Expressive language disorder (315.31)

Definition

ELD occurs when a person has problems expressing him or herself using spoken language. A child with an 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. The child often has a smaller vocabulary than his or her peers.

DSM-IV-TR diagnostic criteria

• A. The scores obtained from standardized individually administered measures of expressive language development are substantially below those obtained from standardized measures of both nonverbal intellectual capacity and receptive language development. The disturbance may be manifest clinically by symptoms that include having a markedly limited vocabulary, making errors in tense, or having difficulty recalling words or producing sentences with developmentally appropriate length or complexity.
• B. The difficulties with expressive language interfere with academic or occupational achievement or with social communication.
• C. Criteria are not met for Mixed Receptive-Expressive Language Disorder or a Pervasive Developmental Disorders.
• D. If Mental Retardation, a speech-motor or sensory deficit, or environmental deprivation is present, the language difficulties are in excess of those usually associated with these problems.

Coding note: If a speech-motor, sensory deficit, or neurological condition is present the condition should be coded on Axis II.

Associated features

• Children with expressive language disorder have great difficulty in the use of expressive language – the ability to express his or herself verbally. Proper pronunciation of words, however, is not a difficulty. Instead, the child with ELD may instead show difficulty in constructing sentences, using correct grammar, or word finding which prevents him or her from communicating their needs and wants in an age-appropriate fashion. There may be disturbances in fluency and formulation with an abnormally rapid rate and erratic rhythm in speaking. There may also be disturbances in structure (“cluttering”). When it is acquired, there may be difficulties in motor articulation, speed, syllabic repetition, monotony, and proper syllabic stress.
• While children with ELD have the same level of language, comprehension ability, and intelligence they generally show a smaller vocabulary than their peers. For example; many different ways in which expressive language disorder can manifest it. Some children do not properly use pronouns, or leave out functional words like “is” or “the.” Other children cannot recall words that they want to use in the sentence and substitute general words like “thing” or “stuff.” Some children cannot organize their sentences; these children would comprehend the material they are trying to express but they just cannot create the appropriate sentences to express their thoughts. Generally, ELD is dissevered into two types; the developmental and acquired type. The developmental type most commonly shows no specific cause and is generally apparent when the child first begins the learning process; whereas the acquired type is most commonly caused by damage to the brain (stroke, concussion).

Child vs. adult presentation

Children most often present with developmental ELD (see “Etiology”), whereas ELD in adults it is usually only seen after direct damage has been inflicted to the brain. Note, however, that acquired ELD can happen at any age.

Gender and cultural differences in presentation

• Boys are more commonly diagnosed with developmental ELD than girls, with studies finding anywhere from a 2:1 to 5:1 ratio. In almost every culture you will find people that struggle with their own language and how to correctly express oneself. Therefore, it is hard to distinguish any difference in presentation among cultures.
• Assessment should take into account individuals’ cultural and language context, particularly individuals growing up in a bilingual environment. Standardized measures for language development and nonverbal intellectual capacity must be relevant for cultural and linguistic groups.

Epidemiology

• A commonly seen disorder of which estimates of the number of of school age children qualifying for a ELD diagnosis range from 3-7%
• Language delays occur in 10-15% of children under the age of three.

Etiology

There are two types of ELD; in the acquired type, one experiences some type of direct trauma to the brain, such as a stroke or traumatic brain injury, which results in difficulties in the use of expressive language. The developmental type of ELD is seen in children, has no known cause, and usually appears during early development when a child is learning to speak.

Empirically supported treatments

Expressive language disorder is normally treated in two ways. The first option for treatment is a child with this disorder to work one-on-one with a speech therapist, where the child practices communication and speech skills. Another type of treatment involves the parents and teachers of the child to work as a team to incorporate the needed language skills in the child’s everyday activities. These treatments are often used together for a more effective treatment.