Receptive & Expressive Language
First of all, it is important to rule out any possible hearing difficulties which may contribute to the child’s delay (Please refer to our information on Hearing for additional information).
An evaluation for receptive language for a young child may involve simply observing the child and completing a rating scale. As a child becomes a little older, formal testing can be administered. This assessment usually involves following directions, pointing to pictures, and responding to questions.
The type of support for a child with receptive language weakness is dependent upon his particular areas of difficulty. Following are some suggestions:
1. The child who does not respond. When a child does not respond to a question, direction, or conversation, it should not be assumed that the child cannot do so. It is up to the adult to determine the reason why the child does not respond at a particular moment. Questions to ask yourself are: Did the child hear me? Was the child distracted/attending to something else? Is the child just ignoring me? Does the child not realize that I am expecting a response? Were there words in my language that the child did not understand? Was my message too long/complex for the child to understand and process?
After the child does not respond the first time, it is helpful for the parent to approach the child, get down on his level while encouraging eye contact, and gently repeat the message. If the child still does not respond, see if you can simplify your message. Following are some examples:
Parent: It is so nice outside today. How about we take a stroll in the neighborhood?
Child: (no response)
Parent: (getting down to the child’s level) Do you want to take a walk with me?
Parent: Before we eat, I need you to pick up all of your toys, put them in the toy box, go upstairs and change into your pajamas.
Child: (continues to play)
Parent: (getting down to the child’s level) Let’s put the toys in the toy box. What are we going to do?
Child: Put the toys away.
Parent: Good. (toys are put away) Now, put on your pajamas.
2. The child who does not easily remember. Poor memory abilities affect both children and adults. In our therapy sessions, we provide exercises and strategies for developing memory skills. At home, it is important to keep in mind the child’s weakness when asking him to follow directions. Instructions should be broken down into single steps or more, depending upon how much the child can remember. It is also helpful to ask the child to repeat a direction once or twice before completing it. This “rehearsal” not only helps him better recall the instruction, but it also allows you to determine if the child did in fact understand the direction.
Weak memory skills have the potential to affect the child in the classroom and when completing homework assignments. Some children need to hear or read information more than once to recall it. We find that helping the child to become a more active listener or reader aids the comprehension and recall process. It is helpful to use strategies such as visualization (where the child tries to imagine what he hears or reads) and association (relating new information to known information).
3. The child who has a weak vocabulary. Children with language deficiencies often need to hear or read a new word many more times than children without such weaknesses, before that word becomes a part of his vocabulary. For young children, it is important to talk about what you and the child are doing, seeing, and experiencing. A new word should be brought to the child’s attention and used a few different ways. Following is a sample dialog:
Parent: Look, there’s an acorn. The acorn fell from that tree. Let’s find some more acorns. I found another acorn.
Child: I found two acorns. This one looks different.
Parent: That acorn lost its cap. See the cap on this one? It looks like a little hat.
Child: Uh-oh, this acorn lost its cap, too!
Older children may need help with the vocabulary related to school work. If the words are not understood, comprehension and grades are sure to suffer. It is important to make sure your child realizes the need to let someone (you, the teacher) know when he does not understand something. It is also crucial to help your child attend to new words, perhaps by creating a special “new word” journal and learning self-reliance skills with a dictionary.
Most of all, it is important that a child with some receptive language weaknesses develop a good self esteem and self image. Sometimes such struggles serve to deflate a child’s ego. Allow the child to focus on all the things he does well, praise him for his hard work, and support him whenever possible.
In order to determine if a child has an expressive language impairment, we may do some testing and then compare the child’s speaking skills with norms for her age.
Testing for a very young child may involve informal assessment, which includes speaking with the parent to get an idea of how the child communicates, observing the child interacting with the parent, and playing with the child. We may also ask the parent to complete a scale which lists the skills expected of a young child. All of this information is considered by the therapist to determine the child’s approximate expressive language age and to decide if enrollment in therapy is warranted.
Testing for older children involves completion of one or more language assessments. These tests may involve tasks such as answering questions, describing pictures, telling stories, and repeating sentences. Results of the test will provide us with a language age-equivalent score. It can also help us determine if the child has any weaknesses, and if so, can assist us in formulating an individual therapy program for her.
For an older child, the support we provide depends upon the nature of her difficulties. One key point to always remember is that what the child says is far more important than how she says it. Most children who experience expressive language and/or speech problems are well aware of their difficulties and differences, and tend to shy away from communication. Because of this, they often speak less than children without such issues. Just as we all need to practice doing something difficult in order to get better at it, a child with an expressive language problem improves her skills by talking more. This is one reason we want to make the child feel comfortable and confident about speaking, regardless of how accurate or efficient her language skills are.
Following are suggested ideas:
- The child who needs to increase the length of her utterances. If your child needs to speak in longer phrases and sentences, you can model at the level you want her to attain. For example, if your child typically says two-word phrases (e.g., “Go home.”), you can add to her phrase as you acknowledge what she has said (e.g., “Yes, let’s go home.”) You can occasionally also ask your child to repeat after you, while emphasizing the added word (e.g., “Can you say, ‘Let’s go home?'”)
- The child with grammar errors. If you have a child who omits words or word endings or substitutes one word for another (e.g., “That my dog. Him love me.”), you can respond to what she is saying by repeating and emphasizing the corrected words (e.g., “Yes, that is your dog. He loves you.”) In this manner, you are acknowledging your child’s comment and providing her with a model of how to correctly say it. If your child is accepting of direct correction, you may wish to occasionally bring an error to her attention and ask her to repeat the corrected form for you (e.g., “Honey, I heard you say, ‘That my dog.’ Let’s say, ‘That is my dog.'”)
- The child with a limited vocabulary. If your child needs to expand her expressive vocabulary and description skills, it is quite helpful to talk about what you are doing, taking care to embellish your language with new words and concepts. For instance, if your child is with you while making cookies, you can say, “We need to stir this dough some more. Right now it’s lumpy–see the lumps? We want to make it smooth.” Likewise, when eating the cookies, the taste and texture of them could be discussed (e.g., “These cookies are sweet and. The edge is crispy, but the middle is soft and chewy.”)
- The child whose language is disorganized and difficulty to follow. Sometimes a child needs help with the organization and sequencing of her language when trying to tell a story or relate an event. A wonderful way to work on this is to talk about the events of the child’s day. In the morning, tell the child what she is going to do (e.g., “First, we are going to school. When I pick you up, we will go visit grandma. Then we will get an ice cream cone.”) After telling your child the sequence of her day, ask her if she can tell it back to you (e.g., “So, what will we do today?”) At dinner time or bed time, you and your child can discuss, step by step, what she did that day.
Keep in mind that it takes a while for a child to learn all of the intricacies and rules of language. You may become frustrated when you hear her make the same mistake over and over again, but with time and support, her skills will improve!