Speech and language disorders refer to problems in communication and related areas such as oral
motor function. These delays and disorders range from simple sound substitutions to the inability to
understand or use language or implement oral-motor for functional speech and feeding.

Speech disorders may be problems with the way sounds are formed, called articulation or
phonological disorders, or they may be difficulties with the pitch, volume or quality of the voice.
There may be a combination of several problems. People with speech disorders have trouble using
some speech sounds, which can also be a symptom of a delay. All communication disorders may
adversely affect a child's educational performance.

Developmental expressive language disorder is a disorder in which a child has a poor
understanding of vocabulary, the production of complex sentences, and recall of words. Receptive
– expressive disorder is one in which both the receptive and expressive areas of communication
may be affected in any degree, from mild to severe.

There are several different types of communication disorders, including the following:

•        Expressive language disorder
Expressive language disorder identifies developmental delays and difficulties in the ability to
produce speech.

•        Mixed receptive-expressive language disorder
Mixed receptive-expressive language disorder identifies developmental delays and difficulties in the
ability to understand spoken language and produce speech.

In a language disorder a child has the inability to understand and/or use words in context, both
verbally and nonverbally. Some characteristics of language disorders include improper use of
words and their meanings, inability to express ideas, inappropriate grammatical patterns, reduced
vocabulary and inability to follow directions. One or a combination of these characteristics may
occur in children who are affected by language learning disabilities or developmental language
delay. Children may hear or see a word but not be able to understand its meaning. They may have
trouble getting others to understand what they are trying to communicate.

A child's communication is considered delayed when the child is noticeably behind his or her peers
in the acquisition of speech and/or language skills. Sometimes a child will have greater receptive
(understanding) than expressive (speaking) language skills, but this is not always the case.

Signs of receptive-expressive language disorder

The following are the most common symptoms of communication disorders. However, each child
may experience symptoms differently.

•        May not speak at all, or may have a limited vocabulary for their age

•        Has difficulty understanding simple directions or are unable to name objects

•        Shows problems with socialization

•        Inability to follow directions but show comprehension with routine, repetitive directions

•        Echolalia (repeating back words or phrases either immediately or at a later time.)

•        Inappropriate responses to "wh" questions

•        Difficulty responding appropriately to: yes/no questions, either/or questions, who/what/where
questions, when/why/how questions

•        Repeats back a question first and then responds to them

•        High activity level and not attending to spoken language

•        Jargon (e.g. unintelligible speech)

•        Uses "memorized" phrases and sentences

•        They may have a problem with words or sentences, both understanding and speaking them

•        Learning problems and academic difficulties

While many speech and language patterns can be called "baby talk" and are part of a young
child's normal development, they can become problems if they are not outgrown as expected. In
this way an initial delay in speech and language or an initial speech pattern can become a disorder
which can cause difficulties in learning. Because of the way the brain develops, it is easier to learn
language and communication skills before the age of 5. The symptoms of communication disorders
may resemble other problems or medical conditions. Always consult your child's physician for a

Possible causes

Communication disorders may be developmental or acquired. The cause is believed to be based
on biological problems such as abnormalities of brain development, or possibly by exposure to
toxins during pregnancy, such as abused substances or environmental toxins such as lead. A
genetic factor is sometimes considered a contributing cause in some cases. Some causes of
speech and language disorders include hearing loss, neurological disorders, brain injury, mental
retardation, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or
misuse. Frequently, however, the cause is unknown.

For unknown reasons, boys are diagnosed with communication disorders more often than girls.
Children with communication disorders frequently have other developmental disorders as well. Most
children with communication disorders are able to speak by the time they enter school, however,
they continue to have problems with communication. School-aged children often have problems
understanding and formulating words. Teens may have more difficulty with understanding or
expressing abstract ideas.

Diagnosis for receptive-expressive language disorder

Most children with communication disorders are first referred for speech and language evaluations
when their delays in communicating are noted. A child psychiatrist is usually consulted, especially
when emotional or behavioral problems are also present. A comprehensive evaluation also
involves psychometric testing (testing designed to assess logical reasoning abilities, reactions to
different situations, and thinking performance; not tests of general knowledge) and psychological
testing of cognitive abilities.

There’s variety of language disorders for example receptive language may be mildly delayed and
expressive language may be severely delayed. Knowing the type of mixed receptive-expressive
language delay is important because the split may impact academics. For one the child may exhibit
severely delayed receptive language skills and only mildly delayed expressive language. The
receptive language difficulties will most likely have a significant impact on being able to follow
directions and understand classroom instruction. This child will need extra help (written directions,
one-on-one time) in order to be successful.

Many speech problems are developmental rather than physiological, and as such they respond to
remedial instruction. Language experiences are vital to a young child's development. In the past,
children with communication disorders were routinely removed from the regular class for individual
speech and language therapy. This is still the case in severe instances, but the trend is toward
keeping the child in the mainstream as much as possible. In order to accomplish this goal,
teamwork among the teacher, speech and language therapist, audiologist, and parents is
essential. Speech improvement and correction are blended into the regular classroom curriculum
and the child's natural environment.

Treatment for communication disorders

A coordinated effort between parents, teachers, and speech/language and mental health
professionals provides the basis for individualized treatment strategies that may include individual
or group remediation, special classes, or special resources. Special education techniques are used
to increase communication skills in the areas of the deficit. A second approach helps the child build
on his/her strengths to overcome his/her communication deficit.

Specific treatment for communication disorders will be determined by your child's physician, special
education teachers, and speech/language and mental health professionals based on:

•        your child's age, overall health, and medical history

•        extent of the disorder

•        type of disorder

•        your child's tolerance for specific medications or therapies

•        expectations for the course of the disorder

•        your opinion or preference

Speech-language pathologists assist children who have communication disorders in various ways.
They provide individual therapy for the child; consult with the child’s teacher about the most
effective ways to facilitate the child’s communication in the class setting; and work closely with the
family to develop goals and techniques for effective therapy in class and at home.

Early detection and intervention can address the developmental needs and academic difficulties to
improve the quality of life experienced by children with communication disorders. The speech-
language pathologist may assist vocational teachers and counselors in establishing communication
goals related to the work experiences of students and suggest strategies that are effective for the
important transition from school to employment and adult life.
Receptive-Expressive Language Disorder
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