research is ongoing to determine which biological or environmental factors may be the cause. Acquired expressive language disorder is caused by damage to the brain.

Damage can be sustained during a stroke, or as the result of traumatic head injury, seizures , or other medical conditions.

The way in which acquired expressive language disorder manifests itself in a specific person depends on which parts of the brain are injured and how badly they are damaged.

Symptoms of expressive language disorder

Children with expressive language disorder have difficulties with the grammatical aspects of spoken language such as using the correct verb tense (they might say ‘I go’ when they mean ‘I went’) and combining words to form accurate phrases and sentences.

They typically produce much shorter phrases and sentences than other children of the same age, and their vocabulary (the number of words they know and use) is smaller and more basic.

Children with expressive language disorder are usually below the average level for their age in:

  • Putting words and sentences together to express thoughts
  • Recalling the names of words
  • Using language appropriately in a variety of settings with different people (for example, at home, in school, with parents and teachers).

Specific examples of expressive language impairment include a seven-year-old child being unable to join sentences with words like ‘and’, ‘but’ or ‘if’, and a three-year-old child who speaks in two-word sentences.

Symptoms of expressive language disorder differ from one child to the next and depend on the child’s age and the degree of the impairment. Common symptoms include:

  • Making grammatical errors, leaving off words (such as helper verbs) and using poor or incomplete sentence structure (for example, ‘He going work’ instead of ‘He’s going to work’ and ‘I talk’ instead of ‘I can talk’)
  • Using noticeably fewer words and sentences than children of a similar age
  • Using shorter, simpler sentence construction than children of a similar age
  • Having a limited and more basic vocabulary than children of a similar age
  • Frequently having trouble finding the right word
  • Using non-specific vocabulary such as ‘this’ or ‘thing’
  • Using the wrong words in sentences or confusing meaning in sentences
  • Relying on standard phrases and limited content in speech
  • Sounding hesitant when attempting to converse
  • Repeating (or ‘echoing’) a speaker’s words
  • Being unable to come to the point or talking in circles
  • Having problems with retelling a story or relaying information in an organised or cohesive way
  • Being unable to start or hold a conversation and not observing general rules of communicating with others
  • Having difficulty with oral and written work, and school assignments.

Demographics

Expressive language disorder is a relatively common childhood disorder. Language delays occur in 10–15% of children under age three, and in 3–7% of school-age children.

Expressive language disorder is more common in boys that in girls. Studies suggest that developmental expressive language disorder occurs two to five times more often in boys as girls.

The developmental form of the disorder is far more common than the acquired type.

Diagnosis

To diagnose expressive language disorder, children must be performing below their peers at tasks that require communication in the form of speech.

This can be hard to determine because it must be shown that an individual understands the material, but cannot express that comprehension.

Therefore, non-verbal tests must be used in addition to tests that require spoken answers. Hearing should also be evaluated, because children who do not hear well may have problems putting together sentences similar to children with expressive language disorder.

In children who are mildly hearing impaired, the problem can often be resolved by using hearing aids to enhance the child’s hearing.

Also, children who speak a language other than English (or the dominant language of their society) in the home should be tested in that language if possible.

The child’s ability to communicate in English may be the problem, not the child’s ability to communicate in general.

The Diagnostic and Statistical Manual of Mental Disorders , fourth edition, text revised (known as the DSM-IV-TR ), states that there are four general criteria for diagnosing expressive language disorder.

The first is that the child communicates using speech at a level that is less developed than expected for his or her intelligence and ability to understand spoken language. This problem with communication using speech must create difficulties for the child in everyday life or in achieving goals.

The child must understand what is being said at a level that is age-appropriate, or at a developmental level consistent with the child’s. Otherwise the diagnoses should be mixed receptive-expressive language disorder .

If the child has mental retardation , poor hearing, or other problems, the difficulties with speech must be greater than is generally associated with the handicaps that the child has.

Cause of expressive language disorder

For many children, the cause of expressive language disorder is not known. Children who experience difficulties in language development alone are typically diagnosed with specific language impairment.

For other children, expressive language disorder is associated with known developmental difficulties or impairments (for example, Down syndrome, autism or hearing loss).

Many children with expressive language disorder will have an accompanying ‘receptive’ language disorder, meaning that they have difficulty in understanding language.

Expressive language disorder can be a developmental (from birth) or acquired impairment. An acquired impairment occurs after a period of normal development. It can be the result of trauma or a medical condition.

Research suggests that in some cases expressive language disorder is a genetic impairment (found frequently in more than one family member and across generations).

Diagnosis of expressive language disorder

If your child is having difficulties with speaking or expressive language, have his or her language skills assessed by a speech pathologist (speech therapist).

Do not delay an assessment, because your child may miss many months of important therapy. It is also important to have your child’s hearing assessed.

Speech pathologists perform specific assessments to identify the areas of language that a child finds difficult. These assessments are not stressful for the child, and parents are usually present during these consultations.

Speech pathologists may also recommend:

  • An auditory processing test (this is different to a standard hearing test)
  • A test for learning difficulties (for school-aged children)
  • An assessment of cognitive function (thinking and intelligence by a registered psychologist.

Treatment for expressive language disorder

Treatment options depend on the severity of the impairment. Treatment may include:

  • Group sessions with a speech pathologist
  • Individual therapy sessions with a speech pathologist
  • School-based language intervention programs
  • Assistance from special education teachers
  • Teacher’s aide support for children with severe language impairment
  • Speech pathology sessions combined with home programs that parents can use with their child.

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