Language disorders in children

Most infants and children develop language naturally starting at birth. To develop language, a child must be able to hear, see, understand, and remember. Children must also be physically able to form speech.

Up to 1 of every 14 children has symptoms of a language disorder. When the cause is unknown, it is called a developmental language disorder.

Problems with receptive language skills usually begin before age 4. Some mixed language disorders are caused by a brain injury. These conditions are sometimes misdiagnosed as developmental disorders.

Language disorders may occur in children with:

• Other developmental problems
• Autism spectrum disorder
• Hearing loss
• Learning disabilities
• Damage to the central nervous system, which is called aphasia

Language disorders are rarely caused by a lack of intelligence.

Language disorders are not the same as delayed language. With delayed language, the child develops speech and language in the same way as other children, but later. In language disorders, speech and language do not develop normally. The child may have some language skills, but not others. Or, the way in which these skills develop will be different than usual.

Children with language disorders may have one, two, or many of the symptoms listed below. Symptoms can range from mild to severe.

Children with a receptive language disorder have problems understanding language. They may have:

• A hard time understanding what other people have said
• Problems following directions that are spoken to them
• Problems organizing their thoughts

Children with an expressive language disorder have problems using language to express what they are thinking or need. These children may:

• Have a hard time putting words together into sentences
• Use short and simple sentences and the word order may be off
• Have difficulty finding the right words when talking, and often use placeholder words such as "um"
• Have a vocabulary that is below the level of other children the same age
• Leave words out of sentences when talking
• Use certain phrases over and over again, and repeat (echo) parts or all of questions
• Use tenses (past, present, future) improperly

Children with language problems may have difficulty in social settings. At times, language disorders may be part of the cause of severe behavioral problems.

A medical history may reveal that the child has close relatives who have also had speech and language problems.

Any child suspected of having this disorder can have standardized receptive and expressive language tests. A speech and language therapist or neuropsychologist will administer these tests.

A hearing test called audiometry should also be done to check for hearing impairment, which is one of the most common causes of language problems.

Speech and language therapy is the best approach to treating this type of language disorder.

Counseling, such as talk therapy, is also recommended because of the possibility of related emotional or behavioral problems.

The outcome varies, based on the cause. Children with brain injury or other structural problems may have long-term problems with language. Other, more reversible causes can be treated effectively.

Many children who have language problems during the preschool years will also have some language problems or learning difficulty later in childhood. They may also have reading disorders.

Difficulty understanding and using language can cause problems with social interaction and the ability to function independently as an adult.

Reading may be a problem.

Depression, anxiety, and other emotional or behavioral problems may complicate language disorders.

If you are concerned that your child's speech or language is delayed, see your child's health care provider. Ask about getting a referral to a speech and language therapist.

Children with this condition may need to be seen by a neurologist or children's developmental specialist to determine if it can be treated.

Contact your child's provider if you see any of the following signs that your child does not understand language well:

• At 15 months, does not look or point at 5 to 10 people or objects when they are named by a parent or caregiver
• At 18 months, does not follow simple directions, such as "get your coat"
• At 24 months, is not able to point to a picture or a part of the body when it is named
• At 30 months, does not respond out loud or by nodding or shaking the head and asking questions
• At 36 months, does not follow 2-step directions, and does not understand action words

Also contact your child's provider if you notice these signs that your child does not use or express language well:

• At 15 months, is not using three words
• At 18 months, is not saying, "Mama," "Dada," or other names
• At 24 months, is not using at least 25 words
• At 30 months, is not using two-word phrases, including phrases that include both a noun and a verb
• At 36 months, does not have at least a 200-word vocabulary, is not asking for items by name, exactly repeats questions spoken by others, language has regressed (become worse), or is not using complete sentences
• At 48 months, often uses words incorrectly or uses a similar or related word instead of the correct word

Developmental aphasia; Developmental dysphasia; Delayed language; Specific developmental language disorder; SLI; Communication disorder - language disorder

Bang JY, Feldman HM. Language development and communication disorders. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 53.

Centers for Disease Control and Prevention website. Building communication skills. www.cdc.gov/hearing-loss-children-guide/parents-guide/building-languages.html. Updated May 15, 2024. Accessed July 4, 2024.

Trauner DA, Nass RD. Developmental language disorders. In: Swaiman KF, Ashwal S, Ferriero DM, et al, eds. Swaiman's Pediatric Neurology. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 53.

Updated by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.