Receptive language disorder

Clinical features and classification

This disorder is characterized by the child's inability or reduced ability to understand language in a way appropriate for his or her mental age. As expressive language production depends on language comprehension; expressive language is also profoundly disturbed and abnormalities in word-sound production can be observed.

The diagnostic guidelines of ICD-10 include the following features:

• failure to respond to familiar names (in the absence of non-verbal clues) by the first birthday

• inability to identify at least a few common objects by !8 months

• failure to follow simple, routine instructions by the age of 2 years

• inability to understand grammatical structures (e.g. questions, comparatives)

• lack of understanding of the more subtle aspects of language (tone of voice, gestures, etc.).

Owing to the disturbances in both receptive and expressive functions, the disorder is called 'receptive-expressive language disorder' in DSM-IV. The diagnostic criteria require scores of both receptive and expressive language development substantially below those obtained from standardized measures of non-verbal intellectual capacity, interference with academic or occupational achievement, and exclusion of pervasive developmental disorders.

Diagnosis and differential diagnosis

Diagnosis is based on three factors: a careful history taken from the child's parents, a thorough clinical investigation including neurological assessment and detailed speech and language assessment, and standardized tests measuring expressive and receptive language functions.

Differential diagnosis should rule out expressive language disorder (which is the case in the presence of language comprehension), specific speech articulation disorder, in which the receptive and expressive language functions are unimpaired, autism (which can be distinguished by the typical communication disturbance), mental retardation, sensory deficits, and severe environmental deprivation. These disorders can be excluded by intelligence tests, audiometric tests, neurological investigations, and taking a history.

Epidemiology

Owing to the absence of epidemiological studies, the frequency with which the disorder occurs can only be estimated. According to estimations, the disorder occurs in up to 3 per cent of school-age children and is probably less common than expressive language disorder.

Aetiology

As in other developmental language disorders, there is evidence that genetic factors play the most important role in aetiology. (7) The frequent association of disturbed language acquisition with adverse psychosocial factors in the family does not contradict a primarily genetic cause, as many children who grow up under these circumstances show entirely normal developmental patterns of speech and language skills.(8)

Course and prognosis

The long-term prognosis is poor. Only half the patients in the sample studied by Rutter et al.'(9) had normal conversational skills when they were in their twenties, and there was a decline in non-verbal IQ from childhood to adulthood. The course again depends on the type (developmental or acquired) and severity of the disorder. The disorder is usually detected before the age of 4 years, but earlier in severe cases. The prognosis is poorer than in expressive language disorder. As far as the acquired type is concerned, the prognosis varies depending on severity, location of brain pathology, the child's age, and the level of language development prior to the disorder.

Treatment

Treatment is generally undertaken along the same lines as in expressive language disorders. However, owing to the nature of the disorder, all factors that facilitate language comprehension should especially be encouraged. Non-verbal forms of communication such as sign language can be helpful.

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