Expressive language disorder: Difference between revisions
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'''Expressive language disorder''' is one of the "specific developmental disorders of speech and language" |
'''Expressive language disorder''' is one of the "specific developmental disorders of speech and language" recognized by the tenth edition of the [[International Classification of Diseases]] (ICD-10). As of the eleventh edition (ICD-11, current 1 January 2022), it is considered to be covered by the various categories of [[developmental language disorder]]. Transition to the ICD-11 will take place at a different time in different countries. |
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The condition is a [[communication disorder]] in which there are difficulties with verbal and written expression.<ref>{{cite web |url=http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Expressive_language_disorder |title=Expressive language disorder |work=The Better Health Channel (BHC) |access-date=2010-06-01 |archive-url=https://web.archive.org/web/20100702022441/http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Expressive_language_disorder |archive-date=2010-07-02 |url-status=dead }}</ref> It is a [[specific language impairment]] characterized by an ability to use expressive [[spoken language]] that is markedly below the appropriate level for the [[mental age]], but with a [[language comprehension]] that is within normal limits.<ref name="icd">{{cite web |url=http://apps.who.int/classifications/icd10/browse/2010/en#/F80.1 |title= F80.1 Expressive language disorder |work=ICD-10 Version:2010}}</ref> There can be problems with vocabulary, producing complex sentences, and remembering words,<ref>{{cite encyclopedia |url=https://www.nlm.nih.gov/medlineplus/ency/article/001544.htm |title=Expressive language disorder - developmental |encyclopedia= MedlinePlus Medical Encyclopedia}}</ref> and there may or may not be abnormalities in [[Manner of articulation|articulation]].<ref name="icd" /> |
The condition is a [[communication disorder]] in which there are difficulties with verbal and written expression.<ref>{{cite web |url=http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Expressive_language_disorder |title=Expressive language disorder |work=The Better Health Channel (BHC) |access-date=2010-06-01 |archive-url=https://web.archive.org/web/20100702022441/http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Expressive_language_disorder |archive-date=2010-07-02 |url-status=dead }}</ref> It is a [[specific language impairment]] characterized by an ability to use expressive [[spoken language]] that is markedly below the appropriate level for the [[mental age]], but with a [[language comprehension]] that is within normal limits.<ref name="icd">{{cite web |url=http://apps.who.int/classifications/icd10/browse/2010/en#/F80.1 |title= F80.1 Expressive language disorder |work=ICD-10 Version:2010}}</ref> There can be problems with vocabulary, producing complex sentences, and remembering words,<ref>{{cite encyclopedia |url=https://www.nlm.nih.gov/medlineplus/ency/article/001544.htm |title=Expressive language disorder - developmental |encyclopedia= MedlinePlus Medical Encyclopedia}}</ref> and there may or may not be abnormalities in [[Manner of articulation|articulation]].<ref name="icd" /> |
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Careful diagnosis is also important because "atypical language development can be a secondary characteristic of other physical and developmental problems that may first manifest as language problems".<ref name="McLaughlin 2011">{{cite journal |author=McLaughlin MR |title=Speech and language delay in children |journal=Am Fam Physician |volume=83 |issue=10 |pages=1183–8 |date=May 2011 |pmid=21568252|url=http://www.aafp.org/afp/2011/0515/p1183.html}}</ref> |
Careful diagnosis is also important because "atypical language development can be a secondary characteristic of other physical and developmental problems that may first manifest as language problems".<ref name="McLaughlin 2011">{{cite journal |author=McLaughlin MR |title=Speech and language delay in children |journal=Am Fam Physician |volume=83 |issue=10 |pages=1183–8 |date=May 2011 |pmid=21568252|url=http://www.aafp.org/afp/2011/0515/p1183.html}}</ref> |
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== Causes == |
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Expressive language disorder is not well understood. It does not have one singular cause, but rather is often a result of many possible causes during development including [[malnutrition]], and damage to the [[cerebrum]]<ref>{{Cite web |title=Developmental expressive language disorder: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/article/001544.htm |access-date=2024-03-09 |website=medlineplus.gov |language=en}}</ref>. Physical abnormalities such as such as cleft plate and other anomalies that affect oral, pharyngeal, laryngeal structures or neuromuscular functions can be a cause Expressive Language Disorder. There is evidence that inadequate stimulus during may be risk factor as well.<ref>{{Cite journal |last=Sunderajan |first=Trisha |last2=Kanhere |first2=Sujata V. |date=2019-5 |title=Speech and language delay in children: Prevalence and risk factors |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6559061/ |journal=Journal of Family Medicine and Primary Care |volume=8 |issue=5 |pages=1642–1646 |doi=10.4103/jfmpc.jfmpc_162_19 |issn=2249-4863 |pmc=6559061 |pmid=31198730}}</ref> |
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== Diagnosis == |
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Diagnosis for expressive language disorder in children are usually marked by milestones markers of the child age grouping. A child can be diagnosed for expressive language disorder as early as two years old. Many pediatricians and speech therapist look into all grounds of what may be causing speech delay. . By the age of 2, children whom are unable to use up to 270 one-word phrases and 25 different phonemes, not averaging 75 words per hour during free play, not able to talk in several two-to-three-word phrases with speech intelligibility or at least 65% and whom are unable to name common objects and pictures are predicted to most likely struggle and be diagnosed with expressive language disorder. Because age vary on diagnosis , treatment varies as well. |
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== Treatment == |
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Treatment of expressive language disorder mostly involves speech and language therapies. However, it is recommended to get a full physical check to rule out other possible disorders such as hearing loss. The recommended way to treat expressive language is to work out a therapy plan by visiting a speech and language therapist. In addition, parents could also aid children at home. For example, parents could have small conversation with their children with slow, clear, and short words to slowly improve children's condition. In this process, patience is key, and it is also important to make the children stressed. Additionally, let children repeat a short sentence or say it in their own words could also be helpful. Early diagnosis and treatment is really important to treat expressive language disorder.<ref>{{Cite journal |last=Rinaldi |first=Sara |last2=Caselli |first2=Maria Cristina |last3=Cofelice |first3=Valentina |last4=D’Amico |first4=Simonetta |last5=De Cagno |first5=Anna Giulia |last6=Della Corte |first6=Giuseppina |last7=Di Martino |first7=Maria Valeria |last8=Di Costanzo |first8=Brigida |last9=Levorato |first9=Maria Chiara |last10=Penge |first10=Roberta |last11=Rossetto |first11=Tiziana |last12=Sansavini |first12=Alessandra |last13=Vecchi |first13=Simona |last14=Zoccolotti |first14=Pierluigi |date=2021-03 |title=Efficacy of the Treatment of Developmental Language Disorder: A Systematic Review |url=https://www.mdpi.com/2076-3425/11/3/407 |journal=Brain Sciences |language=en |volume=11 |issue=3 |pages=407 |doi=10.3390/brainsci11030407 |issn=2076-3425 |pmc=PMC8005159 |pmid=33806938}}</ref> |
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== Prognosis == |
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The prognosis for this disease is shown to be associated with a class of different issues ranging from broad areas in a child's life such as social relationships, mental health, literacy, etc. This is tied into the inability to properly communicate or express language due to the plethora of functional impairments that come with this disorder.<ref>{{Cite journal |last=Hagen |first=Åste M |last2=Rogde |first2=Kristin |last3=Lervåg |first3=Arne |last4=Melby-Lervag |first4=Monica |last5=Norbury |first5=Courtenay |date=2023-01-20 |editor-last=Cochrane Developmental, Psychosocial and Learning Problems Group |title=Long-term prognosis of low language proficiency in children |url=http://doi.wiley.com/10.1002/14651858.CD015268 |journal=Cochrane Database of Systematic Reviews |language=en |volume=2023 |issue=1 |doi=10.1002/14651858.CD015268 |pmc=PMC9854239}}</ref> |
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==Models of language production== |
==Models of language production== |
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==Scientific studies of speech and language== |
==Scientific studies of speech and language== |
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Some of the earliest |
Some of the earliest '''discoveries in the field of [[neuroscience]]''' were related to the discovery that damage to certain areas of the brain related to impairments in language, such as the discovery of [[Wernicke's area]] and [[Broca's area]]. Lesions in these parts of the brain impair language comprehension and language production, respectively. [[Paul Broca]] was the first to note that the left hemisphere of the brain appeared to be localized for language function, particularly for right handed patients. Modern neuroscientific research has verified this, though language may be lateralized to the right hemisphere in some right-handed individuals..<ref name="Knecht 2000">{{cite journal |vauthors=Knecht S, Deppe M, Dräger B, etal |title=Language lateralization in healthy right-handers |journal=Brain |volume=123 |issue= 1|pages=74–81 |date=January 2000 |pmid=10611122 |doi= 10.1093/brain/123.1.74 |doi-access= }}</ref><ref name="Pujol 1999">{{cite journal |vauthors=Pujol J, Deus J, Losilla JM, Capdevila A |title=Cerebral lateralization of language in normal left-handed people studied by functional MRI |journal=Neurology |volume=52 |issue=5 |pages=1038–43 |date=March 1999 |pmid=10102425 |doi=10.1212/WNL.52.5.1038 |s2cid=45298083 }}</ref> |
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===Developmental verbal dyspraxia=== |
===Developmental verbal dyspraxia=== |
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Revision as of 03:35, 25 March 2024
| Expressive language disorder | |
|---|---|
| Specialty | Pediatrics |
Expressive language disorder is one of the "specific developmental disorders of speech and language" recognized by the tenth edition of the International Classification of Diseases (ICD-10). As of the eleventh edition (ICD-11, current 1 January 2022), it is considered to be covered by the various categories of developmental language disorder. Transition to the ICD-11 will take place at a different time in different countries.
The condition is a communication disorder in which there are difficulties with verbal and written expression.[1] It is a specific language impairment characterized by an ability to use expressive spoken language that is markedly below the appropriate level for the mental age, but with a language comprehension that is within normal limits.[2] There can be problems with vocabulary, producing complex sentences, and remembering words,[3] and there may or may not be abnormalities in articulation.[2]
Careful diagnosis is also important because "atypical language development can be a secondary characteristic of other physical and developmental problems that may first manifest as language problems".[4]
Causes
Expressive language disorder is not well understood. It does not have one singular cause, but rather is often a result of many possible causes during development including malnutrition, and damage to the cerebrum[5]. Physical abnormalities such as such as cleft plate and other anomalies that affect oral, pharyngeal, laryngeal structures or neuromuscular functions can be a cause Expressive Language Disorder. There is evidence that inadequate stimulus during may be risk factor as well.[6]
Diagnosis
Diagnosis for expressive language disorder in children are usually marked by milestones markers of the child age grouping. A child can be diagnosed for expressive language disorder as early as two years old. Many pediatricians and speech therapist look into all grounds of what may be causing speech delay. . By the age of 2, children whom are unable to use up to 270 one-word phrases and 25 different phonemes, not averaging 75 words per hour during free play, not able to talk in several two-to-three-word phrases with speech intelligibility or at least 65% and whom are unable to name common objects and pictures are predicted to most likely struggle and be diagnosed with expressive language disorder. Because age vary on diagnosis , treatment varies as well.
Treatment
Treatment of expressive language disorder mostly involves speech and language therapies. However, it is recommended to get a full physical check to rule out other possible disorders such as hearing loss. The recommended way to treat expressive language is to work out a therapy plan by visiting a speech and language therapist. In addition, parents could also aid children at home. For example, parents could have small conversation with their children with slow, clear, and short words to slowly improve children's condition. In this process, patience is key, and it is also important to make the children stressed. Additionally, let children repeat a short sentence or say it in their own words could also be helpful. Early diagnosis and treatment is really important to treat expressive language disorder.[7]
Prognosis
The prognosis for this disease is shown to be associated with a class of different issues ranging from broad areas in a child's life such as social relationships, mental health, literacy, etc. This is tied into the inability to properly communicate or express language due to the plethora of functional impairments that come with this disorder.[8]
Models of language production
Willem Levelt outlined the currently accepted theory of speech production. Words are produced after the concept waiting to be produced is conceptualized, related words are selected, encoded and the sound waves of speech are produced.[9]
Association with language networks
There is significant debate about whether specific language impairments, such as expressive language disorder, are caused by deficits in grammar or by a deficit in processing language information.[10] However, an alternative hypothesis to the cause of SLIs has been posited, called the Procedural Deficit Hypothesis. The Procedural Deficit Hypothesis states that we can explain language impairments due to abnormal development of brain structures that are involved in procedural memory, our memories that remember how to perform different cognitive and motor tasks. The procedural memory system is associated with basal-ganglia circuits in the frontal lobe and further investigation of this particular hypothesis could aid in the development of a clinical neurological picture of what the underlying causes of SLI are.[11]
Scientific studies of speech and language
Some of the earliest discoveries in the field of neuroscience were related to the discovery that damage to certain areas of the brain related to impairments in language, such as the discovery of Wernicke's area and Broca's area. Lesions in these parts of the brain impair language comprehension and language production, respectively. Paul Broca was the first to note that the left hemisphere of the brain appeared to be localized for language function, particularly for right handed patients. Modern neuroscientific research has verified this, though language may be lateralized to the right hemisphere in some right-handed individuals..[12][13]
Developmental verbal dyspraxia
In 1990, it was reported that the several generations of the KE family had developmental verbal dyspraxia and orofacial praxis that were inherited in a typical autosomal dominant pattern.[14] Further analysis traced this inheritance pattern back to mutations in the FOXP2 genes.[15][16] These studies have allowed scientists to begin to investigate how changes to one gene can alter human communication.
FOXP2 is the first gene that has been identified that is specifically linked to speech and language production. Mutant alleles of the normal FOXP2 gene have been found to be the cause of severe speech impairments.[15]
Specific language impairment
Neuroimaging techniques, such as structural and functional MRI, found no significant differences between individuals with SLI and normal controls. However, more subtle and sophisticated techniques, such as voxel-based morphometry studies have allowed researchers to identify bilateral abnormalities in neural volume in areas of the brain associated with motor functions, such as the caudate nucleus, in the affected members of the KE family when compared to the unaffected family members. This volume reduction showed a high correlation between reduced volume and tests of oral praxis, supporting the idea that odd development of the caudate nucleus is related to the problems in motor control observed in the KE family.[15]
Due to the vague nature of the diagnosis of expressive language disorder, there is little specific scientific research that we can currently locate. A larger body of research exists around neuroscientific studies with children diagnosed with a specific language impairment (SLI). fMRI studies have shown that children with SLI have a significantly smaller left hemispheric pars triangularis (Broca's area) and asymmetry of dominance of language structures, as opposed to the more typical left hemisphere dominance.[17] Scientists are beginning to elucidate differences in activation patterns in children with SLIs using neuroimaging techniques to capture brain activity while performing different cognitive tasks. A major observation is lack of left hemisphere lateralization in major language structures such as the inferior frontal gyrus-opercularis, inferior frontal gyrus-triangularis, supramarginal gyrus and superior temporal gyrus. The same study reported hypoactivation and hyper activation of other brain regions - the supramarginal junction and anterior insula, respectively.[18] Other in-depth imaging studies report finding previously undiagnosed lesions in the brains of children with well-characterized developmental language development.[19] Together, these findings strongly suggest that language impairments are the result of an underlying neurological defect in an area of the brain related to language.
Studies looking at long-term outcomes for individuals with specific language impairments such as expressive language disorder track these individuals from childhood to adulthood. As Whitehouse and his colleagues [20] suggest, "When childhood language problems persist into adulthood, they can have far reaching consequences in terms of academic, social and vocational outcomes." These researchers found that children diagnosed with an SLI would have persistent problems with language and are more likely to pursue vocational training rather than university, thereby avoiding professions requiring high levels of literacy. A lower socioeconomic status was also noted by adults who were diagnosed with an SLI as a child. Whitehouse [20] also reported that these adults had more difficulties in establishing friendships, most likely due to a decreased ability to express themselves socially.
Current educational interventions for students with an SLI
Specific language impairments are often secondary characteristics of other disorders such as autism spectrum disorder and attention deficit hyperactivity disorder. In these cases, issues with speech and language are often not treated specifically, but rather attention is given to the primary complaint. Due to the high correlation of an SLI with other disorders, it is difficult to tell the difference between "pure SLI" or language impairments due to the presence of another disorder.[21]
See also
References
- ^ "Expressive language disorder". The Better Health Channel (BHC). Archived from the original on 2010-07-02. Retrieved 2010-06-01.
- ^ a b "F80.1 Expressive language disorder". ICD-10 Version:2010.
- ^ "Expressive language disorder - developmental". MedlinePlus Medical Encyclopedia.
- ^ McLaughlin MR (May 2011). "Speech and language delay in children". Am Fam Physician. 83 (10): 1183–8. PMID 21568252.
- ^ "Developmental expressive language disorder: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2024-03-09.
- ^ Sunderajan, Trisha; Kanhere, Sujata V. (2019-5). "Speech and language delay in children: Prevalence and risk factors". Journal of Family Medicine and Primary Care. 8 (5): 1642–1646. doi:10.4103/jfmpc.jfmpc_162_19. ISSN 2249-4863. PMC 6559061. PMID 31198730.
{{cite journal}}: Check date values in:|date=(help)CS1 maint: unflagged free DOI (link) - ^ Rinaldi, Sara; Caselli, Maria Cristina; Cofelice, Valentina; D’Amico, Simonetta; De Cagno, Anna Giulia; Della Corte, Giuseppina; Di Martino, Maria Valeria; Di Costanzo, Brigida; Levorato, Maria Chiara; Penge, Roberta; Rossetto, Tiziana; Sansavini, Alessandra; Vecchi, Simona; Zoccolotti, Pierluigi (2021-03). "Efficacy of the Treatment of Developmental Language Disorder: A Systematic Review". Brain Sciences. 11 (3): 407. doi:10.3390/brainsci11030407. ISSN 2076-3425. PMC 8005159. PMID 33806938.
{{cite journal}}: Check date values in:|date=(help)CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link) - ^ Hagen, Åste M; Rogde, Kristin; Lervåg, Arne; Melby-Lervag, Monica; Norbury, Courtenay (2023-01-20). Cochrane Developmental, Psychosocial and Learning Problems Group (ed.). "Long-term prognosis of low language proficiency in children". Cochrane Database of Systematic Reviews. 2023 (1). doi:10.1002/14651858.CD015268. PMC 9854239.
{{cite journal}}: CS1 maint: PMC format (link) - ^ Levelt WJ (November 2001). "Spoken word production: a theory of lexical access". Proc. Natl. Acad. Sci. U.S.A. 98 (23): 13464–71. doi:10.1073/pnas.231459498. PMC 60894. PMID 11698690.
- ^ Joanisse MF, Seidenberg MS (July 1998). "Specific language impairment: a deficit in grammar or processing?". Trends Cogn. Sci. (Regul. Ed.). 2 (7): 240–7. doi:10.1016/S1364-6613(98)01186-3. PMID 21244922. S2CID 38440.
- ^ Ullman MT, Pierpont EI (June 2005). "Specific language impairment is not specific to language: the procedural deficit hypothesis". Cortex. 41 (3): 399–433. CiteSeerX 10.1.1.211.8238. doi:10.1016/s0010-9452(08)70276-4. PMID 15871604. S2CID 1027740.
- ^ Knecht S, Deppe M, Dräger B, et al. (January 2000). "Language lateralization in healthy right-handers". Brain. 123 (1): 74–81. doi:10.1093/brain/123.1.74. PMID 10611122.
- ^ Pujol J, Deus J, Losilla JM, Capdevila A (March 1999). "Cerebral lateralization of language in normal left-handed people studied by functional MRI". Neurology. 52 (5): 1038–43. doi:10.1212/WNL.52.5.1038. PMID 10102425. S2CID 45298083.
- ^ Hurst JA, Baraitser M, Auger E, Graham F, Norell S (April 1990). "An extended family with a dominantly inherited speech disorder". Dev Med Child Neurol. 32 (4): 352–5. doi:10.1111/j.1469-8749.1990.tb16948.x. PMID 2332125. S2CID 2654363.
- ^ a b c Vargha-Khadem F, Gadian DG, Copp A, Mishkin M (February 2005). "FOXP2 and the neuroanatomy of speech and language" (PDF). Nat. Rev. Neurosci. 6 (2): 131–8. doi:10.1038/nrn1605. PMID 15685218. S2CID 2504002.
- ^ Liégeois F, Baldeweg T, Connelly A, Gadian DG, Mishkin M, Vargha-Khadem F (November 2003). "Language fMRI abnormalities associated with FOXP2 gene mutation". Nat. Neurosci. 6 (11): 1230–7. doi:10.1038/nn1138. PMID 14555953. S2CID 31003547.
- ^ Gauger LM, Lombardino LJ, Leonard CM (December 1997). "Brain morphology in children with specific language impairment". J. Speech Lang. Hear. Res. 40 (6): 1272–84. doi:10.1044/jslhr.4006.1272. PMID 9430748.
- ^ de Guibert C, Maumet C, Jannin P, et al. (October 2011). "Abnormal functional lateralization and activity of language brain areas in typical specific language impairment (developmental dysphasia)". Brain. 134 (Pt 10): 3044–58. doi:10.1093/brain/awr141. PMC 5331119. PMID 21719430.
- ^ Webster RI, Erdos C, Evans K, et al. (August 2008). "Neurological and magnetic resonance imaging findings in children with developmental language impairment". J. Child Neurol. 23 (8): 870–7. doi:10.1177/0883073808315620. PMID 18660471. S2CID 206547104.
- ^ a b Whitehouse AJ, Watt HJ, Line EA, Bishop DV (2009). "Adult psychosocial outcomes of children with specific language impairment, pragmatic language impairment and autism". Int J Lang Commun Disord. 44 (4): 511–28. doi:10.1080/13682820802708098. PMC 2835860. PMID 19340628.
- ^ Hans Van Balkom; Verhoeven, Ludo Th (2004). Classification of developmental language disorders: theoretical issues and clinical implications. Hillsdale, N.J: Lawrence Erlbaum Associates. ISBN 978-0-8058-4122-0. OCLC 803128031.
Further reading
- Bacon C, Rappold GA (November 2012). "The distinct and overlapping phenotypic spectra of FOXP1 and FOXP2 in cognitive disorders". Hum. Genet. 131 (11): 1687–98. doi:10.1007/s00439-012-1193-z. PMC 3470686. PMID 22736078.
- Bearzotti F, Tavano A, Fabbro F (June 2007). "Development of orofacial praxis of children from 4 to 8 years of age". Perceptual and Motor Skills. 104 (3 Pt 2): 1355–66. doi:10.2466/pms.104.4.1355-1366. PMID 17879670. S2CID 11775613.
- Caulfield MB, Fischel JE, DeBaryshe BD, Whitehurst GJ (April 1989). "Behavioral correlates of developmental expressive language disorder". J Abnorm Child Psychol. 17 (2): 187–201. doi:10.1007/bf00913793. PMID 2745899. S2CID 7560818.
- Pinel P, Fauchereau F, Moreno A, et al. (January 2012). "Genetic variants of FOXP2 and KIAA0319/TTRAP/THEM2 locus are associated with altered brain activation in distinct language-related regions". J. Neurosci. 32 (3): 817–25. doi:10.1523/JNEUROSCI.5996-10.2012. PMC 6621137. PMID 22262880.