Unlocking Communication: Understanding Receptive and Expressive Language Skills

If your child is being evaluated for Early Intervention or Special Education Services, you may be introduced to the terms ‘receptive language skills’ or ‘expressive language skills.’

As humans, we all have communication skills. Those skills are either expressive or receptive.

For Parents: Receptive Language Vs Expressive Language Disorder | Receptive Vs Express Language Skills And Strategies | IEP Goals

If you do not struggle to understand incoming communication or to express yourself, it can be something that we take for granted.

But, like many other skills and processing disorders that some of our kids have to overcome, expressing oneself or being able to accurately interpret incoming communication is a crucial life skill.

Why is Expressive and Receptive Language Important?

Receptive Language Skills

Children who have difficulty understanding language may struggle with the following:

•Following directions
•Understanding what gestures mean, like pragmatics
•Answering questions
•Identifying objects and pictures
•Reading comprehension
•Understanding a story
Remember that many issues overlap. So for example, following directions might be receptive language. But it also could be processing, executive functions and other things.

What is Expressive Language?

Expressive language is the “output” of language, the ability to express your wants and needs through verbal or nonverbal communication. It is the ability to put thoughts into words and sentences in a way that makes sense and is grammatically correct.

Children that have difficulty communicating their wants and needs may have expressive language difficulties or an expressive language disorder.

For example, children may have expressive language difficulties if they are unable to tell you when they need to use the bathroom or when they are hungry. Again, it can be other issues such as interoception.

Children who have difficulty producing language may struggle with the following:

•Asking questions
•Naming objects
•Using gestures
•Using facial expressions
•Making comments
•Vocabulary
•Syntax (grammar rules)
•Semantics (word/sentence meaning)
•Morphology (forms of words)

Mixed Receptive-Expressive Language Disorder

Many children have this (including mine!). Like other disorders, it has a range on a spectrum. My son’s is severe or profound–which means he is non-verbal. This is a condition listed in the DSM and on his medical records.

He has no verbal expression, but he can communicate.

Mixed Receptive-Expressive Language Disorder (MRELD) is a communication disorder where a child has difficulty both understanding (receptive language) and using (expressive language) spoken language. This means that the child struggles with both comprehending what others are saying and effectively expressing their own thoughts, feelings, or needs.

Key Characteristics of MRELD:

Receptive Language Issues: Difficulty understanding spoken language. For example, the child may struggle to follow directions, understand questions, or comprehend what is being said in conversations.
Expressive Language Issues: Difficulty using spoken language. This could include trouble with vocabulary, grammar, sentence formation, or using language appropriately in social contexts.

Common Symptoms:

Receptive Language Problems:
- Difficulty following verbal instructions.
- Problems understanding questions or complex sentences.
- Struggles with understanding new words or concepts.
- Difficulty grasping the meaning of stories or conversations.
Expressive Language Problems:
- Limited vocabulary compared to peers.
- Difficulty constructing sentences that make sense or are grammatically correct.
- Challenges in using language in appropriate social contexts (e.g., telling a story or making a request).
- Frequent pauses or hesitation while speaking.

Symptoms of Expressive Language Disorders

A receptive language disorder is a condition in which a child has trouble understanding and processing words. They may be able to hear and read the words, yet not connect the words to greater meaning. Children with a receptive language disorder may tune out during conversation because what they hear has little meaning to them.

They can have a hard time following directions, especially when spoken. Receptive language disorders usually begin by age 4. They are sometimes confused with other disabilities such as autism or delayed learning. For this reason, it’s very important for a child to be thoroughly tested by a specialist to learn the cause of their symptoms.

Children with a receptive language disorder may:

Develop language slowly or later than their age peers.
Rarely be interested when people are talking, either at home or school.
Have trouble following directions, especially when directions are spoken.
Often misunderstand what was asked or said. For example, if you say, “What is the cat doing?” they may respond with an answer that is close, but not what you asked. Such as “The cat is gray.”
Have a limited vocabulary and have trouble learning new words.
Be able to hear or see words but have trouble understanding their meaning.
As another example, I have a friend whose son struggles with this. One time he was trying to relay a story about rain. However, he kept talking about water and waterfalls and dripping water. In the context of the conversation, it took us a while to figure out what he was talking about. And, he was getting frustrated with us for asking him more questions.

When to Seek Professional Help

It’s very important to get treatment as soon as you suspect your child might have a language disorder. Since most children don’t start speaking until after age 2, it’s eseential that you look for early warning signs. Especially if your family has a history of learning disabilities.

I’m not a doctor nor do I play one on the internet. However, after a decade of advocacy, I don’t think I have ever met or even heard of a child that had just one language disorder. Language disorders are in that category of “rarely travels alone” so make sure that your child is evaluated in every area of suspected disability.

Receptive and expressive language disorders are often co-morbid with things like autism, ADHD and dyslexia.

Contact your healthcare provider if your child:

Is rarely interested when people are talking.
Is not interested when parents read books to them.
Often misunderstands the meaning of what was asked or said or written.
Have difficulty attending and listening to language.
Not paying attention within group times at daycare or preschool.
Not follow instructions that others the same age would be able to follow.
Respond to questions by repeating what you say instead of giving an answer.
Find it difficult to listen to stories.
Give unusual answers to questions.

Causes of Receptive Language Disorders

The cause of a receptive language disorder is often not known. Receptive language disorders usually begin by age four. A language disorder can result from:

Family history. A child is more likely to have a language disorder if a mother, father, sister, or brother also has one.
Other disorders. Language disorders may happen in children with other problems, such as autism, hearing loss, or learning disabilities.
A head injury.
Neglect or abuse.

Language Disorders: Evaluations, Diagnosis, and Tests

Symptoms of receptive language disorder can be confused with another learning disability. It’s important to be evaluated by a speech-language therapist. Your healthcare provider or school can refer you to a speech-language therapist.

Children younger than age three can be evaluated through early intervention. This is a system of services in every state to help young children with disabilities.

When children have difficulties with receptive language, they might also have difficulties with:

Forming friendships and engaging in positive social interactions with peers.
Completing tests, exams, and academic tasks in higher-level education.
Applying for jobs in both an interview and written application and answering questions during job interviews.
Developing reading and writing skills.
Following and giving directions to find unfamiliar or new places.

Treatments

A speech-language therapist may work with a child one-on-one or in a small group. In public schools, children with a receptive language disorder can use the special education services available if they are found eligible for an IEP.

This includes:

Diagnosing your child’s specific language problem.
Individual therapy for the child.
Working with the child’s teacher on the best ways to help the child communicate in the classroom.
Working closely with children and families to learn effective therapy in class and at home.

Can you prevent language disorders?

Not all receptive language disorders can be prevented, but some can.

Spend time talking and reading with your child every day.
Take your child for regular check-ups.
Prevent head injuries. Make sure your child wears a seat belt in the car and a helmet for sports.
Don’t drink or use drugs when pregnant.
Receptive language disorder can affect the child’s ability to communicate, learn, and play with others. For this reason, it’s very important to get treatment as soon as the problem is discovered.

Activities to Help Improve Receptive and Expressive Language

I narrate our every day, all day. I was instructed to do this when K was just a baby. So everything we do, I talk about it while we’re doing it. All our ADLs, etc.
Name items together when completing tasks, such as looking at a book, in the car, looking outside, while playing or when shopping.
Day-to-day activities: When going shopping and visiting places, such as the park, zoo or museum encourage the child to talk about what you did and saw and possibly even draw or act out what happened.
Model new words: Play activities with the child that they really enjoy and throughout the game model new words and phrases.
Explain new concepts in different ways (e.g. looking at the concept of “wet”: use water to wet things and talk about things that are wet and dry; look at pictures of things that are “wet”; if it rains, or the child is in the bath, talk about the concept of being “wet”; make up sentences and stories about being wet/dry).
Simon says: Take turns with the child in following and giving instructions. Also, gradually increase the length of the command that is provided (e.g. ‘Simon says touch your toes’; ‘Simon says first touch your toes, then clap your hands’; ‘Simon says before you shout hurrah, count to 10’). Additionally, reinforce body parts (e.g. pat your head, pull your ear) and simple verbs (e.g. jump, shake) when playing the activity.
Minimal instructions: Refrain from giving too many instructions at once.
Simplify the language you use with the child so it is at a level that they can understand (i.e. usually just above their expressive language level or how much they are saying).
Chunk verbal instructions into parts. Instead of “Go and get your lunchbox and your hat and go outside”, say “Get your lunchbox.” When the child has followed that instruction, say “Now get your hat” then “OK, now you can go outside”.
Repeat: Ask the child to repeat the instruction to ensure that they have understood what they need to do (e.g. “Go and get your bag then sit at the table. What do I want you to do?”).
‘First/then’: Use this concept to help the child know what order they need to complete the command (e.g. “First get your jacket, then put on your shoes”).
Clarify: Encourage the child to ask for clarification if they forget part of the instruction or have trouble understanding what they need to do. Encourage them to ask for the command to be repeated or clarified (e.g. “Can you say that again please?”).
Show: Physically show the child what to do when giving them an instruction so that they can ‘see’ what the concept within the instruction looks like.
Visual aids (e.g. picture schedules, gestures, body language, facial expression) can be used to assist the child’s comprehension and recall of the instruction.
Describe: In everyday activities describe to the child what they are doing (e.g. when the child is packing up their toys you might say: “Put the toys in the box” or when dressing/undressing you might say: “Take your shoes off/Put your shoes on”).
Emphasize the word you want the child to learn about and repeat the concept in a variety of situations or settings so that the child sees the different ways in which a concept can be used (e.g. “Lights on“vs. “The book is on the table”).
Play: For the young child to engage in play on a regular basis, model how to play with toys, follow the child’s lead and talk about what they are doing with the toys.
Reduce background noise: Turn off background noise in the home (e.g. television, radio, music) when engaging with the child to reduce/minimize distractions.
Visuals such as signs or pictures can be used to facilitate and support a child’s understanding.
Books: Look at books that interest the child and talk about the pictures and the story. Ask the child to predict what might happen next or explain why something might have happened in the story.
Obstacle course: Put together an obstacle course in the house or outside in the backyard. Take turns with the child in following and giving instructions. Gradually increase the length of the command that is provided (e.g. run to the sandpit; first run to the sandpit then crawl over to the bikes).
Hide and Seek Object Game: Place different everyday items/objects (e.g. toothbrush, car, cup, block) into a bag. Take turns with the child in taking an item out of the bag. Encourage the child to Reach into the bag and try to guess what the item is before taking it out. Describe characteristics about the item once they have pulled it out of the bag (e.g. color, shape, use/function). Answer questions about the item that they have pulled out (e.g. Is it round? Can you eat it?). Guess the item that you have pulled out of the bag by asking you questions (e.g. Is it round? Can you eat it?).
Books: Look at picture books with the child. Take turns in asking each other questions about the pictures (e.g. Who is in the picture? What is the girl/boy doing?). Try to think about what might happen next in the story and different possible endings.
Role Model to communicate appropriately with their peers (e.g. having a conversation about shared topics of interest using specific language, asking and answering questions).
Guided Practice to communicate appropriately with adults and unfamiliar individuals (e.g. retelling events, sequencing ideas, answering questions appropriately).
Pursue alternative forms of communicating (e.g. sign, picture exchange communication system, voice output devices) if the verbal language is not developing.

good luck and I hope this helps!