Signs and symptoms of spoken language disorders (SLD) vary across individuals, depending on the language domain(s) affected, severity and level of disruption to communication, age of the individual, and stage of linguistic development. Furthermore, signs and symptoms of SLD may become apparent through evaluation of metacognitive/metalinguistic ability; when later-developing language domains, such as reading and writing (i.e., literacy), are developing; when children encounter the unique disciplinary language associated with certain academic subjects (e.g., humanities classes vs. science classes); or through observation of emotional/behavioral difficulty.
Below are common signs and symptoms among monolingual English-speaking children with spoken language difficulties. These signs and symptoms are grouped by domain and in descending order from basic to higher-order skills. Although these domains are listed separately, it is important to note that skills are not discrete, and there is a synergistic relationship across domains. Skills within form (phonology, syntax, and morphology), function (semantics), and use (pragmatics) interact to form a dynamic integrative whole (Berko Gleason, 2005).
Metalinguistic and metacognitive skills (awareness of language and of one's own thinking and behavior), while not listed below, are critical for the development of advanced language skills. Metalinguistic awareness impacts both spoken language and written language abilities to varying degrees. Phonological awareness is one type of metalinguistic skill, which has been shown to be highly correlated with later reading and writing skills (Al Otaiba, Puranik, Zilkowski, & Curran, 2009).
Phonological deficits include
- delay in acquisition of phonological skills, including errors similar to those of younger, typically developing children but with greater variability in production at similar stages of phonological development;
- tendency to vocalize less and use less varied/less mature syllable structures than those of same-age, typically developing toddlers;
- problems with early speech sounds affecting intelligibility, generally resolving over time;
- difficulty learning the speech sound system of language, resulting in poor repetition of single and multisyllabic nonwords;
- limited phonological awareness (e.g., rhyming, sound/syllable deleting, segmentation, and blending).
Morphology and syntax deficits include
- late acquisition of word combinations;
- restricted mean length of utterance (MLU) in morphemes for younger children (although developmental order of morpheme acquisition may be similar to that of typically developing children) and shorter utterances in words for school-age children and adolescents;
- errors occurring most often on verbs (especially verb endings, auxiliary verbs, and past tense marking of regular and irregular forms), function words (e.g., articles and prepositions), and pronouns;
- errors of omission occurring more frequently than errors of misuse, although occurrence of both error types may be inconsistent;
- use of more mature and less mature word forms;
- difficulty comprehending grammatical morphemes, particularly units of short duration (phonetically less salient);
- deficits in morphological awareness (e.g., derivational morphemes, such as prefixes and suffixes, including inflectional morphology, such as plural, present progressive, and past tense markers);
- difficulty judging grammaticality;
- difficulty identifying and correcting grammatical errors;
- difficulty identifying parts of speech;
- problems comprehending and using complex syntactic structures;
- extensive use of simple, non-subordinated utterances in narratives;
- use of subordinating clauses of the earlier developing types, when complex sentences are used;
- difficulty with curriculum-related expository discourse production;
- difficulty decoding (comprehending) morphologically complex words that are common in various academic subjects.
Deficits in semantics include
- slower rate of vocabulary development than that of typically developing children (not attributed to second language acquisition);
- late acquisition of first words and word combinations;
- delays in verb acquisition, particularly in languages in which verbs are highly inflected morphologically;
- poor fast-mapping (after a brief or single encounter) of a new word to its referent;
- difficulty understanding new words, particularly action words;
- word-finding difficulties;
- slower confrontation naming that may reflect less rich and less elaborate semantic memory networks;
- use of filler words like "um" to take up time while the child is searching for a word or formulating thoughts;
- difficulty monitoring comprehension;
- difficulty requesting clarification;
- difficulty understanding questions and following directions that are heard;
- difficulty paraphrasing information;
- problems comprehending and using synonyms and antonyms, multiple-meaning words, and figurative language (e.g., idioms, metaphors, proverbs, humor, poetic language);
- poor organization of narratives and expository discourse (impacts ability to convey intended meaning);
- poor comprehension of narrative or expository text, particularly when it is necessary to draw inferences from literal content or when expository text is associated with different academic disciplines.
Deficits in pragmatics include
- difficulty initiating play with peers, may play alone;
- difficulty understanding others;
- perceived immaturity in relation to same-age peers;
- difficulty expressing ideas, feelings, and personal experiences;
- use of same pragmatic functions as typically developing peers, but may express them differently and less effectively;
- difficulty initiating and sustaining conversations;
- less effective at securing conversational turns than same-age, typically developing peers;
- less flexible language when attempting to tailor a message to the listener or when repairing communication breakdowns;
- limited classroom discourse skills (e.g., language productivity and complexity, self-monitoring; turn-taking), depending on the context (e.g., curriculum-related or non-academic peer interactions);
- difficulty making relevant contributions to classroom discussions;
- uncertainty about what to say and what not to say;
- uncertainty about when to talk and when not to talk;
- difficulty using language to sequence events of a story—narratives lack cohesion;
- tendency to omit some story components.
social communication disorder for more information about pragmatics.
Children with language disorders may experience social/emotional problems and/or exhibit behaviors secondary to language impairment. These difficulties may impact self-perception and awareness, academic performance, peer relationships, and social interactions. Furthermore, the impact of language disorders can result in misperceptions and misattributions of the child's behavior (Cohen, Davine, Horodesky, Lipsett, & Isaacson, 1993).
Children with spoken language disorders may
- exhibit behavioral difficulties, including hyperactivity and attentional difficulties (Dockrell, Lindsay, Palikara, & Cullen, 2007),
- demonstrate behavioral reticence (withdrawal, wariness, shyness) that can affect initiation of close relationships in adolescence (Fujiki, Spackman, Brinton, & Hall, 2004),
- have difficulty inferring emotional reactions of others (Ford & Miloski, 2003),
- have difficulty judging when it is appropriate to hide emotions/feelings (Brinton, Spackman, Fujiki, & Ricks, 2007),
- have difficulty regulating emotions (e.g., monitoring, evaluating, and modifying emotional reactions; Fujiki, Brinton, & Clarke, 2002),
- have poor social self-esteem (Marton, Abramoff, & Rosenzweig, 2005),
- have difficulty forming and maintaining close social relationships—as adolescents, may be less emotionally engaged in their close relationships (Wadman, Durkin, & Conti-Ramsden, 2011),
- be at risk for bullying and other forms of abuse (Blood, 2014; Brownlie, Jabbar, Beitchman, Vida, & Atkinson, 2007).