All about language disorders

Language disorders can lead to many questions, both in the classroom and elsewhere. How will the school handle it? What can you do to help at home? And what if you’re not even sure if a language disorder is what your child is struggling with?

In this episode of In It, hosts Gretchen Vierstra and Rachel Bozek talk with Kelli Johnson, a Minneapolis-based educational speech-language pathologist who is also a writer and expert reviewer at Understood. 

Kelli explains what her job is all about, and what it means to have a language disorder. She also talks about making her work with students fun while helping them navigate this learning and thinking difference.

Related resources

• Language disorder fact sheet 

• What are language disorders 

• How speech-language pathologists work with kids

Episode transcript

Gretchen: From the Understood Podcast Network, this is "In It," a podcast about the ins and outs... 

Rachel: ...the ups and downs... 

Gretchen: ...of supporting kids who learn and think differently. I'm Gretchen Vierstra, a former classroom teacher and an editor here at Understood.

Rachel: And I'm Rachel Bozek, a writer and editor with a family that's definitely in it. Today we're getting into language disorder.

Gretchen: A term which includes receptive language disorder and expressive language disorder. 

Rachel: Joining us to break it all down is Kelli Johnson, an educational speech-language pathologist based in Minneapolis. 

Gretchen: Kelli holds a master in communication disorders and is also a writer and expert reviewer here at Understood. 

Rachel: We're so glad to have her helping us out today. So, Hello Kelli. 

Kelli: Hello. 

Rachel: Welcome to "In It." We're so glad to have you here. To get us started, would you mind telling us what it means to be an educational speech-language pathologist? 

Kelli: Well, an educational speech-language pathologist is somebody who serves disabilities in the school setting as they relate to a child's ability to participate in the school curriculum. And so, the disability areas we deal with are things like stuttering, speech sound disorders, or articulation, where kids have difficulty saying specific speech sounds.

And what we're going to talk about today, which is language disorder, where kids' language development is really significantly... they have significant challenges compared to their same-age peers. 

Gretchen: Let's go into a little more depth. What is a language disorder, exactly? 

Kelli: Broadly speaking, language disorder is a disorder or an impairment that involves the ability to understand the language that's all around you. The meanings of language, the language that we get in writing or verbally, and also expression. So, how we use language to convey the messages that we want to put out there. 

Gretchen: How common are language disorders? 

Kelli: So, you know, the studies that we have available on five-year-olds — which is kind of when, language disorder tends to be discovered — is that it occurs for 1 in 14 kids. And that is the rate at which it's identified in kindergarten. But those language difficulties generally persist in some way or other, in some severity or other through adulthood. 

Rachel: Wow. You've touched on this already, but I wonder if you could say more about the difference between receptive and expressive language disorder. 

Kelli: Sure. So, receptive language is all about what you're taking in. It's language understanding or language comprehension. And so, these are kiddos that are going to have difficulty taking in, longer directions like 3-step directions. These are kiddos that, may not understand the question you just asked them. They will certainly have difficulty understanding verbal instruction. You know, when teachers are teaching a longer lesson. 

Expressive language is how kids or how people use language to say their own ideas express themselves. And so, these are kiddos that are going to have trouble putting sentences together in a way that is meaningful to the people around them. And so, that can look like, difficulty with grammar. It can look like difficulty with what we call syntax, which is sort of how we put all these words together, telling stories, or difficulty organizing sentences. 

But broadly speaking, expressive language disorder is difficulty putting the message out there in the way that you want to say it. 

Rachel: So, what are some of the signs? We talked a little bit about kindergarten being kind of the beginning of when this might get spotted. What are some of the signs that might indicate that a younger child has a language disorder? 

Kelli: Right. And I do want to just kind of clarify a little bit. We've got good studies in kindergarten that tell us that often those distinctions will get spotted really early because, you know, little children aren't meeting those really well-explained developmental milestones, you know, with their checkups with their pediatrician. So, they're not starting to put two words together at the age that you would expect them to put two words together. 

As they're getting a little bit older, you know, as teachers are sort of interacting with them in class, they might notice, "Wow, this kiddo is using just single words or pointing at a lot of things." They might notice that when that child is trying to say something that happened to them — you know, they have a conflict with another kiddo — they can't tell the story of what happened to them. They might have a more limited vocabulary. 

They tend to be not the kids that are raising their hands to participate. If it's a receptive or receptive-expressive difficulty, those are the children that are going to struggle to follow directions in the classroom setting. They're going to be the children that answer questions in an off-topic way. So, you're saying you know, "Who did you see?" And they might start telling you a story that is, you know, completely unrelated. 

And some of that is just a thing that children do. But as you're comparing it, you know, you're comparing it to the other kids in class you're going to find that that's much more of a trend with children who struggle with receptive language. 

Rachel: And how does that differ as they get older, like, is what you see different with older kids? 

Kelli: It is. I mean, I should say, for children with language disorder, we generally see those concerns much earlier. It's not usual to identify, say, a fifth-grade child with language disorder. However, the things that stick out are going to be different because the academic demands have been increased. So, you know, in classroom discussions, you might find that they're just not as able to show what they know. Maybe they do understand what's going on. 

And you can kind of tease that out if you ask questions that don't require longer responses, but they're not going to be the child that can kind of explain things in a complex way. You're going to start seeing it in their writing. If it's an expressive language disorder, those are going to be kids that really struggle with those composition assignments. In part because, you know, these are often children who also have reading and writing difficulties. You know, they're getting support in those areas, too. 

If it's a child who's experiencing receptive language problems, reading comprehension is going to continue to be difficult. And you may see this mismatch between decoding and comprehension. Many of these children are fluent readers. They can decode words but when you ask them, you know, just to check up on comprehension questions, they will typically have a lot of difficulty. And these are often kids that will sort of like use what they know about the subject to answer the question instead of what's really on the page. 

There are children who are not going to do as well under, you know, answering questions on tests. And those are also children who may start to have some social difficulties because they are not, you know, they're not able to pick up on all of the language that's coming at them from their peers. And so they're not responding in a way that their peers would expect. 

Gretchen: So, who would be the one at a school or anywhere to typically diagnose a language disorder? 

Kelli: That's me. Yeah. It goes to the speech-language pathologist and it you know, there's a process, right? The teacher or parent will identify an area of difficulty. And schools do have a process for getting everybody together and saying, "I'm concerned about this child." And there's an early phase where you sort of try to tease out what, what needs another look. But I'm the person on the team that does all of the testing to identify language disorder. 

Rachel: So, a quick question before my next question. When we're talking about all of this is the kind of like common terminology to say, "Kids who have a language disorder" or "Kids who have language disorder," like, that's the name of it? I just want to make sure we're kind of like, asking it the right way. 

Kelli: I think you're asking it the right way. Children who have language disorder. Yeah. 

Rachel: OK

Kelli: Yeah, yeah. Or a language disorder. That's really fine. 

Rachel: OK. So, can you tell us a little bit about what your work with kids who have language disorder looks like, and maybe walk us through, like, the kinds of exercises that you might do with younger kids first, and then we can talk about older kids. 

Kelli: Yeah. So, we always start with what the evaluation tells us about that specific child. And language disorder breaks down into all these little subsets of skills. Right. So, some children might have a really difficult time with using what we call morphemes. Right. How we create the past tense, how we show that something is going to happen versus did happen. So, that child, you know, obviously would have a goal in that area. 

Some children might have difficulties with prepositions — in, on, whatever — and then there's some variability in how every speech pathologist works. I embed those skills in play for little kids. And that can also be books. You know, we sort of want to get them interested in books pretty early because that's where we're going in the academic setting. But we might do play-based things. 

So, for a child that is struggling with place, right? I might read a book about — there's really, there's a book I use a lot — called "Rosie's Walk," where a chicken's being followed by a fox, and the fox keeps changing position. And so we can talk about "On top of" "Behind" "Between." 

And then, you know, because this play-based, I get a little toy fox at the end and we play a little game where we put the fox at different places around us. If it's a child who's working on using longer sentences, I might get a bunch of toys that that child likes. 

And, you know, they can practice asking me. I'll give them a little frame for, "I want the... red one. I want the... black one." And so little by little, we add these words in and we start to expand. We can also just do things where they give me an answer, and I reframe it to add a couple more words and then say, "You tell me that." But for little children, trying to tap into what they are already interested in, is where we really want to go with that, because we want language to have a payoff. It should stay fun. 

Rachel: Yeah, yeah. 

Kelli: So, older kids, we start thinking a lot more about the direct connection of language to academic expectations. I try very hard to use texts or adapted versions of those texts in the context of our language sessions, and we might work on how do we summarize that. You know, some of the kids I see because you know, they have reading challenges as well. We might do this in a verbal way. You know, stories have these parts. They have a character, they have a setting, have kickoff where the story starts. 

So, they'll learn all those parts, and then they learn how to tell a cohesive — what we call a narrative or a summary — about that story. And the great thing is, it kind of applies to when we're telling stories about our lives and trying to give details about, you know, what happened when I got in a conflict with this other student? We might use writing more. I do a lot with what are called graphic organizers, where, you know, they may have an assignment in their class to write a report. 

And so, I kind of consult with a teacher about what those expectations are. And we put that in the context of a graphic organizer. And I might supplement it with, you know, kind of the step-by-step instructions from the classroom that I can add visuals to. And then that, you know, the other piece of that is, I would collaborate with the classroom teacher a lot to see how can we sync up what we're doing. 

How can you use these sorts of visuals, these sorts of verbal cues or written cues to help this child be more successful when they're actually in the classroom? And how can I pick up on my end to help them understand the expectations and meet the expectations with a little bit of language support. 

Gretchen: That relates to this question I have, which is what are some common classroom accommodations that kids might get in their IEP if they have language disorder? 

Kelli: Right. So, when I'm thinking of receptive language difficulties in particular, you might see an accommodation that says "The teacher should check for understanding after delivering a direction. Direction should be given in small pieces. Check with the child within five minutes of starting the assignment to give feedback or redirection." 

Expressive language accommodations might look like having graphic organizers available, having extra time to complete assignments, having a visual of what the expectations are, you know, because that puts it — without getting too deep in the weeds — kids who are trying to complete something that's really, really difficult might not have the working memory, right?

The ability to kind of keep one thing in their head while they're doing another thing. They might not have the working memory to remember what the expectation is, and also use their little, graphic organizer to complete the assignment. 

I like to do buddies — you know, so to help kids access a peer who can maybe work with them to do, like, if it's a written assignment that will be a presentation — how can we work with a buddy, and how can the teacher help divvy up the responsibilities of each part of the buddy system? And then also, there's usually an accommodation that the speech-language pathologist will connect with the teacher on the specific accommodations that are needed by that kiddo, right?

Because language disorder looks different for different children. And so, what they're working on at any given time will be different. You know, they're so just sort of staying in touch with the classroom teacher and saying, "This is the specific thing we're working on right now. Here are some ways that you can practice this in class." 

Rachel: So, can language disorder be cured? Or is there a point at which some children are not struggling with it anymore? And those might not be the same thing, but... 

Kelli: Well, it might. Yeah, exactly. When children are identified really young with language disorder, sometimes it is a need for more exposure. Right? Every household is different. What every kid is exposed to is different. And so, sometimes those little people, when they end up in, say, an early childhood program, which is all language, all the time, super engaging. I have seen kids just blossom. 

And so, you know that in those cases, we've just come across a child that just needed some really intense stimulation, maybe a little bit of extra time and maybe the, you know, the speech therapist is no longer involved after age 5 or 6. Typically, language disorder is something that is going to persist into adulthood. People can acquire skills. You know, therapy is helpful. 

It can make a difference, but it doesn't really go away. It is generally the case that while folks who are adults who had language disorder as a child are very functional, it is likely going to be the case that their verbal skills are not going to be their best skill. And, you know, the best-case scenario is that they have learned ways to self-advocate. They have learned specific skills that help them be better at communicating their ideas. But it might be still an area where they feel like, "Yeah, communication is not my strong suit."

Gretchen: Yeah. And it seems like you said, too. All the strategies, hopefully right, that they've learned over the years just come into play. And so, it's less of a challenge because they're used to using strategies to work with that challenge. 

Kelli: Right. And you know, I think too, you know, the best outcome for people who've had therapy for language disorder is that they sort of just come to appreciate the totality of who they are. Right. That there's just this "Yes, this is a thing. Nobody's perfect. This is just something that I've had to work on in my life. And, you know, I'm proud of the things I've done to work on it." 

Gretchen: What are some things that you encourage parents and caregivers to do at home to help a child with a language disorder? 

Kelli: I would say the first thing is, you know, talk to your child's speech pathologist because they are going to know specifically what's being worked on at that time. One really fun one that we tell parents to do with the littles is engage them in everyday household stuff. "Let's do this together." Usually at that age, they love it, right? As kids get older, they may not be as interested in making dinner with their mom, but at that young age they are often very excited about it. 

It gives an opportunity to talk things through, use vocabulary they maybe haven't heard before, and it keeps it really fun. I really feel like kids need it to have a payoff. It shouldn't feel like homework. For parents who are, you know, trying to help their older child who, has a language disorder, making them aware of maybe what supports are needed. You know, at the end of the day, when you want to talk to your child about their day, maybe we can have like a specific set of questions we go through. 

Maybe when the child gives a short answer, you can sort of recast that and confirm with a slightly longer answer and not necessarily have the expectation that the child's going to copy you, but keeping it natural, you know, just talking through what you're seeing with them. Keeping as much verbal communication as possible open as a model, as an opportunity, without having this huge expectation that feels like homework for the child. 

And there may be some specific little things, like when a child uses the present tense to express all things that happen. They might need some really specific practice, and I might send home, "Hey, you know, we're working on adding -ed to make the past tense. Maybe you can, you know, go through these flashcards during the day." But mostly just like, use it or find opportunities to say, "Oh, wait, I didn't understand that. You know? did that happen? Is that happening right now or did that happen before?" 

There are lots of different ways, and the best jumping-off point for the parent is to connect with the speech pathologist and say, "You know, what are you working on? How can I include that in our everyday communication?" 

Rachel: So, we hear a lot about how some learning differences, like ADHD also have upsides, where, you know, we hear a lot of the word lately, "Superpowers." Like they have the ability to kind of hyperfocus on things that they're really good at or that they're interested in, like we've talked about here. Is there any kind of equivalent or parallel that you've seen with kids with language disorder? 

Kelli: Well, I'll tell you. One thing I see — and I can't really say their causal right, that the absence of strong language skills leads to this other skill — but what I can say is that every single child I see has something they're just superstars at. Maybe they have strong math skills. Maybe they are just that kid that's got really great social skills in spite of not being really conversational. You know, I have those children that are just beloved because they are so kind and they're so interested and they want to help. 

I have children who are phenomenal at art, and I have among my receptive language kids with receptive language difficulties, kids who get really good at observing what's going on around them. Because when you don't understand the directions, you are looking around to see what the expectation is. 

So, I don't know that we can say, you know, there's a causal relationship between those things, but all of my kids have areas that are huge strengths for them. I have kids that are better than I am at lots of things, and I point this out to them all the time that, "Wow, you just taught me something today." That is not an infrequent occurrence. 

Rachel: That's great. That's great. 

Gretchen: Yeah, yeah, I think it's a good note to end on. Right. Strengths, that everyone's got their strengths. 

Kelli: Absolutely. It keeps me coming to work every day. 

Gretchen: Well, thank you so much for talking with us today. 

Kelli: Thank you for having me. It was a wonderful conversation. 

Gretchen: You've been listening to "In It" from the Understood Podcast Network.

Rachel: This show is for you. So we want to make sure you're getting what you need. Email us at init@understood.org to share your thoughts. We love hearing from you. 

Gretchen: If you want to learn more about the topics we've covered today, check out our show notes. We include more resources as well as links to anything we mentioned in the episode.

Rachel: Understood.org is a resource dedicated to helping people who learn and think differently discover their potential and thrive. Learn more at understood.org/mission. 

Gretchen: "In It" is produced by Julie Subrin. Ilana Millner is our production director. Justin D. Wright mixes the show. Mike Ericco wrote our theme music. 

Rachel: For the Understood Podcast Network, Laura Key is our editorial director, Scott Cocchiere is our creative director, and Seth Melnick is our executive producer. Thanks for listening.

Gretchen: And thanks for always being "in it" with us.