Learning Disabilities in Expressive Language

Expressive Language Disorder Assessment and Treatment

If your child or loved one has been diagnosed with an expressive language disorder, you may be wondering where to go from here. What causes this problem, is it considered only a disorder or also a learning disability, what treatments are available, and how will it impact your child's future?

Let's take a look at each of these points, along with some things to watch out for during your child's language development, myths surrounding expressive language disorder, and the next steps to take in helping your child.

Father helping his son with schoolwork

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Definition of Expressive Language Disorder

Expressive language is exactly what it sounds like: the ability to express yourself using spoken or written language in a way that is understandable and appropriate. Most children are able to use words with relative ease by the time they are about 5 years old.

When a child has expressive language disorder, however, they have trouble communicating their thoughts and feelings at an age-appropriate level. This difficulty may be observed with verbal language, written language, or both.

Some children experience both expressive and receptive language disorders, meaning that they have a hard time understanding language (receptive) and using words to communicate (expressive).

Developmental language disorders, as they are sometimes called in children, are fairly common. They are often diagnosed in conjunction with developmental language delays or other cognitive disorders, such as autism.

It is important to note that language disorders are not the same as speech impairments, which include stuttering, hesitating when speaking, or having difficulty forming sounds correctly (known as apraxia of speech).

Disorder or Disability?

There is ongoing debate among language experts about whether or not expressive language disorder should be considered a learning disability.

Some speech therapists classify it as a developmental disorder that is at the root of a variety of learning disabilities, while others say that the learning disabilities commonly seen in children with expressive language disorder are a continuation of the disorder itself.

Causes

Expressive language disorder involves abnormalities within the language processing centers of the brain, making it difficult to form connections between words and the ideas they represent.

While this disorder has been linked to a variety of risk factors, often a direct cause is not obvious. However, some of the most common health conditions among children with expressive language disorder include:

Characteristics

Because language skills build on each other sequentially (one after the other), any delays or gaps along the way can affect children's future success in using more sophisticated language skills.

For instance, babies and toddlers understand language months before they begin expressing it. And expressing themselves verbally comes months before they are able to begin reading, which happens before writing skills are acquired.

These skills can be thought of as bricks used to build a wall from the ground up. If a brick near the bottom is not placed correctly, the bricks higher up on the wall will also be unstable.

Children with expressive language disorder often exhibit delays in the foundational aspects of language development, such as learning and using the simple sounds that make up speech.

They often have a hard time increasing their vocabulary and may speak only in simple sentences. Linking several thoughts together into a complex sentence can be especially difficult.

These children may also have trouble with the following:

  • Expressing thoughts and feelings appropriately
  • Naming common objects
  • Reciting poems
  • Singing songs
  • Telling or writing stories

Using filler words (such as "um") in response to a question, or simply repeating the question, are also common. Children with this disorder may appear quiet or answer questions with only a few words.

Signs of a Language Disorder

The American Speech-Language-Hearing Association (ASHA) provides the following developmental signs that could indicate a language disorder:

  • Birth–3 months: Not smiling or playing with others
  • 4–7 months: Not babbling
  • 7–12 months: Making only a few sounds and/or not using gestures like waving or pointing
  • 7 months–2 years: Not understanding what others say
  • 12–18 months: Saying only a few words
  • 1½–2 years: Not putting two words together
  • 2 years: Saying fewer than 50 words
  • 2–3 years: Having trouble playing and talking with other children
  • 2½–3 years: Having problems with early reading and writing (For example, your child may not like to draw or look at books.)

Diagnosing Expressive Language Disorder

An evaluation by your child's pediatrician and a speech–language pathologist (SLP) can provide information to help your child's educators develop effective strategies. Underlying physical causes, such as hearing loss, will first be ruled out. Then further testing will be done to determine the possible causes and nature of your child's language disorder.

With older children, diagnostic writing and speech/language tests can be used to determine what specific types of language difficulties are affecting the learner's communication skills. Testing for other learning disabilities may be done at this time also.

Through observations, analysis of school work, cognitive assessment, and occupational therapy evaluations, speech pathologists and teachers can develop individualized therapy and education programs that will help the student learn.

If your child is very young and/or is not yet writing, the SLP will conduct an evaluation either in a one-on-one setting or a group play setting, observing how your child communicates with others, listens to and follows directions, and understands and repeats the names of objects.

Treatment Strategies

Methods often used by SLPs to treat expressive language disorder center on language therapy to develop the fundamental concepts necessary for communication.

Often the SLP will begin by helping young children relax and learn to communicate through play. They may incorporate the use of toys, books, and craft projects to teach children different ways of expressing themselves, gradually adding verbal and written communication.

The SLP will also help your child practice asking and answering questions. The exact methods used will vary based on your child's needs, and the SLP can explain what approaches are the most helpful for your child during treatment.

Vocabulary development and practice using language in social situations are other helpful therapeutic methods.

Children with expressive language disorder are eligible for special education programs and other types of accommodation at school.

Students with substantial communication disorders may require specially designed instruction on their individualized education plans (IEPs). IEPs are documents created by your child's school (with your input) that spell out which special education services your child will receive.

Prognosis

The prognosis for children with expressive language disorder largely depends on the underlying causes, as well as getting prompt diagnosis and treatment.

Children who do not display other motor skill problems or coordination delays, as well as those who have only biological causes (such as malnutrition), often progress through treatment rapidly and overcome their language delay remarkably well.

Others who have other complicating factors may take longer to improve, but with consistent treatment and compassionate care from caregivers and educators, they can learn to communicate increasingly well.

Among children who receive speech therapy and other services for expressive language disorder, some may still experience academic challenges throughout their school years and even into adulthood. The areas of reading, writing, spelling, and oral presentations can be the most difficult.

This is one of the reasons for ongoing discussion about whether the label of disorder or learning disability is the most appropriate for this condition.

Myths

It's important for everyone working with a child with an expressive language disorder—both at school and at home—to realize that the child is able to understand what is said around them, as this is often not obvious from their speech or written words.

Being misunderstood can be extremely frustrating for the child and may result in a number of negative emotions, ranging from sadness to anger.

People with expressive language disorder may appear less capable than they really are because they cannot effectively express themselves.

Except in rare cases, their understanding of language and subjects in school is often as well-developed as that of other learners their age. In other words, expressive language disorders do not usually reflect anything about a child's intelligence.

Children who speak in more than one language will have the same problems using expressive language in all the languages they speak.

Coping With an Expressive Language Disorder

Dealing with communication difficulties and feeling misunderstood, which are often the experience of children with expressive language disorder, can be very frustrating. When an expressive language disorder goes undiagnosed, children may have further problems such as decreased self-esteem, social isolation, and learning disabilities.

Caring for a child with this disorder requires a comprehensive approach that addresses not only language development, but also social, emotional, and academic issues.

Counseling may be very helpful as a child copes with the social issues related to their disability. Other measures oriented towards increasing a child's self-esteem are also important.

Ways to Reduce the Risk of a Language Disorder

The years between birth and age 3 appear to be the most critical in the development of language. During this period of your child's life, it is important to continually expose them to a variety of sounds, speech, language, and sights to encourage the growth of connections in the brain that are related to language and speech development.

Because low birth weight, fetal alcohol syndrome, and malnutrition can also play a role in language disorders, making healthy choices during pregnancy and receiving prenatal care may lower your child's risk of developing this disorder.

Next Steps for Caregivers

If you are concerned that your child or loved one may have an expressive language disorder and/or a learning disability that requires special education, contact your pediatrician, school principal, or school counselor for information on how to request an assessment.

For students in college and vocational programs, their school's advising office can assist with finding resources to help ensure their success. Students with expressive language deficits and learning disabilities will need to develop self-advocacy skills, which can be challenging when they already have a hard time communicating.

The importance of supportive parents and other caregivers cannot be overstated in helping these students learn to thrive and feel comfortable speaking for themselves.

Visit the ASHA online directory to find an SLP near you, or call 800-638-8255.

With a referral from an educator or doctor, your child may be able to receive low-cost or free speech therapy services.

A Word From Verywell

While expressive language disorder can be frustrating for both you and your child, know that it is a common condition and there are many resources available to help.

Your child's doctor and educators can get you connected with speech therapists and other professionals to provide treatments that will help your child thrive in school and into adulthood.

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Article Sources
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