Expressive language disorder

What is expressive language disorder?

Children with expressive language disorder have difficulty conveying or expressing information in speech, writing, sign language or gesture. (For preschool children, the difficulty expressing themselves in writing is not evident, as they have not started formal education.)

Some children are late in reaching typical language milestones in the first three years, but eventually catch up to their peers. These children are commonly referred to as ‘late-talkers’. Children who continue to have difficulty with verbal expression may be diagnosed with expressive language disorder or another language impairment.

Symptoms of expressive language disorder

Children with expressive language disorder have difficulties combining words to form accurate phrases and sentences. For example, a child may not use the correct form of the verb tense (they might say ‘I goed’ when they mean ‘I went’) or they might omit important grammatical words (they might say ‘I going’ when they mean ‘I am going’). 

They typically produce much shorter phrases and sentences than other children of the same age, and their vocabulary (the number of words they know and use) is smaller and more basic. 

Children with expressive language disorder are usually below the average level for their age in:

• putting words and sentences together to express thoughts and ideas
• recalling words
• using language appropriately in a variety of settings with different people (for example, at home, in school, with parents and teachers).

Specific examples of expressive language impairment include:

• a seven-year-old child being unable to join sentences with words like ‘and’, ‘but’ or ‘if’ (such as ‘I went to the movies. I had popcorn’ instead of ‘I went to the movies and had popcorn’ which is a more mature form of expression
• a three-year-old child who speaks in two-word phrases only (such as ‘mummy car’ when they mean ‘That’s mummy’s car.’).

Symptoms of expressive language disorder differ from one child to the next and depend on the child’s age and the degree of the impairment. Common symptoms include:

• making grammatical errors, leaving out words and using poor or incomplete sentence structure (for example, ‘He going work’ instead of ‘He’s going to work’ and ‘I talk’ instead of ‘I can talk’).
• using noticeably fewer words and sentences than children of a similar age
• using shorter, simpler sentence construction than children of a similar age
• having a limited and more basic vocabulary than children of a similar age
• frequently having trouble finding the right word
• using non-specific vocabulary such as ‘this’ or ‘thing’
• using the wrong words in sentences or confusing meaning in sentences
• relying on standard phrases and limited content in speech
• sounding hesitant when attempting to converse
• repeating (or ‘echoing’) a speaker’s words
• being unable to come to the point, or talking ‘in circles’
• having problems with retelling a story or relaying information in an organised or cohesive way
• being unable to start or hold a conversation 
• not observing general rules of communicating with others
• having difficulty with oral and written work, and school assignments.

Treatment for expressive language disorder

Treatment options depend on the severity of the impairment. Treatment may include:

• group sessions with a speech pathologist
• individual therapy sessions with a speech pathologist
• school-based language intervention programs
• assistance from special education teachers
• teacher’s aide support for children with severe language impairment
• speech pathology sessions combined with home programs that parents can use with their child.

Cause of expressive language disorder

For many children, the cause of expressive language disorder is not known. Some children experience difficulties in language development alone, while other areas of their development are progressing as expected. For other children, expressive language disorder is associated with known developmental difficulties or impairments (for example, Down syndrome, autism or hearing loss).

Many children with expressive language disorder will have an accompanying ‘receptive’ language disorder, meaning that they have difficulty in understanding language. 

Expressive language disorder can be a developmental impairment (from birth) or an acquired impairment (occurs after a period of normal development). It can be the result of trauma (such as a knock to the head) or a medical condition. Research suggests that, in some cases, expressive language disorder occurs in more than one family member, and across generations.

Diagnosis of expressive language disorder

If your child is having difficulties with speaking or using language to express themself, it is important to:

• have their language skills assessed by a speech pathologist (sometimes referred to as a speech therapist)
• have their hearing tested by an audiologist

as soon as possible.

(You do not need a referral from your doctor to make an appointment with a speech pathologist or audiologist, although you can ask for one if you prefer.)

Speech pathologists perform specific assessments to identify the areas of language that a child finds difficult. These assessments are not stressful for the child, and parents are usually present during these consultations.

Speech pathologists may also recommend:

• an auditory processing test (this is different to a standard hearing test)
• a test for learning difficulties (for school-aged children)
• an assessment of cognitive function (thinking and intelligence) by a registered psychologist.

Where to get help

• Your doctor
• Your maternal and child health nurse
• A speech pathologist
• Speech Pathology Australia Tel. (03) 9642 4899