What are language disorders? And does my child have one?
Language refers to the symbol system we use to communicate on a daily basis—without really thinking about it, we know that “ball” refers to those spherical things we can throw and bounce, and that putting an “-ed” at the end of regular verb means something already happened. We take our understanding of these symbols and rules pretty much for granted, but it’s something that we had to learn early on in life.
Sometimes kids have a hard time cracking the code, so to speak. There’s a wide range in what’s considered typical development, so what one child may have mastered by his or her first birthday may still be a struggle for another child. When we’re thinking about whether kids need help with language, with get a bit more specific about different skills.
Receptive Language broadly refers to the ability to understand the things that are said to a listener. It’s important to know that a receptive language disorder does not mean there’s anything impaired with a child’s ability to think, it simply means that those rules and symbols may feel a bit like hieroglyphics—they haven’t cracked the code and so they’re not quite sure how what they’re hearing maps on to what they know.
Expressive language, on the other hand, refers to the ability of the speaker to access and manipulate all of these symbols and rules to be able to express wants, needs, or ideas. If expressive language difficulty is very impaired, speakers can have a hard time combining multiple words into sentences. It can also be more subtle, and speakers could struggle with thinking of the word they want to say, or occasionally use incorrect grammatical endings in sentences. Expressive language difficulties may also present as written language challenges, particularly for some students who might struggle with complex language structures that we often use in more advanced grades when writing complex thoughts.
And, some kids have both receptive and expressive language disorders, meaning they struggle with both understanding what’s said to them, and expressing their own ideas.
Within these broad categories, we can also talk about different subskills that make up language abilities.
Phonology refers to the sound system of our languages. For example, in English, the words “lid” and “lip” are two different words with different meanings because they end in two different phonemes. These phonemes are the smallest unit of language that denotes meaning. Some kids struggle with learning these distinctions between sounds. They may struggle receptively, and not be able to hear the difference between words like “lid” or “lip,” or they may struggle expressively and not be able to mark the difference in their own speech. If you’ve ever tried to correct a 4 year old who was telling you about a “wabbit,” you may have gotten an indignant response—“That’s what I said! WABBIT!” This is a classic sign of a kiddo whose receptively phonology is ahead of their expressive phonology, and very very common.
Morphology refers to those grammatical markers we put on words, like possessive -s, plural -s, regular past tense -ed and so forth. If you’ve ever tried to learn a foreign language, you know that these rules can feel never-ending and then learning all of the exceptions–! Definitely a challenge and one that some kids struggle with.
Syntax is sometimes equated with grammar, but more broadly refers to the structure of sentences. All sentences have a syntactic structure that includes things like nouns, verbs, objects, prepositions, and so forth, and every language has rules about how those various components can be arranged. How do we know that “The boy chased the dog” and “The dog chased the boy” mean two different things in English? Because we have an understanding that the subject of the sentence is the agent, and the object of the sentence is being acted upon. And even if we learn the vocabulary to talk about that in school, we already know it implicitly just from having learned English growing up. And this example can get even more complicated—“did you know that the boy had been chased by the dog?” Having a very solid understanding of all the syntactic rules of our language lets us manipulate the words we use in almost unending ways. Understanding and using these syntactic rules can be hard for some kids to master.
Semantics refers to the meaning of words. We know words that have very concrete things they refer to, like “chair.” But we also have more abstract concepts we talk about—things like “love,” “friendship,” and “independence.” We learn what these words refer to through exposure. And, our vocabulary gets built like a sort of card catalog, where we index different words based on meaning, sounds, and relationships to other words we know. Babies and toddlers are primed to learn new words very rapidly—but sometimes kids with a language disorder may struggle with learning new words. It may take more repetition before those words make it into their vocabulary, and they may also have problems retrieving words when they need them.
Pragmatics, or social language, refers to the ability to use all of these subcategories of language in social, functional exchanges. Knowing how to say “Hello,” have to have conversational exchanges back and forth, these types of skills are critical for interacting with others in our day to day life, but can be a struggle for some children.
So, how do we know if a child has a language disorder?
A speech-language pathologist uses a combination of informal observations combined with standardized testing, when appropriate, to determine if a child’s skills fall within the normal range of development, or may require therapy.
As a general rule, we expect language skills to be emerging from birth to around age 4 or 5. This means that there’s a lot of variability in what we expect from kids in these early age groups. After age 5, once kids get to be in school, we more or less expect that they use complete sentences and are able to express themselves to family and other adults and be understood. The farther kids get in school, the more their language skills are really pushed to the max with reading and writing increasingly complex thoughts. So we sometimes keep an eye out for concerns in those domains as we think about language in older kids.
In those first years of life, we want to see constant improvement. Many kids begin to demonstrate their first attempts at language with babbling, which influences their first attempts at phonology and first words. So, around 4-6 months, we hope to hear some syllables like “mamama” or “babababa.” Around 9-10 months, we hope that the baby’s babbling becomes even more sophisticated, with a variety of consonants and vowels like “bidoogida.” This lays the stage for vocabulary growth! Babies should start to demonstrate an understanding of words too—things like calling their name, asking “where’s (sibling or pet name)” should cause them to turn to you or look for the person or familiar object you named. Babies are primed to engage in “joint attention,” which means that you and baby both look at the same object at the same time. This helps with learning new words.
First words typically start emerging around a baby’s first birthday, although there’s a very wide range in vocabulary development. First words are usually very simple, maybe “mama” or “dada” for “mom” or “dad,” and simplifications of adult words like “baba” for bottle. All of these count as words for babies and if a baby is using a handful of these by his or her first birthday—wow! That is excellent language development!
From age 1 to 2 is when we hope babies will be exploding in their vocabulary. We want them to demonstrate use of new words regularly (even if they use it once and then not again for 6 months—this “tabling” happens in typical development and it still counts as a word they use). Young kids also sometimes use one word to refer to many different things. For example, calling all animals by the dog’s name is okay early on in vocabulary development. We also want to see babies at this age start to follow longer directions, like “go get the book” or “throw me the ball.”
A baby’s second birthday is when we start to listen for early sentences. These are typically two word combinations like “mommy up” or “more milk.” Their words are likely still simplified when compared to adult versions, but hopefully they’ve gotten to the point where the number of words they use is more than what you can easily remember. A ballpark of their vocabulary size could be anywhere from 100 to 300 words. This is a common age for toddlers to start therapy for language concerns because we can easily identify small vocabularies or difficulty with following directions or expressing different kinds of thoughts, like commenting versus requesting.
Between age 2 and 3, we like to see more regular two and three word phrases, along with emerging grammatical markers—that “morphological” development signals acquisition of the rules of the language. You might start to hear progressive -ing endings “I sleeping” or “I playing,” use of plurals (who doesn’t always want more “toys” or more “cookies”), use of grammatical words like prepositions (put “on”), and regular past tense -ed endings. Hearing these advancements suggests that kids are developing a robust set of language rules, and often overgeneralize. So you may hear them use -ed endings for all verbs for a while, or they may use some phrases to refer to seemingly different things (for example, one of my kids said “close the door” when he wanted to be held—go figure—but it had a very clear meaning that we all understood, so it counted).
From age 3 to 4, we want to see kids continue to produce longer sentences, increasing to 4 to 5 words in length, expressing more complex and abstract thoughts and using increasing grammatical structure. At these ages, if kids have concerns with language development, a speech-language pathologist will likely conduct more in depth testing to get specific scores for their receptive versus expressive vocabulary and their understanding and usage of grammatical endings of words and different sentence structures.
Once kids turn 4, we more or less expect them to be able to carry on a conversation about pretty much anything they might experience in their 4 year old life without too much difficulty. While they might still have minor differences in pronunciation of some sounds, their speech and language should make them more or less understood by the majority of adults in their life, all of the time. Again, we can keep an eye out for any struggles with more complex language in an academic setting, but for the most part, we don’t expect to encounter many errors in conversation. If your child is 4 or older and is hard to understand, or seems to have a hard time understanding you or telling you what they want or need, that might be a good sign that it’s time to talk to a speech-language pathologist about your concerns. The good news is therapy is effective at improving skills in all of the areas discussed above, and the goal is always to help improve function through increasing language skills!
Do you have questions about possible language issues? Reach out today for a consult!