Language Disorder

Many young children have difficulty with communication at some time in their lives. Most will eventually catch up. However, some will continue to have problems. Communication disorders include speech disorders and language disorders. Language disorders are discussed in this article. Some general guidelines are also given. This will help you decide if your child needs to be evaluated by a speech-language pathologist.  

When a child has difficulty getting his meaning across using speech, writing, or even gestures, we may be seeing a language disorder. Some children have a language disorder even though they produce sounds well and have understandable speech. Difficulty expressing meaning to other people is called an expressive language disorder.  Difficulty understanding other speakers is called a receptive language disorder. A child might have difficulties with both.  This is what is called a mixed receptive-expressive language disorder.

Receptive Language Disorder

A child may have difficulty understanding the words or sentences used by others. Or the child may seem to show poor attention to speech. This may cause difficulty following spoken directions.  It may also lead to problems with learning.

Expressive Language Disorder

A child may have difficulty coming up with the right words when talking.  The child may be unable to join words correctly into sentences. The child may have a small vocabulary or the child may use words incorrectly. He or she may speak using short, “telegraphic” phrases, leaving out small but important words, or the child may put sentences together incorrectly.

For both types of language disorder, the main problem may be with content (that is, words and their meanings), form (grammar or word order), or use (the ability to understand and use language appropriately).

Causes of language disorders may include hearing loss, cognitive disability, emotional disturbance, a lack of exposure to language in the environment, or brain injury. Often, the cause of a language problem in a particular child is unknown.

  • If the child does not use any words by 16-18 months
  • If, by 18 months, the child cannot follow simple instructions such as, “Give me your shoe,” or cannot point to body parts or common objects when asked
  • If the child has not started combining words by the age of 2
  • If the child does not use any complete sentences by the age of 3
  • If, at 3, the child imitates or “echoes” parts of questions or commands instead of responding properly.  For example, if when asked, “What's your name?” the child says, “Your name!”
  • If sentences are still usually short or jumbled by the age of 4
  • If, by 4, the child often uses words incorrectly.  Or if the child uses a related word instead of the one he or she meant. For example, a child may say “cut” for “scissors,” or “dog” for “cow.”

A child may be at risk for a communication disorder if there is a history of cleft lip or cleft palate; craniofacial anomalies; velopharyngeal insufficiency; dental malocclusion; oral-motor dysfunction; neurological disease or dysfunction; brain injury; respirator dependency or respiratory compromise; tracheostomy; vocal fold pathology; paralysis or paresis of the vocal folds; developmental delay; autism; prematurity or traumatic birth; hearing loss or deafness. Note: Ankyloglossia (tongue-tie) rarely causes speech or language problems.

Early intervention is very important for children with communication disorders. Treatment is best started during the toddler or preschool years.  These years are a critical period of normal language learning, and strong speech habits have not yet been formed. The early skills needed for normal speech and language development can be evaluated even in infants. At that age, the speech-language pathologist works with the parents on stimulating speech and language development in the home. Active treatment in the form of individual therapy is usually begun between the ages of 2 and 4.

If there is a concern about the child’s communication skills at any age, this should first be discussed with the child’s doctor. The doctor will likely refer the child to a speech-language pathologist for evaluation and treatment. All children with language disorder should also have their hearing tested.

Children learn speech and language skills by listening to the speech of others, and practicing as they talk to others. Parents are the most important teachers for their child in the early years. They can help the child by giving lots of opportunities to listen to speech and to talk. This can be done by frequently pointing out and naming important people, places and things. They can also read to the child and talk to the child throughout the day, especially during daily routines, interactive play and favorite activities. Parents can give the child models of words and sentences to repeat. Parents can also set up opportunities for the child to answer questions and talk. Listening to music, singing songs, and sharing nursery rhymes and finger play are also great ways to build speech and language while having fun with your child.

For more information, contact the Division of Speech-Language Pathology, 513-636-4341.

Last Updated 01/2016