Receptive Language

Children with receptive language impairments can have difficulty with understanding what is said to them.  Most children with a receptive language disorder will also have an expressive language disorder (difficulty using language to express ideas). Children with a receptive language delay can have difficulty with any of the following:

• Understanding what gestures mean

• Following directions

• Understanding questions

• Identifying objects and pictures

• Taking turns when talking with others

• Understanding the order of words in a sentence

• Understanding grammar such as plurals and verb tenses

• Understanding age-appropriate vocabulary and knowledge about objects

• Understanding the steps and sequence of events

• Understanding the functions of language (e.g. to obtain a desired object, tell a story, ask questions, comment)

• Understanding how to use language to achieve goals (e.g. appropriately using language to get a desired object)

• Carrying out cooperative conversations (e.g. perspective-taking and turn-taking)

Expressive Language

An expressive language disorder is an impairment or set of impairments associated with difficulty speaking, writing, and / or using other symbol systems (i.e. sign language).  Expressive language disorders may be developmental, appearing as the child is learning to talk, or acquired (i.e. traumatic brain injury). Individuals with an expressive language disorder are able to understand language easier than they are able to express it.  Children with expressive language difficulties may have trouble with any of the following:

• Limited vocabulary use

• Excessive use of non-specific vocabulary (i.e. thing, stuff)

• Difficulty defining or describing

• Inability to recall the appropriate word to use

• Poor grammar

• Short or incomplete sentences

• Difficulty telling stories

• Inability to clearly convey a concept or idea

• Problems putting sentences together coherently

Early Literacy

Early literacy difficulties include challenges with phonemic awareness, letter-sound knowledge, and print knowledge, all of which are critical for successful reading and writing. Research has shown that children with language disorders and / or articulation disorders often demonstrate difficulties with literacy skills of varying degrees.

Fluency

Fluency disorders are difficulties with speaking in a fluid, or flowing way.  Children with fluency impairments may say the whole word or parts of the word more than once, or pause awkwardly between words. This is known as stuttering. They may speak fast and run words together, or say “uh” often. This is called cluttering.

These changes in speech sounds are called disfluencies. Many people have a few disfluencies in their speech. But if a child has a fluency disorder, they will have many disfluencies when they speak. For them, talking and being understood may be a daily struggle. 

Social Communication

Social communication disorders are difficulties with the use of verbal and nonverbal language for social purposes.  Children with social communication disorders exhibit difficulties with social interaction, social cognition, and pragmatics. Specific deficits may impact a child’s ability to:

• Communicate for social purposes in ways that are appropriate for the particular social context

• Change communication to match the context or needs of the listener

• Follow rules for conversation and storytelling

• Understand nonliterate or ambiguous language

• Understand what is not explicitly stated

Articulation

An articulation or speech sound disorder is a communication disorder characterized by persistent difficulty with saying speech sounds correctly. All children simplify speech sounds as they are learning to speak, often omitting or substituting sounds.  However, if a child continues to use immature or simplified speech sounds and does not say certain sounds by specific ages, they may have an articulation or speech sound disorder. Only a certified speech-language pathologist is qualified to provide a differential diagnosis of articulation or speech sound disorders. The term, “speech sound” disorders is an umbrella heading under which there are several sub-categories including articulation disorder (sound production), phonological disorder (sound patterns), childhood apraxia of speech (difficulties with motor planning), and / or physiological deficits (tongue thrust or dysarthria).  Children with speech sound disorders do not have problems understanding language itself. Rather, they have difficulties expressing language in speech sounds at an age-appropriate level.

Sensory Processing

Sensory processing disorders (SPD) are diagnosed by a pediatrician or occupational therapist and treated by an occupational therapist.  A speech therapist does not diagnose this disorder, but can provide support for children already diagnosed with sensory differences.  Occupational therapists will focus on the root cause of the SPD while a speech-language pathologist can support therapy for communication concerns, which in many cases accompany a sensory processing disorder.

Sensory processing refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses.  Sensory processing disorder exists when the brain has difficulty receiving, understanding and responding to information coming through the senses.  These sensory signals don’t get organized into appropriate responses and may negatively impact a child’s attention, behavior, and development.  Children with a SPD are often delayed in speech and / or language. If a child is distracted by discomfort caused by their environment, or if they are busy seeking sensations that are not readily available, they are less likely to be able to attend to speech and language learning opportunities.

Indicators that a child may have sensory processing disorder include:

• Unusually high activity level

• Unusually low activity level

• Poor body awareness – clumsy, difficulty with balance and motor skills, bumps into things

• Unpredictable and/or unsafe behaviors

• Behavior issues – short attention span, impulsivity, excessive tantrums

• Delay in learning new skills

• Low muscle tone – floppy, leans on others for support

• Difficulty with academics despite normal intelligence

• Difficulty with gross and fine motor skills – handwriting, using scissors, tying shoes, buttoning, etc.

• Tendency to walk on toes

• Avoidance of certain textures while eating or playing, picky eater

• Tendency to chew on objects

• A struggle to focus and tendency toward getting distracted

• Overreaction to loud noises and dislike of crowded places

• Sensitivity to certain clothing items