Expressive Language Disorder

What Causes Expressive Language Disorder?

The cause of ELD is often unclear, but sometimes a neurological, physical, or developmental disorder is an identifiable cause. Possible causes include:

• Autism spectrum disorder
• Hearing loss
• Down syndrome
• Cerebral palsy
• Traumatic brain injury (TBI)
• Stroke
• Brain tumors
• Fetal alcohol syndrome
• Intellectual disabilities

In addition to the causes above, some risk factors may increase the risk of ELD, including:

• Family history of communication disorders
• Premature birth or low birth weight
• Malnutrition

Is Expressive Language Disorder Hereditary?

People with a family history of communication disorders have a higher risk of developing disorders such as ELD, suggesting a possible inherited component to the disorder. However, scientists have not identified a single gene definitively associated with ELD or other communication disorders. Sometimes a genetic predisposition may work in combination with environmental factors to trigger expressive language disorder.

How Is Expressive Language Disorder Detected?

ELD typically begins in childhood as a child is learning how to speak. A certain degree of non-fluency is expected during this early development, making it challenging to spot the earliest signs of the disorder.

Some potential warning signs of ELD include:

• Lack of typical babbling in infancy
• Lack of interaction with others in infancy
• Not using typical gestures (e.g., waving) in early childhood
• Problems interacting with other children in toddlerhood
• Limited vocabulary (fewer than 50 words at the age of 2 years)
• Failure to build sentences
• Lack of interest in books, reading, or drawing

How Is Expressive Language Disorder Diagnosed?

Diagnosis of ELD begins with determining that the patient has a cluster of symptoms that meet the diagnostic criteria for the disorder. A doctor will start with a physical exam to rule out other problems that may be causing the symptoms. After these exams, if the doctor suspects that ELD or another language disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment to solidify the diagnosis.

Diagnostic steps may include:

• A physical exam. This exam aims to rule out physical conditions that could be causing the symptoms.
• Assessment by a speech-language pathologist. This assessment will attempt to understand the person’s ability to speak and understand language.
• Psychological assessments. If no physical or neurological causes can be found, the doctors may use these assessments to determine if the disorder has a psychological cause. The assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

The results of the psychological assessments will be compared to the diagnostic criteria for language disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM criteria for language disorders include:

• The person has problems with language that interfere with communication or cause impairment in social, school, work, or other situations. The difficulties can include limited vocabulary, problems with sentence construction, or difficulties using language appropriately in conversation.
• The person’s language abilities are well below those typical of someone their age.
• The symptoms begin in early childhood.
• The symptoms are not better explained by a neurological problem, a medical disorder, a sensory problem, or another mental health-related issue.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Expressive Language Disorder Treated?

Speech-language therapy is typically the most effective approach to improving ELD symptoms. In cases where an underlying neurological or physical condition causes the disorder, treatment of the underlying condition should also be pursued. If other mental health-related issues, emotional problems, or behavioral issues are present, psychotherapy might be recommended.

How Does Expressive Language Disorder Progress?

Although treatment can help a child to develop their language skills, ELD and other language disorders usually continue into adulthood. Without treatment, the effects of the disorder can cause serious mental health and social issues. Potential complications of ELD include:

• Low self-esteem
• Being bullied
• Problems with schoolwork
• Impairment of social relationships
• Anxiety

How Is Expressive Language Disorder Prevented?

There is no known way to prevent ELD. However, recognizing the disorder early and intervening with treatment may lessen the severity of symptoms.

Expressive Language Disorder Caregiver Tips

Language disorders often exist alongside other mental health and brain-related conditions, a situation called co-morbidity. These disorders are commonly associated with LDs:

• Children with language disorders may be at increased risk of attention-deficit/hyperactivity disorder (ADHD).
• Language disorders may be associated with an increased risk of anxiety or depression.

Expressive Language Disorder Brain Science

Although the cause of a language disorder can often be traced to an underlying neurological or developmental condition, scientists are not entirely sure how such conditions interfere with a person’s ability to use and understand language. Language processing involves many different parts of the brain and relies on processes that neurologists still don’t understand completely.

Some theories on how differences in brain structure and function may cause language disorders include:

• Language disorders may result from a person’s inability to process complex sounds, such as spoken language, quickly enough and they may not be able to remember the sounds sufficiently to process them. These difficulties could stem from structural problems in the brain’s language centers, especially a region on the left side of the brain called Broca’s area, which is instrumental in the production of speech.
• The difficulties might also lie in the basal ganglia, structures deep in the brain that play a role in learning how to produce complex physical processes such as speaking.
• Studies have shown that some children with language disorders have less than a normal amount of brain cells called white matter on the left side of their brains, specifically in an area between the areas responsible for language and motor processing. The deficit of white matter may mean that there are not enough connections between the parts of the brain that process language and those responsible for speech production.

Expressive Language Disorder Research

Title: Maximizing Outcomes for Preschoolers With Developmental Language Disorders

Stage: Recruiting

Principal Investigator: Megan Y. Roberts, PhD

Northwestern University

Evanston, IL  

The objective of the proposed study is to evaluate the efficacy of the Enhanced Milieu Teaching-Sentence Focus (EMT-SF) intervention, implemented by caregivers and interventionists, relative to a control condition enrolling 108 30-month-old children and their caregivers. The central hypothesis is that intervention will improve overall child language skills at 49 months.

A multi-site, phase 2, randomized clinical trial will be used to determine whether communication support strategies are effective for improving language outcomes in children with an emergent developmental language disorder.

At study entry, 108 children with emergent developmental language disorder (DLD) at 30 months of age will be randomly assigned 1:1 to either the EMT-SF treatment condition or a Business as Usual (BAU) control group. The control group is necessary to determine the efficacy of the EMT-SF intervention. The EMT-SF group is necessary to evaluate the effects of systematically teaching caregivers to use these strategies. Because all children in the study have language delays that will make them eligible to receive the early intervention services through the state early intervention program, children in both experimental conditions will receive state-provided community-based intervention according to their Individualized Family Service Plan – the current standard of care or from private speech-language therapy providers. Children in the EMT-SF condition will receive an additional 18 months of interventionist plus caregiver-implemented intervention sessions. Children in both groups will be assessed at the start of the study and every 3 months until the child is 49 months old. The goal is to enroll all children at 30 months of age and provide a minimum of 60 of the planned 66 sessions of intervention to each child in the treatment condition; however, variability in age at study entry (e.g., 30 months), intervention dosage, and the number of assessment data points will be addressed in the statistical analysis.

Title: Retrieval-Based Word Learning in Developmental Language Disorder

Stage: Recruiting

Principal investigator: Laurence B. Leonard, PhD

Purdue University

West Lafayette, IN 

Children with developmental language disorder (DLD, also referred to as specific language impairment) experience a significant deficit in language ability that is longstanding and harmful to the children’s academic, social, and eventual economic well-being. Word learning is one of the principal weaknesses in these children. This project focuses on the word-learning abilities of four- and five-year-old children with DLD. The goal of the project is to build on our previous work to determine whether, as we have found thus far, special benefits accrue when these children must frequently recall newly introduced words during learning. In this first of a series of studies, we seek to increase the children’s absolute levels of learning while maintaining the advantage that repeated retrieval holds over comparison methods of learning.

Title: Determining Optimal Treatment Intensity for Children With Language Impairment

Stage: Recruiting

Principal investigator: Mary Beth Schmitt, PhD

University of Texas

Austin, TX

This study aims to determine the amount of speech-language intervention children with language impairment need to make vocabulary gains. The investigators hope to identify the optimal amount of intervention required and the point at which adding more intervention is no longer beneficial.

Participants will be randomly assigned to attend therapy either once a week for 10 weeks (2 hours a session) or 4 times a week for 10 weeks (30 min per session). Each therapy session will follow a word-learning intervention designed to increase children’s word-learning abilities using rich, robust word-learning strategies within storybook readings.

The optimal amount of intervention relates to duration, dose, and frequency. Duration refers to how long the child is seen (e.g., 10 weeks, 1 year). Dose represents the number of exposures to each new vocabulary word within a therapy session. Frequency represents the number of therapy sessions per week.

The investigators will test the hypothesis that distributed learning leads to higher gains. The investigators propose that the greatest gains will be observed for children who receive high-frequency/low-dose or low-frequency/high-dose treatments as compared to children who receive high-frequency/high-dose or low-frequency/low-dose treatments.

The investigators will test the hypothesis that for both low-frequency and high-frequency treatments, there is a point at which increases in treatment dose do not correspond to any additional gains in children’s vocabulary skills during treatment.

At the close of this four-year study, evidence concerning the optimal treatment intensity of a word learning intervention will be instrumental for immediately informing speech-language pathologists on how much vocabulary treatment to prescribe and for designing additional clinical trials.