Expressive language disorder is generally a childhood disorder. There are two types of expressive language disorder: the developmental type and the acquired type. Developmental expressive language disorder does not have a known cause and generally appears at the time a child is learning to talk. Acquired expressive language disorder is caused by damage to the brain. It occurs suddenly after events such as stroke or traumatic head injury. The acquired type can occur at any age.

Causes and symptoms

Causes

There is no clearly identified cause of developmental expressive language disorder. Research is ongoing to determine which biological or environmental factors may be the cause. Acquired expressive language disorder is caused by damage to the brain. Damage can be sustained during a stroke, or as the result of traumatic head injury, seizures , or other medical conditions. The way in which acquired expressive language disorder manifests itself in a specific person depends on which parts of the brain are injured and how badly they are damaged.

Symptoms

Expressive language disorder is characterized by a child having difficulty with self-expression using speech. The signs and symptoms vary drastically from child to child. The child does not have problems with the pronunciation of words, as occurs in phonological disorder. The child does have problems putting sentences together coherently, using proper grammar, recalling the appropriate word to use, or other similar problems. A child with expressive language disorder cannot communicate thoughts, needs, or wants at the same level or with the same complexity as peers and often has a smaller vocabulary compared to peers.

Children with expressive language disorder have the same ability to understand speech as their peers and have the same level of intelligence. Therefore, a child with this disorder may understand words but be unable to use the same words in sentences. The child may understand complex spoken sentences and be able to carry out intricate instructions, although unable to form complex sentences.

There are many different ways in which expressive language disorder can manifest itself. Some children do not properly use pronouns, or leave out functional words such as “is” or “the.” Other children cannot recall words that they want to use in the sentence and substitute general words such as “thing” or “stuff.” Some children cannot organize their sentences so that the sentences are easy to understand. These children do comprehend the material they are trying to express—they just cannot create the appropriate sentences with which to express their thoughts.

Demographics

Expressive language disorder is a relatively common childhood disorder. Language delays occur in 10-15% of children under age three, and in 3-7% of school-age children. Expressive language disorder is more common in boys than in girls: studies suggest that developmental expressive language disorder occurs two to five times more often in boys. The developmental form of the disorder is far more common than the acquired type.

Diagnosis

To diagnose expressive language disorder, children must be performing below their peers at tasks that require communication in the form of speech. This can be hard to determine because it must be shown that an individual understands the material but cannot express that comprehension. Therefore, nonverbal tests must be used in addition to tests that require spoken answers. Hearing should also be evaluated because children who do not hear well may have problems putting together sentences, in a way that is similar to children with expressive language disorder. In children who are mildly hearing-impaired, the problem can often be resolved by using hearing aids to enhance the child’s hearing. Also, children who speak a language other than the dominant language of their society (e.g., English in the United States) in the home should be tested in that language if possible. The child’s ability to communicate in English may be the problem, not the child’s ability to communicate in general.

The Diagnostic and Statistical Manual of Mental Disorders , fourth edition, text revision (known as the DSM-IV-TR), states that there are four general criteria for diagnosing expressive language disorder. The first is that the child communicates using speech at a level that is less developed than expected for his or her intelligence and ability to understand spoken language. This problem with communication using speech must create difficulties for the child in everyday life or in achieving goals. The child must understand what is being said at a level that is age-appropriate, or at a developmental level consistent with the child’s. Otherwise the diagnoses should be mixed receptive-expressive language disorder. If the child has mental retardation , poor hearing, or other problems, the difficulties with speech must be greater than is generally associated with the handicaps of the child.

Treatment

There are two types of treatment used for expressive language disorder. The first involves the child working one-on-one with a speech therapist on a regular schedule and practicing speech and communication skills. The second type of treatment involves the child’s parents and teachers working together to incorporate spoken language that the child needs into everyday activities and play. Both of these kinds of treatment can be effective and are often used together.

Prognosis

The developmental form of expressive language disorder generally has a good prognosis. Most children develop normal or nearly normal language skills by high school. In some cases, minor problems with expressive language may never resolve. The acquired type of expressive language disorder has a prognosis that depends on the nature and location of the brain injury. Some people get their language skills back over days or months. For others it takes years, and some people never fully recover expressive language function.

Prevention

There is no known way to prevent developmental expressive language disorder. Because acquired language disorder is caused by damage to the brain, anything that would help to prevent brain damage may help to prevent that type of the disorder. This can include such things ranging from lowering cholesterol to preventing stroke to wearing a bicycle helmet to prevent traumatic brain injury.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text rev. Washington, D.C.: American Psychiatric Association, 2000.

Sadock, Benjamin J., and Virginia A. Sadock, eds. Comprehensive Textbook of Psychiatry, 7th ed. Philadelphia: Lippincott Williams and Wilkins, 2000.

PERIODICALS

Roberts, Joanne E., Richard M. Rosenfeld, and Susan A. Zeisel. “Otitis Media and Speech and Language: A Meta-Analysis of Prospective Studies.” Pediatrics 113 (2004): 238–48.

Stein, Martin T., Steven Parker, James Coplan, and Heidi Feldman. “Expressive Language Delay in a Toddler.” Journal of Developmental & Behavioral Pediatrics 22.2 (April 2001): 99.