Manhattan, NYC, Expressive Language Delay
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Even before children learn to talk, they understand a lot more than what they can speak. As they continue to develop their communication skills and meet language milestones, they begin to put their thoughts and feelings into words. But in some cases, a child may find it difficult to find the words to express themselves and have trouble speaking with others. If a child is having significant expressive language issues compared to peers, this is known as an expressive language disorder (also known as spoken language disorder) or an expressive language delay (for children 4 years and younger).
One of the ways that children express themselves is through narratives. Acquiring narrative skills is crucial as young children begin to expand their use of language and communication by retelling or describing stories, experiences, or past events. Narrative development is directly correlated with a child’s success in school and academic achievement.
Typically developing children commonly acquire all grammatical morphemes by age four (see chart below). But for children struggling with narrative language, parents may notice some delays or missing aspects in their child’s language skills. At Manhattan Letters, we work with students who struggle with narrative development.
Read about Early Childhood Developmental Milestones.
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Narrative Development in Children
According to research, narrative development can play a significant role in determining a child’s later success in school and literacy. This is because narration and relaying a previous experience allow the child to communicate and use language beyond the present context or the “here and now.” This determines the child’s grasp of linguistic structure and words chosen. But what exactly is narrative development? And how do you know your child’s progress is appropriate for his or her age?
A child’s narrative skills refer to his or her ability to use speech and language in telling or communicating a story. As children develop their narrative skills, they learn to follow the rules of story-telling. This involves sequencing of events, organization, introducing characters, establishing the plot or main idea, and taking perspectives.
Narrative skills are first developed and introduced in very young children through storytelling or bedtime story sessions with their parents.
By listening to stories and being exposed to story-telling, children begin to understand and develop narrative structure. In most cases, children with language impairments or conditions struggle with comprehending and executing narratives. At Manhattan Letters, we work with children who have narrative speech and language difficulties.
What is an Expressive Language Disorder?
Unlike speech sound disorders, which involve difficulties in producing spoken sounds, language disorders refer to problems using spoken language compared to peers. These expressive problems manifest in at least one of these areas: spoken vocabulary, complexity of what the child is saying (grammar), and social use of words (pragmatics). These issues become more apparent when children, older than 4 years of age, have difficulties telling stories and making friends.
Expressive Language Delays or Disorders are classified into two types:
Mixed Receptive-Expressive Language Disorder – Difficulty with comprehension or understanding the words or complexity of what the individual understands compared to peers and has an expressive language disorder.
Expressive Language Disorder – Receptively, the individual is age-appropriate but there are significant issues expressing oneself (speech and language) compared to peers.
There is no such thing as just a receptive language disorder. If a child is misdiagnosed with this label, either the child has significant attentional difficulties or the child’s expressive language skills were not thoroughly assessed. Speech language pathologists are the best professionals to thoroughly assess expressive language skills.
Spoken or expressive language disorder is a lifelong condition and appears in early childhood. It is often developmental in nature but may also be caused by traumatic brain injury. Children with expressive language disorder exhibit normal comprehension skills but have difficulty with written and/or verbal expression. This can impair academic achievement and make it more difficult to socialize in groups with peers.
Causes of Expressive Language Disorder
The exact cause of expressive language disorder is not entirely known, but it can either be a primary disability or be related to other disorders. Some of the common conditions associated with language disorders are:
- developmental disorders such as autism
- brain injury or tumor
- birth defects (Down syndrome, cerebral palsy)
- pregnancy or birth problems due to poor nutrition, fetal alcohol syndrome, premature birth, or low birth weight
- hearing loss caused by ongoing ear infections
- genetics or family history
But, most of the time, the cause is unknown.
What Are the Signs of an Expressive Language Disorder?
Depending on the age, linguistic development, and affected language domains, the signs of an expressive language delay or disorder can vary among individuals. In children with expressive language disorder, these symptoms can manifest in a variety of ways and affect the following language domains:
Phonology – The ability to recognize and work with sounds in spoken language, e.g. rhyming or playing around with sounds.
Syntax – Another word for grammar.
Morphology – A specific type of grammar dealing with units of words called morphemes.
Semantics – Vocabulary.
Pragmatics – Using appropriate language (including nonverbal communication) in social situations and daily interactions.
In many cases, signs of an expressive language delay or disorder may not be obvious to parents and teachers. Some signs and behaviors may not directly imply a language problem. Children with an expressive language disorder may:
- have less developed vocabulary than their peers
- often say fillers like “um,” “uh,” and “huh”
- have no problems with understanding, but struggle with speaking, asking questions, or answering
- use short phrases or sentences or say the same words or phrases over and over;
- struggle with telling stories
- for toddlers, relies on using gestures
- lack intonation and modulation when talking
- shy away from conversation and avoid social situations or group interactions
- may say a lot but not make much sense
Because expressing thoughts, feelings, and ideas is a huge struggle for children with expressive language disorder, this may further lead to problems with their self-esteem and confidence. At school, it can be challenging for children to connect with teachers and classmates. They may also find it difficult to participate in class discussions, answer questions, or do written work.
Diagnosing Expressive Language Disorder
As with any speech and language disorder, it is always important to first ensure that there are no hearing issues affecting language development. A hearing assessment by an audiologist is necessary to rule out any issues with hearing (ears). Even undetected ear infections can interfere with acquiring language in younger children.
To get your child diagnosed with an expressive language delay or disorder, a speech and language pathologist (SLP) or speech therapist must do a thorough evaluation. A comprehensive assessment must be conducted with the help of the child’s family and teachers. This evaluation process includes both informal and formal assessments. Formal evaluation comes in the form of standardized tests, while informal evaluation involves interviews, observations, checklists, and language samples.
While both types are essential in providing accurate diagnosis and appropriate treatment goals, it is the language sample that provides a clearer picture of the child’s language abilities and conversational skills. Through language sampling, an SLP is able to gain better understanding of the child’s strengths and weaknesses with regards to key language areas. These areas include syntax or grammar, semantics or word meanings, morphology (suffixes and prefixes), and pragmatics or social skills.
Our SLPs at Manhattan Letters conduct language sampling in order to accurately diagnose and assess the needs of your child using the Systematic Analysis of Language Transcripts or SALT program. The typical expressive language development in young children, aged 12 months to 47 months onwards, is outlined in the Acquisition of Sentence Forms Within Brown’s Stages of Development. This framework is an invaluable tool used by SLPs in conducting a structural analysis of a language sample.
(Related: Find out more about language sampling in this article on the Structural Analysis of a Language Sample.)
During this phase, speech language pathologists will need to know the child’s:
- full case history (including birth and medical records; history of language, speech, reading, or academic difficulties in the family; languages or dialects spoken at home; and, the family’s and teacher’s own observations and concerns)
- spoken language skills (phonology and phonological awareness, semantics, morphology, syntax, and pragmatics)
- level of reading and writing (if the child is school age)
How to Treat Expressive Language Disorder
Once a diagnosis is made, the speech-language therapist will conduct further analysis and observations before creating an individualized program for children with expressive language delay. However, it is important to remember that therapy will not offer a permanent “cure” for the disorder. Instead, SLPs can equip children with strategies and techniques to enhance language development and help them manage their condition.
Speech therapy methods can vary, depending on the therapist and the child’s needs. Modeling target behavior is one technique where the therapist models and reinforces aspects of speech that need to be targeted, such as sounds, vocabulary, and grammatical structure.
Some areas of language development where SLPs can help children with expressive language delays or disorders include:
For preschoolers (ages 3 to 5):
- enhancing phonological awareness through rhyming, blending, and segmenting spoken words
- improving vocabulary and understanding of semantic relationships
- increasing sentence types, length, and complexity
- improving conversational skills
- developing narrative skills
- increasing language flexibility in different contexts
- building and encouraging literacy skills
For elementary school children (ages 5 to 10)
- enhancing phonological awareness
- improving understanding and depth of vocabulary
- understanding figurative language and ambiguities (words with multiple meanings, ambiguous sentence structures)
- paraphrasing information and comprehension
- using more advanced morphology (prefixes, suffixes)
- formulating more complex sentence structures
- judging and correcting grammar and morphological errors
- using language to convey politeness, persuasion, and clarification
- increasing knowledge and skills on a discourse level
- making contributions to discussions and repairing conversational breakdowns
- learning what and what not to say and when and when not to talk
- Narrative Intervention: Principles to Practice
- Sketch and Speak: An Expository Intervention Using Note-Taking and Oral Practice for Children With Language-Related Learning Disabilities
- Looking at Expository Discourse Across the Grade Levels
- Expository Discourse Intervention for Adolescents With Language Disorders
Manhattan Letters also offers the following services:
- School Age Expressive Language
- Early Childhood Expressive Language
- Receptive Language Disorder
- Vocabulary Intervention
- Listening Difficulties (auditory and language processing)
- Writing & Speaking Intervention
- Comprehension- Listening & Reading Intervention
- Social Skills
- Developmental Language Disorder
- A 200-Year History of the Study of Childhood Language Disorders of Unknown Origin: Changes in Terminology by Laurence B. Leonard
- Clinical Lessons From Studies of Children With Specific Language Impairment by Mabel L. Rice
- Children’s Language Disorders: What’s in a Name? by Rhea Paul
- Considering the Language Disorder Label Debate From a School Speech-Language Pathology Lens by Kimberly A. Murza and Barbara J. Ehren