Mixed Receptive-expressive Language Disorder: What Is It?
Language and communication are of great importance, especially in childhood and in the early stages of development, but also in adulthood, and throughout life.
There are multiple disorders that affect language… here we will see one of them: mixed receptive-expressive language disorder We will learn what it consists of, what its diagnostic criteria are, how it manifests, what subtypes exist and, ultimately, what characteristics it presents.
Mixed receptive-expressive language disorder (MRELD) is a communication disorder characterized by difficulties in understanding and expressing language. Individuals with MRELD may struggle to comprehend spoken or written language, as well as to express themselves verbally or in writing. In this article, we explore the causes, symptoms, diagnosis, and treatment of mixed receptive-expressive language disorder.
Mixed receptive-expressive language disorder: what does it consist of?
Mixed receptive-expressive language disorder, also called “receptive dysphasia,” is a language disorder characterized by Both receptive and expressive language are below the normative level according to age, developmental level and intellectual capacity of the child (if we compare him/her with his/her reference group).
That is, performance in these two fields is affected, and is below normal. This translates into difficulties expressing ideas and difficulties understanding what others are saying.
This is a more serious disorder than expressive disorder (where only expression is affected) or receptive disorder (where only understanding is impaired).
As a result of what was mentioned, in the mixed receptive-expressive language disorder Difficulties appear in communication that can involve both verbal and non-verbal language (for example gestures). At the prevalence level, this disorder appears in approximately 3% of the child population.
Causes of Mixed Receptive-expressive Language Disorder
The exact cause of mixed receptive-expressive language disorder is not fully understood, but it is believed to result from a combination of genetic, neurological, and environmental factors. Risk factors may include:
Family history of language disorders
Neurological conditions or brain injuries
Premature birth or low birth weight
Environmental factors such as limited exposure to language stimulation during early childhood
MRELD can stem from various factors, including genetic predispositions, environmental influences, and neurological differences. While specific causes may vary from person to person, a combination of genetic and environmental factors often contributes to the development of this disorder. Studies suggest that abnormalities in brain structure and function may also play a role in MRELD.
Symptoms of Mixed Receptive-expressive Language Disorder
Symptoms of mixed receptive-expressive language disorder may vary depending on the severity and individual characteristics, but they often include:
Difficulty understanding spoken or written language
Limited vocabulary and difficulty finding the right words
Challenges in forming grammatically correct sentences
Trouble following directions or understanding complex sentences
Difficulty participating in conversations or expressing thoughts and ideas
Delayed speech and language development compared to peers
Individuals with MRELD typically exhibit challenges in both understanding and expressing language. They may struggle to comprehend spoken words or sentences, leading to difficulties in following instructions or participating in conversations. Expressive language difficulties manifest as struggles in forming coherent sentences, finding the right words, or organizing thoughts verbally. These challenges can significantly impact social interactions, academic performance, and overall quality of life.
Diagnosis of Mixed Receptive-expressive Language Disorder
Diagnosing mixed receptive-expressive language disorder typically involves a comprehensive assessment by a speech-language pathologist (SLP) or other qualified healthcare professional. The evaluation may include:
Review of developmental history and family medical history
Observation of language skills and communication abilities
Standardized language assessments and tests to evaluate receptive and expressive language abilities
Screening for other developmental disorders or medical conditions that may contribute to language difficulties
Diagnosing MRELD involves comprehensive assessments conducted by speech-language pathologists. These evaluations may include standardized tests to measure language comprehension, expression, and overall communication skills. It is crucial to rule out other potential causes of language difficulties, such as hearing impairments or intellectual disabilities, through thorough examination and medical history review.
Diagnostic criteria
In order to be diagnosed with a mixed receptive-expressive language disorder, it is necessary that the diagnostic criteria for it be met. The DSM-IV-TR (Diagnostic Manual of Mental Disorders) specifies the following criteria:
1. Scores below expectations
Criterion A specifies that the scores obtained through evaluations of the development of the two types of language, receptive and expressive, these being extracted from standardized tests and administered individually, are substantially below those obtained through standardized assessments of non-verbal intellectual ability.
Criterion A also specifies the following manifestations that appear in mixed receptive-expressive language disorder:
2. Performance interference
Criterion B of the mixed receptive-expressive language disorder establishes that the deficiencies that appear in receptive and expressive language, create interference in academic or work performance, or social communication
3. It is not a pervasive developmental disorder (PDD)
On the other hand, in order to be diagnosed with mixed receptive-expressive language disorder, the boy or girl must not meet the criteria for a PDD. That is to say, the diagnosis of PDD would nullify the diagnosis of mixed receptive-expressive language disorder
4. If there is another disorder, the deficiencies are excessive
Finally, in the event that there is another previous diagnosis (for example: intellectual disability, environmental deprivation, sensory or motor speech deficit…), the deficiencies that appear in language exceed those usually associated with this type of disorders. That is, the previous diagnosis would not explain these difficulties.
Treatment for Mixed Receptive-expressive Language Disorder
Treatment for mixed receptive-expressive language disorder aims to improve language comprehension, expression, and communication skills. Interventions may include:
Speech-language therapy: Individualized therapy sessions with a speech-language pathologist focus on improving receptive and expressive language skills through structured activities, games, and exercises.
Parent training: Educating parents and caregivers about strategies to support language development at home, including modeling language, providing language-rich environments, and incorporating language activities into daily routines.
Classroom accommodations: Collaborating with educators to implement accommodations and modifications in the classroom setting, such as visual aids, repetition, and simplified language instructions.
Multidisciplinary approach: In some cases, additional interventions such as occupational therapy, behavioral therapy, or educational support may be recommended, depending on the individual needs and comorbid conditions.
Early intervention is key in managing MRELD effectively. Speech therapy tailored to the individual’s needs forms the cornerstone of treatment. These sessions focus on improving language comprehension, vocabulary development, grammar skills, and enhancing communication abilities. Additionally, individualized education plans (IEPs) in educational settings can provide targeted support and accommodations to help students succeed academically.
Prognosis
The prognosis for individuals with MRELD varies depending on the severity of symptoms, early intervention, and ongoing support. With appropriate therapies and interventions, many individuals can improve their language skills and lead fulfilling lives. However, some may continue to experience challenges in adulthood, particularly in social and professional settings.
Tips for Parents and Caregivers
Support from family members and caregivers is crucial in helping individuals with MRELD thrive. Creating a nurturing environment that encourages communication and provides opportunities for practice is essential. Parents can engage in activities that promote language development, such as reading together, playing word games, and having meaningful conversations. Seeking guidance from speech-language professionals and collaborating with educators can also facilitate progress.
Expressive and receptive language
In order to better understand what mixed receptive-expressive language disorder entails, we must differentiate what expressive language and receptive language consist of.
Expressive language has to do with speech at a motor level That is, it is the language that is used to communicate and express ideas. If, for example, I ask a child what a certain object is, and she answers me, I am evaluating her expressive language.
2. Receptive language
Receptive language, on the other hand, has to do with understanding language If, following the previous example, I ask a child to give me a certain object, from a set of them, in this case I am evaluating his receptive language.
Difficulties in expressive language
As we have seen, the main characteristic of mixed receptive-expressive language disorder is difficulties in both expressive and receptive language. In expressive language, how do these difficulties manifest themselves?
The child’s vocabulary is significantly limited (that is, he/she has little vocabulary). In addition, difficulties appear in producing fluid and fast motor sequences. They also appear difficulties remembering words or producing sentences of length or complexity typical of developmental age Finally, there is a general difficulty expressing ideas.
Receptive language difficulties
Regarding receptive language in mixed receptive-expressive language disorder, there is fundamentally a difficulty in understanding words, phrases or specific types of words. That is, broadly speaking, the child presents difficulties understanding what is being said
Other associated alterations
Beyond those mentioned, there are other alterations or deficits associated with mixed receptive-expressive language disorder. These are the following:
Subtypes of the disorder
There are two major subtypes of mixed receptive-expressive language disorder: developmental and acquired. Its course is different, as we will see below.
1. Evolutionary
The evolutionary subtype appears from birth They tend to be more serious cases, which are detected earlier (around 2 years of age). However, when they are milder cases, they are detected a little later (at 4 years of age).
2. Acquired
In the acquired subtype, as its name indicates, The disorder is acquired by some injury or accident at the brain level In these cases, the course is variable, and depends on the location of the injury, its severity, the age of the child at the time of the injury, etc.
Other classifications: DSM-5 and CIE
We have seen how mixed receptive-expressive language disorder is located within the DSM-IV-TR, as a language disorder. However, The new version of the manual, the DSM-5, introduces changes and unifies the problems of comprehension and expression, within a single disorder called “Language Disorder”. In this way, mixed receptive-expressive language disorder, in the DSM-5, would become Language Disorder.
On the other hand, in the ICD-10 (International Classification of Diseases, WHO), Mixed Receptive-Expressive Language Disorder does not exist as such; Instead, either the expressive disorder or the receptive disorder is usually diagnosed (the most severe is diagnosed).
Mixed receptive-expressive language disorder is a communication disorder characterized by difficulties in understanding and expressing language. By understanding the causes, symptoms, diagnosis, and treatment options for MRELD, individuals, families, and healthcare professionals can work together to support language development and improve communication skills.
