Mixed receptive-expressive language disorder

Last updated
Mixed receptive-expressive language disorder
Specialty Psychiatry   OOjs UI icon edit-ltr-progressive.svg

Mixed receptive-expressive language disorder (DSM-IV 315.32) [1] is a communication disorder in which both the receptive and expressive areas of communication may be affected in any degree, from mild to severe. [2] Children with this disorder have difficulty understanding words and sentences. This impairment is classified by deficiencies in expressive and receptive language development that is not attributed to sensory deficits, nonverbal intellectual deficits, a neurological condition, environmental deprivation or psychiatric impairments. [3] [4] Research illustrates that 2% to 4% of five year olds have mixed receptive-expressive language disorder. This distinction is made when children have issues in expressive language skills, the production of language, and when children also have issues in receptive language skills, the understanding of language. Those with mixed receptive-language disorder have a normal left-right anatomical asymmetry of the planum temporale and parietale. This is attributed to a reduced left hemisphere functional specialization for language. Taken from a measure of cerebral blood flow (SPECT) in phonemic discrimination tasks, children with mixed receptive-expressive language disorder do not exhibit the expected predominant left hemisphere activation. [5] Mixed receptive-expressive language disorder is also known as receptive-expressive language impairment (RELI) or receptive language disorder. [6]

Contents

Classification

If assessed on the Wechsler Adult Intelligence Scale, for instance, symptoms of mixed receptive-expressive language disorder may show as relatively low scores for Information, Vocabulary and Comprehension (perhaps below the 25th percentile). If a person has difficulty with specific types of concepts, for example spatial terms, such as 'over', 'under', 'here' and 'there', they may also have difficulties with arithmetic, understanding word problems and instructions, or difficulties using words at all. [7] They may also have a more general problem with words or sentences, both comprehension and orally. Some children will have issues with pragmatics – the use of language in social contexts as well; and therefore, will have difficulty with inferring meaning. Furthermore, they have severe impairment of spontaneous language production and for this reason, they have difficulty in formulating questions. [5] Generally, children will have trouble with morphosyntax, which is word inflections. These children have difficulty understanding and applying grammatical rules, such as endings that mark verb tenses (e.g. -ed), third-person singular verbs (e.g. I think, he thinks), plurals (e.g. -s), auxiliary verbs that denote tenses (e.g. was running, is running), and with determiners (the, a). Moreover, children with mixed receptive-expressive language disorders have deficits in completing two cognitive operations at the same time and learning new words or morphemes under time pressure or when processing demands are high. These children also have auditory processing deficits in which they process auditory information at a slower rate and as a result, require more time for processing. [6]

Presentation

Studies show that low receptive and expressive language at young ages was correlated to increased autism symptom severity in children in their early school years. [8] Below is a chart depicting language deficits of children on the autistic spectrum. This table indicates the lower levels of language processing, receptive/expressive disorders, which is more severe in children with autism. When autistic children speak, they are often difficult to understand, their language is sparse and dysfluent, they speak in single, uninflected words or short phrases, and their supply of words is severely depleted. [9] This leads to limited vocabulary while also having deficits in verbal short term memory. [10]

Aspect of languageLower level receptive/expressive disorders
Comprehension:
PhonologyVery impaired
SyntaxVery impaired
SemanticsVery impaired
PragmaticsVery impaired
ProsodyVery impaired
Production:
PhonologyVery impaired
SyntaxVery impaired
SemanticsVery impoverished
PragmaticsVery impaired
ProsodyOften impaired, monotonous, robotics
Amount of languageSparse or absent
FluencyDysfluent

Management

Children who demonstrate deficiencies early in their speech and language development are at risk for continued speech and language issues throughout later childhood. Similarly, even if these speech and language problems have been resolved, children with early language delay are more at risk for difficulties in phonological awareness, reading, and writing throughout their lives. [10] [11] Children with mixed receptive-expressive language disorder are often likely to have long-term implications for language development, literacy, behavior, social development, and even mental health problems. [6] If suspected of having a mixed receptive-expressive language disorder, treatment is available from a speech therapist or pathologist. Most treatments are short term, and rely upon accommodations made within the environment, in order to minimize interfering with work or school. Programs that involve intervention planning that link verbal short term memory with visual/nonverbal information may be helpful for these children. [10] In addition, approaches such as parent training for language stimulation and monitoring language through the "watch and see" method are recommended. The watch-and-see technique advises children with mixed receptive-expressive language disorder who come from stable, middle-class homes without any other behavioral, medical, or hearing problems should be vigilantly monitored rather than receive intervention. It is often the case that children do not meet the eligibility criteria established through a comprehensive oral language evaluation; and as a result, are not best suited for early intervention programs and require a different approach besides the "one size fits all" model. [11]

See also

Related Research Articles

Aphasia is an inability to comprehend or formulate language because of damage to specific brain regions. The major causes are a cerebral vascular accident (stroke), or head trauma, but aphasia can also be the result of brain tumors, brain infections, or neurodegenerative diseases.

Dyslexia, also known as reading disorder, is characterized by trouble with reading despite normal intelligence. Different people are affected to different degrees. Problems may include difficulties in spelling words, reading quickly, writing words, "sounding out" words in the head, pronouncing words when reading aloud and understanding what one reads. Often these difficulties are first noticed at school. When someone who previously could read loses their ability, it is known as "alexia". The difficulties are involuntary and people with this disorder have a normal desire to learn. People with dyslexia have higher rates of attention deficit hyperactivity disorder (ADHD), developmental language disorders, and difficulties with numbers.

Expressive aphasia Language disorder involving inability to produce language

Expressive aphasia, also known as Broca's aphasia, is a type of aphasia characterized by partial loss of the ability to produce language, although comprehension generally remains intact. A person with expressive aphasia will exhibit effortful speech. Speech generally includes important content words but leaves out function words that have only grammatical significance and not real-world meaning, such as prepositions and articles. This is known as "telegraphic speech". The person's intended message may still be understood, but their sentence will not be grammatically correct. In very severe forms of expressive aphasia, a person may only speak using single word utterances. Typically, comprehension is mildly to moderately impaired in expressive aphasia due to difficulty understanding complex grammar.

A communication disorder is any disorder that affects an individual's ability to comprehend, detect, or apply language and speech to engage in discourse effectively with others. The delays and disorders can range from simple sound substitution to the inability to understand or use one's native language.

Agnosia

Agnosia is the inability to process sensory information. Often there is a loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss. It is usually associated with brain injury or neurological illness, particularly after damage to the occipitotemporal border, which is part of the ventral stream. Agnosia only affects a single modality, such as vision or hearing. More recently, a top-down interruption is considered to cause the disturbance of handling perceptual information.

Aphasiology is the study of language impairment usually resulting from brain damage, due to neurovascular accident—hemorrhage, stroke—or associated with a variety of neurodegenerative diseases, including different types of dementia. It is also the name of a scientific journal covering the area. These specific language deficits, termed aphasias, may be defined as impairments of language production or comprehension that cannot be attributed to trivial causes such as deafness or oral paralysis. A number of aphasias have been described, but two are best known: expressive aphasia and receptive aphasia.

Conduction aphasia

Conduction aphasia, also called associative aphasia, is an uncommon form of difficulty in speaking (aphasia). It is caused by damage to the parietal lobe of the brain. An acquired language disorder, it is characterised by intact auditory comprehension, coherent speech production, but poor speech repetition. Affected people are fully capable of understanding what they are hearing, but fail to encode phonological information for production. This deficit is load-sensitive as the person shows significant difficulty repeating phrases, particularly as the phrases increase in length and complexity and as they stumble over words they are attempting to pronounce. People have frequent errors during spontaneous speech, such as substituting or transposing sounds. They are also aware of their errors and will show significant difficulty correcting them.

Expressive language disorder is a communication disorder in which there are difficulties with verbal and written expression. It is a specific language impairment characterized by an ability to use expressive spoken language that is markedly below the appropriate level for the mental age, but with a language comprehension that is within normal limits. There can be problems with vocabulary, producing complex sentences, and remembering words, and there may or may not be abnormalities in articulation.

Specific language impairment (SLI) is diagnosed when a child's language does not develop normally and the difficulties cannot be accounted for by generally slow development, physical abnormality of the speech apparatus, autism spectrum disorder, apraxia, acquired brain damage or hearing loss. Twin studies have shown that it is under genetic influence. Although language impairment can result from a single-gene mutation, this is unusual. More commonly SLI results from the combined influence of multiple genetic variants, each of which is found in the general population, as well as environmental influences.

Speech Human vocal communication using spoken language

Speech is human vocal communication using language. Each language uses phonetic combinations of vowel and consonant sounds that form the sound of its words, and using those words in their semantic character as words in the lexicon of a language according to the syntactic constraints that govern lexical words' function in a sentence. In speaking, speakers perform many different intentional speech acts, e.g., informing, declaring, asking, persuading, directing, and can use enunciation, intonation, degrees of loudness, tempo, and other non-representational or paralinguistic aspects of vocalization to convey meaning. In their speech speakers also unintentionally communicate many aspects of their social position such as sex, age, place of origin, physical states, psychic states, physico-psychic states, education or experience, and the like.

Social communication disorder (SCD)—previously called semantic-pragmatic disorder (SPD) or pragmatic language impairment (PLI)—is a disorder in understanding pragmatic aspects of language. People with SCD have special challenges with the semantic aspect of language and the pragmatics of language. Social communication disorder has been formally recognized as a diagnosis since the DSM-5 was released in 2013.

Language disorders or language impairments are disorders that involve the processing of linguistic information. Problems that may be experienced can involve grammar, semantics (meaning), or other aspects of language. These problems may be receptive, expressive, or a combination of both. Examples include specific language impairment, better defined as developmental language disorder, or DLD, and aphasia, among others. Language disorders can affect both spoken and written language, and can also affect sign language; typically, all forms of language will be impaired.

Developmental coordination disorder (DCD), also known as developmental motor coordination disorder, developmental dyspraxia or simply dyspraxia, is a chronic neurological disorder beginning in childhood. It is also known to affect planning of movements and co-ordination as a result of brain messages not being accurately transmitted to the body. Impairments in skilled motor movements per a child's chronological age interfere with activities of daily living. A diagnosis of DCD is then reached only in the absence of other neurological impairments such as cerebral palsy, multiple sclerosis, or Parkinson's disease.

Muteness or mutism is defined as an absence of speech while conserving or maintaining the ability to understand the speech of others. Mutism is typically understood as an inability to speak on the part of a child or an adult due to an observed lack of speech from the point of view of others who know them such as family members, caregivers, teachers, or health professionals including doctors and speech and language pathologists. Muteness may not be a permanent condition, depending upon etiology (cause). In general, someone who is mute may be mute for one of several different reasons: organic, psychological, developmental/ neurological. For children, a lack of speech may be developmental, neurological, psychological, or due to a physical disability or a communication disorder. For adults who previously had speech and then became unable to speak, loss of speech may be due to injury, disease, termed aphasia, or surgery affecting areas of the brain needed for speech. Loss of speech in adults may occur rarely for psychological reasons.

Auditory processing disorder (APD), rarely known as King-Kopetzky syndrome or auditory disability with normal hearing (ADN), is an umbrella term for a variety of disorders that affect the way the brain processes auditory information. Individuals with APD usually have normal structure and function of the outer, middle, and inner ear. However, they cannot process the information they hear in the same way as others do, which leads to difficulties in recognizing and interpreting sounds, especially the sounds composing speech. It is thought that these difficulties arise from dysfunction in the central nervous system.

Auditory agnosia is a form of agnosia that manifests itself primarily in the inability to recognize or differentiate between sounds. It is not a defect of the ear or "hearing", but rather a neurological inability of the brain to process sound meaning. It is caused by bilateral damage to the anterior superior temporal gyrus, which is part of the auditory pathway responsible for sound recognition, the auditory "what" pathway.

Speech and language impairment

Speech and language impairment are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency.

Autism spectrum Range of neurodevelopmental disorders

The autism spectrum encompasses a range of neurodevelopmental conditions, including autism and Asperger syndrome, generally known as autism spectrum disorders (ASD). Individuals on the autistic spectrum experience difficulties with social communication and interaction and also exhibit restricted, repetitive patterns of behavior, interests, or activities. Symptoms are typically recognized between one and two years of age. However, a lot of children are not finally diagnosed until they are older. Final diagnosis could still be given as an adolescent or even as an adult. The term "spectrum" refers to the variation in the type and severity of symptoms. Those in the mild range may function independently, while those with moderate to severe symptoms may require more substantial support in their daily lives. Long-term problems may include difficulties in performing daily tasks, creating and keeping relationships, and maintaining a job.

Verbal intelligence

Verbal intelligence is the ability to understand and reason using concepts framed in words. More broadly, it is linked to problem solving, abstract reasoning, and working memory. Verbal intelligence is one of the most g-loaded abilities.

Developmental language disorder (DLD) is identified when a child has problems with language development that continue into school age and beyond. The language problems have a significant impact on everyday social interactions or educational progress, and occur in the absence of autism spectrum disorder, intellectual disability or a known biomedical condition. The most obvious problems are difficulties in using words and sentences to express meanings, but for many children, understanding of language is also a challenge, although this may not be evident unless the child is given a formal assessment.

References

  1. "Diagnostic criteria for 315.31 Mixed Receptive-Expressive Language Disorder". behavenet.com.
  2. "Special Education Support Service: Information on Specific Speech and Language Disorder" (PDF). Archived from the original (PDF) on 2014-12-21.Cite journal requires |journal= (help)
  3. Willinger, Ulrike; Brunner, Esther; Diendorfer-Radner, Gabriele; Sams, Judith; Sirsch, Ulrike; Eisenwort, Brigitte (2016). "Behaviour in Children with Language Development Disorders". The Canadian Journal of Psychiatry. 48 (9): 607–14. doi: 10.1177/070674370304800907 . PMID   14631881.
  4. Oram Cardy, Janis E; Flagg, Elissa J; Roberts, Wendy; Roberts, Timothy P.L (2008). "Auditory evoked fields predict language ability and impairment in children". International Journal of Psychophysiology. 68 (2): 170–5. doi:10.1016/j.ijpsycho.2007.10.015. PMID   18304666.
  5. 1 2 Pecini, C; Casalini, C; Brizzolara, D; Cipriani, P; Pfanner, L; Chilosi, A (2005). "Hemispheric Specialization for Language in Children with Different Types of Specific Language Impairment". Cortex. 41 (2): 157–67. doi:10.1016/S0010-9452(08)70890-6. PMID   15714898. S2CID   4484372.
  6. 1 2 3 Boyle, James; McCartney, Elspeth; o'Hare, Anne; Law, James (2010). "Intervention for mixed receptive-expressive language impairment: A review" (PDF). Developmental Medicine & Child Neurology. 52 (11): 994–9. doi:10.1111/j.1469-8749.2010.03750.x. PMID   20813021. S2CID   34951225.
  7. Simms, Mark D (2007). "Language Disorders in Children: Classification and Clinical Syndromes". Pediatric Clinics of North America. 54 (3): 437–67, v. doi:10.1016/j.pcl.2007.02.014. PMID   17543904.
  8. Kjellmer, Liselotte; Hedvall, Åsa; Fernell, Elisabeth; Gillberg, Christopher; Norrelgen, Fritjof (2012). "Language and communication skills in preschool children with autism spectrum disorders: Contribution of cognition, severity of autism symptoms, and adaptive functioning to the variability". Research in Developmental Disabilities. 33 (1): 172–80. doi:10.1016/j.ridd.2011.09.003. PMID   22093662.
  9. Rapin, Isabelle; Dunn, Michelle (1997). "Language disorders in children with autism". Seminars in Pediatric Neurology. 4 (2): 86–92. doi:10.1016/S1071-9091(97)80024-1. PMID   9195665.
  10. 1 2 3 Riccio, Cynthia A; Cash, Deborah L; Cohen, Morris J (2007). "Learning and Memory Performance of Children with Specific Language Impairment (SLI)". Applied Neuropsychology. 14 (4): 255–61. doi:10.1080/09084280701719203. PMID   18067421. S2CID   36696694.
  11. 1 2 Flax, Judy F; Realpe-Bonilla, Teresa; Roesler, Cynthia; Choudhury, Naseem; Benasich, April (2008). "Using Early Standardized Language Measures to Predict Later Language and Early Reading Outcomes in Children at High Risk for Language-Learning Impairments". Journal of Learning Disabilities. 42 (1): 61–75. doi:10.1177/0022219408326215. PMID   19011122. S2CID   10146503.
Classification
D