Receptive Language Disorder: Signs, Assessment and Support

01Basics

What does receptive language mean?

Receptive language is the ability to understand language: words, sentences and the message coming from others. MedlinePlus explains that children with language disorders may have problems with one or both of two sides of language: understanding the message from others (receptive language disorder) and getting their own message across (expressive language disorder).

Children with a language disorder can produce sounds, and their speech can be understood. The difficulty lies in language itself, not in pronunciation. MedlinePlus says up to 1 in 14 children has symptoms of a language disorder, and that problems with receptive language usually begin before age 4.

02Receptive vs expressive

Understanding versus expressing language

Receptive and expressive language are different skills, although many children have difficulties with both (a mixed language disorder). MedlinePlus describes them like this:

• Receptive: a hard time understanding what other people have said, problems following spoken directions and problems organizing thoughts.
• Expressive: trouble putting words together into sentences, short sentences with unusual word order, difficulty finding words, a smaller vocabulary than peers, leaving words out and misusing tenses.

Language disorders are also different from delayed language. With a delay, the child develops language in the usual way but later; with a disorder, language does not develop in the usual way, and some skills may be present while others are not.

03Signs

Signs of receptive language difficulties

MedlinePlus advises contacting the child’s provider if you notice these signs that a 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
• at 18 months, does not follow simple directions, such as “get your coat”
• at 24 months, cannot point to a picture or a body part when it is named
• at 30 months, does not respond out loud or by nodding or shaking the head
• at 36 months, does not follow 2-step directions or understand action words

In older children and adults with DLD, the NIDCD lists difficulty understanding figurative language, limited use of complex sentences, trouble finding words, reading problems and disorganized storytelling and writing. Language difficulties can be mistaken for behavior problems: a child who does not understand instructions may seem not to follow them on purpose, or seem shy because they avoid conversation.

04Causes

Causes and developmental language disorder (DLD)

When the cause of a language disorder is unknown, MedlinePlus says it is called a developmental language disorder. The NIDCD describes DLD as a communication disorder that interferes with learning, understanding and using language, not explained by hearing loss, autism or lack of exposure to language. It affects about 1 in 14 children in kindergarten and its impact persists into adulthood.

DLD is a neurodevelopmental disorder, and its exact causes are unknown. It tends to run in families: the NIDCD says 50 to 70 percent of children with DLD have at least one family member with it. Language disorders can also occur with other developmental problems, autism, hearing loss, learning disabilities or damage to the brain (aphasia). Some mixed language disorders are caused by a brain injury. MedlinePlus notes that language disorders are rarely caused by a lack of intelligence.

05Hearing and other causes

Hearing, autism and multilingualism

MedlinePlus says a hearing test called audiometry should always be done, because hearing impairment is one of the most common causes of language problems. A child who does not hear well cannot fully understand what is said.

A receptive language difficulty does not automatically mean autism. Autism is one condition in which language disorders can occur, but DLD is defined as a language problem not explained by autism, so the assessment has to look at the whole picture. Our guide on speech delay vs autism discusses that difference.

Learning more than one language does not cause DLD, and the NIDCD says learning several languages is not harmful for a child with DLD. In multilingual children, DLD affects all the languages they speak, which is why assessment should consider each language, not only one.

06Assessment

How receptive language is assessed

A speech-language pathologist (speech and language therapist) evaluates language skills. The NIDCD explains that the evaluation depends on the child’s age and concerns and generally includes direct observation, interviews and questionnaires for parents or teachers, assessment of learning ability, and standardized tests of current language. MedlinePlus adds that standardized receptive and expressive language tests can be given by a speech and language therapist or a neuropsychologist, and that a neurologist or developmental specialist may be involved.

Each term answers a different question: a receptive difficulty describes what the person struggles with; DLD is a diagnosis made when other explanations, such as hearing loss, have been ruled out; a hearing test checks for hearing loss; and aphasia refers to language lost because of brain damage. The assessment clarifies which applies.

07Support

Therapy and everyday support

Speech and language therapy is the best approach to treating language disorders, according to MedlinePlus, and talk therapy may also be recommended because of possible emotional or behavioral problems. The NIDCD says treatment depends on age and needs. For young children it can help build understanding and use of words and social communication; for school-age children it may focus on understanding classroom instructions, following directions, understanding the words teachers use and organizing information.

Families and schools are part of the support. Telling teachers about the difficulty helps them avoid interpreting it as misbehavior. Adults entering new jobs or study may need help learning technical vocabulary, and many adults develop strategies that improve their social, family and work lives. Children’s therapy is beyond what our centre offers, but in our speech therapy practice in Bilbao we can assess an adult’s understanding and use of language (consultations are in Spanish).

08Outlook

Does a child outgrow it?

The NIDCD explains that DLD appears in early childhood and will likely continue, but change, as children get older; children do not simply grow out of it. Early treatment in the preschool years can improve the skills of many children with language delays, and older children can still benefit. People can benefit from treatment whenever it begins.

MedlinePlus notes that the outcome depends on the cause: children with a brain injury or other structural problems may have long-term difficulties, while more reversible causes can be treated effectively. Many children with preschool language problems still have some language or reading difficulties later.

09Sources

Where the sources differ

Focus. MedlinePlus describes language disorders in children and separates receptive and expressive types. The NIDCD focuses on DLD and describes it across childhood and adulthood, without splitting receptive and expressive forms.

Who assesses. The NIDCD places the evaluation with a speech-language pathologist. MedlinePlus says tests can be given by a speech and language therapist or a neuropsychologist, and that a neurologist or developmental specialist may be needed.

Names. MedlinePlus lists alternative names such as developmental dysphasia and specific language impairment; the NIDCD notes that DLD has also been called specific language impairment, language delay or developmental dysphasia, while MedlinePlus says language disorders are not the same as delayed language.

10Summary

In summary

A receptive language disorder is difficulty understanding language: what others say, spoken directions and complex or figurative language. It often goes with expressive difficulties and is common in developmental language disorder, which affects about 1 in 14 young children and continues into adulthood.

A hearing test and a speech-language assessment are essential, and autism and other conditions need to be considered. Multilingualism does not cause it. Speech and language therapy, together with support at home and school, helps; sudden loss of understanding needs urgent medical care.