The Diagnostic and Statistical Manual of Mental Disorders - 4th Edition (DSM-IV, 1994) gives criteria for Receptive and Mixed Expressive/Receptive Language Disorder. Speech and language problems fall into two categories: receptive and expressive. Any child who has difficulty understanding language will also have problems with expression, but some children have good receptive skills while being unable to formulate their thoughts and feelings into spoken language. For this reason,
- Receptive language disorder
means the child has difficulties with understanding what is said to them. The symptoms vary between individuals but, generally, problems with language comprehension usually begin before the age of four years. Children need to understand language before they can use language effectively. In most cases, the child with a receptive language problem also has an expressive language disorder, which means they have trouble using spoken language.
It is estimated that between three and five per cent of children have a receptive or expressive language disorder, or a mixture of both. Other names for receptive language disorder include central auditory processing disorder and comprehension deficit. Treatment options include speech–language therapy.
There is no standard set of symptoms that indicates receptive language disorder, since it varies from one child to the next. However, symptoms may include:
- Not seeming to listen when they are spoken to
- Lack of interest when story books are read to them
- Inability to understand complicated sentences
- Inability to follow verbal instructions
- Parroting words or phrases (echolalia)
- Language skills below the expected level for their age.
The process of understanding spoken language
Understanding spoken language is a complicated process. The child may have problems with one or more of the following skills:
- Hearing - a hearing loss can be the cause of language problems.
- Vision - understanding language involves visual cues, such as facial expression and gestures. A child with vision loss won’t have these additional cues, and may experience language problems.
- Attention - the child’s ability to pay attention and concentrate on what’s being said may be impaired.
- Speech sounds - there may be problems distinguishing between similar speech sounds.
- Memory - the brain has to remember all the words in a sentence in order to make sense of what has been said. The child may have difficulties with remembering the string of sounds that make up a sentence.
- Word and grammar knowledge - the child may not understand the meaning of words or sentence structure.
- Word processing - the child may have problems with processing or understanding what has been said to them.
Treatment options: The child’s progress depends on a range of individual factors, such as whether or not brain injury is present. Treatment options can include:
- Speech-language therapy
- One-on-one therapy as well as group therapy, depending on the needs of the child
- Special education classes at school
- Integration support at preschool or school in cases of severe difficulty
- Referral to a mental health service for treatment (if there are also significant behavioural problems).
Expressive language disorder
A child with receptive language disorder may also have expressive language disorder which means they have difficulties with using spoken language. Expressive Language Disorder is a language or communication speech disorder where the individual has difficulty in verbally expressing himself. Generally, comprehension of language is better than its expression in such cases. The person fumbles for using correct grammar, tenses, structure, vocabulary, etc., and the speech becomes hesitant. It is of two types:
- Developmental: This is seen in children. There is no specific cause for this disorder and is believed to affect boys more than girls.
- Acquired: It is acquired by an individual post stroke or head injury in adulthood.
- Frequently grasping for the right word
- Using the wrong words in speech
- Making grammatical mistakes
- Relying on short, simple sentence construction
- Relying on stock standard phrases
- Inability to ‘come to the point’ of what they’re trying to say
- Problems with retelling a story or relaying information
- Inability to start or hold a conversation.