Language Disorder in Children: Ronald B Gillam Sandra Laing Gillam

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Language Disorder in Children
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DOI: 10.1007/978-3-319-57196-6
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Running Head: LANGUAGE DISORDER 1
Language Disorder in Children
Ronald B. Gillam
Sandra L. Gillam
Sarai Holbrook
Carla Orellana
Utah State University
In S. Goldstein & M. DeVries (Eds.), Handbook of DSM-5 Disorders in Children and

Adolescents (pp. 57-76), NY: Springer https://doi.org/10.1007/978-3-319-57196-6
Abstract
Children with language disorder have unusual difficulties understanding and/or using
vocabulary or grammar in age-appropriate ways. Their difficulties with language development
cannot be attributed to underlying conditions such as intellectual disability, sensory disorders,
medical conditions, neurological disorders, or motor dysfunctions. Language disorder affects
approximately 7% of preschool and school-age children children. Researchers have hypothesized
neurophysiological, biological (genetic), and psychological (cognitive/linguistic) causes of
language disorder, but the precise etiology of language disorder has yet to be determined.
Preschoolers with language disorder often have difficulties using grammatical morphemes to
mark tense and agreement These grammatical difficulties may continue into the school-age
years, when children with language disorder exhibit difficulties understanding and producing
narratives and expository texts and often present reading and writing delays. A complete
assessment of language disorder should include a detailed case history, interviews with the
individual’s family and teachers, administration of ecologically valid standardized and non-
standardized measures of communication, and consideration of related areas (e.g., behavioral,
medical, educational status). Language intervention for children with language disorder involves
techniques designed to remediate or modify the factors that contribute to language disorder or
teaching compensatory strategies to reduce the impact of a language disorder on academic, social
and/or vocational functioning. In the DSM-V, communication disorders (including language
disorder) are categorized as neurodevelopmental disorders along with intellectual disability,
autism spectrum disorder, attention-deficit/hyperactivity disorder, specific learning disorder, and
motor disorders.
Keywords
Language development
Language impairment
Language disorder
Grammar
Vocabulary
Communication
Overview of Language Disorder and History in DSMs

Children with language disorder have unusual difficulties understanding and/or using
vocabulary or grammar in age-appropriate ways. Their language impairments cannot be
attributed to underlying conditions such as intellectual disability, sensory disorders (hearing or
vision), medical conditions, neurological disorders, or motor dysfunctions (American Psychiatric
Association [APA], 2013). For example, children who are born with Down syndrome, severe
hearing impairment, or fetal alcohol syndrome are likely to have problems learning and using
language, but these children should receive diagnoses that are based on their primary disorder.
Thus, the diagnosis of language disorder should be reserved for children whose receptive and/or
expressive language skills are significantly below that which would be expected for their age in
the absence of any other developmental disability that could cause the language difficulties.
Language disorder occur fairly commonly, affecting approximately 7% of preschool and
school-age children children (Tomblin et al., 1997). Children whose language learning
difficulties do not resolve by age 5 frequently have difficulties with social and academic
language during the elementary school years (Tomblin et al., 2003), and they are likely to
continue to exhibit social, academic, and vocational difficulties well into the high-school years
(Johnson et al., 1999; Stothard, Snowling, Bishop, Chipchase, & Kaplan, 1998). Because reading
and writing are language tasks (Kamhi & Catts, 1999), many school-age children with language
disorders present literacy learning problems (Catts, Fey, Weismer & Bridges, 2014). Terms such
as developmental language disorders, specific language impairment, and primary language
impairment are also used as diagnostic labels for unexplained developmental language problems
(Bishop, 2014).
History of Language Disorder
Until the late 1950’s, language disorders and speech disorders were collapsed into a
single category of, “speech disturbances” (DSM-1, 1952) or “other speech impediments” (ICD-7,
1957). The modern era of clinical research that focused on children who demonstrated
significant language delays without co-occurring mental retardation, hearing impairment, or
autism began in the 1960’s, when researchers like Jon Eisenson and his colleagues at Stanford
studied children he referred to as having developmental aphasia (Eisenson, 1966, 1968). About
that same time, Mildred Berry and her colleagues at Texas Women’s University and the
University of Wisconsin at Madison were studying children that they referred to as having
idiopathic language retardation or neurogenic learning disabilities (Berry, 1969). Most
researchers at the time assumed that such children had atypical neural organization, often
referred to as “minimal brain dysfunctions” (Clements, 1966) that interfered with language
learning.
The ICD-9 (1978) differentiated between speech and language disorders, but both types
of disorders were part of a single diagnostic category called “developmental speech/language
disorders.” It was not until the DSM-III in 1980 that children with language disorders had their
own diagnostic category (developmental language disorder – expressive and receptive type) that
was separate from a “developmental articulation disorder.” The designation was further divided
into developmental expressive language disorder and developmental receptive language disorder
in the DSM-III-R (1987).
In both the DSM-III and the DSM-III-R, developmental language disorders were part of
the category of Specific Developmental Disorders that included developmental reading disorder
(dyslexia), developmental arithmetic disorder, and mixed specific developmental disorder. The
key to the diagnosis was that the child had a particular skill that was impaired relative to age
expectations but overall development was within the normal range. Grouping developmental
reading disorder and developmental language disorder in the same category acknowledged the
close relationships between these conditions.
In the DSM-V, communication disorders (including language disorder) are categorized as
neurodevelopmental disorders along with intellectual disability, autism spectrum disorder,
attention-deficit/hyperactivity disorder, specific learning disorder, and motor disorders. The
disorders in this grouping have similar genetic risk factors, shared neural substrates, and similar
clinical features such as cognitive processing problems, higher rates of co-morbidity with each
other, and a continuous course of development into adulthood (Andrews et al., 2009). It is
interesting that in some respects, the current characterization of language disorder as a
neurologically-based disorder is similar in nature to the neurological-oriented characterization
that was prevalent in the 1960’s, albeit with a much stronger scientific base.
Current Diagnostic Criteria for Language Disorder
Language disorder is characterized by impairments in vocabulary, sentence structure, and
discourse level communication (American Psychiatric Association, 2013; American Speech-
Language Hearing Association [ASHA], 1993). These difficulties should be apparent across
multiple modalities including speaking, writing, and/or sign language (American Psychiatric
Association, 2013; ASHA, 1993). Language disorder affects receptive language, expressive
language, or both. Receptive language relates to an individual’s ability to comprehend linguistic
information, whereas expressive language relates to an individual’s ability to formulate and
produce linguistic information. To be diagnosed with a language disorder, the child’s language
performance must be shown to be significantly below age expectations to the extent that it would
be likely to interfere with communicative, social, academic, and/or vocational functioning.
Finally, language disorder must be present from early development and must not be attributable
to intellectual impairment or global developmental delay. Language difficulties exist in the
absence of or to a greater degree than could be explained by other sensory, motoric, medical, or
neurological conditions that may be present (APA, 2013).
The DSM-5 does not list specific psychometric criteria for diagnosing language disorder.
To date, the only epidemiologically-derived diagnostic criteria comes from a series of
longitudinal studies of kindergarten children with specific language impairment by Tomblin and
his colleagues (Catts et al., 2008; Fey et al., 2004; Leonard et al., 2007; Tomblin et al., 2003).
Tomblin, Records and Zhang (1996) reported excellent sensitivity and specificity (values above
.9) for a standard score cut-off of 83 on a global language test that assessed receptive and
expressive language skills in the areas of vocabulary, syntax, and discourse processes or for
performance of -1.25 standard deviations or more below the mean on two or more composite
scores representing language comprehension, language production, vocabulary skill,
grammatical skill, and narrative skill. Looking across a number of studies of children with
language disorders, many investigators identify language disorder by performance that is -1 or
more standard deviations below the mean on multiple tests or subtests of receptive or expressive
language (Leonard, 2014; Spaulding, Plante & Farinella, 2006).

Assessment of Language Disorders
A complete assessment of language disorder should include a detailed case history,
interviews with the individual and his family, ecologically valid standardized and non-
standardized measures of communication, and consideration of related areas (e.g., behavioral,
medical, educational status). Thus, assessment of language disorder should be a multifaceted
process that involves consideration of the aspects of an individual’s life that are affected by
language. A single individual can collect this data, but the preference is for professionals from
different disciplines to work together in the assessment process. According to the World Health
Organization this practice model is called Interprofessional Practice (IPP). In IPP, professionals
work collaboratively in health care and education settings to learn about, from and with each
other (World Health Organization, 2010). When multiple service providers from different
professional backgrounds work together, they are better able to provide comprehensive
healthcare and educational services to individuals and the families they serve.
Infants and toddlers
Assessment of language disorders in infants and toddlers is primarily related to predicting
which children have significant delays in language development that will persist over time.
However, the diagnostic accuracy of identifying infants and toddlers with persistent language
disorder is relatively poor (Woods et al., 2014). For this reason, a diagnosis of language disorder
is rarely made before 24 months of age.
Test instruments and analyses used for infants and toddlers include items to assess
developmental milestones related to communication, motor, cognitive, sensory, and social-
emotional skills. An example of a norm-referenced test for measuring general development in
multiple domains is the Battelle Developmental Inventory, Second Edition (BDI-2) (Newborg,
2007), which can be used to obtain developmental age scores for personal-social skills, adaptive
behaviors, communication skills and cognitive abilities. The Rosetti Infant Toddler Language
Scale (Rosetti, 2006) has items measuring gestures, play, language comprehension, and language
expression, but it does not compare toddlers to other children their same age. In addition,
informal observation and sampling may be used when the infant or toddler may not be able to
cooperate with a test procedure because of compliance issues or extreme disability.
Parent report is often the best way to obtain evidence about language and communication
skills in infants and toddlers. There are screening and assessment measures such as the
MacArthur-Bates Communicative Development Inventories (CDI), in which parents of children
between 8 and 37 months of age report which words their child understands or uses. The scale
divides the words children understand and produce into semantic classes so that examiners can
get a sense for the concepts and categories of words that are present or need elaboration. In
addition, there is a section that asks parents to report the communicative and symbolic gestures
their child has attempted or mastered.
Preschool and School-age children
A combination of assessment tools and analyses are needed in order to gain a full
understanding of a preschool-aged child’s receptive and expressive language skills. Some
standardized tests assess multiple areas of language to provide a broad view of an individuals’
communication system. Two of these global language measures are the Clinical Evaluation of
Language Fundamentals – 5th Edition (CLEF-5; Wiig, Semel, & Secord, 2013) and the Test of
Language Development – 4th Edition which is available for two levels, primary (TOLD-P:4;
Hammill & Newcomer, 2008) and intermediate (TOLD-I:4; Hammill & Newcomer, 2008). Both
tests offer composites that represent overall language functioning as well as domain specific
skills. Adding the Test of Narrative Language (Gillam & Pearson, 2004) to either of these
measures would provide examiners with the type of composite scores used in the Tomblin
epidemiological studies: overall indices of expressive and receptive language as well as scores
representing comprehension and use of vocabulary, grammatical morphology, syntax, and
narration. Many other tests are available that assess specific areas of language skill. Examiners
should select standardized tests that are reliable and valid in relation to the child being tested,
particularly if the child is from a culturally or linguistically diverse background (Friberg, 2010;
Paul, 2012; Spaulding, Plante & Farinella, 2006).
Although standardized tests can give information about an individual’s communication
functioning relative to a normative population, non-standardized assessments of language
provide a rich description of an individual’s communication functioning in multiple contexts.
Examples of non-standardized assessments include language samples, interviews, and dynamic
assessment.
Examiners commonly collect a language sample, or segment of connected speech, from
children in natural environments. Language samples reveal information about the individual’s
language productivity (total number of words, number of different words, mean length of
utterance), language complexity (complex vocabulary and sentence structure), and accuracy
(grammatical acceptability and articulatory intelligibility) and may reveal information about the
individual’s communication that is not readily apparent in standardized measures (Costanza-
Smith, 2010). Language samples are collected using a variety of methods. Conversational
language samples, in particular, illuminate an individual’s ability to comprehend questions and
statements within the normal flow of discourse. These can be collected through direct
observation by the examiner or family members may provide videos of an individual’s

communication with friends, siblings, parents, and others, which can then be analyzed. Language
samples are particularly useful for assessing individuals of culturally and linguistically diverse
backgrounds (Laing & Kamhi, 2003).
Input from people who interact regularly with a child suspected of having a language
disorder further informs the diagnostic process. Parents and other family members provide
valuable information regarding birth and development of children; further, they provide critical
insight into how the child’s communication affects family life, social interactions, and academic
functioning. Teachers can also assist, giving information about academic and social functioning
within the school setting. As children mature, information from self-reports becomes
increasingly important to inform intervention as the individual’s priorities need to be considered.
Examiners may also use a process called dynamic assessment to improve diagnostic
accuracy. Dynamic assessment is a “test-teach-retest” method in which clinicians obtain
evidence of a child’s ability to perform a language task (such as narration), then observe the
child’s learning processes as they teach the skill during two teaching sessions, and then retest to
determine how much the child learned. This method does not rely on the prior experience of an
individual; it is designed to assess an individual’s ability to respond to teaching. Observations of
the child’s ability to modify their responses based on the clinician’s input is the key to making
correct judgments of language impairment (Peña & Gillam, 2000; Peña, Gillam & Bedore,
2014).
The assessment of language disorder involves a battery of assessment tools, both formal
and informal. Understanding an individual’s abilities compared to others of similar age and
experience is important for diagnosing language impairment accurately Collecting information

about the individual’s functional abilities, strengths, and weaknesses can be even more important
for developing intervention plans.
Etiology of Language Disorder
Researchers have hypothesized neurophysiological, biological (genetic), and
psychological (cognitive/linguistic) causes of language disorder. As with nearly all of the
neurodevelopmental disorders, the precise etiology of language disorder has yet to be
determined.
By definition, children with language disorders present language difficulties in the
absence of frank neurological impairments such as brain lesions. However, it is reasonable to
assume that there is a connection between neural functions and language ability. To date,
relatively little neuroimaging research has been conducted with this population. Some studies
have revealed neurological differences between children with language disorders and typically-
developing children. For example, structural differences have been noted in inferior frontal
cortex (Gauger, Lombardino & Leonard, 1997) and the temporal-parietal junction (Jernigan et
al., 1991) in children with language disorders. In addition, many of these children have been
shown to have atypical hemispheric asymmetries in which the perisylvian area (inferior frontal
gyrus back to the supramarginal gyrus) in the right hemisphere is larger than the same area in the
left hemisphere (Plante, Swisher, Vance & Rapcsak, 1991; Gauger, Lombardino & Leonard,
1997). This pattern is the opposite of the left lateralization that is seen in most typically-
developing children. However, fMRI studies (Ellis Weismer, et al, 2005) and functional Near
Infrared Spectroscopy (fNIRS) studies (Gillam et al, 2015) have not revealed laterality
differences between children with and without language disorders as they were engaged in
memory or language tasks.

There have been many more electrophysiological studies of children with language
disorders using EEG and ERP techniques, primarily because this technology is relatively
inexpensive and data can be collected in more naturalistic settings. Results of a number of
electrophysiological studies suggest that attention processes for auditory nonspeech and speech
stimuli are unusual in children with language disorders (McArthur, Atinson & Ellis, 2009;
Weber-Fox, et al., 2010). Group differences have been detected for grammatical processing
(Shafer et al., 2000; Weber-Fox et al., 2010) but not for semantic processing (Fonteneau & van
der Lely, 2008; Weber-Fox et al, 2010). Importantly, it has been shown that ERP responses of
children with language disorder become more like their typically-achieving peers after
participating in a narrative language intervention (Popescu et al., 2009). The EEG and ERP
evidence suggests that neural processing differences contribute to language disorder. More
importantly, these processes can be altered through language intervention. Clearly, this is a
fertile area for future research.
There are genetic contributions to language disorder. A number of studies have shown
that children with language disorder have higher percentages of family members with a history
of language problems than control children without language disorder (Barry, Yasin & Bishop,
2007; Flax et al, 2003). Studies of twins consistently reveal higher concordance rates (both
twins presenting language disorder) for monozygotic twin pairs than for dizygotic twin pairs
(Bishop, North & Donlan, 1995; Tomblin & Buckwalter, 1998). Molecular genetic studies have
identified potential genetic variants that may contribute to language disorder including FOXP2
(Lai et al, 2001; Tomblin et al, 2009), CNTNAP2 (Vernes et al. 2008), and 6p22 (Rice, Smith, et
al., 2009). Rice (2012) has proposed that the start-up mechanisms responsible for gene
expression may be delayed in children with language disorder. This hypothesis is consistent
with evidence of slower growth trajectories in children with language disorders (McArthur &
Bishop, 2005; Rice, Wexler & Hershberger, 1998; Tomblin, et al. 2003).
Psychological hypotheses about the etiology of language disorder can be divided into
linguistic (domain-specific) and cognitive (domain-general) factors. Domain-specific
explanations of language disorder suggest that the difficulty children with language impairment
have is specifically related to the grammatical system. Most domain-specific accounts of
language disorder are related to the notion that some children treat certain linguistic rules as
optional rather than obligatory (Marinis & van der Lely, 2007; Friedman & Novogrodsky, 2007).
One early explanation is called the extended optional infinitive hypothesis proposed by Wexler
(1994). Under this account, language disorder is thought to arise from a specific difficulty in
understanding that one must mark tense in a main clause. Inconsistent marking of tense is typical
for all children as they acquire language, however students with language impairment continue to
do so long after their typically developing peers (Rice, Wexler & Hershberger, 1998).
Domain-general explanations of language disorder suggest that limitations in cognitive
processing interfere with one’s ability to learn language. Evidence has shown that children with
language impairment demonstrate slower response times during linguistic and nonlinguistic tasks
(Kail, 1994; Leonard et al., 2007), however some have argued that processing efficiency, rather
than processing speed, may better explain performance of children with language impairment on
these tasks (Gillam, Cowan & Day, 1995). It is likely that some combination of cognitive factors
including limited information processing capacity (including attention, perception, and memory)
and slowed processing speed play an important role in language disorder. For example, working
memory and processing speed together has been shown to account for 62% of the variance in the
composite language scores of adolescents with language disorder (Leonard et al., 2007).
Symptom Presentation, Course of the Disorder, and Developmental Changes
Preschool Years
During the preschool years, children should learn a variety of words that represent
different word classes (e.g., question words, colors, spatial terms), conjunctions (e.g.,
coordinating, subordinating), and words that may be used to categorize, and describe objects,
actions and events (Anderson, 2010). By 24 months of age, children developing typically are
using 2-word phrases with diverse and varied vocabulary, while children with a language
disorder may still be pointing at objects they want or using a few single words. Preschoolers who
do not learn words easily or who have difficulty expressing a range of semantic relationships
such as possession (e.g., mommy’s shoe), recurrence (e.g., mommy came back), and location
(e.g., mommy in the kitchen) may have a language disorder.
Preschoolers with language disorders often produce very few grammatical morphemes
(e.g., possessives, plurals) correctly and have difficulties using them to mark tense and
agreement (e.g., She walkded home. She my friend). They may also have difficulty
understanding and using complex sentences. Preschoolers developing typically generally
produce sentences that are grammatically correct (70%) at the age of 3, while preschoolers with
language disorder at the same age make significantly more errors (>70%).
School-age Children
School-age children may continue to make some grammatical errors in their sentences,
however no more than 20% of their sentences should be grammatically incorrect. In addition, the
conversational speech of school-aged children should contain a variety of complex sentences (at
least 20% in a 100 utterance sample). Children with language disorders tend to use fewer
complex sentences and tend to make more grammatical errors throughout the school-age years
(Gillam & Johnston, 1993)

Another sign of a potential language problem for school-age students includes delays or
deficits in phonological awareness (Gillon, 2005). Phonological awareness is the knowledge that
individual sounds make up the words in the language. Tasks that measure this awareness include
those that requires sound categorization (e.g., which word starts like leg; lamb, fox, ball),
blending (e.g., when you combine the sounds, /b/, /a/, /l/ they make the word?), and segmentation
(e.g., the word ball may be broken into what 3 sounds?) Problems with phonological awareness
may make it more difficult for children with language disorder to make the necessary
connections between letters and the sounds they represent, making word recognition difficult.
Narration (storytelling) is an important form of discourse during the school-age years.
Children developing typically produce narratives that are generally grammatical and contain an
adequate number of syntactically diverse and complex sentences (>20%). Their stories contain
basic story elements (settings, events, actions, endings) that are organized temporally and
logically. Children with language disorder are likely to produce narratives that are disorganized,
and that contain more ungrammatical sentences and fewer complex sentences (Gillam &
Johnston, 1993).
Finally, a hallmark of a language problem during the school-age years is difficulty
understanding and using higher-level skills such as inferences (Laing & Kamhi, 2002; Karasinski
& Ellis-Weismer, 2010). Inferences are assumption that are made about concepts or ideas that
were not stated. For example, in the paragraph, “The girl watched while the boy jumped onto the
steps. He slipped and fell. She laughed,” inferences are required to understand that the child who
“slipped and fell” was the boy, and that the girl was the one who laughed.
Secondary School
Children with a language disorder at the adolescent stage may demonstrate difficulty with
understanding and using figurative language, multiple meaning words, idioms and abstract or
curricular vocabulary. Much of the conversational and written discourse that is encountered
during the adolescent years contains morphologically complex words that require knowledge and
experience with word structure as well as mastery of sophisticated metalinguistic skills (Nippold
& Sun, 2008). Students with language impairment may demonstrate poor comprehension of
curricular texts presented orally or in written form identified by an inability to state main ideas,
and to recall and report facts about persons, dates and details, and to make logical generalizations
and conclusions (Gillam, Fargo & St. Clair, 2008). They may also have difficulties composing
book reports, essays, and term papers that require integration of information contained in oral
and written discourse.
Sociodemographic Trends in Language Disorder Identification
As mentioned earlier, Tomblin et al (1997) conducted an epidemiological study on the
prevalence of language disorders based on a stratified sample from regions of Illinois and Iowa.
They estimated an overall prevalence rate of 7.4%. They further estimated a prevalence rate of
6% in girls and 8% in boys, which differs from the the 2:1 male to female ratio that had been
previously reported in the literature. When race and ethnicity were taken into consideration,
variations across groups were found, with Native American children having the highest
prevalence rates, followed by African-American children, then Hispanic children. None of the
Asian American children were found to have a language disorder in that particular study.
Children who spoke another language than English or who heard another language spoken at
home were excluded from the study. The differences in prevalence rates could be attributed to
culturally and linguistically biased assessments. These differences were further confounded by a
socioeconomic factor, namely, that racial/ethnic background correlated with parental education,
which was also associated with language disorder.

Epidemiological studies reveal cracks in the referral and diagnosis system. Tomblin et al
(1997) found that only 29% of the parents of children identified with a language disorder had
been informed by a professional that their child had a speech or language problem. When
accounting for severity of the child’s disorder 39% of the parents of the more severely impaired
children had prior knowledge of their child’s language problems compared to 27% of the less
severely impaired children. Similarly, in a study of 513 at-risk, low SES children, King et al
(2005) found that at least one source (parent, primary care provider, or home visitor) reported
initial concerns about 60% of the more severely language impaired children but only 43% of the
less severely language impaired children.
Peña, Gillam, Bedore, and Bohman (2011) determined the risk for language disorder in a
sample of 1, 100 bilingual pre-kindergarten children in two states. Using the criteria of
performance at or below the 25th percentile on at least one Spanish measure and one English
measure, they found that 30.6% of 1029 Latino children were at-risk for language disorder.
There were no differences in the risk of language disorder for various sub-groups of children
with differing levels of exposure to English and Spanish when controlling for age. Unlike the
Tomblin et al (2007) study, there was a weak association between socioeconomic status and risk
for language disorder in this Latino population. When they followed 167 at-risk children over a
two-year period of time, they found that 12% of at-risk bilingual children were language
impaired (Gillam et al., 2013). This is consistent with the King et al. (2205) finding that 10% of
their at-risk population had language disorders. The availability of linguistically and culturally
appropriate assessments may impact accuracy of prevalence in diverse groups leading to both
overrepresentation and underrepresentation of these groups. It appears that a process that

involves universal screening for language ability followed by more complete language testing
yields a prevalence rate of 10 – 12% for samples of monolingual and bilingual children.
Associated Impairments
Problems with the acquisition and use of language are prominent characteristics of a
number of diagnostic conditions. Language disorder may result from deficits in the growth and
development of the brain. Language disorder is also associated with neurocognitive disorders
such as traumatic brain injuries or sensory disorders such as hearing impairment. Finally,
language disorder can be related to neglect and abuse, behavioral problems, and emotional
problems. The most common associated conditions are late talkers (early delayed language),
social communication disorder, intellectual disorder, and autism spectrum disorder.
Late Talkers
Children who start speaking very late (fewer than 50 words at 18 months of age) are often
referred to as late talkers. When these children have age-appropriate language comprehension
skills and no family history of language impairment, they are likely to catch up to their peers by
the time they reach kindergarten (Rescorla, 2002). They often perform within the normal range
on a variety of language measures by the time they reach high school (Rescorla, 2009). Late
talkers whose deficits persist into the school-age years are usually identified as having a
language disorder.
Social Communication Disorder
An important change in the DSM-V involves the distinction between disorders that
primarily affect semantic and syntactic aspects of language and those that primarily affect the
pragmatic aspect of language. Social (pragmatic) Communication Disorder (SCD) is defined as
a primary deficit in the social use of nonverbal and verbal communication as demonstrated by
impairments in social communication (greetings, sharing information), in the ability to meet
listener needs, and in such skills as taking turns in conversations. These problems limit the
ability to develop and maintain social relationships. Many children have symptoms that cross
the boundaries between SCD and language disorder. For example, children with impairments of
language form (syntax) and content (vocabulary) may have social communication difficulties as
well. However, in diagnosing a social communication disorder, the clinician must determine that
the child’s poor social language skills do not result primarily from vocabulary or grammar
impairments.
Intellectual Disability
An intellectual disability is indicated by severe deficits in intellectual functions (e.g.,
reasoning and problem solving) and adaptive behaviors (e.g., communication and activities of
daily living) that appear during childhood or adolescence. Children with intellectual disabilities
often present motor, language and social delays before 2 years of age. Later in development,
they earn scores below 70 on both IQ tests and measures of adaptive functioning. Intellectual
disabilities can be caused by genetic conditions such as Down Syndrome or Fragile X syndrome,
maternal infections during pregnancy such as rubella or cytomegalovirus, complications during
delivery resulting in anoxia, diseases such as measles and meningitis, or environmental factors
such as neglect or severe malnutrition. Children with intellectual disabilities almost always have
language impairments related to language content, and many also have impairments in the area
of language form (Rakhlin & Grigorenko, 2015). It is common for these children to be
significantly delayed in learning words, and to use short, simple sentences well into the school-
age years. Despite the fact that children with a language disorder do not have deficits in basic
intelligence, the nature of the language impairment demonstrated by children in both groups can
be quite similar (Laws & Bishop, 2004). The exception is that there is often a bigger
discrepancy between comprehension and production abilities in children with a language
disorder than in children with an intellectual disability (Polišenská, & Kapalková, 2014).
Autism Spectrum Disorder
Children diagnosed with autism spectrum disorder (ASD) must have pervasive and
sustained difficulties with reciprocal social communication and social interaction characterized
by severe problems with conversation, sharing of interests or emotions and initiating or
responding to social interactions. Children with ASD must also present restricted or repetitive
patterns of behavior, interests or activities such as repetitive motor movements (e.g., rocking or
rubbing their heads), insistence on sameness, and/or inflexible adherence to routines. These
symptoms are present from early childhood, and they interfere with daily activities and the
ability to learn through socialization. Language impairment accompanied by a lack of interest in
socializing (e.g., lack of eye contact), or unusual social interactions (e.g., not responding to
speaker or responding to anything said by saying the same words over and over) may be early
signs of ASD. Even though a number of individuals with ASD have intellectual disabilities
and/or language disorder, their key symptoms cannot be explained by these other deficits
(American Psychiatric Association, 2013).
In the past, ASD and language impairment have been viewed as separate and distinct
disorders, however, it has become increasingly clear that there are a number of areas in which the
two overlap in their language profiles (phenotype), as well as neural processing patterns and
genetic contributions (Ellis-Weismer, 2014). In terms of language profiles, children with ASD as
well as some with language impairment have been shown to demonstrate similar problems in
language use or pragmatics. While some have suggested that basic language skills such as
phonology, morphology and syntax remain intact in ASD, recent research has shown that many
students with ASD experience more basic language deficits involving all of the domains of
language. In fact, as many as 50% of students with ASD never develop functional
communication skills (Eigsti et al., 2011).
There are neurological and genetic differences between children with language disorders
and children with ASD. While some studies have shown rightward hemispheric asymmetry in
children with ASD and children with language disorder, children with language disorder are
more likely to have structural differences in inferior frontal cortex (Boca’s area) than children
with ASD. Genetic studies that have explored potential overlap between language disorder and
ASD have shown that the incidence of ASD is increased for both siblings of children with SLI
and ASD, however there is no clear indication of a common genetic etiology between ASD and
language disorder (Rakhlin & Grigorenko, 2015).
Comorbid Disorders
Attention Deficit Hyperactivity Disorder
Attention deficit hyperactivity disorder is characterized by the presence of
developmentally inappropriate levels of hyperactivity, impulsivity and inattention across
multiple contexts and settings that affects 3-5% of the school age children (National Institutes of
Health [NIH] Consensus Development Panel, 2000). Children with ADHD may demonstrate
comorbid deficits in language but it is not uncommon for the presence of ADHD to result in
misdiagnosis of language disorder. Generally, children with ADHD without language
impairment do not demonstrate significant errors in marking tense while children with language
impairment do (Redmond, 2005). In addition, students with ADHD with no comorbid deficits in
language have been shown to perform similarly to typically developing peers in producing
organized stories that contained critical story elements (events, actions, endings), while students
with language impairments do not (Luo & Timler, 2008). In a recent study, Redmond et al.,
(2011) examined the extent to which tense marking, nonword repetition, sentence recall and
narrative proficiency accurately characterized language impairment in 60, 7-8 year old children.
Findings revealed that students with ADHD performed similarly to their typical peers on
measures of tense-marking, nonword repetition, and sentence recall while the students with
language impairment did not.
Specific Learning Disorder
Specific learning disorder (more commonly referred to as a learning disability) is
characterized by persistent difficulties learning academic skills. These children’s skills in the
areas of word decoding, reading comprehension, spelling, writing, number facts, and/or
mathematical reasoning are well below the expectations for their chronological age. These
learning disorders are “specific” because, like language disorder they cannot be explained by
intellectual disabilities, visual or hearing problems, other mental or neurological disorders, or
poor instruction.
Treatment for Children with Language Disorders

Language intervention for children with language disorder involves techniques designed to
remediate or modify the factors that contribute to language disorder or teaching compensatory
strategies to reduce the impact of a language disorder on academic, social and/or vocational
functioning. Clinicians design treatment programs that target deficiencies in language form,
content and use for preschoolers (ages 3-5), elementary students (ages 5-10), and adolescents
(11-21). In the next sections, we will discuss language targets (form, content and use) as well as
methods and techniques used to remediate, modify or help children compensate for factors that
contribute to difficulties in these language domains.
Intervention for Preschoolers
Targets. Intervention targeting language form in preschoolers typically focus on
improving morphological abilities such as the use of copula BE (am, is, are, was, were), auxiliary
BE (am, is, are, was, were), or auxiliary DO (do, does, did). Other forms that might be targeted
in intervention sessions include the use of possessive –s, 3rd person present –s, and irregular and
regular past tense verbs. Clinicians may work with preschoolers to increase the length and
complexity of the sentences they use and to use more diverse types of sentences such as
statements, commands, and interrogatives.
Intervention for preschoolers may also focus on the content of language. For example,
clinicians may work with children to increase the size of their vocabulary (e.g., basic concepts,
colors), their use of various semantic relationships (e.g., agent-action, agent-action-object), and
their understanding and production of verbs, pronouns and conjunctions.
Language use or pragmatic goals may also be a part of language intervention programs for
preschool children. Intervention for language use might include teaching children to be more
flexible in their use of language in different contexts, to use their imagination and/or to improve
their abilities to participate and contribute to conversations they have with parents, teachers and
their peers. Clinicians may help preschoolers develop their conversational skills by improving
their abilities in initiating and maintaining conversational topics, taking turns and in knowing
when and how to change topics. In addition, preschoolers with language disorders may also need
to learn how to let others know when they do not understand something and to clarify
information they provide during conversations that may be misunderstood by others (Brinton &
Fujiki, 1995).
Clinicians may also work with preschoolers on narrative comprehension and production.
Preschoolers with narrative language difficulties may work on their abilities to answer basic
questions about stories such as “who did what to whom?” Clinicians may work with preschoolers
to relate past experiences, to describe ongoing activities or routinized events or to recount or
generate fictional stories. All aspects of language form and content necessary for preschoolers to
understand and produce narratives would be integrated into this kind of intervention program.
Preschoolers with language disorders may develop problems in literacy so intervention might
also target emergent literacy skills such as print awareness, book awareness, and letter-sound
correspondence or activities designed to foster phonological awareness. Phonological awareness
lessons may involve teaching preschoolers to blend and segment spoken words, delete whole
words from compound words and to delete syllables and phonemes from spoken words, phrases
or sentences (Goldstein & Olszewski, 2015).
Methods and Techniques for improving language form, content and use for
preschoolers. There are 3 basic approaches for providing intervention services to young children
with language impairments. These include clinician centered, client-centered and hybrid
approaches (Fey, Long & Finestack, 2003). Clinician-centered approaches include very
structured techniques such as engaging children in drill and drill-play activities. Child-centered
techniques include indirect stimulation approaches. Hybrid approaches incorporate both
clinician-centered and child-centered techniques.
Clinicians may use various indirect language facilitation techniques and contingent responses
within each of these general approaches to model the forms, content and pragmatic skills the
child needs to learn. Indirect language facilitation techniques may include demonstrations,
expansions, expatiations, and vertical structures (See Cleave, Becker, Curran, Van Horne, &
Fey, 2015 for a meta-analysis of the efficacy of these techniques). Demonstrations are the
repeated but variable use of linguistic patterns during ongoing play activities, such as when
playing with a toy farm set. For example, to highlight the use of past-tense -ed, a clinician might
say, “The pig trotted into the barn. The cow trotted into the barn. The goat trotted into the barn.
They all trotted into the barn.”
Expansions are contingent verbal responses that increase the length or complexity of an
utterance produced by the child during the play interaction. For example, a child might say,
“Puppy” to which the clinician might say, “Yes, that is a puppy.” In this example, the utterance
“Yes that is a puppy” is used contingently by the SLP because it incorporates what the child said
(puppy) and it is an expansion because it incorporates the child’s utterance into a longer more
complex utterance from one (puppy) to five (yes, it is a puppy).
Expatiations are contingent verbal responses that add new but relevant information to the
child's utterance. For example, a child might say, “goat” to which the clinician may respond,
“That is a stinky goat.” The utterance provided by the clinician is contingent because it includes
what the child offered (goat) but it is also an expatiation because it adds new information (There
is a goat AND it is stinky).
Vertical structures are language facilitation techniques that involve asking children
questions to elicit at least two responses from them. These responses are then combined by the
clinician into one longer, more complex utterance. For example, consider the following
interaction targeting the causal connective “because”:
Clinician: The pig got a new hat. How do you think he feels?
Preschooler: Happy.
Clinician: Why does he feel happy?

Preschooler: Because he got a hat.
Clinician: The pig is happy because he got a new hat.
When using vertical structuring as a language facilitation technique, it is important to remember
that both utterances that are elicited from the preschooler must be combined into a complete
sentence (happy, because he got a new hat). Simple repetitions of each of the utterances
independently does not constitute a vertical structure.
Language Intervention during the elementary school years (ages 5-10)
Targets. Language Intervention during the elementary school years (ages 5-10) targets
similar language skills as those of the preschool years (e.g., morphology, sentence structure,
vocabulary, pragmatics and literacy) but may incorporate more advanced forms using
curriculum-based instructional materials (e.g., books, classroom conversation). For example,
elementary students may need morphological intervention to help them understand and use
advanced morphological forms (e.g., prophet/prophetic), prefixes and suffixes (e.g., dis-, inter-, -
ic, -tion) and to be more aware of grammatical errors they may be making in spoken and written
language. Further, students may need to learn and practice certain sentence structures such as
those that contain dependent clauses (e.g., prepositional phrases, adverbial clauses) so they that
may better understand and produce more complex sentence structures.
Language content or vocabulary instruction may target understanding and use of basic
word knowledge, abstract or figurative language, as well as literate language such as
coordinating and subordinating conjunctions, adverbs, metalinguistic and metacognitive verbs
and elaborated noun phrases. In addition to teaching students new words, Clinicians may also
assist them in learning strategies so they may learn new words on their own.
Intervention for language use (pragmatics) during the elementary school years involves
helping students to learn the discourse management skills they need to participate in
conversations and to repair conversational breakdowns. Other conversational skills that may be
part of an intervention program for elementary students with language disorder may include
teaching students to request clarification when they do not understand and to express their ideas
in polite or persuasive ways in a variety of contexts.
Students may also need instruction to help them understand and use narrative and
expository discourse skills. Fictional narratives contain characters whose goal motivated actions
become part of a story. Students with language disorders may need instruction to learn how to
identify the parts of a story (character, setting, initiating event, action, consequence) so they may
better organize their own stories and recall stories they have heard or read. Instruction may also
focus on assisting students in telling stories that contain multiple embedded or associated
episodes using coherent and organized linguistic form and content.
Expository discourse such as comparison, cause and effect or problem-solution becomes
important in academic settings during the elementary school years (Gillam, Fargo & Robertson,
2009). Clinicians may provide students with language disorder instruction on how to identify
features of the different types of expository structures. For example, to identify comparison texts
students would be taught signal words such as different from, same as, similar to, instead of, and
although. Students would then be taught how to use these words to compare how two or more
events, topics, concepts, theories, problems or objects compare.
Clinicians may focus on helping elementary students with language disorder to learn the
underlying language skills they need to become proficient readers. For example, students in the
early grades learn the difference between long and short vowels and how to blend sounds into
words while reading. Clinicians may design lessons to strengthen their phonological processing
skills. Higher-level phonemic awareness tasks such as deletion (e.g., deleting sounds from
clusters), and practice with multi-syllabic words (e.g., intellectual) might be part of such a
program.
Methods and Techniques for improving language form, content and use for school-age
students.
Several treatment procedures including the clinician, client-centered and hybrid
approaches used with preschoolers are appropriate to improve language form, content and use
with school-age children. Another popular approach to language intervention during the school-
age years incorporates aspects of modeling, practice, role play and discussion and is called
literature-based language intervention.
Literature based language intervention utilizes children’s literature as a context for
teaching specific form (morphology, syntax), content (semantics/vocabulary) use (narrative,
expository and conversational discourse) and literacy targets (phonological awareness) that
students may to work on to be successful in multiple settings. Literature –based activities
typically include clinician-led discussions about concepts and ideas that are contained in the
books. Clinicians may read and reread a story, pointing out specific aspects in the story that are
relevant to the goals the student is working on. For example, students may be working on
narrative discourse comprehension and retelling. In this case, the clinician might read a story,
highlight the story elements that are contained in the story (character, setting, events) and then
ask students to answer questions about the story elements. The clinician may re-read the story,
and then ask students to retell the story using the pictures in the book, and then without them, to
foster recall and memory specific details.
If language form is a target, the clinician may re-read the book while highlighting the
form that is the focus of instruction at that point in time, for example causal words such as
“because” or “so.” The clinician may use vertical structuring to facilitate students use of complex
sentences containing the words such as in the following example using the book “Tacky the
Penguin.”
Clinician: How did the penguins in the book feel about the hunters?
Student: The penguins were afraid of the hunters.
Clinician: Why were they afraid?
Student: Because the hunters might get them.
Clinician: the penguins were afraid because the hunters might get them.
Similarly, vocabulary is a frequent target of literature-based language intervention. Literature-
based vocabulary instruction is most effective when words are embedded in stories that are read
repeatedly, when the meaning of words are explicitly taught within the story context, and when
students are given opportunities to use the target vocabulary during their own discussions and
retellings about the text (Beimiller & Boote, 2006).
In one recent study, Gillam, Gillam and Reese (2012) found that literature-based
language intervention that incorporated these important aspects of instruction resulted in larger
narrative and vocabulary gains than more clinician-directed, drill based language intervention
procedures.
Language Intervention during the adolescent years (ages 11-21)

Targets. Adolescent language intervention often focuses on targeting skills to support
students so they may meet the increasing linguistic demands of middle and high school. This is
important if they are going to be ready to enter the workforce or to be prepared for college-entry
should they choose that path. Intervention programs for adolescents will target higher-level
language skills they need to understand curricular texts such as the use of inferencing and the
comprehension of figurative language and advanced vocabulary, including words they need to
understand to access their curricular materials. In addition, Clinicians will assist students in
learning the language skills they need to analyze and construct well-supported arguments.
Unfortunately, not all activities are designed to remediate or modify a language disorder
particularly in the adolescent years. Very often, Clinicians must teach compensatory strategies to
students at this stage so they are able to circumvent some of the underlying problems that may
not be remediable. Strategies include teaching students how to use graphic organizers, checklists,
and organizational techniques in order to help them recall and use information to answer
questions, recall information and construct spoken and written arguments. Strengthening
students’ metalinguistic and metacognitive skills will also be an important part of intervention
efforts during the adolescent years. Students may be taught specific strategies they may use to be
able to monitor their own performance during reading, writing, and even in social contexts. In
addition to teaching strategies and self-monitoring skills, Clinicians may need to put certain
modifications in place to help students to be more successful in the classroom such as
preferential seating and making recorded lectures available to them.
Methods and Techniques for improving language form, content and use for adolescents.
Many of the same methods and techniques used for younger school-age students may
also be effective for adolescents and include direct instruction during literature-based activities,
however, because adolescents are more cognitively sophisticated, they may take part in more
meta-cognitive activities that involve encouraging them to think about what they know, and how
they learn best. Role playing becomes an important intervention context at this stage and may
involve presenting students with situations where they must generate solutions that target form,
content or use goals that are important for them. For example, students may be asked to provide
a solution to a scenario that takes into consideration how characters feel and does not
compromise the relationship between the two characters. Further, students may be asked to
explain “why” they feel their solutions are appropriate in different situations. In particular,
adolescents must be able to generate long-term solutions to problems and discuss why short-term
solutions may not be sufficient. Any number of language targets, strategies, and self-monitoring
skills may be taught during role-playing with adolescents, and is a popular method for teaching
at this stage.
Contexts of Intervention
In years past, removing one or more students from the classroom has been the traditional
method for providing intervention to students of all ages. More recently, in light of the World
Health Organization’s call for Interprofessional Practice in health care and educational settings,
Clinicians and educators have become more comfortable working together, sometimes in regular
classroom, to provide services to children with language disorders. This approach to language
intervention makes it possible to integrate language-learning goals (complex sentence usage,
narrative abilities, phonological awareness, vocabulary, expository texts, learning strategies, etc.)
into aspects of the academic curriculum. Clinicians and classroom teachers may work together to
plan lessons and will either carry them out together with the whole class or one of them may lead
the class while the other facilitates student participation. For example, a clinician might conduct
lessons on creating narratives with the entire class all at once (Gillam, et al., 2014) while the
classroom teacher works with small groups of students in the classroom by helping them ask or
answer relevant questions.
Another possibility it to arrange the classroom into small “centers” that allow for groups
of children to rotate through them to practice various phonological awareness skills (van Kleeck,
Gillam & McFadden,1998) or even to develop new vocabulary (Gillam, S., 2007). For example,
students may participate in a listening center, where they hear definitions of new vocabulary pre-
recorded on a digital recorder that are relative to a curricular topic, such as volcanos. In the next
center, they may watch a short film about volcanos. In the last center, students may participate in
discussions with the clinician, and asked to provide definitions and explanations about the
concepts and ideas they are learning. Any number of language targets may be taught in this
format. The overwhelming findings suggest that speech-language pathology services may be
effectively provided in regular classroom contexts (Cirrin, et al., 2010; Hadley, Simmerman,
Long & Luna, 2000).
Prognosis and Outcomes of Children with Language Disorders

Unfortunately, symptoms related to language disorder tend to persist. There have been a
number of longitudinal studies that have followed children diagnosed with language disorders as
preschoolers or kindergartners into their teenage years. Approximately 70% of these children
continued to demonstrate language impairments as teenagers (Beitchman et al., 1996; Nippold et
al., 2009). The results of these studies suggest that teenagers with a history of language disorders
are highly likely to present with cognitive, linguistic, social and academic problems (Johnson et
al., 2009; Lindsey, Dockrell, Nippold, & Fujiki, 2012; Nippold et al, 2009; Tomblin & Nippold,
2014). Studies of adults with a history of language disorder during childhood indicate that they
often have persisting difficulties with measures of language and literacy, poor memory skills,
lower levels of employment, and fewer close friendships than individuals with no history of
language disorder (Clegg et al., 2005; Johnson, Beitchman & Brownlie, 2010). However, these
individuals are likely to perceive their quality of life in much the same way as their non-impaired
peers (Records, Tomblin & Freesse, 1992; Johnson Beitchman & Brownlie, 2010). Individuals
who had less severe impairments during childhood tend to have the best language outcomes at
high-school and into adulthood. Specifically, in a well-designed longitudinal study, language
ability during childhood was a significant predictor of educational attainment and occupational
SES during adulthood, especially when it was combined with teacher ratings of behavior, family
SES and reading ability (Johnson et al., 2010). It is clear that there is a strong need to develop
more effective interventions for children with language disorders and for teachers, parents, and
other professionals who work with these children to advocate for educational and vocational
programs that will promote better life-long outcomes.
Conclusion
Language disorder can be diagnosed when children’s receptive and/or expressive
language skills are (1) significantly poorer than the language that is typically expected for same-
age peers; (2) when his or her language difficulties interfere with the ability to participate in and
learn from everyday interactions with adults and other children; and (3) when the language
deficits cannot be attributed to any other disability. Neurophysiological, biological (genetic) and
psychological (cognitive/linguistic) factors contribute to language disorder.
Very young children with language disorder may not combine words to express
relationships until well after 2 years of age. During the preschool years, children with language
disorder may learn new words more slowly and often make more grammatical errors than their
typically developing peers. During the elementary school years, children with language disorders
have difficulty learning and using words that are important for functioning in their classrooms;
their conversational language may contain an unusually large percentage of ungrammatical
utterances; and they may experience difficulties understanding and creating coherent narratives.
Older school age children with language disorder do not comprehend and use morphologically
complex words like summarization and predictive that appear in the curricular materials they
encounter in school, and they have difficulty understanding the expository texts they read for
their courses.
Language disorder can be diagnosed reliably in the late preschool and early school-age
years. Clinicians assess language abilities with the use of standardized tests and informal
assessment procedures such as language sample analysis, observations of children as they are
conversing with others, and interviews with parents and teachers. Clinicians can conduct
assessment independently, or they can employ interprofessional approaches to assessment in
which professionals from different disciplines conduct evaluations.
Three basic models of language intervention services were described: child-centered,
clinician-centered and hybrid, as were facilitative techniques such as self-talk, parallel talk,
focused stimulation, expansion, and vertical structures. Many clinicians use book discussions as
the primary context for language intervention with school-age children. Clinicians who work in
public school settings sometimes conduct language intervention in the regular classroom. This
approach to language intervention is helpful when clinicians want to integrate their language-
learning goals (complex sentence usage, narrative abilities, phonological awareness, vocabulary,
expository texts, learning strategies, etc.) with the expectations of the academic curriculum.
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Language Disorder in Children

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Language Disorder in Children

Utah State University

In S. Goldstein & M. DeVries (Eds.), Handbook of DSM-5 Disorders in Children and

vocabulary or grammar in age-appropriate ways. Their difficulties with language development

cannot be attributed to underlying conditions such as intellectual disability, sensory disorders,

medical conditions, neurological disorders, or motor dysfunctions. Language disorder affects

approximately 7% of preschool and school-age children children. Researchers have hypothesized

neurophysiological, biological (genetic), and psychological (cognitive/linguistic) causes of

standardized measures of communication, and consideration of related areas (e.g., behavioral,

and/or vocational functioning. In the DSM-V, communication disorders (including language

disorder) are categorized as neurodevelopmental disorders along with intellectual disability,

autism spectrum disorder, attention-deficit/hyperactivity disorder, specific learning disorder, and

Overview of Language Disorder and History in DSMs

vocabulary or grammar in age-appropriate ways. Their language impairments cannot be

attributed to underlying conditions such as intellectual disability, sensory disorders (hearing or

vision), medical conditions, neurological disorders, or motor dysfunctions (American Psychiatric

Language disorder occur fairly commonly, affecting approximately 7% of preschool and

as developmental language disorders, specific language impairment, and primary language

History of Language Disorder

significant language delays without co-occurring mental retardation, hearing impairment, or

idiopathic language retardation or neurogenic learning disabilities (Berry, 1969). Most

of disorders were part of a single diagnostic category called “developmental speech/language

in the DSM-III-R (1987).

close relationships between these conditions.

In the DSM-V, communication disorders (including language disorder) are categorized as

neurodevelopmental disorders along with intellectual disability, autism spectrum disorder,

attention-deficit/hyperactivity disorder, specific learning disorder, and motor disorders. The

interesting that in some respects, the current characterization of language disorder as a

neurologically-based disorder is similar in nature to the neurological-oriented characterization

Current Diagnostic Criteria for Language Disorder

Language disorder is characterized by impairments in vocabulary, sentence structure, and

discourse level communication (American Psychiatric Association, 2013; American Speech-

language, or both. Receptive language relates to an individual’s ability to comprehend linguistic

information, whereas expressive language relates to an individual’s ability to formulate and

be likely to interfere with communicative, social, academic, and/or vocational functioning.

to intellectual impairment or global developmental delay. Language difficulties exist in the

neurological conditions that may be present (APA, 2013).

To date, the only epidemiologically-derived diagnostic criteria comes from a series of

scores representing language comprehension, language production, vocabulary skill,

language disorders, many investigators identify language disorder by performance that is -1 or

language (Leonard, 2014; Spaulding, Plante & Farinella, 2006).

Assessment of Language Disorders

A complete assessment of language disorder should include a detailed case history,

standardized measures of communication, and consideration of related areas (e.g., behavioral,

medical, educational status). Thus, assessment of language disorder should be a multifaceted

Infants and toddlers

Assessment of language disorders in infants and toddlers is primarily related to predicting

is rarely made before 24 months of age.

developmental milestones related to communication, motor, cognitive, sensory, and social-

emotional skills. An example of a norm-referenced test for measuring general development in

cooperate with a test procedure because of compliance issues or extreme disability.

MacArthur-Bates Communicative Development Inventories (CDI), in which parents of children

their child has attempted or mastered.

Preschool and School-age children

understanding of a preschool-aged child’s receptive and expressive language skills. Some

representing comprehension and use of vocabulary, grammatical morphology, syntax, and

Paul, 2012; Spaulding, Plante & Farinella, 2006).

Although standardized tests can give information about an individual’s communication