Overview
If your child has a developmental expressive language disorder (DELD), they might have difficulty remembering vocabulary words or using complex sentences. For example, a 5-year-old with DELD might speak in short, three-word sentences. When asked a question, they might not be able to find the right words to answer you if they have DELD.
DELD is usually limited to expression and doesn’t affect your child’s ability to read, listen, or produce sounds, unless your child also has other learning disabilities.
The cause of DELD is poorly understood. It’s usually not related to your child’s level of intelligence. Typically, there’s no specific cause. The condition may be genetic, or run in your family. In very rare cases, it may be caused by a brain injury or malnutrition. Other issues, such as autism and hearing impairment, accompany some language disorders. These issues can worsen your child’s symptoms. If your child’s central nervous system is damaged, they may be more likely to develop a language disorder called aphasia.
The disorder may appear alone or with other language deficiencies. The symptoms are usually limited to vocabulary issues and faulty word memory. For example, your child may not be able to recall words they’ve just learned. Your child’s vocabulary may be below average in comparison with other children in the same age group. Your child may not be able to form a long sentence and might omit words or use them in the wrong order. They might also confuse tenses. For example, they might say “I jump” instead of “I jumped.”
Children with DELD commonly use filler sounds such as “uh” and “um” because they can’t think of how best to express themselves. They also commonly repeat phrases and questions. Your child might repeat part of your question back to you while thinking about how to answer.
Receptive-expressive language disorder
If your child exhibits the above symptoms and also has a hard time understanding what you’re saying, they might have receptive-expressive language disorder (RELD). In that case, your child might also struggle to understand information, organize thoughts, and follow directions.
Some children’s language skills are delayed but will catch up over time. In the case of DELD, however, your child might develop some language skills but not others. Understanding common language milestones in children can help you decide whether or not to visit your child’s doctor.
Your child’s doctor may recommend that your child sees a speech therapist, a psychologist, or a child development specialist. They will usually ask for a medical history to determine if other people in your family have a language disorder or speech problems.
| When to see a doctor about your child’s language development | |
| 15 months old | Your child is not saying any words. |
| 2 years old | Your child’s vocabulary is limited to fewer than 25 words. |
| 3 years old | Your child is still speaking in two-word sentences. |
| 4 years old | Your child often repeats your questions or does not speak in full sentences. |
A speech-language pathologist is a commonly recommended specialist. They specialize in treating and evaluating people who have difficulty with expressing language. During a visit with a specialist, your child will undergo a standard test for expressive language disorder. Your child may also need a hearing test to rule out the possibility that hearing impairment is causing the language problem. They may also be tested for other learning disabilities.
Treatment options for DELD include language therapy and counseling.
Language therapy
Children need to be able to do the following to develop language skills:
- receive information
- understand information
- retain information
Speech therapy focuses on testing and strengthening these skills and helping your child increase their vocabulary. A speech therapist can use word repetition, images, tailored reading materials, and other tools to help nurture your child’s communication skills.
Counseling
Children who have difficulty expressing themselves may feel frustrated and socially isolated. Your child might get into fights because they can’t find the right words during an argument. Counseling can teach your child how to cope if they become frustrated by their communication difficulties.
The outlook for children with DELD is best when the disorder is not combined with another condition, such as a hearing impairment, brain injury, or learning disability. Through language therapy, children with DELD can usually learn how to express themselves fully. Counseling can also help your child to adjust socially and avoid low self-esteem. Seeking treatment early is important for minimizing the psychological challenges that your child might experience as a result of the disorder.
Q:
My first child had difficulty communicating with us and started speaking at a later age than most. I am worried that the same will happen with my second child who is currently 15 months old. Is there anything I can do to prevent her from having the same language challenges as her older brother?
A:
It’s completely understandable for you to be concerned about your daughter’s verbal development. Without knowing your first child’s diagnosis, I cannot predict what the odds of a similar delay are for your daughter. For most DELD conditions, the cause is not fully known, although genetics are thought to play a part. If you feel that she is also falling behind on verbal or social milestones, I would highly recommend that you voice these concerns to her pediatrician at the 15-month (or 18-month) checkup so that her doctor can do a thorough assessment.
Steve Kim, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.