Expressive Language Disorder in Children

With contributions from Vinita Kokatnur-Lemercier, M.A., CCC-SLP

What is Expressive Language Disorder in Childhood?

Expressive Language Disorder is characterized by a limited or decreased vocabulary for the child’s age, difficulty using pronouns, and trouble with verb forms, plurals, and the rules of language. 

Expressive language disorder is fairly common in childhood and is amenable to treatment. 

Children with expressive language disorder are likely to have academic difficulties, particularly in language arts. They may have trouble with reading, writing, and oral expression. 

The disorder is typically diagnosed and treated by speech language pathologists. However, psychologists, counselors, and school psychologists may work with children who have language deficits. These providers often support children to improve their social skills, emotional expression, and communication with peers. 

Symptoms of Expressive Language Disorder in Children

• Limited vocabulary: children with expressive language disorder may know fewer vocabulary words to express their thoughts or feelings
• Difficulties with plurals: children with expressive language disorder may misuse words, saying “childs” for children or “gooses” for geese
• Misunderstanding rules of language: children with expressive language disorder may misuse pronouns, mix up verb tenses, or speak in phrases that are grammatically incorrect 
• Trouble expressing thoughts clearly: children with expressive language disorder might say things in a jumbled-up order, making it sound confusing for the listener
• Challenges getting ideas from head to paper: children with expressive language disorder may have difficulty expressing themselves in written language
• Socially hesitant: children with expressive language disorder may appear to be shy or not speak much because it is difficult to get their ideas out clearly
• Incoherent stories: children with expressive language disorder may tell stories that do not make sense. These issues are referred to clinically as ‘narrative coherence’

What to Do About Expressive Language Disorder

If you are concerned about your child’s expressive language, consider these strategies. It is a good idea to start with your pediatrician for referrals in your area. There may also be professionals at school who can help.

Provided below are some additional strategies you can try at home to support your child’s language skills. Regardless of the strategy you choose, it is important to start early and be persistent. Fortunately, expressive language skills are highly treatable and amenable to intervention.

• Talk with your pediatrician: for a referral to see a speech-language pathologist. You may discuss family history with your doctor because children can inherit some language issues. Discuss your child’s needs in terms of language, behavior, and social skills. Be persistent and do not give up until you get help.
• Talk to your child’s teacher or counselor: for help at school. Consider a meeting with the school speech-language pathologist, who can determine if an evaluation is necessary. The school special education team may be able to determine if further testing is required to consider academic problems or learning disabilities. The school team may include a speech-language pathologist, a learning specialist, a school psychologist, or a school counselor. Your child’s school team can compare your child’s strengths to same-aged peers. 
• Practice at home: for improved language skills. You can make a lot of progress with your child in verbal expression by practicing skills at home. You can help improve your child’s ability by working on choosing a topic, commenting on someone else’s comment, asking questions, answering questions, and telling a story.
• Parental modeling: for improved language skills. The importance of directly modeling the correct way to speak cannot be overstated. Speech therapists make use of modeling and repetition to teach children to communicate more clearly and effectively. You can do the same. When your child says something that doesn’t follow the rules of language, gently point it out. Ask the child to say it again.

For example, if your child says, “Mom, there’s gooses, we seen gooses at the park,” correct the mistake right away. Say, “you saw geese at the park? Awesome, please tell me again.” If your child says, “yes, I saw geese at the park,” instantly praise your child for getting it right. This constant practice is the most important thing you can do as a parent to support your child’s language skills.

• Storytelling practice: for improved narratives. If your child is struggling with storytelling, it is recommended that you practice these skills frequently. Listed here are three great techniques you can use.
• Story cubes strategy: You might try Story Cubes to teach your child to tell stories. The parent would roll the dice and look at the pictures on top. Using one of the pictures, the parent starts the story. The parent stops after a few sentences. Now it is the child’s turn to roll the dice and add to the story. 
• Index card strategy: Another way to practice telling stories is to use index cards. Parents can put topic ideas on the card. The topics might be shown in pictures cut out of magazines, emojis, or words. Just as discussed above, this can be a fun interactive activity. You start by choosing a card and beginning the story. Then, turn it over to your child to add to the story. It is okay for stories to get silly or goofy. The point is to have fun in a storytelling activity.
• Visualizing and verbalizing (Lindamood-Bell): Check out the book by Nanci Bell on this method of teaching storytelling. You can try this technique at home or visit a Lindamood-Bell learning center if there is one in your area. This technique walks a child through visualizing a word, a sentence, a paragraph, a page, and a chapter. The child is learning to describe the movie in their minds as they read, and to tell the story back in sequential order. This is an excellent way to improve your child’s storytelling skills.

Typical Expressive Language Development

During typical development, we see a child’s speech skills progressing from babbling, to words, to phrases, and full sentences. Expressive language is the ability to express one’s own thoughts and ideas. Simply put, “expressive language is saying what you want to say.” Expressive language skills involve articulation, communication, and vocabulary. Typically, we expect a progression as shown below.

3-months-of age: young babies start cooing and using facial expressions to communicate and engage with their mother

9-months-old: once a baby reaches this age, we expect some babbling sounds to emerge. Babies start saying ‘ba ba’ ‘ma ma’ and ‘na na.’ 

18-months-old: a good rule of thumb is 18 words by 18 months. We expect babies of this age to have about 18 words they can say. It is not important that the word comes out perfectly but that the child knows the meaning of the word

24-months-old: toddlers at this age can say two-word phrases or shorter utterances, such as “get up,” “see plane,” or “want cookie”

30-36 months and beyond: we expect toddlers of this age to string together words into phrases. They can say phrases like, “I go outside now” or “It’s my turn” or “Please open this.” 

Some children check off these milestones with no issues at all. Yet, for many children these skills do not come along as naturally. 

Some children have trouble sharing ideas, getting their points across, and telling stories. Expressive language problems can be common in children and can impact self-esteem. 

Assessments for expressive language deficits

If you have concerns about your child’s language skills as explained above, it is a good idea to seek out an evaluation. Clinicians take a language sample as a first step in doing an assessment. The clinician will be looking to see if your child is using shorter utterances, phrases, or coherent sentences. A child may be a late talker, have a language delay, or it may be a true expressive language disorder. 

The next step for an evaluator is to understand your child’s skills in various areas of expressive language. The issue may come up in verbal expression, formulating sentences, word finding, word-choice, or social language. To assess these, the evaluator may do a test like the Clinical Evaluation of Language Fundamentals, Fifth Edition (CELF-5), Pragmatic Language Scales (PLS-5), Goldman-Fristoe Test of Articulation, Third Edition (GFTA-3), or other standardized measure. 

Ideally, your child will have a comprehensive assessment to identify the specific speech language challenges that are getting in your child’s way in terms of communication skills. Even better, consider a full comprehensive psychological or neuropsychological assessment to further evaluate your child for developmental disabilities like autism, developmental delay, Attention Deficit Hyperactivity Disorder (ADHD), or social communication disorder.

Types of Expressive Language Difficulties 

Parents and professionals can help by identifying the specific expressive language challenge a child is experiencing. It is often the case that people know kids are struggling because their words just don’t come out quite right. If this is the case for your child, have a look at the list below for help in identifying the specific challenges your child may be experiencing.

Verbal expression. If verbal expression is an issue, your child may frequently say, “I don’t know” or “I don’t remember” when trying to express their thoughts

Formulating sentences. If your child understands what you are asking but cannot come up with an appropriate response, sentence formation may be the issue. Your child may have difficulty identifying the correct vocabulary to create long and complex sentences. 

Word-finding. If your child struggles with word-finding if you hear something like, “I can think of it, but I don’t know the word” or “I can’t find my words.” They may not appropriately use verb tenses, such as past, present, and future. Due to problems with verb tenses, they may have difficulty writing stories and describing an event that happened.

Word choice. If your child is struggling with word choice, they may not use the correct words and might get frustrated. This frustration could result in behavioral problems or low self-esteem. Children with expressive language problems sometimes misuse words because they don’t understand what they mean. 

Social language. If your child is having trouble talking to peers, it may be a pragmatic language problem. They may be having trouble interpreting other’s perspectives, intentions, and interests. There may be difficulties sharing ideas with others and participating in a back-and-forth conversation. Pragmatic language also includes nonverbal communication including eye contact, gestures, body language, and facial expressions. If your child is self-conscious of their language difficulties and may even be hesitant to make new friends or engage in social activities due to their communication skills.

The issues described above are not necessarily signs of a diagnosable language disorder. Instead, they are clues about where your child is struggling. Knowing the specifics can help you target the right school-based or community-based interventions. 

As one can imagine in reading through the list above, expressive language difficulties can be extremely challenging. It is wise to do your homework and reach out to the school if you think this could be going on for your child. With either a disorder or a delay in expressive language, you will hear a child say phrases like these:

“I can’t find my words”

“I don’t remember” 

“I can’t say it” 

“I know what I want to say but I can’t think of the word”

Keep in mind that if your child is struggling socially or academically, these expressive language issues may be the culprit. Language deficits can impact a child’s ability to make friends or achieve in the classroom. They may have limited reading or writing skills. Problems at school may occur in speeches, debates, group work, and oral presentations.

“A child with these challenges may limit conversation with others or cry easily when constantly misunderstood. Some children may use a sibling to communicate their ideas. It might appear that a child doesn’t care about something, but in reality, they are just intimidated by the language required to participate.”

Fortunately, there is a great deal of research and intervention available to address expressive language challenges. 

Other Causes of Expressive Language Difficulties

English language learner

If your child is new to the cultural environment, it is normal to see some difficulties with expressive language. It could be that your child is assimilating to a new group of kids with cultural norms and expectations. There could be slang language that your child is slowly learning with peers. This process takes time.

Autism

Autism is a developmental disorder that can be a cause of expressive language problems. Many autistic children are developmentally behind peers in terms of expressive language. Sometimes an autistic child starts talking very late, at 3 years old or older. Other times an autistic child can speak clearly but may struggle to express thoughts and ideas, particularly about oneself. Autistic children may have trouble telling stories, sharing experiences, or communicating during conversations.

Global developmental delay

Children with significant delays may struggle in multiple areas, including language. They may be delayed in speaking or not communicate verbally at all. They may have intellectual disabilities. In this case, there may be difficulties comprehending spoken language, following directions, and completing academic tasks. These developmental delays may include social and motor skills issues as well.

When to Seek Help For Expressive Language Difficulties

When your child has a lot of trouble communicating clearly… If your child struggles with coming up with the words they want to say, sharing ideas with others, and telling stories, it is probably time to get help. A language evaluation from a speech-language pathologist is a great first step.

The good news is that these language challenges are readily amenable to treatment. Speech therapy can do wonders for a child struggling to express their thoughts at school, at home, or in the community.

When your child is not socializing well with peers… If your child seems to be choosing not to socialize much with other children their age, it could be because of difficulties communicating. They may prefer to play alone or with family members who understand them. If your child is experiencing these challenges at school, consult with the teacher early and often.

When your child is struggling academically… If your child is falling behind in school, it could be time to get help. Expressive language can affect all academic areas. These challenges can impact written language tasks, speaking in class, and social communication. Your child may struggle with various subjects that require public speaking or verbally sharing ideas. Due to difficulties with phonological awareness, your child’s academic difficulties may appear in reading, writing, and spelling. 

If this is the case, it is wise to inform the school. Often interventions are available through the school’s Response to Intervention (RtI) program. The school may have an interventionist who can provide support for your child’s expressive language or academic challenges. Assistive technology may support your child in school. For example, dictation software can help a struggling writer in terms of academic performance. It may be that your child knows the answers but is having difficulty getting their thoughts down on paper. Assistive technology can ease that process by reducing the ‘cognitive load’ on your child’s brain. There are also speech-to-text and text-to-speech accommodations available for taking tests. These accommodations can help on in-class tests or standardized assessments.. If you want to know more about these resources, start with a school administrator, school counselor, or 504 Coordinator. 

Further Resources on Expressive Language Issues

• Speech-language pathologists: to provide speech therapy in expressive language and communication skills if special needs there are identified
• Special education teacher: to help with reading and writing that may be impacted by expressive language or a speech disorder
• Psychologist: to help with any emotional or social challenges associated with the expressive language problem
• Pediatrician: to provide a referral for therapy or diagnose any related medical conditions
• Geneticist: to evaluate if genetic issues are suspected

Related Conditions to Expressive Language Disorder

• Receptive language problems: expressive and receptive language are closely related skills. Some children will have difficulty with both types of language
• Social skills challenges: expressive language issues can impact social skills 
• Learning concerns: expressive language issues may impact schoolwork or grades, particularly in language arts and social studies
• Tantrums: expressive language challenges may lead to tantrums or acting out behaviors
• Executive functioning: expressive language challenges can be related to planning out what to say and controlling impulses
• Auditory processing: expressive language skills can be related to problems with processing auditory information

Resources for Expressive Language Challenges In Children

Apel, Kenn & Masterson, Julie (2012). Beyond Baby Talk: From Speaking to Spelling: A Guide to Language and Literacy Development for Parents and Caregivers.

American Speech-Language Hearing Association. http://www.asha.org/

Bernstein, Deena K. &   Tiegermann-Farber, Ellenmorris (2017). Language and Communication Disorders in Children, Third-Sixth Editions.

Law, James; Garrett, Zoe & Nye, Chad. (2003). Speech and language therapy interventions for children with primary speech and language delay or disorder.

Lewis, Ph.D., Jeanne, Calvery, Ph.D., Margaret, & Lewis, Ph.D., Hal (2002). Brainstars. Brain Injury: Strategies for Teams and Re-education for Students. US Department of Education: Office of Special Programs.

Speech Language Milestones: http://www.asha.org/public/speech/development/chart.htm