Some children develop problems with language. Language is defined as any method of expression or communication, whether verbal or non-verbal.
Language is not the same as speaking, though the two are often related. Speaking, or speech, is the use of the voice to express ideas. A child may be unable to speak or talk, but still able to communicate using sign language. However, children with language difficulties usually have trouble speaking due to the language problem. There are many different causes of language problems in children.
There are many different types of language problems seen in children, including: language delay, which may represent delayed or total lack of language developmentdevelopmental aphasia, a problem in developing language that can result in poor pronunciation, limited speech, and problems with grammarvocabulary difficultiesreceptive language disorder, or an inability to understand languagelanguage disorders related to decreased intelligence or IQ, which may affect multiple areas of language developmentexpressive language disorder, or a limited ability to communicate even though language can be understoodautistic expression, which describes the use of a bizarre, individual form of languageelective mutism, that is, refusing to use language in certain situations where it would normally be appropriate psychotic or disorganized language, that is, the use of language that is disorganized and hard to understand
Other types of language problems are also possible.
There are many causes of language problems. One of the most common is hearing impairment, which interferes with the ability to learn vocal language. In the case of complete deafness, language can often be learned if taught without sound. This is the basis for sign language.
Children need to hear sounds in order to learn and imitate them. Hearing loss can be due to different causes. Chronic otitis media due to repeated middle ear infections in children, is one common cause of hearing loss. Meningitis, an infection of the lining that surrounds the brain, is another.
Nervous system disorders can result in a wide variety of language problems. These depend on the area of the brain that is affected. Examples include: cerebral palsy, a type of brain damage that is often present at birthinherited conditions, such as Down syndrome, or aminoaciduria, a problem with protein metabolismexposure to toxins or infections in the womb, such as the fetal alcohol syndrome head injury other brain damage, such as from a stroke or AIDS
Autism, a form of brain dysfunction, usually occurs for unknown reasons. Affected children fail to develop normal language, but may use language in a way that cannot be understood by other people. In elective mutism, a child chooses not to use language in certain settings. This usually means the child has an emotional or psychiatric disturbance due to child abuse, neglect, or other problems.
Some language delays are simply due to lack of education. Children can only learn a language if they are taught it. Other causes of language problems are also possible. Sometimes, no cause can be found.
Prevention is often not possible. Providing a loving, supportive home can prevent cases due to child abuse or neglect. Mothers who avoid alcohol use during pregnancy can prevent cases from this cause.
A parent or teacher often notices the problem first and refers the child for medical evaluation. Sometimes the cause is obvious to the healthcare professional from the history and physical findings. In other cases, further testing may be needed.
For instance, a formal hearing test may be done if hearing loss is suspected. One such test is called brain stem-evoked response audiometry, or a BAER test. A formal test of intelligence, also called an IQ test, may be done to test for mental retardation.
Formal language tests can also help determine the nature of the language problem. Examples of language tests include the Early Language Milestone Scale and the Clinical Linguistic Assessment Measurement Test. An x-ray test called a cranial CT scan may be ordered if nervous system damage is suspected. Psychological tests, such as a Rorschach inkblot test, may be ordered to look for evidence of a possible emotional problem.
Children with language problems may have trouble in school or with peers. As children get older, they will have social, work, and relationship problems if the language disorder remains. Other long-term effects are related to the cause. For instance, those with hearing impairment often quickly catch up to their peers once a hearing aid is used. In these cases, there may be no long-term effects. Some children with cerebral palsy have severe mental retardation and movement problems. These children may need around-the-clock care.
Language disorders are not contagious. They pose no risk to others. Parents and family members of affected children may experience guilt or other negative feelings. If the cause of the language disorder is an infection, such as otitis media, the infection may be contagious.
Treatment is directed at the cause, when possible. For instance, children with trouble hearing often benefit from a hearing aid. Children who are completely deaf can often learn sign language. The language problem of a child who was abused will often improve markedly once the child is removed from the abusive environment. Children with psychiatric problems may benefit from medications and counseling.
Children with chronic otitis media may benefit from antibiotics. Some of these children may also benefit from surgery for ear tube insertion. Speech therapy can be beneficial for children with nervous system damage. Special classes or learning environments are often advised for children with more severe problems, such as cerebral palsy or Down syndrome. Parents may have to lower their expectations for language development in some cases.
Surgery to place tubes into the eardrums may result in eardrum damage or new infections. Medications used for psychiatric problems may cause allergic reactions, sleepiness, or stomach upset.
The longer-term outcomes depend on the cause of the condition, as well as on the success of interventions that are tried. Those with cerebral palsy or mental retardation may need lifelong therapy and treatment. Those with hearing impairment may have their language problem "cured" by a hearing aid. These children may need no further treatment once they catch up with their peers.
The parents can report any change in the child's language or response from treatment to the healthcare professional. The underlying cause(s) of the condition also needs to be followed up. For instance, children with emotional problems often need frequent counseling and monitoring, during which any difficulties in other areas of development can be identified.
Pediatric Rehabilitation, 1992, Molnar et al.
Rudolph's fundamentals of Pediatrics, 1998, Rudolph et al.