Receptive-Expressive Language Disorder is based on standardized test scores (e.g. IQ test scores), as well as on behavior. It is characterized by delays and impairment in receptive language skills where the child has difficulty “translating” language into usable information and expressive language skills where the child has a limited vocabulary, difficulty producing words and using sentences, and not using tenses correctly. Onset is generally before the age of 4. However, this disorder can occur if there is some type of physical trauma later in childhood, e.g. a head injury. With intervention, some children can develop normal language. This may not occur in children with significant brain damage. If the disorder is severe enough, it may lead to a learning disorder.
The DSM-IV description of the diagnostic features of Mixed Receptive-Expressive Language Disorder includes the following (p.58):
The essential feature of Mixed Receptive-Expressive Language Disorder is an impairment in both receptive and expressive language development as demonstrated by scores on standardized individually administered measures of both receptive and expressive language development that are substantially below those obtained from standardized measures of non-verbal intellectual capacity (Criterion A). …The language difficulties interfere with academic or occupational achievement or with social communication (Criterion B), and the symptoms do not meet the criteria for Pervasive Developmental Disorder (Criterion C).
Associated features and disorders include (p.59):
Conversational skills (e.g., taking turns, maintaining a topic) are often quite poor or inappropriate. Deficits in various areas of sensory information processing are common, especially in temporal auditory processing (e.g., processing rate, association of sounds and symbols, sequence of words and memory, attention to and discrimination of sounds). …Phonological disorder, Learning Disorders, and deficits in speech perception are often present and accompanied by memory impairments. Other associated disorders are Attention-Deficit/Hyperactivity Disorder, Developmental Coordination Disorder, and Enuresis. [Bold emphasis added.]
The DSM-IV (p.59) adds this note on specific culture and gender features:
Assessments of the development of communication abilities must take into account the individual’s cultural and language content, particularly for individuals growing up in bilingual environments. The standardized measures of language development and of nonverbal intellectual capacity must be relevant for the cultural and linguistic group.
A school psychologist, clinical psychologist, psychiatrist, or other qualified specialist should make this diagnosis. If there is a head injury or other medical problem (e.g. encephalitis), a physician should be on the diagnostic team.
Language disorders can impact a person’s performance across many aspects of life, and certainly vocational development is no exception. Persons with FAS/ARND may be talkative, but what they say can sometimes seem inappropriate or out of place. They have been described as “talking too much and too fast, but having little to say” (Streissguth, LaDue, & Randels, 1988, p. 31). The capacity for verbal output may exceed their ability to process verbal output: They may find it difficult to absorb and recall a simple list of instructions. However, “careful observation and testing may be able to illustrate high levels of competence in non-language based problem solving (e.g. Block Design on the WISC-R) and may help to differentiate the language disabled student from the child with Fetal Alcohol Syndrome” (Wegmann, Colfax, Gray, & Reed, 1998, p. 31).