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Language Therapy
What is a Language Disorder?
The idea of a child needing language therapy is often difficult to understand, because when we use the word language in daily life we're generally referring to a foreign language. And what's the difference between speech and language anyways?
It's easiest to understand this way. Language is the message and speech is one way in which we can express the message. When your brain comes up with the words you want to say and gets those to your mouth to be said or hands to be written or fingers to be touched on an AAC device, that's language. When that message comes out through the mouth, that's speech.
In other words, language is "what the message is" and speech is the "how your mouth says the message". When we work on language we're working on the message itself.
There are lots of ways in which the message (language) can be difficult to produce ("expressive language") or understand ("receptive language"). Some common examples are trouble with:
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Understanding and learning new words (or even not so new ones)
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Understanding multi-meaning words
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Recognizing and understanding non-literal language (idioms, metaphors, sarcasm)
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Understanding how changing one part of a word (like "walk" and "walked") or sentence ("You gave it to the vet" vs "The vet gave it to you") changes the meaning.
Whatever the reason, a language disorder affects your ability to share your message (expressive language disorder) or understand the messages of others (receptive language - as what you don't understand you can't communicate to others either, we call the result a "mixed receptive/expressive language disorder").
This means that very different treatment is required for each client. A person could have a language disorder diagnosis that affects a very limited area and is comparatively mild, such as trouble understanding negation (words like "not" and "don't") or using pronouns. On the other end, a language disorder could be significant enough that the person affected may only be able to say a few words or none at all.
Either end of the continuum is where things get tricky. From an evaluation perspective, "mild" language disorders can be so subtle that a cookie cutter evaluation can miss them. On the other hand, "profound" language disorders are readily detected, but many therapists can struggle to appropriately treat them.
Detecting Subtle Language Disorders
Many elements of language disorders often hide under the surface, and without a thorough evaluation they may go undiagnosed or underdiagnosed (where one area of weakness is caught but others go undetected/untreated). Kids want to do well, so they'll use whatever tools they have to succeed in the tasks they're given - which has the side effect of covering up possible language disorders. On the surface, they may be able to mostly pass as understanding everything said to them, but it may turn out that they're using other tone of voice or context cues to help them figure out what a statement probably means. In cases like these, since most of the time they can pass as understanding what others say, the times they don't quite understand right and follow a direction wrong or get something incorrect are chalked up to other causes, such as intentional disobedience, being silly, or not paying attention.
Let's visit just one of the many ways in which a language area of struggle can be missed: the deceptively simple word "not". I can't tell you how many kids I've had come through that did not understand that word, even though they were able to give the impression in daily life that they did. From watching other kids, listening to tone of voice (such as "Do not do that again"), and following a routine it may seem like they understand it. But with a child with this particular language area of weakness, if you give them a ball and a book, and ask them to point to the one that is not a ball and they'll point to the ball.
Sometimes trouble with executive function is actually what's actually causing difficulties with communication. For example, poor working memory can cause problems with comprehension as well as trouble constructing a narrative that makes sense. In these cases, working on language alone will only take you so far, because it's not really the problem. That's why it's critical to get a speech therapist familiar with executive function to conduct testing.
Profound Language Disorders
Kids with profound language disorders are often referred to as non-speaking or minimally speaking. It's pretty easy to detect when there's a language disorder of this level. However, once they move beyond the "early intervention" <3 year old age group, it can be harder and harder to find therapists who know how to treat these. That's because kids with this level of language disorders often:
1. Have additional disabilities that the therapist may or may not be familiar with treating
2. Have difficulty doing traditional therapy activities
3. Require very personalized care
4. Need someone who has taken a lot of time getting additional training
That's why your average clinician can often struggle to treat this level of disorder. I'm happy to report that I'm familiar with most disabilities that commonly co-occur with profound language disorders, have gotten a lot of additional training in areas related to their treatment and I customize my care to the specific child's needs.
The Bottom Line
Whether your child's language disorder is subtle, profound, or anything in between, I'm here to provide the therapy they need.