Language Disorders

Dr. Petrosky has evaluated and consulted with clients with language disorders for many years. See answers to common questions about receptive and expressive language challenges below.
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What is a language disorder?
A language disorder involves trouble communicating. People often use the term “language disorder” to refer to problems speaking and listening, although language disorder also refers to difficulties with written language, that is, reading and writing.
What is receptive language?
Receptive language is the ability to comprehend or understand language.
What is expressive language?
Expressive language is the ability to produce language.
What is aphasia?
“Aphasia” is a diagnostic term used to describe different types of language disorders.

“Language disorder” is a broad category of multiple types of language difficulties. The term “aphasia” is usually used to refer to a specific type of language disorder. Clinicians can vary in terms of which words they use when making a diagnosis.

What are different types of aphasias?

There are multiple types of aphasias, including:

  • Expressive aphasia (a.k.a. Broca’s aphasia) refers to difficulty speaking.
  • Receptive aphasia (a.k.a. Wernicke’s aphasia) refers to difficulty comprehending or understanding language.
  • Conduction aphasia refers to difficulty repeating words. Conduction aphasia also may be associated with poor grammar, as the person has trouble connecting the right verb to the right action. For example, the person might say, “you walk to the park,” when the intended meaning is “you walked to the park.”
  • Anomic aphasia refers to difficulty naming or recalling the word for different objects. For example, the person may say, “hand me the writing thing” because she or he has trouble recalling the word for “pencil.”
What are signs of a language disorder? What are signs of an aphasia?

There are many different potential signs of a language disorder or aphasia, including the following. Keep in mind that most people with a language disorder or aphasia will have some of these symptoms, but not necessarily every single one of them. In addition, this list represents some of the more common symptoms, but there can be other signs of language impairment as well.

  • Delays in language milestones, such as the age of the child’s first words or the age in which the child speaks in sentences.
  • Being nonverbal, that is, not speaking at all or speaking in phrases or incomplete sentences past the age at which it is developmentally appropriate.
  • Using poor grammar and syntax.
  • Difficulty re-telling events, such as, “What happened at school today?” The child may tell stories that are overly vague or confusing, give details with no context such that you don’t know what s/he is talking about, or sequence events out of order.
  • Taking a long time to answer questions.
  • Word retrieval difficulty, that is, trouble “finding the word you’re looking for.” As a result, the child may use non-descript words as fillers, like the word “thing.” For example, the child may say, “Can you hand me the writing thing?” instead of saying, “Can you hand me the pen?” Word retrieval difficulty also can make the person overly wordy as s/he needs extra words to explain what s/he mean. For example, the person says, “Can we go to the ice skating place?” because s/he doesn’t recall the word for “rink.”
  • Producing paraphasias, that is, “misspeaking.” “Semantic paraphasias” refer to substituting the intended word for a word that is related in meaning (saying “dinner” instead of “breakfast” or “living room” instead of “kitchen”). “Literal / phonemic paraphasias” refer to mispronouncing the word by saying something that sounds similar to the intended word (e.g. saying “clup” instead of “cup.”).
  • Poor vocabulary.
  • Trouble understanding directions, stories, and other passages.
How can you tell if someone is not following directions because of a language disorder or because s/he wasn’t paying attention or has ADHD?

All things being equal, a child who has ADHD but who does not have a language disorder can be expected to follow directions if you have the child’s attention and if you ensure the directions are not longer than the person can process. (People with ADHD can have trouble following directions because the directions are too lengthy). If you ensure you have the child’s attention (e.g. speaking to the child one on one, making sure the child is making eye contact, etc.) and you make sure the directions are not too lengthy and the child is able to execute the directions, this suggests the issue is not a language disorder. On the other hand, if you ensure you have the child’s attention and you make sure the directions are not too lengthy and the child is still unable to follow them, this suggests the issue is a language disorder. To clear, however, an actual, definitive diagnosis would need to be based on a comprehensive review of multiple pieces of data. The above is intended as a general rule of thumb to guide one’s thinking process, not as a black and white “litmus test” so to speak.

Neuropsychological testing can be a useful tool to help answer this question.

What causes a language disorder? What causes aphasias?

A language disorder / aphasias are usually associated with dysfunction in the language dominant hemisphere (half) of the brain. For most (but not all) people this is the left side of the brain, more specifically, the left temporal lobe. The left temporal lobe corresponds to the left side of the head (as opposed to, for example, the left top part of the brain).

There are multiple potential causes of this dysfunction. The person may have been born that way, such as due to genetics. Language disorder / aphasias also can be caused by brain injury, such as from a blow to the head or a stroke.

What can help a person with a language disorder? What can help a person with an aphasia?

The specific needs of a student with a language disorder will vary based on the individual, but potential interventions include the following:

  • Speech and Language Therapy. Speech pathologists can be helpful, not only in providing direct service, but also in consulting with teachers about how to modify the lesson and adapt to the needs of children with language disorders as well as by providing parents with exercises to do with children at home.

    Some people associate “speech therapy” exclusively with helping children with articulation (pronouncing words correctly) or stuttering. Speech therapy certainly targets these areas, however, it is important to know that Speech Pathologists are language specialists in general, who, depending on their specific areas of expertise, target a wide range of receptive and expressive language challenges, well beyond only articulation and stuttering.

  • Classroom modifications and testing accommodations, such as: directions presented in small parts and repeated, directions simplified / paraphrased, check for understanding of directions, copy of class notes, modified questions during class participation (e.g. avoiding asking the student open-ended questions), extra wait time when answering questions in class, providing cues to facilitate word retrieval, and other modifications and accommodations.
6 students of all ages
Language Disorders are often (but not always) associated with dysfunction in the left temporal lobe of the brain.