Expressive language disorder interferes with a person’s ability to express thoughts, ideas, or information. It affects speech, writing, and nonverbal communication.
Expressive language is a person’s communication output. If a person has a neurological difference that makes it difficult to fully express what they’re thinking, they may have expressive language disorder.
Expressive language isn’t just about speech. It also includes written words or nonverbal means of communication like gestures.
People who have expressive language disorder may be able to understand more than they can convey. They can experience frustration when they try to communicate with others but aren’t able to adequately express themselves.
Communication is the bridge that connects people and society. Identifying and treating expressive language disorders can foster and maintain important connections while improving quality of life.
An expressive language disorder interferes with a person’s ability to express thoughts, ideas, or information. The disorder affects speech, writing, and nonverbal communication like gestures.
In preschool children, signs of an expressive language disorder can appear in the form of missed early language milestones. Some children who miss these milestones are late talkers who catch up with their peers, while others receive a language disorder diagnosis.
Expressive language disorder is not the same as expressive language delay. In the case of a delay, children can catch up with their age peers over time. However, some children with a language disorder may not develop certain skills.
People with expressive language disorder who also have a hard time understanding what they hear might have a combination diagnosis of receptive-expressive language impairment (RELI).
Signs of expressive language disorder include:
- limited vocabulary
- vague words
- short sentences (written or spoken)
- using the wrong words in sentences
- word omission
- sounding hesitant when trying to converse
- grammatical errors, such as “I going” rather than “I’m going”
- difficulty with describing, paraphrasing, or explaining something
- talking in circles
- poor note-taking skills in school
- repetition of questions people have asked them
- behavioral issues (due to embarrassment)
People with an expressive language disorder may say things or act out in ways that don’t represent their feelings. This is sometimes to cover embarrassment or hide their condition.
For example, a child might tell their teacher that a book was boring because they’re not able to describe their favorite chapter.
Language development differences can vary according to age. A preschooler with an expressive language disorder might say “mommy shoe” instead of “that’s mommy’s shoe.”
An older child might use simpler language than that of other children. They might say, “I put away my toys. I made my bed.” By comparison, an age peer with no language disorder might use more complex sentences, such as “I put away my toys and then I made my bed.”
There are two categories of the causes of expressive language disorder: acquired and developmental.
An acquired language disorder occurs in people who initially develop typically but then experience an illness or brain injury that affects the language areas in their brain. This type of acquired language disorder is called aphasia.
Aphasia is more common as a cause of expressive language disorder in adults, although it can occur in children.
Veteran actor Bruce Willis is living with aphasia, according to a March 30, 2022, announcement by his family.
Because of aphasia’s impact on his cognitive abilities, Willis is stepping away from a celebrated career that began in the 1980s, spanning 4 decades and including around 100 films.
Willis’ family has indicated that he’s been experiencing some health issues, although they haven’t revealed the exact cause of his aphasia diagnosis.
“As a result of this and with much consideration, Bruce is stepping away from the career that has meant so much to him,” Willis’ family shared.
There are four primary areas that aphasia can affect, both expressive and receptive language:
- spoken language expression (expressive language)
- written output/expression (expressive language)
- oral language comprehension (receptive language)
- reading comprehension (receptive language)
It’s quite common for a person with aphasia to have typical cognitive skills such as memory. However, these can also change depending on the scope of the injury or illness.
One of the brain regions that aphasia can affect is
Broca’s area is responsible for aspects of language production such as grammar and word meaning. However, language processing is complex and uses multiple areas of the brain.
A second vital communication brain region is called Wernicke’s area, named after German neurologist Carl Wernicke. This area is associated with language comprehension and is connected to Broca’s area.
Wernicke’s aphasia can also affect the way a person speaks. Unlike Broca’s aphasia, where sentences are shorter and missing words, Wernicke’s aphasia may feature long and complex sentences but with words that don’t fit or are made up.
Examples of illness or injury that cause aphasia include:
- traumatic brain injury (TBI)
- seizure disorder
- brain tumor
Sometimes treatment for other conditions can cause expressive language difficulties, such as radiation for cancer.
Aphasia can impact more than just communication and cognition. It’s also linked to mental health conditions such as depression and anxiety.
A 2019 study examining aphasia from stroke found that most participants met the diagnostic criteria for depression after 1 year. The themes identified included:
- the trauma from a stroke causes mood and depression issues
- stroke rehabilitation has only limited psychological support to help with communication and mood issues
The study identified individually tailored therapy and supported communication as two helpful interventions for people living with aphasia.
Developmental expressive language disorder (DELD) may not have an identifiable cause. It’s not usually connected to intellectual ability. In some cases, it may be genetic.
Sometimes DELD occurs with other neurological differences like autism, a learning disorder, or hearing impairment. This can make DELD symptoms more pronounced. However, language difficulties often exist in these conditions without a diagnosis of DELD.
The first step of expressive language disorder treatment is to get a proper diagnosis. Sometimes language disorder symptoms have other causes, which testing can rule out.
Useful tests include:
- a hearing test: to make sure that hearing impairment isn’t the reason for expressive language differences
- an auditory processing test: to assess how the brain processes language sounds
- learning disabilities testing: to see whether other neurological factors can cause language use differences
- a cognitive functioning assessment: to determine whether there’s an intellectual disability present
There are no medications to treat language disorders. Instead, treatment involves therapy and support.
Depending on the severity of the disorder, treatment might consist of:
- individual or group speech therapy sessions with a speech-language pathologist (SLP)
- school-based language interventions, such as weekly sessions with a district SLP
- support from specialized school staff, such as education assistants who work one-on-one with students to help them express their comprehension of learned material
- private tutoring
- assistive technology, such as iPad speech apps
- home-based programs directed by a speech pathologist
- counseling to help with the emotional regulation issues that can result from communication differences
Usually, SLPs treating expressive language disorder in children meet their young clients in person, although some offer remote sessions using telephone or videoconferencing.
A 2017 study found that telepractice can be an acceptable alternative to in-person meetings and doesn’t reduce the rapport between SLPs and children. However, more research is needed.
It helps to remember that behavior is a type of communication. A child with expressive language disorder may act out because they can’t use language well enough to express what they’re thinking or feeling.
You can help your child work through their frustration by making communication easier.
For example, they might be sullen after school if they failed a math test, lost their favorite eraser, and dropped their lunch on the floor. If you ask, “what’s wrong,” the amount of language expression required to explain can frustrate them further.
Instead, ask a series of questions that are easier to answer:
- Did something upset you at school?
- Was it one thing, or more than one thing, that upset you?
- Was it at recess or in the class?
- Was it about schoolwork or something else?
Continue until you’ve narrowed down the issue enough so your child can talk about their day without feeling overwhelmed.
Using specific questions can make any conversation easier. This is a simple approach to engaging your child in two-way conversations that help develop their expressive language skill.
As your child’s language abilities progress, you can use more open-ended questions. This will help your child optimize the gains they’ve made. You can also make encouraging statements, such as “you explained that well” or “what you’re saying makes a lot of sense.” This will help reinforce your child’s improved speaking skills.
Expressive language disorder can significantly impact a person’s relationships and daily functioning, but it’s treatable.
If you think your child might have a language disorder, a healthcare professional can help. The earlier intervention begins, the better your child’s progress can be.
The American Speech-Language-Hearing Association (ASHA) has a locator tool to find certified audiologists and SLPs in your area: ASHA ProFind.
Looking for a mental or emotional health therapist but unsure where to start? Psych Central’s How to Find Mental Health Support resource can help.