What can be done for a patient with an expressive language disorder?

Management of Expressive Language Disorder

Speech-language therapy is the primary evidence-based treatment for children with expressive language disorder, with good evidence supporting its effectiveness, particularly when initiated early and delivered in intensive sessions several times per week. 1

Initial Assessment and Diagnosis

Before initiating treatment, comprehensive evaluation is essential to distinguish primary expressive language disorder from secondary causes:

• Conduct audiological evaluation to rule out hearing loss as a contributing factor 1
• Assess all language modalities including auditory comprehension, reading, spoken language, and writing to determine if the disorder is purely expressive or mixed receptive-expressive 2
• Determine linguistic level of difficulty in terms of single words versus connected discourse, and evaluate lexical semantics versus morphosyntax 2
• Evaluate stimulability for target sounds and estimate overall intelligibility 3
• Screen for comorbid developmental conditions including autism spectrum disorder, intellectual disability, and attention problems, as language delay can be a secondary manifestation 1

Primary Treatment Approach: Speech-Language Therapy

Core Intervention Components

Direct symptomatic therapy should target specific expressive deficits with the following evidence-based approaches:

• Traditional articulation therapy combined with auditory discrimination training for speech sound production 3
• Phonological awareness activities to build foundational language skills 3
• Minimal pairs therapy to establish phonemic contrasts 3
• Auditory bombardment to increase exposure to target sounds and language structures 3
• Cued articulation techniques to provide visual and tactile feedback for sound production 3

Treatment Intensity and Setting

• Provide intensive therapy with sessions several times per week rather than weekly sessions, as clinical experience suggests this approach is most successful in helping patients regain normal function and maintain treatment gains 2
• Deliver individual therapy initially in a clinic setting, as this is the most commonly used and effective service delivery model 3
• Expect variable improvement rates: approximately one-third of children show no improvement, one-third show mild improvement, and one-third reach normal range within 5 months 4

Parent Involvement and Home Programming

Parent participation is critical for treatment success and should be integrated from the beginning:

• Train parents to observe and participate in therapy sessions, as this is standard practice and improves outcomes 3
• Implement structured home programs with specific activities for parents to complete between sessions 3
• Teach parents to administer expressive language sampling tasks at home, as this has been shown feasible with good test-retest reliability 5
• Include siblings and grandparents in intervention sessions when appropriate to maximize practice opportunities 3

Prognostic Factors and Monitoring

Three key variables predict improvement and should guide treatment planning:

• Initial vocabulary size (parentally reported) is the strongest predictor, with 81% accuracy in identifying improvement status 4
• Children with lower initial test scores typically show more improvement than those with higher baseline scores 6
• Morphosyntactic skills show the least improvement compared to vocabulary and comprehension, requiring sustained attention and intervention 6

Special Populations

• Multilingual children should receive intervention in their primary home language, with family members or interpreters assisting during assessment and treatment 2, 3
• Multilingual children show comparable or better gains in expressive vocabulary compared to monolingual children, so do not delay treatment based on multilingualism 6
• Children with receptive-expressive disorders benefit equally from intervention as those with expressive-only disorders 6

Treatment Duration and Expectations

• Many children achieve some improvement during the initial consultation when appropriate techniques are used, though this does not mean the disorder has fully resolved 2
• Continue therapy for several sessions integrating symptomatic work with parent counseling and education 2
• Monitor progress every 4 weeks using standardized language measures to track vocabulary, syntax, and overall expressive ability 5

Common Pitfalls to Avoid

• Do not delay intervention waiting for spontaneous improvement, as only one-third of children improve without treatment and early intervention is more effective 4, 1
• Do not rely solely on English-language tests for multilingual children, as this underestimates their true language abilities; use informal assessment procedures and family-assisted evaluation 3
• Do not focus exclusively on articulation while neglecting morphosyntax, as morphosyntactic deficits are the most persistent feature of expressive language disorder and require explicit targeting 6
• Do not assume high or low non-verbal IQ predicts treatment response, as cognitive ability does not correlate with language growth in children with expressive language disorder 6