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Language disorders in children

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

Language disorders in children are problems with the development of language skills.

Children may have problems with one or both of the following:

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

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

Causes

Most infants and children develop language naturally starting at birth. To develop language, a child must be able to hear, see, understand, and remember. Children must also be physically able to form speech.

Up to 1 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. These conditions are sometimes misdiagnosed as developmental disorders.

Language disorders may occur in children with:

• Other developmental problems
• Autism spectrum disorder
• Hearing loss
• Learning disabilities
• Damage to the central nervous system, which is called aphasia

Language disorders are rarely caused by a lack of intelligence.

Language disorders are not the same as 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

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

Children with a receptive language disorder have problems understanding language. 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
• Use short and simple sentences 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

Children with language problems may have difficulty in social settings. At times, language disorders may be part of the cause of severe behavioral problems.

Exams 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.

A hearing test called audiometry should also be done to rule out hearing impairment, 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.

Counseling, such as talk therapy, is also recommended because of the possibility of related emotional or behavioral problems.

Outlook (Prognosis)

The outcome varies, based on the cause. Children with brain injury or other structural problems may 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.

Possible 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.

When to Contact a Medical Professional

If you are concerned that your child's speech or language is delayed, see your child's doctor. Ask about getting a referral to a speech and language therapist.

Children with this condition may need to be seen by a neurologist or children's developmental specialist to determine if it can be treated.

Contact your child's doctor 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

Centers for Disease Control and Prevention website. Language and speech disorders in children. www.cdc.gov/ncbddd/developmentaldisabilities/language-disorders.html. Updated May 11, 2022. Accessed July 28, 2022.

Simms MD. Language development and communication disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 52.

Trauner DA, Nass RD. Developmental language disorders. In: Swaiman KF, Ashwal S, Ferriero DM, et al, eds. Swaiman's Pediatric Neurology: Principles and Practice. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 53.

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Review Date: 5/2/2022  

Reviewed By: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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