Mixed Receptive-Expressive Language Disorder

[Anonymous]

Anonymous wrote:It's weird that you just received a MERLD diagnosis. It's no longer in the current DSM and is covered by these categories:

--Language Impairment
--Late Language Emergence
--Specific Language Impairment
--Social Communication Disorder
--Voice Disorder

We were diagnosed with MERLD under the previous DSM. You can definitely have it with or without being on the spectrum. Language Impairment and Specific Language Impairment are so broad and lump in a lot of things in the current DSM.


You might find reading up on Social Communication (Pragmatics) Disorder helpful:
https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/communication-disorders/understanding-social-communication-disorder

and Language Disorders:
https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/communication-disorders/understanding-language-disorders

My guess would be on a practical level, your kid might have trouble with back and forth conversations, particularly with peers. Kids who fit the MERLD profile have difficulty tracking what others are saying as well as simultaneously processing what they want to say. Your kid may also have difficulty with group sports, like soccer--where there are a lot of other bodies, the ball, the coach. Your kid may also have difficulty organizing his thoughts to paper, organizing paragraphs for example. (A lot of these issues are also present in kids with ADHD.)

A lot of these issues are related to executive function and processing. So if your kid has ADHD and dyslexia, it doesn't surprise me that he has MERLD. I just find it surprising that the psychologist gave this diagnosis now and wondering if it was a private or school testing.

If you have MERLD, you do not have ASD/PDD, as a previous poster said.


MERLD is still diagnosed everyday. Just because it's not in the DSM doesn't mean professionals aren't using it.

[Anonymous]

MERLD is a term to diagnose receptive and expressive language issues. The issue is not if it is in the DSM but rather OP child being recognized to have the concerns. How sad for the child that he has been struggling all these years without the proper diagnosis. OP, you need a good SPL to diagnose language disorders and most psychologists and generalists like developmental ped's do not really understand it and often slap on an ADD, ADHD or autism diagnosis. Then you get the parents on here who are very dismissive and make it about their child's autism or ADHD and ignore your concerns.

Best thing to do is get intensive speech therapy with someone who understand it and can help as your child gets older. Its very hard to find someone skilled at older kids and MERLD. Ours is great and works on the reading comprehension, answering questions, verbally responding to questions, etc. on top of the language issues.

One big thing is when you talk to him, be aware to use simple sentences that are not run on. If you tell him someone in a long paragraph he may get lost 1/2 way through vs. one sentence which he can easily follow. This is very common that kids really struggle in older grades with more lecture/verbal teaching vs. visual.

There are a bunch of Facebook groups for language disorders and MERLD. Join a few even though its basically the same people on all of them. They are a great bunch of parents who are very supportive.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:DS, in 6th grade, was just diagnosed with this. He's long had ADHD and dyslexia and has struggled a ton in school. He has had speech evaluations in the past but no one ever flagged this specifically. Any insights/recommendations/encouragement. We're trying to wrap our heads around this, including whether it goes together with an autism spectrum DX (he has not been DX'd ever as being on the spectrum and has had a recent neuropsych evaluation). Many thanks!

OP, MERLD is not a spectrum disorder. it is a language based disorder. Was your testing done by the school system or by an actual psychologist?

The testing was done by a very good SLP. He separately had neuropsych testing and the neuropsychologist recommended speech-language testing.

OP I totally understand your confusion. If you trust your SLP and the psychologist, and neither of them used the word "autism spectrum" then you have nothing to be concerned about. Do keep in mind however that many of the therapies will be the same as what a chid on the spectrum would receive.

We are in MCPS. My DS is 13, with significant ADHD which impairs his language and social interactions because he can't focus long enough to really "catch" social queues. You can imagine the snowball effect this has! We had him tested 3 times over the years. Twice by neuropsychologist and once by a developmental pediatrician at Kennedy Kreiger (KKI). All agreed on ADHD, and early on one psychologist suspected MERLD but that was later replaced by the signifiant ADHD diagnosis. All the while MCPS kept stomping their feet, trying to shove ASD down our throats because their "quasi-psychologist" who has MAYBE a Masters degree and not a Doctorate degree felt that was the correct diagnosis. This is because they have zero idea what they're talking about. Its easier for them to just shove your kid into a neat little box so that they can just be done with it. That has disastrous outcomes, so if you're in that position please be weary of this.

FWIW we pulled DS out of MCPS and put him in private because they pretty much washed their hands of DS. They thought they had him figured out and treated him as such- as a low achieving kid who would not amount to much.

Do you realize you are making it about your child and not OP? Please don't confuse her more. There is a difference between a language disorder and what you are describing where the language and social is based off attention issues. Language disorders are real. You may not want to believe them and that's ok but if OP child has a true language disorder they need intensive speech therapy. Its very common to have an ASD diagnosis shoved onto you. We had that experience. We basically only use that practitioner for referrals to get services paid for an ignore all his advice as it is not relevant. He forced us into ABA and it was a huge waste of time and took away from speech therapy time which was more helpful. ASD is the new buzz word, just like ADD and ADHD was 20+ years ago.

[Anonymous]

The actual, definable criteria:

Diagnostic criteria for 315.31 Mixed Receptive-Expressive Language Disorder


DSM IV - TR





A. The scores obtained from a battery of standardized individually administered measures of both receptive and expressive language development are substantially below those obtained from standardized measures of nonverbal intellectual capacity. Symptoms include those for Expressive Language Disorder as well as difficulty understanding words, sentences, or specific types of words, such as spatial terms.

B. The difficulties with receptive and expressive language significantly interfere with academic or occupational achievement or with social communication.

C. Criteria are not met for a Pervasive Developmental Disorder.

D. If Mental Retardation, a speech-motor or sensory deficit, or environmental deprivation is present, the language difficulties are in excess of those usually associated with these problems.

Coding note: If a speech-motor or sensory deficit or a neurological condition is present, code the condition on Axis III.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000 American Psychiatric Association

[Anonymous]

Anonymous wrote:

Anonymous wrote:It's weird that you just received a MERLD diagnosis. It's no longer in the current DSM and is covered by these categories:

--Language Impairment
--Late Language Emergence
--Specific Language Impairment
--Social Communication Disorder
--Voice Disorder

We were diagnosed with MERLD under the previous DSM. You can definitely have it with or without being on the spectrum. Language Impairment and Specific Language Impairment are so broad and lump in a lot of things in the current DSM.


You might find reading up on Social Communication (Pragmatics) Disorder helpful:
https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/communication-disorders/understanding-social-communication-disorder

and Language Disorders:
https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/communication-disorders/understanding-language-disorders

My guess would be on a practical level, your kid might have trouble with back and forth conversations, particularly with peers. Kids who fit the MERLD profile have difficulty tracking what others are saying as well as simultaneously processing what they want to say. Your kid may also have difficulty with group sports, like soccer--where there are a lot of other bodies, the ball, the coach. Your kid may also have difficulty organizing his thoughts to paper, organizing paragraphs for example. (A lot of these issues are also present in kids with ADHD.)

A lot of these issues are related to executive function and processing. So if your kid has ADHD and dyslexia, it doesn't surprise me that he has MERLD. I just find it surprising that the psychologist gave this diagnosis now and wondering if it was a private or school testing.

If you have MERLD, you do not have ASD/PDD, as a previous poster said.


MERLD is still diagnosed everyday. Just because it's not in the DSM doesn't mean professionals aren't using it.

Well, that's not very professional of them. BTW, PDD isn't the DSM either anymore. Having MERLD doesn't preclude you from being on the spectrum. You can have both or just one. It's a processing issue.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It's weird that you just received a MERLD diagnosis. It's no longer in the current DSM and is covered by these categories:

--Language Impairment
--Late Language Emergence
--Specific Language Impairment
--Social Communication Disorder
--Voice Disorder

We were diagnosed with MERLD under the previous DSM. You can definitely have it with or without being on the spectrum. Language Impairment and Specific Language Impairment are so broad and lump in a lot of things in the current DSM.


You might find reading up on Social Communication (Pragmatics) Disorder helpful:
https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/communication-disorders/understanding-social-communication-disorder

and Language Disorders:
https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/communication-disorders/understanding-language-disorders

My guess would be on a practical level, your kid might have trouble with back and forth conversations, particularly with peers. Kids who fit the MERLD profile have difficulty tracking what others are saying as well as simultaneously processing what they want to say. Your kid may also have difficulty with group sports, like soccer--where there are a lot of other bodies, the ball, the coach. Your kid may also have difficulty organizing his thoughts to paper, organizing paragraphs for example. (A lot of these issues are also present in kids with ADHD.)

A lot of these issues are related to executive function and processing. So if your kid has ADHD and dyslexia, it doesn't surprise me that he has MERLD. I just find it surprising that the psychologist gave this diagnosis now and wondering if it was a private or school testing.

If you have MERLD, you do not have ASD/PDD, as a previous poster said.


MERLD is still diagnosed everyday. Just because it's not in the DSM doesn't mean professionals aren't using it.

Well, that's not very professional of them. BTW, PDD isn't the DSM either anymore. Having MERLD doesn't preclude you from being on the spectrum. You can have both or just one. It's a processing issue.

Untrue. Read above. If you have MERLD, by definition, you don't have autism. And yes, I'm well informed that PDD is not in the DSM any longer.

But MERLD was -- and actually remains -- a specific condition, apart from autism. It's too bad they got rid of it in the DSM. The other language definitions don't get to the heart of the issue like MERLD did.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It's weird that you just received a MERLD diagnosis. It's no longer in the current DSM and is covered by these categories:

--Language Impairment
--Late Language Emergence
--Specific Language Impairment
--Social Communication Disorder
--Voice Disorder

We were diagnosed with MERLD under the previous DSM. You can definitely have it with or without being on the spectrum. Language Impairment and Specific Language Impairment are so broad and lump in a lot of things in the current DSM.


You might find reading up on Social Communication (Pragmatics) Disorder helpful:
https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/communication-disorders/understanding-social-communication-disorder

and Language Disorders:
https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/communication-disorders/understanding-language-disorders

My guess would be on a practical level, your kid might have trouble with back and forth conversations, particularly with peers. Kids who fit the MERLD profile have difficulty tracking what others are saying as well as simultaneously processing what they want to say. Your kid may also have difficulty with group sports, like soccer--where there are a lot of other bodies, the ball, the coach. Your kid may also have difficulty organizing his thoughts to paper, organizing paragraphs for example. (A lot of these issues are also present in kids with ADHD.)

A lot of these issues are related to executive function and processing. So if your kid has ADHD and dyslexia, it doesn't surprise me that he has MERLD. I just find it surprising that the psychologist gave this diagnosis now and wondering if it was a private or school testing.

If you have MERLD, you do not have ASD/PDD, as a previous poster said.


MERLD is still diagnosed everyday. Just because it's not in the DSM doesn't mean professionals aren't using it.

Well, that's not very professional of them. BTW, PDD isn't the DSM either anymore. Having MERLD doesn't preclude you from being on the spectrum. You can have both or just one. It's a processing issue.

Ok anti MERLD MOM, we get that you do not believe in MERLD.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It's weird that you just received a MERLD diagnosis. It's no longer in the current DSM and is covered by these categories:

--Language Impairment
--Late Language Emergence
--Specific Language Impairment
--Social Communication Disorder
--Voice Disorder

We were diagnosed with MERLD under the previous DSM. You can definitely have it with or without being on the spectrum. Language Impairment and Specific Language Impairment are so broad and lump in a lot of things in the current DSM.


You might find reading up on Social Communication (Pragmatics) Disorder helpful:
https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/communication-disorders/understanding-social-communication-disorder

and Language Disorders:
https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/communication-disorders/understanding-language-disorders

My guess would be on a practical level, your kid might have trouble with back and forth conversations, particularly with peers. Kids who fit the MERLD profile have difficulty tracking what others are saying as well as simultaneously processing what they want to say. Your kid may also have difficulty with group sports, like soccer--where there are a lot of other bodies, the ball, the coach. Your kid may also have difficulty organizing his thoughts to paper, organizing paragraphs for example. (A lot of these issues are also present in kids with ADHD.)

A lot of these issues are related to executive function and processing. So if your kid has ADHD and dyslexia, it doesn't surprise me that he has MERLD. I just find it surprising that the psychologist gave this diagnosis now and wondering if it was a private or school testing.

If you have MERLD, you do not have ASD/PDD, as a previous poster said.


MERLD is still diagnosed everyday. Just because it's not in the DSM doesn't mean professionals aren't using it.

Well, that's not very professional of them. BTW, PDD isn't the DSM either anymore. Having MERLD doesn't preclude you from being on the spectrum. You can have both or just one. It's a processing issue.

Exactly and it is treated exactly the same way whether ASD is present or not with speech therapy.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It's weird that you just received a MERLD diagnosis. It's no longer in the current DSM and is covered by these categories:

--Language Impairment
--Late Language Emergence
--Specific Language Impairment
--Social Communication Disorder
--Voice Disorder

We were diagnosed with MERLD under the previous DSM. You can definitely have it with or without being on the spectrum. Language Impairment and Specific Language Impairment are so broad and lump in a lot of things in the current DSM.


You might find reading up on Social Communication (Pragmatics) Disorder helpful:
https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/communication-disorders/understanding-social-communication-disorder

and Language Disorders:
https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/communication-disorders/understanding-language-disorders

My guess would be on a practical level, your kid might have trouble with back and forth conversations, particularly with peers. Kids who fit the MERLD profile have difficulty tracking what others are saying as well as simultaneously processing what they want to say. Your kid may also have difficulty with group sports, like soccer--where there are a lot of other bodies, the ball, the coach. Your kid may also have difficulty organizing his thoughts to paper, organizing paragraphs for example. (A lot of these issues are also present in kids with ADHD.)

A lot of these issues are related to executive function and processing. So if your kid has ADHD and dyslexia, it doesn't surprise me that he has MERLD. I just find it surprising that the psychologist gave this diagnosis now and wondering if it was a private or school testing.

If you have MERLD, you do not have ASD/PDD, as a previous poster said.


MERLD is still diagnosed everyday. Just because it's not in the DSM doesn't mean professionals aren't using it.

Well, that's not very professional of them. BTW, PDD isn't the DSM either anymore. Having MERLD doesn't preclude you from being on the spectrum. You can have both or just one. It's a processing issue.

Exactly and it is treated exactly the same way whether ASD is present or not with speech therapy.

No, its not treated the same way.

[Anonymous]

I always wonder why the MERLD posts attract such vitriol.

My DS had this diagnosis under the old DSM. What we found with him is that the expressive disorder was really just a follow on from the receptive language disorder. He was rock bottom on scores for this (3%). Expressive was actually quite a bit better, low normal around 25%. The SLP said he must have been exploiting every bit of the little receptive language he had to get the expressive scores he had.

He was dx'ed with an auditory processing disorder at GW. We did a lot of language therapy, as well as Fast Forward. He fortunately was one of those it helped--enormously. The gains he made on his testing after each of the two rounds of FFW would have taken many more years of language therapy to achieve.

[Anonymous]

Anonymous wrote:I always wonder why the MERLD posts attract such vitriol.

My DS had this diagnosis under the old DSM. What we found with him is that the expressive disorder was really just a follow on from the receptive language disorder. He was rock bottom on scores for this (3%). Expressive was actually quite a bit better, low normal around 25%. The SLP said he must have been exploiting every bit of the little receptive language he had to get the expressive scores he had.

He was dx'ed with an auditory processing disorder at GW. We did a lot of language therapy, as well as Fast Forward. He fortunately was one of those it helped--enormously. The gains he made on his testing after each of the two rounds of FFW would have taken many more years of language therapy to achieve.

what is FFW?

[Anonymous]

Anonymous wrote:I always wonder why the MERLD posts attract such vitriol.

I suspect it's because it gets confused with autism a lot, and nobody wants the autism label if their child isn't really autistic.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I always wonder why the MERLD posts attract such vitriol.

My DS had this diagnosis under the old DSM. What we found with him is that the expressive disorder was really just a follow on from the receptive language disorder. He was rock bottom on scores for this (3%). Expressive was actually quite a bit better, low normal around 25%. The SLP said he must have been exploiting every bit of the little receptive language he had to get the expressive scores he had.

He was dx'ed with an auditory processing disorder at GW. We did a lot of language therapy, as well as Fast Forward. He fortunately was one of those it helped--enormously. The gains he made on his testing after each of the two rounds of FFW would have taken many more years of language therapy to achieve.

what is FFW?

Fast Forward

[Anonymous]

Where did you do Fast Forward therapy?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I always wonder why the MERLD posts attract such vitriol.

I suspect it's because it gets confused with autism a lot, and nobody wants the autism label if their child isn't really autistic.

Vitriol poster here.

Actually neuropsych dx'ed DS with PDD NOS. But not on the obvious language problem alone. He added in "stereotypical behaviors" and was visibly irritated when I called them tics. It was all very confusing as those only started when DS was 7 following strep and were accompanied with OCD. He actually had what NIH dx'ed a couple of years later as PANDAS. We weren't really sure where to go after neuropsych but ended up at a psychiatrist who treats a lot of kids with autism and he said definitively DS did not have autism and dx'ed him with "tic-related OCD."

Whether it was autism or not, he would have needed the language therapy. But OCD/Tics/PANDAS requires something completely different from autism, so diagnosis can matter.