Language and communication are of great importance, especially in childhood and the early stages of development, but also in adulthood and throughout life.
There are multiple disorders that affect language… here we will see one of them: the mixed receptive-expressive language disorder . We will know what it consists of, what its diagnostic criteria are, how it manifests itself, what subtypes exist and, in short, what characteristics it presents.
Mixed receptive-expressive language disorder: what is it?
Mixed receptive-expressive language disorder, also called “receptive dysphasia”, is a language disorder characterized by the fact that both receptive and expressive language are below the norm according to the child’s age, developmental level and intellectual capacity (compared to the reference group).
In other words, performance in these two areas is affected, and is below normal. This translates into difficulties in expressing ideas and difficulties in understanding what others are saying.
This is a more serious disorder than either expressive disorder (where only expression is affected) or receptive disorder (where only understanding is impaired).
As a result, in mixed receptive-expressive language disorder , communication difficulties appear that can involve both verbal and non-verbal language (e.g. gestures). At a prevalence level, this disorder appears in approximately 3% of the child population.
In order to be diagnosed with a mixed receptive-expressive language disorder, the diagnostic criteria for this disorder must be met. The DSM-IV-TR (Diagnostic Manual of Mental Disorders) specifies the following criteria:
1. Scores below expectations
Criterion A specifies that the scores obtained through assessments of the development of both receptive and expressive language, these being extracted from standardized tests and administered individually, are substantially below those obtained through standardized assessments of non-verbal intellectual capacity.
In addition, criterion A specifies the following manifestations, which appear in mixed receptive-expressive language disorder:
- Difficulties understanding specific words, phrases or types of words (such as spatial terms)
- The same difficulties that appear in expressive language disorder (where only expressive language is affected)
2. Interference in performance
Criterion B of the mixed receptive-expressive language disorder establishes that the deficiencies that appear in receptive and expressive language, create interference in academic or work performance, or social communication .
3. Not a pervasive developmental disorder (PDD)
On the other hand, in order to be diagnosed with mixed receptive-expressive language disorder, the child must not meet the criteria for GDD. That is, a diagnosis of GDD would nullify the diagnosis of mixed receptive-expressive language disorder .
4. If there is another disorder, the deficiencies are excessive
Finally, in the case that there is another previous diagnosis (for example: intellectual disability, environmental deprivation, sensory or motor speech deficit…), the deficiencies that appear in language exceed those that are usually associated with this type of disorder. In other words, the previous diagnosis would not explain these difficulties.
Expressive and receptive language
In order to better understand what is involved in mixed receptive-expressive language disorder, we must differentiate between expressive and receptive language.
1. Expressive language
Expressive language has to do with speech at the motor level . In other words, it is the language used to communicate and to express ideas. If, for example, I ask a child what a certain object is, and he answers me, I am evaluating his expressive language.
2. Receptive language
Receptive language, on the other hand, has to do with understanding language . If, following the previous example, I ask a child to give me a certain object, from among a set of them, in this case I am evaluating receptive language.
Expressive language difficulties
As we have seen, the main characteristic of mixed receptive-expressive language disorder is difficulties in both expressive and receptive language. In expressive language, how do these difficulties manifest themselves?
The child’s vocabulary is noticeably limited (i.e., he or she has little vocabulary). In addition, there are difficulties in producing fast and fluid motor sequences. Difficulties also appear in remembering words or producing sentences of length or complexity appropriate to the developmental age . Finally, there is a general difficulty in expressing ideas.
Receptive language difficulties
In receptive language of mixed receptive-expressive language disorder, there is primarily a difficulty in understanding specific words, phrases, or word types. That is, broadly speaking, the child presents difficulties in understanding what is being said .
Other associated alterations
Beyond those mentioned, there are other alterations or deficits associated with mixed receptive-expressive language disorder. These are the following:
- Problems of discrimination
- Attention problems
- Auditory memory deficits
- Deficits in auditory sequential memory
Subtypes of the disorder
There are two major subtypes of mixed receptive-expressive language disorder: developmental and acquired. Their course is different, as we will see below.
The evolutionary subtype appears from birth . They are usually more severe cases, which are detected earlier (around 2 years of age). However, when they are milder cases, they are detected a little later (at 4 years of age).
In the acquired subtype, as its name indicates, the disorder is acquired by some injury or accident at the brain level . In these cases, the course is variable, and depends on the location of the injury, the severity of the injury, the age of the child at the time of the injury, etc.
Other classifications: DSM-5 and CIE
We have seen how the mixed receptive-expressive language disorder is situated within the DSM-IV-TR, as a language disorder. However, the new version of the manual, the DSM-5, introduces changes and unifies comprehension and expression problems , within a single disorder that it calls “Language Disorder”. In this way, the mixed receptive-expressive language disorder, in the DSM-5, would become the Language Disorder.
On the other hand, in the ICD-10 (International Classification of Diseases, WHO), Mixed Receptive-Expressive Language Disorder does not exist as such; instead, either the expressive disorder or the receptive disorder (the most severe one is diagnosed) is usually diagnosed.
- American Psychiatric Association (APA) (2014). DSM-5. Diagnostic and statistical manual of mental disorders. Madrid: Panamericana.
- American Psychiatric Association (APA). (2002). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. Barcelona: Masson.
- Mulas, F., Etchepareborda, M., Díaz-Lucero, A. and Ruiz, R.(2006). Language and neurodevelopmental disorders. Review of clinical features. Journal of Neurology, 42(Supl 2): S103-S10.
- WHO (2000). ICD-10. International Classification of Diseases, Tenth Edition. Madrid. Pan-American.
- Perelló, J., Guixá, J., Leal, M., Peña, J. and Vendrell, J.M. (1984): Language Disturbances. Barcelona, Scientific-Medical.