Language Impairment – The “Hidden” Learning Disability

It affects at least one child in every classroom. It impacts on a child’s ability to learn to read, write and spell. It is at least as common as Dyslexia and much more common than Autism, yet no one really knows about it. Language Impairment has been referred to as the “hidden disability” and it’s time for that to change!

When people find out that I am a speech pathologist, they generally smile, nod and ask me about lisps and stutters. Whilst these cases are certainly part of my caseload, they hardly form the bulk of it.

When I explain that a great deal of my time is spent helping children who have difficulties with language, conversation quickly follows with anecdotes about whether or not English really is the most difficult language to learn.

The thing is, when I’m talking about language, I’m not referring to French versus Cantonese or Spanish. I am talking about how we understand what we hear, see and read, and how we express ourselves using gestures, spoken and written words.

What is language?

Language is what we speak, write, read, and understand. It is also seen in our body movements and gestures, such as bringing a finger to your lips to silently indicate “Be quiet!”. There are two distinct areas of language:

Receptive Language refers to what we hear and understand from others’ speech, gestures or written words.

Expressive Language refers to the words or gestures we use to create messages others will understand.

Language is complicated and most of us take for granted how easily we use and understand it.

If someone told you they were a “Stylist to the stars!” would you have to stop and ask, “Excuse me – are you referring to the bright objects in the night sky, or celebrities?”. No you wouldn’t (at least I hope not!) because you have a clear understanding and can make sense of the meanings of words.

Similarly, you know how to choose and change words (e.g., friend/friendly/ friendliest/ befriended) and how to put words together in a way that makes sense. Unlike that lovable Yoda… Go to speech therapy he will!

Most of us also have an understanding of what is considered appropriate in certain situations. For example you might politely say, “Excuse me, would you be able to move over slightly?” to a stranger at a school concert, whereas you might scream “Move! I can’t see!” to your family at home.

Before we go too much further, I think we need to cover one key point that often creates confusion when I am speaking to parents and teachers…

Language and Speech are not the same thing!

“Language” is what we say and “Speech” is how we say it.

When I talk about “Speech”, I am referring to the way we produce the sounds of speech (articulation), the quality of our voice (e.g. nasal or husky) and the rhythm with which we speak (fluency).

Generally, the “speech” side of things seems to make more sense to people because they can actually hear a lisp, a stutter or the piercing nasality of Nanny Fine’s, “Oh Mr Sheffield!!”. On the other hand, the “language” side of things is much more of a mystery.

What is a language impairment?

A person who has trouble understanding others (receptive language), or sharing thoughts, ideas, and feelings completely (expressive language) has a language impairment.

 Language impairments are also known as language disorders and can range from being mild, moderate to severe in nature.

Sometimes the cause of the language impairment may be related to:

  • Hearing loss
  • Intellectual disabilities
  • Neuro-developmental disorders such as Autism, Down Syndrome and Cerebral Palsy
  • Brain injury due to accident or illness
  • Premature birth/ low birth weight
  • Family history of language impairment

Often there is no known cause.

Signs and symptoms

Every person is unique and will have their own strengths and weaknesses within language. Consequently, it can be hard for parents and teachers to identify which children are experiencing language difficulties because no two children will present in the same way.

Some children may become loud, disruptive and display defiant or challenging behaviors. This may be in a bid to mask their problems, or as a result of feeling angry and frustrated that they do not understand or cannot express themselves.

On the other hand some children become quiet, withdrawn and avoid participating in class. Again, this may be an attempt to mask their difficulties or as a result of feeling anxious that they are going to say or do the wrong thing because they haven’t understood the task or cannot explain their answer.

Some children with language impairment may also have trouble making or keeping friends because they do not understand the rules of games being played and cannot negotiate with their peers etc.

When I speak to teachers and parents about their concerns for a particular child, no one ever says to me, “I think young Jimmy here is experiencing language difficulties”. Instead, the most common response goes along the lines of “Something is not right. I can’t put my finger on it, but something is going on”. They then usually go on to discuss the behaviours they have observed at home or school such as:

  • The child has trouble getting started with their work
  • The child doesn’t finish their work
  • They copy what others are doing
  • They present work that has nothing to do with the task
  • They often look blank when asked a question
  • They have trouble following instructions
  • They don’t want to do their homework
  • They have problems with reading and/or spelling
  • They don’t use long/complex sentences
  • They make grammatical errors
  • They mix up words
  • They have a limited vocabulary

Is language really that important?

In short… yes! As parents we just want our children to be happy. We know that not everyone is destined to become a university lecturer or an award winning author, so who cares if my child isn’t at the top of the class for English. It’s not the end of the world if they mix up a few words here and there!

I agree with those sentiments (to an extent) but what many people fail to realise is that a language impairment can last a lifetime. Even mild impairments can have a serious impact on how a person functions in their daily life. For example, participating in class to ask and answer questions, ordering a meal in a restaurant or finding a job. Language impairment can also impact on a person’s interactions at home, at work and socially.

When it comes to school, language underpins everything in and out of the classroom. Therefore, language difficulties can have a huge impact on a lot more than just the English subject. Long-term implications of language impairment include poor academic achievement, risk to mental health, reduced employment options and social isolation. While it may not seem like a big deal when they are young, do you want to take the risk of it turning into something more as they get older?

They can do it, they just don’t want to!

I have heard this sentiment expressed by bewildered parents and teachers time and time again! If only they would apply themselves. Maybe if they paid attention then they would understand. I have repeated the instruction 3 times- if you didn’t listen that’s your problem. Figure it out!

Language impairment is often misunderstood and sometimes misdiagnosed.

Some of the common “labels” used to describe misunderstood children who are experiencing language difficulties include:

  • Lazy
  • Forgetful
  • Poor listener
  • Poor reader
  • Inattentive
  • Impulsive
  • Distractible
  • Shy
  • Loner

Sometimes a language impairment is only investigated once other concerns have been raised (e.g. problems with reading and spelling), or after another diagnosis has been made such ADHD or Dyslexia. At other times the language impairment may form part of another diagnosis such as in Autistic Spectrum Disorder.

In my opinion diagnostic labels are tricky things. In many settings they are necessary in order to apply for funding or to receive support. In that way they can be helpful. However it is very important to remember that labels DO NOT tell us everything. Sometimes they may even distract us from other important issues or information.

It is important to remember that children innately want to do well and are keen to succeed. For the most part their difficulties are something they cannot help.

What should we do?

Consider this…

  • 20% of 4 year olds have difficulty understanding or using language
  • Children with a language impairment are six times more likely to have a reading problem than children without
  • 14% of 15 year olds have only basic literacy skills
  • 46% of young Australian offenders have a language impairment

Clearly we need to do something!

We need to start by raising awareness about language impairment so that parents, teachers and other people working with children know a bit more about what to look out for.

The UK based RALLI campaign (Raising Awareness of Language Learning Impairment) has some wonderful short videos from different perspectives, including speech pathologists, speech and language academics, teachers and parents. I believe the most powerful are the videos where children who have experienced language difficulties speak for themselves about what it is like for them. Go to www.youtube.com/rallicampaign for more information.

We must also remember that every child is unique and every child has strengths. Perhaps they like sport or music? Maybe they have a passion for art or dance? It is important to find out about and build on a child’s strengths and interests as well as to provide support and encouragement in areas they find more difficult.

Early Intervention is the key!

 Speech Pathologists can help children experiencing difficulties with language. It is a case of “the sooner the better” because good language skills help with learning, behaviour, self- esteem, and social skills.

You should talk to a speech pathologist if your child…

  • Does not understand what you say
  • Does not follow instructions well (including those with multiple steps)
  • Has trouble understanding and answering questions
  • Does not use gestures
  • Has trouble naming objects and actions
  • Has trouble putting words into sentences
  • Gets confused with grammar and words such as he/she, take/took
  • Cant retell stories or past events clearly
  • Finds it hard to express their thoughts, feelings and ideas

If you have any concerns at all about your child’s communication skills contact a speech pathologist for advice. If there is an issue we can advise you of the best way to nip it in the bud before it gets any bigger. Alternatively, if there is no issue you’ll have peace of mind!

Win-Win!

Language Impairment has been called “the hidden disability”. Let’s change that by bringing it out into the open… starting right now!

 

Don’t forget to Like Modern Speechie on Facebook for more information and tips to help children be the best communicators they can be!

5 Comments
  • Razia Sally
    Posted at 06:25h, 04 June Reply

    Hi , my son is three and a half years and speaks just a handful of words. I feel he is far behind kids of his age. He has started preschool for two days, and started picking up a few words lately. But he does not use sentences. I’m worried for him.
    I have booked an appointment with his paediatrician next month.
    Though he understands what we speak to him, sometimes he does have certain pronounciation problems.
    He is the only child at home and spends a lot of time in the iPad.
    I would much appreciate if you could please give me a feedback.
    Thank you

    • clare
      Posted at 13:36h, 05 June Reply

      Hi Razia. I can certainly understand why you are concerned. By 3 and a half most children use and know hundreds of words and speak in sentences so i strongly suggest you make an appointment to see a speech pathologist for an assessment. There could be many different reasons as to why your son isn’t talking much. A speech pathologist will be able to help you work out what the main issue is for your son and give you a plan about how to help him. One of the easiest and best things you can start doing right now is to talk to your son LOTS! Talk about and show him everything you are doing, “Mummy is cooking dinner now. I’m cutting up some carrots. Carrots are orange” or “Lets hang out the washing. Here are some socks. This is a shirt” etc. I know there are lots of educational games on the iPad and I’m sure he loves playing them but try to put it away for a while now (or to only let him use it for a very short time). Instead you can play other games with him like building a tower with blocks, drawing and reading books. These games and activities will help him talk more than the iPad games will! Good Luck!

      • Razia
        Posted at 16:09h, 06 June Reply

        Hi,
        Thank you so much for your quick response. Much appreciated.
        Yes I will follow your advice, the iPad is taken away from him, and he has been alright so far without it.And I will make it a point that I spend more time with him. I am finding for a good speech therapy hope I can find someone soon.
        Thank you once again and will post on his changes
        Have a wonderfull weekend
        Kind regards
        Razia

  • Joanne Eckermann
    Posted at 11:22h, 14 June Reply

    Is it normal for kids to go backwards a bit in terms of understandability? Our nearly 3yo has had a phenomenal vocabulary and ability to converse from 18 months, makes extended conversation and can be understood by everyone. Can also understand and follow all instructions. However, recently I find he isn’t as understandable, and I have to get him to repeat things more often. He also has an occasional lisp creeping in. I wonder if it’s the consequence of having a word explosion and he’s rushing to fit all the new words in, or something we should look into? His cousin is an OT who says his language is amazing, I’m just surprised it has gone backwards a bit, probably over 5 weeks now. No ear infection issues though we have all been crook. Just interested in your thoughts. Thanks.

    • clare
      Posted at 21:30h, 14 June Reply

      Hi Joanne,

      You sound like you’ve got a great little communicator on your hands! Generally speaking we expect children to become clearer and easier to understand as they get older. For instance we would expect a 2 year old to be understood by a stranger approximately 50% of the time, whereas the expectation for a 3 year old is 75%. In saying that, I agree that in your particular case it sounds like your little one may just be getting a bit muddled because they have so many new words to say and are trying to figure out how to say them all together in longer and more complex sentences. The fact that you have all been sick and probably quite tired too may also add to a temporary drop in speech clarity. Give it a few more weeks to see if it starts to settle down again and hopefully their intelligibility will improve. If it doesn’t, or more so if it starts to gets worse I would suggest seeing a speech pathologist for an assessment. In terms of a lisp, if it sounds like a “th” instead of a “s” and you can see their tongue poking out between their front teeth, that is a very normal developmental error that sorts itself out in most cases. If on the other hand it is more of a “slushy” kind of sound, that is not part of typical development and would be best to get that treated as soon as possible. Let me know how you go and if you have any more questions don’t hesitate to ask.

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