Language is the foundation for speaking, listening, reading, and writing.

We evaluate, treat, and remediate underlying language skills. Underlying language skills include sound, vocabulary, and grammar development; these skills significantly affect how we talk, listen, and how we learn to read and write.

Our analysis will target where your child is having difficulty with his or her speech and language development. Pinpointing the underlying difficulties is critical for effective treatment. In addition to Language Processing Expressive & Receptive Therapy, we provide speech therapy for all ages.

Narrative Development in Children

Problems with narrative development is a tell-tale sign of 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 Disorder are classified as 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 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. An individual with expressive language disorder exhibits normal comprehension skills but has difficulty with written and/or verbal expression. This can impair academic achievement and make it more difficult to socialize in groups with peers. 

Signs of an Expressive Language Disorder

Depending on the age, linguistic development, and affected language domains, the signs of an expressive language disorder can vary among individuals. In children, 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 disorder may not be obvious to parents and teachers. In some cases, 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

Diagnosing Expressive Language Disorder

As with all speech or language disorders, 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 disorder, a speech-language pathologist (SLP) 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.

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 SLP will conduct further analysis and observations before creating an individualized program. 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 help them manage their condition. 

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 that SLPs address are:

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