Children can have receptive language impairments, expressive language impairments or both. Some children do "catch up" to their peers but many continue to have difficulty and the gap between their skill level and that of their peers may increase over time. As there are multiple factors affecting outcome, it is hard to predict who will "recover" or how great the gains will be. Language disorders are changeable; at different stages of development children have different demands on their language systems. Children with language impairment in the preschool years may appear to catch up to peers by age 5 or 6 years, but then in later years when demands change and children begin to learn to read difficulties become apparent.

Receptive language impairments mean that a child has difficulty understanding language. They may have a limited vocabulary. They may not understand the meaning of word endings: that adding "s" makes a noun plural, or "'s" indicates possession, or that an "ed" ending on a verb means that the action is past. They may have difficulty understanding nonverbal signals, like body language. They may not understand sarcasm, or indirect requests (e.g., "it's cold in here" can mean "please close the window").

Expressive language impairments show up in how a child speaks. They may use only a few words in each sentence. They may leave off word endings, or the little words like "is" and "are". They may not know the names of many words. They may not always use language appropriately and appear to be rude by being too direct or blunt. They might not consider their partner's needs, using ambiguous referents (lots of "he", "she" and "it" when the subject has not been clearly identified), or changing topics abruptly.

Language therapy with preschoolers often focuses on working with families to create an optimal environment for learning language. The Hanen Centre in Toronto has developed an excellent program for helping families of children with language impairments. Their principles are widely used. As adults, we tend to do most of the talking when we are communicating with children. We're better at it, so why not? Think of a conversation you may have had with someone who did all the talking? Did you enjoy it? Did you feel they were hogging the floor? Did you get a chance to have your say, to talk about what you thought? This is how many children feel when speaking with adults. A child who appears to have nothing to say, may have lots to say but just doesn't get a chance. They may be communicating in other ways, not just speech. We need to look for the clues, the signals they send that show they are communicating then help them build on them. Have you every spoken with someone who uses big words, long complicated sentences? You have trouble understanding and keeping up and eventually give up and even tune out. This is how children respond when the language they are hearing is too far above their level. Remember that receptive language is usually slightly ahead of expressive language. If a child is speaking in 2 word utterances, he/she is probably able to fully understand 3 word utterances.

These are general suggestions for communicating with language impaired children. They also apply to all children.

Be at the same physical level. Get face to face.

Follow the child's lead. Let them choose the "topic".

Take turns. The child's turn may be a non-verbal one. Give them a chance to be an equal partner.

Use language that is at or slightly above their level. This provides them with models that they can try to imitate.

Expand what they say to show that you have understood and value what they've said and to provide them with a model of a more mature form. For example, child: "eating", adult "yes, he's eating"; child "dog", adult "big dog".

There are some general symptoms aphasic individuals can experience. Word finding difficulties, or anomia, can be frustrating and slow down communicaiton. Some people try to work around word finding diffficulty by giving descriptions or definitions or talking around their difficulties. This is called circumloction.

A person with aphasia might use an incorrect word or unrecognizable word in place of the target word. This is a paraphasia. Paraphasias can be classified in 3 types. Phonemic or literal paraphasias are word errors that sound very close to the intended word (e.g., coke for coat). A verbal or semantic paraphasia occurs when a word that is related in meaning to the target word is substituted (e.g., plum for peach). The third type of paraphasia is a neologism - an invented word that is not recognizable as a word in the speaker's language.

Repetition of a word or phrase when it is no longer appropriate is "perseveration". The individiual seems to get stuck in a pattern of response and cannot break out of it.

When speaking with a person who has aphasia, it helps to minimize distractions, speak slowly and clearly. If they have comprehension difficulties, use short simple sentences and pause between sentences. Pair gestures with your speech to aid comprehension. Allow them more time to respond. If you need to find out information, ask questions that can be answered easily with a yes or no or other single word. Remember that a person with aphasia has not lost their intelligence, they just have difficulty communicating.