receptive-expressive Mixed language disorder
Symptoms
The signs and symptoms of mixed receptive-expressive language disorder are for the most part
the same as the symptoms of expressive language disorder . The disorder has signs and
symptoms that vary considerably from child to child. In general, mixed receptive-expressive
language disorder is characterized by a child's difficulty with spoken communication. The child
does not have problems with the pronunciation of words, which is found in phonological
disorder . The child does, however, have problems constructing coherent sentences, using proper
grammar, recalling words, or similar communication problems. A child with mixed receptiveexpressive language disorder is not able to communicate thoughts, needs, or wants at the same
level or with the same complexity as his or her peers. In addition, the child often has a smaller
vocabulary than his or her peers.
Children with mixed receptive-expressive language disorder also have significant problems
understanding what other people are saying to them. This lack of comprehension may result in
inappropriate responses or failure to follow directions. Some people think these children are
being deliberately stubborn or obnoxious, but this is not the case. They simply do not understand
what is being said. Some children with this disorder have problems understanding such specific
types of terms as abstract nouns, complex sentences, or spatial terms.
Diagnosis
The Diagnostic and Statistical Manual of Mental Disorders , fourth edition, text revised (
DSM-IV-TR ), which is the standard reference work consulted by mental health professionals,
specifies four general criteria for diagnosing mixed receptive-expressive language disorder. The
first criterion states that the child communicates using speech and appears to spoken
language understand at a level that is lower than expected for the child's general level of intelligence.
Second, the child's problems with self-expression and comprehension must create difficulties for
him or her in everyday life or in achieving his or her academic goals. If the child understands
what is being said at a level that is normal for his or her age or stage of development, then the
diagnosis would be expressive language disorder. If the child is mentally retarded, hard of
hearing, or has other physical problems, the difficulties with speech must be greater than
generally occurs with the other handicaps the child may have in order for the child to be
diagnosed with this disorder.
The disorder is usually diagnosed in children because a parent or teacher expresses concern
about the child's problems with spoken communication. The child's pediatrician may give the
child a physical examination to rule out such medical problems as hearing loss. Specific testing
for mixed expressive-receptive language disorder requires the examiner to demonstrate that the
child not only communicates less well than expected, but also understands speech less well. It
can be hard, however, to determine what a child understands. As a result, most examiners will
use non-verbal tests in addition to tests that require spoken questions and answers in order to
assess the child's condition as accurately as possible. In children who are mildly hearingimpaired, the problem can often be corrected by using hearing aids. Children who speak a
language other than English (or the dominant language of their society) at home should be tested
in that language if possible. In some cases, the child's ability to understand and communicate in
English is the problem, not his or her competence with spoken language in general.