Mixed receptive-expressive language disorder
Mixed receptive-expressive language disorder is diagnosed when a child has problems expressing him-or herself using spoken language, and also has problems understanding what people say to him or her.
Mixed receptive-expressive language disorder is generally a disorder of childhood. There are two types of mixed receptive-expressive language disorder: developmental and acquired. Developmental mixed receptive-expressive language disorder does not have a known cause and normally appears at the time that a child is learning to talk. Acquired mixed receptive-expressive language disorder is caused by direct damage to the brain . It occurs suddenly after such events as a stroke or traumatic head injury. The acquired type can occur at any age.
Causes and symptoms
There is no known cause of developmental mixed receptive-expressive language disorder. Researchers are conducting ongoing studies to determine whether biological or environmental factors may be involved. The acquired form of the disorder results from direct damage to the brain. Damage can be sustained during a stroke, or as the result of traumatic head injury, seizures , or other medical conditions. The specific symptoms of the acquired form of the disorder generally depend on the parts of the patient's brain that have been injured and the severity of the damage.
The signs and symptoms of mixed receptive-expressive language disorder are for the most part the same as the symptoms of expressive language disorder . The disorder has signs and symptoms that vary considerably from child to child. In general, mixed receptive-expressive language disorder is characterized by a child's difficulty with spoken communication. The child does not have problems with the pronunciation of words, which is found in phonological disorder . The child does, however, have problems constructing coherent sentences, using proper grammar, recalling words, or similar communication problems. A child with mixed receptive-expressive language disorder is not able to communicate thoughts, needs, or wants at the same level or with the same complexity as his or her peers. In addition, the child often has a smaller vocabulary than his or her peers.
Children with mixed receptive-expressive language disorder also have significant problems understanding what other people are saying to them. This lack of comprehension may result in inappropriate responses or failure to follow directions. Some people think these children are being deliberately stubborn or obnoxious, but this is not the case. They simply do not understand what is being said. Some children with this disorder have problems understanding such specific types of terms as abstract nouns, complex sentences, or spatial terms.
The Diagnostic and Statistical Manual of Mental Disorders , fourth edition, text revised ( DSM-IV-TR ), which is the standard reference work consulted by mental health professionals, specifies four general criteria for diagnosing mixed receptive-expressive language disorder. The first criterion states that the child communicates using speech and appears to understand spoken language at a level that is lower than expected for the child's general level of intelligence. Second, the child's problems with self-expression and comprehension must create difficulties for him or her in everyday life or in achieving his or her academic goals. If the child understands what is being said at a level that is normal for his or her age or stage of development, then the diagnosis would be expressive language disorder. If the child is mentally retarded, hard of hearing, or has other physical problems, the difficulties with speech must be greater than generally occurs with the other handicaps the child may have in order for the child to be diagnosed with this disorder.
The disorder is usually diagnosed in children because a parent or teacher expresses concern about the child's problems with spoken communication. The child's pediatrician may give the child a physical examination to rule out such medical problems as hearing loss. Specific testing for mixed expressive-receptive language disorder requires the examiner to demonstrate that the child not only communicates less well than expected, but also understands speech less well. It can be hard, however, to determine what a child understands. As a result, most examiners will use non-verbal tests in addition to tests that require spoken questions and answers in order to assess the child's condition as accurately as possible. In children who are mildly hearing-impaired, the problem can often be corrected by using hearing aids. Children who speak a language other than English (or the dominant language of their society) at home should be tested in that language if possible. In some cases, the child's ability to understand and communicate in English is the problem, not his or her competence with spoken language in general.
Mixed receptive-expressive language disorder is diagnosed in about 5% of preschool-age children, and 3% of children in school. It is less common than expressive language disorder. Children who have mixed receptive-expressive language disorder are more likely to have other disorders as well. Between 40%–60% of preschoolers who have this disorder may also have phonological disorder (difficulty forming sounds). Reading disorder is linked to as many as half the children with mixed receptive-expressive language disorder who are of school age. Children with mixed receptive-expressive language disorder are also more likely to have psychiatric disorders, especially attention-deficit disorder (ADD); it is estimated that 30–60 percent of children with mixed receptive-expressive language disorder also have ADD. Children from families with a history of language disorders are more likely to have this or other language disorders.
Mixed receptive-expressive language disorder should be treated as soon as it is identified. Early intervention is the key to a successful outcome. Treatment involves teachers, siblings, parents, and anyone else who interacts regularly with the child. Regularly scheduled one-on-one treatment that focuses on specific language skills can also be effective, especially when combined with a more general approach involving family members and caregivers. Teaching children with this disorder specific communication skills so that they can interact with their peers is important, as problems in this area may lead to later social isolation, depression, or behavioral problems. Children who are diagnosed early and taught reading skills may benefit especially, because problems with reading are often associated with mixed receptive-expressive language disorder and can cause serious long-term academic problems. There is little information comparing different treatment methods; often several are tried in combination.
The developmental form of mixed receptive-expressive language disorder is less likely to resolve well than the developmental form of expressive language disorder. Most children with the disorder continue to have problems with language skills. They develop them at a much slower rate than their peers, which puts them at a growing disadvantage throughout their educational career. Some persons diagnosed with the disorder as children have significant problems with expressing themselves and understanding others in adult life.
The prognosis of the acquired type of mixed receptive-expressive language disorder depends on the nature and location of the brain injury. Some people get their language skills back over days or months. For others it takes years, and some people never fully recover expressive language function or the ability to understand speech.
Because the causes of developmental mixed receptive-expressive language disorder are unclear, there are no specific ways to prevent it. A healthy diet during pregnancy and regular prenatal care are always recommended. Because the acquired form of the disorder is caused by damage to the brain, anything that helps to prevent brain damage may offer protection against that form of the disorder. Preventive measures include such precautions as lowering blood cholesterol levels, which may help to prevent stroke; or wearing bicycle helmets or automobile seat belts to prevent traumatic head injury.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text revised. Washington DC: American Psychiatric Association, 2000.
Sadock, Benjamin J. and Virginia A. Sadock, eds. Comprehensive Textbook of Psychiatry. 7th ed. Philadelphia: Lippincott Williams and Wilkins, 2000.
Stein, Martin T., Steven Parker, James Coplan, Heidi Feldman. "Expressive Language Delay in a Toddler." Journal of Developmental & Behavioral Pediatrics 22 no. 2 (April 2001): 99.
American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (847) 434-4000. <www.aap.org> .
American Psychological Association. 750 First Street NE, Washington, DC 20002-4242. Telephone: (800) 374-2721. <www.apa.org> .
American Speech-Language-Hearing Association. 10801 Rockville Pike, Rockville, MD 20852. (800) 638-8355. <http://www.asha.org> .
Tish Davidson, A.M.