Spoken Language Disorder: Causes, Signs, Treatment

A spoken language disorder is when someone has trouble understanding or speaking a language in any of its parts, like how words sound or how sentences are put together. For example is when there is difficulty pronouncing certain sounds or syllables correctly, such as saying “wed” instead of “red” or “pasghetti” instead of “spaghetti.” 

This can happen independently or with conditions like autism or hearing loss. People with language disorders might also have trouble with reading and writing and difficulty communicating with others. Language disorders can affect a person’s ability to learn in school, and they are often diagnosed before learning disabilities.

Is it common?

The prevalence of language delay/disorder in children under the age of 7 in the UK range from 2.63% to 16% for different types of language impairment. In Canada, the overall prevalence of language impairment in kindergarten children was 8.04%.

Children with psychiatric disorders in Canada were found to have a language impairment in 40% of cases. In addition, the prevalence of specific language impairment (SLI) was found to be 7.4%, with higher rates among boys than girls.

What are the signs?

Spoken language disorders (SLD) can have different signs and symptoms depending on the individual, such as the language domain affected, the level of communication disruption, the age of the individual, and the stage of linguistic development. The domains of SLD are form (phonology, syntax, and morphology), function (semantics), and use (pragmatics), which interact to form a dynamic whole.

Phonological deficits include problems with early speech sounds, difficulty learning a speech, and limited phonological awareness. Morphology and syntax deficiency include errors occurring most often on verbs and function words, late acquisition of word combinations, difficulty comprehending and using complex syntactic structures, and problems comprehending morphologically complex words that are common in various academic subjects.

Deficits in semantics include a slower rate of vocabulary development, difficulty understanding new words, word-finding difficulties, and poor comprehension of narrative or expository text. Deficiencies in pragmatics include difficulty initiating play with peers, difficulty initiating and sustaining conversations, limited classroom discourse skills, and uncertainty about what to say and when to talk.

Metalinguistic and metacognitive skills are critical for advanced language skills. Phonological awareness is a type of metalinguistic skill that is highly correlated with later reading and writing skills. It’s crucial to recognize that even though the domains are categorized individually, skills aren’t isolated entities, and there’s an interconnected relationship among them.

Other Considerations

Children with this disorder may experience social, emotional, and behavioral difficulties that can affect their self-perception, academic performance, peer relationships, and social interactions. These difficulties can also lead to misperceptions and misattributions of the child’s behavior. Children with language disorders may exhibit behavioral difficulties such as hyperactivity and attentional problems, behavioral reticence, difficulty inferring emotional reactions, poor social self-esteem, and difficulty forming and maintaining close relationships. They may also be at risk for bullying and other forms of abuse.

What are the causes?

A spoken language disorder can happen alone (SLI) or with other disabilities (like ASD and ADHD). When it happens with other disabilities, the causes are related to those specific conditions. With SLI, it’s hard to tell the exact cause, but some factors have been suggested, like cognitive processing, biology, and genetics. These factors could be related to each other, like genetic differences that affect brain function and lead to differences in cognitive processing.

How to assess a person?

Screening and assessment are crucial processes in diagnosing and treating language disorders. Screening aims to identify potential language difficulties and recommend further assessment, including a comprehensive language skills evaluation. This assessment is performed by a speech-language pathologist and includes a case history, hearing screening, spoken language testing, oral mechanism examination, and a literacy assessment. It may be suitable to conduct a speech sound evaluation to determine the feasibility of implementing augmentative and alternative communication (AAC) techniques based on the child’s developmental background and the type and extent of their impairments.

Several methods can be used for a comprehensive assessment of language disorders. Standard assessments are developed evaluation tools with established reliability and validity. Language sampling, dynamic assessment, systematic observation, contextual analysis, ethnographic interviewing, and parent/teacher/child report measures are also utilized. Curriculum-based assessment is a technique that uses information from a student’s curriculum and academic demands to evaluate their language skills.

Before conducting an assessment, it’s essential to consider the language or dialect the children use. Translation of a standard assessment invalidates the results. In cases where the primary language spoken at home is not English, the clinician must collect comprehensive details regarding the utilization of both the primary language and English.

What are Treatments?

Spoken language disorders (SLD) vary in severity and are unique to each individual. Bilingual individuals require special consideration during the intervention. Language intervention aims to improve overall language development and communication skills. Effective intervention involves teaching communication strategies, ongoing assessment, individualized treatment, and promoting knowledge beyond current levels. Intervention strategies vary depending on age and developmental level, and for older individuals with severe SLD, interventions focus on building independence in everyday settings.

For preschoolers

Intervention for preschoolers (ages 3-5) with language difficulties typically targets areas such as phonology, semantics, morphology and syntax, pragmatics, and literacy. Goals may include:

• Improving intelligibility.
• Enhancing phonological awareness skills.
• Increasing vocabulary size and understanding of semantic relationships.
• Facilitating acquisition and use of age-appropriate morphemes.
• Improving conversational and narrative skills.

Emergent literacy skills may also be addressed, including print awareness and letter knowledge.

For elementary school children

The primary objective of intervention for elementary school children with language difficulties is to assist them in acquiring the necessary language skills to excel and thrive in a classroom setting. The goals of the intervention are designed to address language deficits within the context of the curriculum, where these abilities are crucial.Areas targeted for this population include:

• Enhancing phonological awareness skills.
• Improving knowledge of vocabulary.
• Increasing the use of more advanced morphology.
• Improving morphosyntactic skills.
• Increasing discourse-level knowledge and skills.

Developing and executing a successful language intervention program, it typically requires a collaborative effort between the speech-language pathologist (SLP), classroom teacher(s), and other school specialists.

For adolescent students

Interventions for adolescent students with language difficulties focus on compensating for deficits rather than closing the gap between skill level and grade level. Instructional strategies often teach rules, techniques, and principles to facilitate the acquisition and use of information across different situations and settings. The intervention program often includes activities that promote the development of metalinguistic and metacognitive skills, and classroom assignments may be utilized as a means of instructing strategies for acquiring academic knowledge. Examples of strategies include using context to deduce meaning, checklists and graphic organizers to plan assignments, spell check and grammar check to edit written work, and digital technologies to access and evaluate information.

For adolescents 

Children and adolescents with language impairment struggle to complete high school and receive a college degree. They tend to seek vocational rather than academic qualifications and are employed in lower-skilled jobs than their typically developing peers. Continued support is necessary to facilitate a successful transition to young adulthood. The support includes transition planning, transition goals, disability support services, and vocational support services. Secondary school personnel can help in the transition process by educating students about their rights, assisting in the application process, and providing current documentation needed to access services in post-secondary settings.

The following treatment modes/modalities can be used to implement various treatment options:

1. Augmentative and Alternative Communication (AAC) involves supplementing or replacing natural speech and/or writing with aided and/or unaided symbols, such as picture communication symbols, speech-generating devices, manual signs, and gestures.
2. Computer-Based Instruction – This method uses computer technology and/or computerized programs to teach language skills, including vocabulary, social skills, social understanding, and social problem-solving.
3. Video-Based Instruction (Video Modeling) – This method uses video recordings to provide a model of the target behavior or skill. Video recordings of desired behaviors are observed and then imitated by the individual, and the learner’s self-modeling can be videotaped for later review.

Treatment options 

Various treatment options for individuals with language disorders can vary along a continuum of naturalness, ranging from contrived or drill-based activities in a therapy room to activities that model play or other everyday activities in more natural settings. The treatments can be categorized into two main groups: behavioral interventions/techniques and language interventions. 

Behavioral interventions aim to teach functional alternative behaviors and reduce problem behaviors through behavior change principles. Some behavioral interventions include Discrete Trial Training, Early Intensive Behavioral Interventions, Functional Communication Training, Incidental Teaching, Lovaas Therapy, Milieu Therapy, and Pivotal Response Treatment. 

On the other hand, language interventions focus on specific language skills or broader language and communication skills. These interventions can be Clinician-Oriented, Child-Oriented, or Hybrid. The choice of treatment approach should consider an individual’s language profile, the severity of the language disorder, factors related to language functioning, cultural background and values, learning style, and communication needs.

Summary

This article is about spoken language disorders, which can occur independently or as a part of other conditions like autism or hearing loss. People with language disorders might have trouble communicating with others and may also struggle with reading and writing. The prevalence of language disorders varies among different regions and populations. Signs and symptoms of language disorder depend on the individual, including the domain affected, level of communication disruption, age, and linguistic development. Behavioral, emotional, and social difficulties are also common in children with language disorders, including difficulties with peer relationships and self-perception. The causes of spoken language disorders are not clear, but cognitive processing, biology, and genetics are thought to be involved. Treatment for spoken language disorders typically involves a comprehensive evaluation of language skills followed by a targeted, individualized approach to intervention that addresses the child’s specific language needs.