Language delay and language disorder in children

Understanding and using language

Speech pathologists talk about receptive language, which is how well a child understands words, questions and instructions, and expressive language, which is how they use words and sentences to get their message across. Many children find expressive language harder, so the difficulty is obvious. Others understand far less than they appear to, and that can be missed for years because they follow the routine, copy the other children, or pick up clues from your tone and gestures.

A delay means your child is following the usual path but arriving later. A disorder means their language is developing differently rather than just slowly. Both respond to support, and the label matters far less than understanding what your child finds hard.

Signs you might notice

• Fewer words than other children their age, or words that have been slow to come
• Short sentences, or sentences with words missing — “me go park” well past the age you would expect
• Trouble following instructions, especially ones with two or three steps
• Answering a question that was not quite the one you asked
• Difficulty telling you about their day in a way you can follow
• Leaning heavily on gesture, pointing, or leading you by the hand
• Frustration or withdrawal when they cannot get their message across
• Educators mentioning that your child seems lost during group instructions

The parts of language we work on

“Language” covers a lot of ground, and a child rarely finds all of it hard. Part of what an assessment does is narrow it down to the bits that actually need work. These are the areas we most often target — we will go into each of these in more detail over time.

• Vocabulary and word finding — how many words a child knows, how well they know them, and whether they can retrieve the right one when they need it. Children who say “that thing” a lot, or talk around a word, often have a word-finding difficulty rather than a small vocabulary.
• Prepositions and early concepts — in, on, under, behind, between, and concept words like big, little, first, last, before, after, same, different. These are small words that carry a lot of meaning, and they are everywhere in classroom instructions.
• Grammar and word endings — plurals, past tense, pronouns, and the little grammatical markers that often go missing. “Him goed to the shop” past the age you would expect is a grammar pattern, not laziness.
• Sentence structure — joining ideas into longer sentences, and using words like because, but, so, if to show how ideas relate to each other.
• Following directions — holding instructions in mind and acting on them, especially instructions with two or three parts, or ones that include concept words.
• Questions — understanding and answering who, what, where, when, why and how. Why and how questions are usually the last to come and the first to show difficulty.
• Telling a story — recounting what happened in order, with enough information that a listener who was not there can follow. This one matters enormously at school and is easy to miss at home, where you already know the context.
• Understanding spoken language at school — the specific demands of classroom language, which is faster, less repetitive and far less supported by context than language at home.

Therapy approaches we use

There is no single method that fits every child. We choose from a set of well-evidenced approaches based on what your child finds hard, how old they are, and what will work in your family’s actual week. In practice we usually combine several.

• Focused stimulation — we set up play so your child hears a target word or structure many times over, without pressure to say it back. High exposure, low demand. It is the backbone of a lot of early language work.
• Modelling, expansion and recasting — your child says “dog run”, you say “yes, the dog is running!” You have confirmed their meaning and shown them a fuller version, without correcting them. It sounds almost too simple. It is one of the most powerful things a parent can do.
• Parent-implemented intervention — structured coaching so you can do the above deliberately and consistently. Programmes of this kind have strong evidence behind them for young children, because you are with your child far more than we are.
• Shared book reading — reading the same book repeatedly with specific questions and comments built in, rather than simply reading the words. Very effective for vocabulary and for the kind of language books use.
• Colourful Semantics — a colour-coded approach to building sentences, where each colour marks a part of the sentence (who, what doing, what, where). Useful for children who understand more than they can organise into words.
• Vocabulary teaching — teaching words in depth rather than in lists: what it means, what it sounds like, what it goes with, where you would meet it. Depth is what makes a word usable.
• Narrative intervention — explicitly teaching the parts of a story and how they fit together, so your child can tell one and follow one.
• Visual supports — pictures, symbols and written cues that reduce how much a child has to hold in their head, used alongside the spoken work rather than instead of it.

Whatever the approach, the aim is the same: more language, used in more situations, with more people. We will tell you which approach we are using and why, so you are never guessing about what is happening in the room.

What sessions might look like

Sessions are play, not drills. With a younger child we might build a tower, run a tea party or read the same book four times, with the language woven through. With an older child we might work on telling a story in order, explaining how something works, or understanding the words their teacher uses. We follow your child’s interests because a motivated child talks more, and we adjust the level so they are stretched but successful.

Much of the real progress happens between sessions, so we coach you. Parents and carers are the people your child talks to most, and small changes to how you respond, pause and expand on what they say can do more than an hour a week ever will. Our broader speech pathology service brings the rest of the team in where it helps.