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Language disorder - children

Language disorder in children refers to problems with either:

  • Getting their meaning or message across to others (expressive language disorder), or
  • Understanding the message coming from others (receptive language disorder)

Some children only have an expressive language disorder. Others have a mixed receptive-expressive language disorder, meaning that they have symptoms of both conditions.

Children with language disorders are able to produce sounds, and their speech can be understood.

Alternative Names

Developmental aphasia; Developmental dysphasia; Delayed language; Specific developmental language disorder; SLI; Communication disorder - language disorder

Causes, incidence, and risk factors

For most infants and children, language develops naturally beginning at birth. To develop language, a child must be able to hear, see, understand, and remember. Children must also have the physical ability to form speech.

Up to 1 out of every 20 children has symptoms of a language disorder. When the cause is unknown, it is called a developmental language disorder.

Problems with receptive language skills usually begin before age 4. Some mixed language disorders are caused by a brain injury, and these are sometimes misdiagnosed as developmental disorders.

Language disorders may occur in children with other developmental problems, autistic spectrum disorders, hearing loss, and learning disabilities. A language disorder may also be caused by damage to the central nervous system, which is called aphasia.

Language disorders are rarely caused by a lack of intelligence.

Language disorders are different than delayed language. With delayed language, the child develops speech and language in the same way as other children, but later. In language disorders, speech and language do not develop normally. The child may have some language skills, but not others. Or, the way in which these skills develop will be different than usual.

Symptoms

A child with language disorder may have one or two of the symptoms listed below, or many of the symptoms. Symptoms can range from mild to severe.

Children with a receptive language disorder have difficulty understanding langugae. They may have:

  • A hard time understanding what other people have said
  • Problems following directions that are spoken to them
  • Problems organizing their thoughts

Children with an expressive language disorder have problems using language to express what they are thinking or need. These children may:

  • Have a hard time putting words together into sentences, or their sentences may be simple and short and the word order may be off
  • Have difficulty finding the right words when talking, and often use placeholder words such as "um"
  • Have a vocabulary that is below the level of other children the same age
  • Leave words out of sentences when talking
  • Use certain phrases over and over again, and repeat (echo) parts or all of questions
  • Use tenses (past, present, future) improperly

Because of their language problems, these children may have difficulty in social settings. At times, language disorders may be part of the cause of severe behavioral problems.

Signs and tests

A medical history may reveal that the child has close relatives who have also had speech and language problems.

Any child suspected of having this disorder can have standardized receptive and expressive language tests. A speech and language therapist or neuropsychologist will administer these tests.

An audiogram should also be done to rule out deafness , which is one of the most common causes of language problems.

Treatment

Speech and language therapy is the best approach to treating this type of language disorder.

Psychological therapy (psychotherapy, counseling, or cognitive behavioral therapy) is also recommended because of the possibility of related emotional or behavioral problems.

Expectations (prognosis)

The outcome varies based on the cause. Brain injury or other structural problems generally have a poor outcome, in which the child will have long-term problems with language. Other, more reversible causes can be treated effectively.

Many children who have language problems during the preschool years will also have some language problems or learning difficulty later in childhood. They may also have reading disorders.

Complications

Difficulty understanding and using language can cause problems with social interaction and the ability to function independently as an adult.

Reading may be a problem.

Depression, anxiety, and other emotional or behavioral problems may complicate language disorders.

Calling your health care provider

Parents who are concerned that their child's speech or language is delayed should see their primary care provider. Ask about getting a referral to a speech and language therapist.

Children who are diagnosed with this condition may need to be seen by a neurologist or children's developmental specialist to determine if the cause can be treated.

Call your child's health care provider if you see the following signs that your child does not understand language well:

  • At 15 months, does not look or point at 5 to 10 people or objects when they are named by a parent or caregiver
  • At 18 months, does not follow simple directions, such as "get your coat"
  • At 24 months, is not able to point to a picture or a part of the body when it is named
  • At 30 months, does not respond out loud or by nodding or shaking the head and asking questions
  • At 36 months, does not follow 2-step directions, and does not understand action words

Also call if you notice these signs that your child does not use or express language well:

  • At 15 months, is not using three words
  • At 18 months, is not saying, "Mama," "Dada," or other names
  • At 24 months, is not using at least 25 words
  • At 30 months, is not using two-word phrases, including phrases that include both a noun and a verb
  • At 36 months, does not have at least a 200-word vocabulary, is not asking for items by name, exactly repeats questions spoken by others, language has regressed (become worse), or is not using complete sentences
  • At 48 months, often uses words incorrectly or uses a similar or related word instead of the correct word

References

Sharp HM, Hillenbrand K. Speech and language development and disorders in children. Pediatr Clin North Am. 2008;55:1159-1173.

Simms MD. Language disorders in children: classification and clinical syndromes. Pediatr Clin North Am. 2007;54:437-467.

Simms MD, Schum RL. Language development and communication disorders, In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap32.

Updated: 6/12/2012

David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine.


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