If you suspect your child may have a language disorder, it’s important to recognize the signs and underlying causes. You’ll want to know the necessary steps to get a diagnosis — and how to get her the learning supports she’ll need to thrive.
When young children are first learning to speak, parents often hear them say words in the wrong tense, or produce sentences with mixed-up word order. If these speech patterns persist past a certain age, they may indicate a language disorder. You’ll want to learn the symptoms, diagnostic process, and early interventions — so you can advocate for her now and going forward.
Language disorders have different names, depending on which organization is speaking about them. The American Speech-Language-Hearing Association (ASHA) calls them “Spoken Language Disorders,” but notes the strong link between oral language and writing. Researchers tend to refer to them as “Specific Language Impairments” (or SLIs). The term “language disorder” refers to any difficulty with spoken language that is not due to a cognitive, hearing, or motor impairment. Language disorders can be “expressive” (i.e., characterized by trouble producing words or sentences), “receptive” (i.e., characterized by trouble understanding words or sentences), or “mixed receptive-expressive.”
It is important to note that language errors that result from bilingualism are not indicative of language disorders. Similarly, certain dialect variations expressed in spoken language are also not considered language disorders.
Children with a language disorder or delay will speak less than their peers, or they may speak in shorter and less complex sentences using fewer conjunctions (words like “but,” “and,” or “instead”). A child with a possible language disorder may also have trouble responding to spoken directions, especially if they contain:
- Directions ordered in time ( “Before you eat your snack, wash your hands.”)
- Concepts organized by location or space ( “Put your socks next to your sweater.”)
- Directions containing descriptive attributes (“Bring me your red, striped sweatshirt.”)
- Instructions with exclusionary terms ( “Bring me all of the forks, except the blue one.”)
Students with language disorders also tend to overgeneralize “regular” morphology — that is, the guiding rules of language — beyond the age of their peers, using phrases such as “I ranned home” or “two feets.”
Children with language disorders may exhibit the following characteristics:
Difficulty with morphology (the endings or tenses of words), including:
- Difficulty with plurals (cat vs. cats, or child vs. children)
- Past-tense verbs (walk vs. walked, or run vs. ran)
- Third-person verbs (I run vs. he runs)
Difficulty with syntax (word order), including:
- Rearrangement of the word order in a sentence
- Transformation of intransitive verbs into transitive ones (“he learned me”)
- Difficulty understanding and/or answering questions
Difficulty with word usage or word finding, including:
- Tendency to take a few seconds to say a word
- Expression of a semantically related word, such as “dog” for “cat”
- Use of under-specific words, such as “this” and “that,” which is a particularly strong sign in children who are not multilingual
- For older children, difficulty with idioms and other figurative language
To learn more about what is normal in young children as they learn to talk, read my article Language Development Milestones: What to Look for in Your Child.
If you notice signs that may indicate a language disorder in your child, here are some factors to consider.
Diagnostician and Testing
Typically, a clinical psychologist, neuropsychologist, or speech language pathologist will conduct an intelligence test and often additional language-based tests. This professional is also likely record a conversation sample and observe your child during play if this is possible and appropriate.
Language tests can be standardized (meaning students are assessed on a bell curve against other children across the country) or criterion-referenced (meaning that children are compared to empirical milestones instead of one another via a bell curve). These tests contain tasks that require children to formulate and respond to different sentence types with different morphology (e.g., “She has just one right foot, but she has two [feet];” “Today, I am eating an apple, but yesterday I (?) [ate] an apple”).
Testing can also include “dynamic assessment,” which evaluates how — and how quickly — children can learn when instructed. (This is important for setting up recommendations for service delivery, i.e., how often a child should receive speech therapy services.) Teacher and parent comments and observations are also typically part of the process.
At the preschool age, length and complexity of verbal utterances and ability to follow directions is assessed. By school age, reading and writing can complement the language testing, which includes more information about vocabulary, more complex syntactic structures, and oral and reading comprehension.
Refer to Noodle’s guide to understanding learning disabilities in children for a more detailed description of the diagnostic process.
Age of Diagnosis
Children can typically be diagnosed with a developmental spoken language disorder (as opposed to one resulting from an injury or traumatic event) between the ages of three and 21 years old. That said, if you are concerned about your child’s language development before the age of three, talk to a speech language pathologist about signs to watch for and possible early interventions.
Older children and adults are typically only diagnosed with a language disorder following a stroke or traumatic brain injury.
According to ASHA, five to eight percent of children have a language disorder or delay, with a slightly higher incidence among boys. Diagnoses are more or less equally distributed among the receptive, expressive, and mixed receptive-expressive types of language disorders.
A language delay occurs in children who are developing at a slower rate than their peers, while a language disorder occurs in a child who is developing in a different order than her peers, or who demonstrates unexpected language patterns. While these terms refer to different issues in learning language, children with either a delay or a disorder will benefit from interventions. For this reason, professional organizations group the two together when they report prevalence figures.
The Brain and Language Disorders
Spoken language is typically generated in the frontal left portion of the brain known as “Broca’s area.” Most brain scans of people with language disorders have been conducted on adults with aphasia (a language disorder that typically results from a stroke), and indeed, these studies show that individuals who have difficulty speaking tend to have visible damage in their frontal left neurological regions. Oral comprehension is typically processed in the left occipito-parietal brain region (by our ears, unsurprisingly), in a section known as “Wernicke’s area.”
Recognition of the Positives
While language disorders present challenges, there are positives that go along with associated interventions:
Language disorders are often treatable with speech language therapy, trained teachers, and/or special education teachers. These professionals or teams will help students develop their vocabulary as well as word and sentence structure. ASHA notes that approximately 70 percent of preschoolers who received services for a language disorder demonstrated gains in at least one area, with earlier intervention leading to higher success rates.
Language disorders often co-occur with other learning disabilities. Since young children can receive supports for language disorders, other learning disabilities may also be addressed through these early interventions.
Interventions are designed by a speech language pathologist and, according to ASHA’s recommendations, should include functional, real-life communicative acts as much as possible. Speech therapy and homework may include:
Scaffolded sentences: This entails providing the beginnings of sentences to model proper word order and sentence types so as to help a child’s syntax. For example, when asking about your child’s day, you can begin with, “I went to...” or “I learned...” or “At school, I...”
Direct contrasts, ideally addressed through natural settings: For example, a child who has difficulty differentiating between “he” and “she” might participate in a play-based activity with Dora and Diego and need to use the appropriate pronouns in order to narrate her play accurately and receive the doll (or other toy) that she would like.
Strategy instruction (for older students): This entails asking for repetition or clarification if students do not understand a direction, whether it’s spoken or written; creating a graphic organizer, such as a web for vocabulary words to brainstorm related words; and following a model sentence to aid the development of word order and sentences.
Expanded utterances (especially for younger children): This involves adding to whatever a child says through repetition and expansion. For example, if your child says, “red car,” you reply, “Yes, that’s a big red car, and it’s going toward the bridge.”
In the classroom, a speech language pathologist can assist teachers in modifying their language, a process that may include:
- Simplifying vocabulary and sentence structure
- Repeating instructions
- Asking more literal than inferential questions
- Providing sentence starters to help students understand how to respond to questions
- Providing visual supports
Parents can help, too! According to ASHA, evidence indicates that it’s “important that parents be involved in interventions to improve communication” — so be sure to follow through on the homework your speech language therapist, special education teacher, or other educator assigns.
Noodle has a range of articles on language disorders and support for your child's development, including:
- Language Development Milestones: What to Watch for in Your Child
- I Suspect My Preschooler Has a Learning Disability
- How to Choose a Preschool: Which Program Philosophy Is Right for Your Child?
- Tools to Help Kids with Autism Spectrum Disorder, which includes information about assistive technology used to facilitate communication
The following outside resources are from well-established authorities in the field of language disorders. You will find in-depth coverage here:
- Parent Hub’s Speech and Language Impairments page
- Reading Rockets tips for books that develop language
- ASHA FAQ about school-aged children and language disorders
- ASHA Language in Brief about defining different parts of language
Crinion, J., Holland, A., & Copland, D., et al. (2013). Neuroimaging in aphasia treatment research: Quantifying brain lesions after stroke. NeuroImage, 73, 208-214. Retrieved March 15, 2015, from ScienceDirect.
Kean, M. (n.d.). The brain. Retrieved March 22, 2015, from Rohan, San Diego State University.
Spoken Language Disorders. (n.d.). Retrieved March 15, 2015, from American Speech-Language-Hearing Association.
Spoken Language Disorders: Overview. (n.d.). Retrieved March 13, 2015, from American Speech-Language-Hearing Association.
Treatment Efficacy Summary. (n.d.). Retrieved March 12, 2015, from American Speech-Language-Hearing Association.