Expressive Language Disorder: Signs, Assessment and Support

01Basics

Expressing and understanding language

Language has two sides: understanding what others say (receptive language) and using words to express ideas (expressive language). MedlinePlus describes developmental expressive language disorder as a condition in which a child has lower than normal ability in vocabulary, saying complex sentences and remembering words, while possibly having the normal skills needed to understand spoken or written language.

MedlinePlus says it is common in school-age children. Older terms for this group of difficulties include specific language impairment.

02Vocabulary

Signs in vocabulary and word finding

MedlinePlus explains that children with an expressive language disorder have a hard time getting their meaning or message across to others. Signs it lists include:

• below-average vocabulary skills
• problems remembering words
• problems making complex sentences
• incorrect use of tenses (past, present, future)

NIDCD adds that younger children with developmental language disorder may be late to put words together into sentences and may struggle to learn new words and make conversation; older children and adults may have difficulty finding the right words.

03Grammar

Grammar and organizing ideas

NIDCD describes frequent grammatical errors in younger children and, in older children and adults, limited use of complex sentences, disorganized storytelling and writing, and frequent grammatical and spelling errors.

A simple example of expressive language is a child telling you what happened at school: choosing the words, putting them in order and linking events. A child with expressive difficulties may know what happened but struggle to say it, using short sentences, vague words or mixed-up tenses.

04Speech sounds

How it differs from speech sound problems

Expressive language is about words, grammar and sentences, not about how clearly sounds are pronounced. Neither MedlinePlus nor NIDCD lists pronunciation problems as a feature of expressive language disorder. A child can pronounce sounds clearly and still struggle to build sentences, or the other way round.

Pronunciation is a separate area that a speech-language pathologist assesses on its own. Our speech sound development chart explains that side; a chart of ages, however, is not enough to diagnose either problem.

05Development

Development and varied profiles

Children develop language at different rates. NIDCD notes that children with developmental language disorder (DLD) often have a history of being late talkers, but that some late talkers catch up with their peers, while children with DLD have persistent language difficulties. MedlinePlus says children without other developmental or motor coordination problems have the best outlook, and that many of them have a family history of late language milestones but eventually catch up.

Profiles also vary. MedlinePlus describes expression as the main difficulty, while NIDCD describes DLD as affecting learning, understanding and using language, so some children also have trouble understanding. The labels overlap, but they are not identical.

06Related conditions

Autism, bilingualism and other conditions

Expressive language disorder is not the same as autism. NIDCD defines DLD as language difficulties not explained by other conditions such as hearing loss or autism, or by lack of exposure to language. NIDCD also notes that dyslexia and autism are more common in family members of a child with DLD. Our guide on speech delay versus autism explains how these are told apart.

Learning more than one language does not cause DLD, according to NIDCD. The disorder can affect multilingual and monolingual children, and in multilingual children it affects all their languages. Learning several languages is not harmful for a child with DLD. On causes, MedlinePlus says they are not well understood; brain damage and malnutrition may cause some cases, and genetic factors may be involved.

07Assessment

Professional assessment

If a parent, teacher or doctor suspects a language disorder, NIDCD advises evaluation by a speech-language pathologist. An evaluation generally includes:

• direct observation of the child
• interviews and questionnaires completed by parents or teachers
• assessment of the child’s learning ability
• standardized tests of current language skills

MedlinePlus adds that standardized expressive language tests and nonverbal intelligence tests should be done if the disorder is suspected, and that testing for other learning disabilities may also be needed. A hearing check is part of ruling out other explanations.

08Support

Language therapy and everyday support

NIDCD points out that language difficulties can be mistaken for behavior problems: a child may avoid conversation and seem shy, or not follow instructions because they did not understand them, and may become frustrated. When a child is struggling at home or school, it is worth asking whether language is part of the problem.

At home, the most useful step is to follow the plan agreed with the speech-language pathologist. NIDCD notes that research is also looking at how to coach parents and peers to support language growth at home and at school.

MedlinePlus says language therapy is the best method of treatment, with the goal of increasing the number of phrases a child can use. NIDCD explains that treatment is provided or overseen by a licensed speech-language pathologist and depends on age and needs. In young children it can help them acquire missing grammar, expand their understanding and use of words and develop social communication; in school-age children it may focus on following directions, organizing information and speaking, reading and writing.

Early treatment is ideal, but NIDCD stresses that people can benefit whenever it begins, and adults may need help with technical vocabulary or workplace writing.

09Sources

Where the sources differ

Understanding. MedlinePlus says a child with expressive language disorder may have normal understanding. NIDCD describes DLD as affecting both understanding and use of language. Each child’s profile needs to be assessed individually.

Outlook. MedlinePlus says many children without other developmental problems eventually catch up, and near-full recovery is possible when there are reversible factors such as vitamin deficiencies. NIDCD says children with DLD do not simply grow out of it; the condition usually continues but changes with age, and treatment helps at any age.

Causes. MedlinePlus mentions brain damage, malnutrition and genetics; NIDCD describes DLD as a neurodevelopmental disorder arising from complex interactions between genes and environment, with 50 to 70 percent of children having an affected family member.

10Summary

In summary

Expressive language disorder means difficulty putting thoughts into words: limited vocabulary, trouble remembering words, grammar and tense errors and problems with complex sentences. It overlaps with developmental language disorder but the two labels are not identical, and some children also have trouble understanding.

It is not caused by bilingualism and is not the same as autism. A speech-language pathologist assesses it with observation, questionnaires and standardized tests, and language therapy can help at any age. If you are concerned, seek an assessment rather than relying on age charts.