Chapter 10: Language Disorders in Children
Learning Outcomes:
• Define a language disorder.
• Explain who identifies and treats children with language disorders.
• Identify the major types of child language disorders.
• Explain how child language disorders are identified and treated.
I. What is a Language Disorder?
A. Practitioners and researchers use many terms to describe language disorders in children,
B. All of these terms are synonyms used to describe individuals who exhibit significant
impairments in the comprehension and/or production of language in form, content, and/or
use.
C. This impairment must be significant enough to have an adverse impact on an individual’s
social, psychological, and educational functioning and cannot reflect a language
difference, such as dialectal variation.
D. Distinguishing Between Language Disorders and Language Differences
2. Failure to differentiate accurately between language disorders and language
3. Such differentiation requires a careful understanding of the cultural context in which
a child is learning and applying his or her language abilities.
4. From a cultural perspective no right or wrong way to socialize children in a cultural
community exists, although variability in child socialization practices can readily
influence children’s rate of language development.
E. Prevalence
1. Language disorders are the most prevalent type of communication impairment
3. Late language emergence (LLE), which generally equates to having a slow start in
language, occurs in an estimated one in five children.
5. Children who do not produce two-word combinations by their second birthday are
viewed as late talkers.
7. Primary language impairment, a significant language impairment in the absence of
8. Because this disorder is specific to language, it is commonly called specific language
impairment (SLI).
9. As they move into adolescence and adulthood, children with LI experience lower
11. Also, genetic research indicates that the risk for SLI runs in families.
13. Common types of secondary language impairment include intellectual or cognitive
disability and the autism spectrum disorders.
15. Children with mild disability outnumber those with severe disability about 3 to 1.
16. These estimates include children who exhibit autism spectrum disorder, which is
currently estimated to affect about 1 in 68 children.
II. Who Identifies and Treats Children with Language Disorders?
A. Direct services include diagnosing language disorders and providing treatment to
children with disorders through clinical and educational interventions.
B. Indirect services include screening children for the possibility of language disorders and
referring them for direct services, as well as counseling parents on approaches to
supporting language development in the home environment.
C. The professionals most intimately involved with direct and indirect services include
speech-language pathologists, psychologists, general educators, special educators, early
interventionists, audiologists, developmental pediatricians, and otorhinolaryngologists.
D. Speech-Language Pathologists
2. The scope of practice for SLPs as related to language disorders includes a number of
3. Typical services provided by SLPs therefore include screening children for possible
4. SLPs work in many different settings, including public and private schools, hospitals,
5. There are currently more than 130,000 SLPs working in the United States; however,
there remains a significant shortage of speech-language pathologists in most regions
of North America.
E. Psychologists
1. Cognitive and perceptual psychology and developmental psychology are two branches
of psychology that conduct research relevant to child language disorders.
2. These researchers conduct basic and applied research on human perception, thinking,
4. These professionals work in public and private schools, clinics, and hospitals, with a
large number providing services through private practice.
5. Clinical psychologists screen for and diagnose impairments of language, often as part
6. Clinical psychologists may offer specialized treatments for various types of language
7. Clinical neuropsychologists and rehabilitation psychologists may oversee the
9. School psychologists typically work in private and public schools, and perform
essential activities on school-based teams that identify children with language
disorders and develop educational programs to remediate or compensate for these
disorders.
F. General Educators
1. General educators include preschool, elementary, middle school, and high school
teachers.
3. When a general educator suspects a child in his or her classroom may have impaired
language abilities, they request that the school’s child study team engage in a
4. The child study team identifies approaches the general educator may use to support
the child’s language performance in the classroom.
5. If these do not alleviate the general educator’s concerns about the child’s language
6. If the team identifies a language disorder, they also will use the MFE to identify the
8. LRE is a federal mandate of the Individuals with Disabilities Education Act (IDEA),
which stipulates that children with disabilities should receive their education to the
maximum extent possible in the same contexts of their peers without disabilities.
G. Special Educators
1. Currently, there are more than 400,000 special educators teaching the nearly 6 million
children with disabilities in our nation’s schools.
3. To meet the needs of students with disabilities, special educators work directly with
4. Some special educators serve as itinerant teachers; they do not have their own
classroom but rather co-teach or collaborate with a number of different teachers.
6. Although special educators may screen and test children for language disorders, their
lead responsibility is to design, deliver, and monitor Individualized Education
7. IDEA provides federal funds to the 50 states to provide intervention services to
8. Organizations may also use federal funds to provide interventions to newborns
through 2-year-olds who exhibit significant medical, biological, and environmental
risk conditions making them vulnerable for later disability.
H. Early Interventionists
1. Early interventionists (sometimes called developmental specialists) are professionals
with specialization in intervention for infants and toddlers.
2. Given the importance of the first few years of life to language development, they
3. These professionals often work directly in families’ homes, side-by-side with the
parents of infants and toddlers to teach them ways to support their children’s
language learning in the home environment.
4. For children found eligible for early intervention services, an IFSP is developed to
5. The IFSP also sets specific objectives for the child and family, and early
interventionists oversee programs toward these objectives.
I. Audiologists
2. For children who are born with profound hearing loss, they might deliver auditory-
verbal therapies that simultaneously promote the child’s use of residual hearing and
her production and comprehension of language.
3. Audiologists also play a critical role in referring children with hearing loss for
4. Audiologists work in many different settings, to include schools, hospitals,
1. Otorhinolaryngologists, or ear-nose-throat physicians (ENTs), are close collaborators
2. They are a particularly important team member for children who exhibit slow
3. OM is one of the most common causes of hearing loss in children.
4. It results from a viral or bacterial infection of the middle ear space, and in some
instances the middle ear space is filled with fluid, which dampens their hearing
ability.
6. The ENT has the key role of halting the progress of OM through the use of antibiotics
and/or the insertion of pressure-equalizing tubes (PE tubes) into the eardrum to
equalize pressure between the middle and outer ear and to release any fluids in the
middle ear space.
III. What are the Major Types of Child Language Disorders?
A. Specific Language Impairment
1. Defining Characteristics
a. SLI is a developmental disability in which an individual shows a significant
impairment of expressive or receptive language that cannot be attributed to any
other causal condition.
b. Children are typically diagnosed with SLI after their third birthday.
• On average, children with SLI produce their first words at about age 2 years
and they continue to struggle with learning new words throughout the
elementary years.
• When provided the opportunity to learn a new word, children with SLI learn it
more slowly than their non-impaired same-age peers do.
h. Many children with SLI show considerable difficulties with grammatical
production and comprehension that begin during toddlerhood and continue
through school age.
• Children with SLI are likely to omit key grammatical morphemes, such as
i. Children with SLI also tend to have difficulty adjusting academically; for
example, they may have problems with social skills, behavior, and peer relations
as well as with academically oriented skills, such as literacy and mathematics.
• Difficulties with reading development – such as timely development of the
j. Most children diagnosed with SLI have long-term difficulties with language
achievement
2. Causes
a. Advances in brain-imaging and epidemiological research suggest a strong
biological and genetic component to this disorder.
b. Children who have immediate family members with language impairment are
more likely than other children to develop SLI, and 20-40% of children with SLI
B. Autism Spectrum Disorder
1. Defining Characteristics
a. Autism spectrum disorder (ASD) is a developmental disability that affects an
estimated 1 in 68 children, with a higher prevalence among boys and among
children with affected family members.
b. This disability is present at birth, although its signs and symptoms may not be
including responding to social overtures from others.
i. In more mild cases, an individual with ASD will engage with others, but he will
show unusual patterns in social communication, such as failing to initiate with
others, or to engage in reciprocal conversations.
j. Many individuals with ASD have restricted interests and repetitive behaviors, and
2. Causes
a. ASDs are neurobiological disorders that are believed to result from an organic
brain abnormality.
b. Genetic research showing high rates of co-occurrence between monozygotic twins
indicates that there is a strong biological basis of this disability.
c. Certain prenatal and perinatal complications, particularly maternal rubella and
anoxia, are associated with an increased risk for autism, as is the presence of some
C. Intellectual Disability
1. Defining Characteristics
a. Intellectual disability (ID) is diagnosed in children younger than age 18 years
who meet two criteria: significant limitations in intellectual functioning and
significant limitations in adaptive behavior.
b. ID ranges from mild to profound (mild cases are more common), and because of
d. Children and adolescents who have Down syndrome, a relatively common cause
of ID, typically produce short sentences, use a fairly small expressive vocabulary,
and exhibit a slow rate of speech.
e. Function words, such as copula and auxiliary verbs are frequently omitted, as well
as pronouns, conjunctions, and articles.
j. An augmentative and alternative communicative (AAC) system can increase their
ability to express themselves.
2. Causes
a. ID can occur for many reasons and is typically the result of an injury, brain
abnormality, or disease.
b. Prenatal damage to the developing fetus due to chromosomal abnormalities or
maternal ingestion of toxins accounts for the majority of cases (about 30%).
D. Traumatic Brain Injury
1. Defining Characteristics
a. Traumatic brain injury (TBI) refers to damage or injury to an individual’s brain
tissue sometime after birth.
b. Young children, adolescent males, and older persons have the highest risk, and
males are affected twice as often as females.
g. The most common type of TBI is a closed head injury (CHI), in which brain
matter is not exposed or penetrated.
h. In contrast, with open head injuries (OHIs), the brain matter is exposed through
penetration, as would occur with a gunshot sound.
i. In both CHI and OHI, the immediate injury to the brain – whether diffuse or focal
2. Causes
a. The most common causes of brain injuries are falls (28% of injuries), motor
E. Hearing Loss
1. Defining Characteristics
a. A hearing loss is a physical condition in which an individual cannot detect or
distinguish the full range of sounds normally available to the human ear.
b. It can result from prenatal, perinatal, or postnatal damage to any of the structures
that carry auditory information from the external world to the brain centers that
process.
h. A hearing loss that occurs after birth is termed an acquired hearing loss.
i. Prominent causes include noise exposure, infection, use of ototoxic medications,
and chronic middle ear infections.
j. Acquired hearing loss is often differentiated into that acquired after birth but
o. Timing of the loss
p. Severity of the loss
q. Age of identification
r. Exposure to language input
s. Cochlear implants serve as an intervention for children ages 12 months and older
u. Although children with implants have variable language outcomes, for many
children with profound hearing loss, cochlear implants provide a promising option
2. Causes
a. As many as 50% of young children experience fluctuating hearing loss as a result
of chronic otitis media.
F. Identification of Language Disorders
1. Identifying children who exhibit language disorders requires administration of a
comprehensive language evaluation, most often conducted by a certified SLP.
2. Case History and Interview
a. The case history documents a child’s developmental history, general health,
3. Comprehensive Language Assessment
a. The SLP designs and administers a comprehensive assessment of a child’s
language abilities.
b. For young children, the assessment may be administered in several test sessions to
prevent fatigue in or frustration of the child in different contexts, including the
4. Diagnosis
a. Once the professional completes the comprehensive language evaluation, he or
she assesses the findings to determine whether a language disorder is present and
if so, to make a diagnosis.
G. Treatment of Language Disorders
2. For instance, if a child has a severe language disorder, his or her treatment approach
will be more intensive than that for a child with mild problems.
3. Likewise, a child whose language disorder is secondary to autism will receive a
5. Treatment Targets
a. Treatment targets, also called treatment objectives, are the aspects of language
addressed during treatment.
6. Treatment Strategies
a. Treatment strategies are the ways in which treatment targets are addressed.
b. One such strategy is called focused stimulation in which the clinician provides
multiple and highly salient models of language targets that are goals for the child.
c. For instance, if a child cannot request using the word want, the clinician would set
h. With older children, a more direct approach might be used to teach children with
language disorders how to apply specific strategies to compensate for underlying
challenges with language comprehension and production.
i. For instance, the clinician might use a barrier game in which he or she places a
barrier between himself or herself and the child.
complete diverse language tasks, such as understanding jokes, initiating
conversation with friends or adults, or deciphering unknown words when reading.
n. Strategy instruction focuses on teaching students specific ways to approach a
linguistic task by following specific steps.
o. First, the clinician will describe and model the strategy; then, the child will
7. Treatment Contexts
a. Treatment contexts are the settings in which treatment targets and strategies are
used.
b. Treatment contexts should include as many settings as possible to promote
Beyond the Book:
1. Identify five ways in which an impairment of language might affect an individual’s social
and educational functioning.
2. Watch a video of a toddler on youtube.com. Document how many different words the
child uses in a 2-minute period and how the child uses these words to meet his or her
needs. How might a child with language impairment look differently than the child you
observed?
Discussion Points:
• In what ways might a language impairment have an adverse impact on an individual’s
social functioning?
• In your own words, describe the difference between a language disorder and a language
difference.
• About one in five children are slow to develop language in the first 2 years of life and are
characterized as late talkers. Many of these children will outgrow these early problems,
although some will not. Do you think late talkers should be treated for their delays, or
would you advocate for a wait-and-see approach in which treatment is given only to
children who have more persistent problems?