Language Disorder

Language Disorder

Language Disorder

Primer

Language Disorder is a disorder characterized by difficulties in the acquisition and use of language, due to deficits in the production or comprehension of vocabulary, discourse, and sentence structure. These deficits will be apparent in spoken communication, written communication, or sign language. These deficits can either be in receptive and/or expressive skills.

Epidemiology

Language disorder occurs early in the developmental period. However, there is great variation in early vocabulary acquisition between individuals up until age 4, making the diagnosis unreliable. However, by 4 years of age, individual differences in language ability stabilize, and deficits by this age are highly predictive for future outcomes in adulthood. Individuals with a family history of language disorders are more likely to develop this disorder.^[1]

Comorbidity

Language disorder is strongly associated with specific learning disorder (in particular with literacy and numeracy), attention-deficit/hyperactivity disorder, autism spectrum disorder, social (pragmatic) communication disorder, and developmental coordination disorder.

Expressive vs. Receptive

Language Requires Both Receptive and Expressive Skills

Language requires both receptive (receiving and understanding language) and expressive (production of language) skills. Thus in assessing for a language disorder, both receptive and expressive skills need to be assessed (i.e. - an individual's expressive skills might be significantly impaired, but receptive language skills might be normal). Expressive ability refers to the production of vocal, gestural, or verbal signals. Receptive ability refers to the process of receiving and understanding language messages.

DSM-5 Diagnostic Criteria

Criterion A

Persistent difficulties in the acquisition and use of language across modalities (i.e. - spoken, written, sign language, or other) due to deficits in comprehension or production that include the following:

Reduced vocabulary (word knowledge and use)
Limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology)
Impairments in discourse (ability to use vocabulary and connect sentences to explain or describe a topic or series of events or have a conversation).

Criterion B

Language abilities are substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication, social participation, academic achievement, or occupational performance, individually or in any combination.

Criterion C

Onset of symptoms is in the early developmental period.

Criterion D

The difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition and are not better explained by intellectual disability or global developmental delay.

Pathophysiology

The etiology of a language disorder can either be developmental (develops at birth), or acquired (through hearing loss, neurological disorders, intellectual disability, autism spectrum disorder, or substance abuse).

Differential Diagnosis

Normal variations in language
- Language disorder needs to be distinguished from normal developmental variations, this is hard to decipher before 4 years of age. Regional, social, or cultural/ethnic variations of language must be considered before giving a diagnosis of language disorder.
Hearing or other sensory impairment
- Hearing impairment should always be excluded first as the primary cause of language problems. Language deficits can be associated with a hearing impairment, other sensory deficit, or a speech-motor deficit. For example, individuals with Central Auditory Processing Disorder (CAPD) can have language deficits. Only when the language deficits are in excess of what is expected, should a diagnosis of language disorder be made.
Intellectual disability
- Language delay is often the presenting feature of intellectual disability, and the definitive diagnosis may not be made until the child is able to complete standardized assessments. A separate diagnosis is not given unless the language deficits are clearly in excess of the intellectual limitations.
Neurological disorders
- Language disorder can be acquired in association with neurological disorders, such as epilepsy, stroke, aphasia, or Landau-Kleffner syndrome (also known as infantile acquired aphasia). If there are symptoms of seizures, a detailed neurologic and seizure history and diagnostic investigations should be ordered (e.g. - Electroencephalogram (EEG))
Autism Spectrum Disorder
- Loss of speech and language in a child younger than 3 years may be a sign of autism spectrum disorder (with developmental regression) or a specific neurological condition, such as Landau-Kleffner syndrome.

Investigations

Neurological and medical evaluation to rule out medical causes of language impairment
Formal audiologic testing to rule out hearing loss that might contribute to the speech impairment
An assessment by a speech and language pathologist (SLP)

Treatment

Speech and language therapy is the main treatment. This can delivered by speech and language pathologists and other clinicians. Assistive technology, special education, and educational accommodations may also be used to help individuals.

Resources

For Patients

For Providers

Articles

Research

¹⁾ Neils, J., & Aram, D. M. (1986). Family history of children with developmental language disorders. Perceptual and motor skills, 63(2), 655-658.

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