Expressive/Receptive language disorder

[Anonymous]

Same as dyslexia? A subset of dyslexia or thing unto itself? DS Diagnosed on Friday and still trying to understand. Functionality effected is around reading accuracy and writing output- translating high cognitive ability and inference towards written and organized output. He’s a voracious reader, yet tests way below average on phonological recognition etc.

I am not sure exactly what I am even asking or if it matters - just trying to understand if they are one in the same, categorically distinct?

Also, how much to share with him? 5th grader. Smart. Finally feeling more confidence about school but challenges are likely ahead.

Thanks.

[Anonymous]

No, not the same but I am a bit surprised that you would get a diagnosis that late in the game and not have noticed it before.

Dyslexia is reading issues.

Expressive language is speaking - how well your child speaks.

Receptive is how well your child understands.

Reading and academics may not be fully impacted. My child was an early reader and loves reading and tests well. Some kids with langauge disorders have other learning disabilities like dyslexia and others don't.

You share it with him. Mine knows and can describe how it impacts him and what's going on. I think it helps for them to know.

Who diagnosed it? What you are describing seems more other disorders.

[Anonymous]

If you haven't yet had a readout with the evaluator, ask your questions directly when you do.

If you had one, and are still confused, call back. Ask how they came to that diagnosis and what are the recommended ways to remediate and support.

[Anonymous]

Anonymous wrote:If you haven't yet had a readout with the evaluator, ask your questions directly when you do.

If you had one, and are still confused, call back. Ask how they came to that diagnosis and what are the recommended ways to remediate and support.

This.

Also, please ask your evaluator how a 5th grader can have phonological recognition issues and not have dyslexia. It’s way more than reading btw.

Also did your evaluation screen for adhd? That can also affect organized thinking and interfere with reading/writing.

[Anonymous]

Op, was this evaluation done by the public school? They don’t like to pay to remediate for dyslexia and they don’t really believe in/understand dysgraphia b/c they don’t provide OT for more than handwriting and usually will cut out OT by 5th.

Your kid may have a language disorder but the other things you mentioned sounds like specific learning disorder (which is the dumbest name ever since it’s pretty much soup to nuts). For kids older than preschool, the term that covers expressive/receptive language disorder is called speech language disorder. To be honest, from what you’ve described, your evaluator sounds really green, really limited, or just not that comprehensive. Depending on what you had done, I would consider additional testing by people who specialize in language disorders. Strixruid’s practice comes to mind, but there are others.

[Anonymous]

Different. My DC has this diagnosis, which she received at 4 after a full neuropsych and speech workup. She was a very late talker and was way behind her age group in auditory processing and comp. She's an excellent reader when it comes to decoding, though - several levels above her peers - and is doing well at math too. She's also strong with puzzles, patterns, and music.

This disorder is called lots of things - MERLD (for mixed expressive-receptive language disorder), SLI (specific language impairment, as it's very limited/specific in terms of which areas are impacted), speech-language disorder, etc. It often presents in otherwise average to above-average IQ kids.

In DC's case (and maybe in all patients' cases, I'm not sure), the specific weaknesses involve processing speed and short-term memory. Inattentive-type ADHD and anxiety are common co-morbidities, which makes sense. we take DC to the developmental peds at Kennedy Krieger in Baltimore. Not the shortest drive from Fairfax County, but we only have to go once or twice a year, and they take insurance and are excellent. Good luck!

[Anonymous]

Anonymous wrote:Op, was this evaluation done by the public school? They don’t like to pay to remediate for dyslexia and they don’t really believe in/understand dysgraphia b/c they don’t provide OT for more than handwriting and usually will cut out OT by 5th.

Your kid may have a language disorder but the other things you mentioned sounds like specific learning disorder (which is the dumbest name ever since it’s pretty much soup to nuts). For kids older than preschool, the term that covers expressive/receptive language disorder is called speech language disorder. To be honest, from what you’ve described, your evaluator sounds really green, really limited, or just not that comprehensive. Depending on what you had done, I would consider additional testing by people who specialize in language disorders. Strixruid’s practice comes to mind, but there are others.

This, but as a parent with a child with a langauge disorder, this don't not sound exactly right. I would do a full psycho-eduational with a language evaluation privately. Even, start with one of the Universities for a language evaluation - GW, Loyola of Columbia or UMD all have clinics. If child has "MERLD" it has to be very mild to be flagged as an older child and reading and "MERLD" are two separate diagnosis. A child can have both or just one. Every child I know who has a "MERLD" diagnosis was obvious from around 2-3 and were later talkers.

[Anonymous]

Anonymous wrote:Different. My DC has this diagnosis, which she received at 4 after a full neuropsych and speech workup. She was a very late talker and was way behind her age group in auditory processing and comp. She's an excellent reader when it comes to decoding, though - several levels above her peers - and is doing well at math too. She's also strong with puzzles, patterns, and music.

This disorder is called lots of things - MERLD (for mixed expressive-receptive language disorder), SLI (specific language impairment, as it's very limited/specific in terms of which areas are impacted), speech-language disorder, etc. It often presents in otherwise average to above-average IQ kids.

In DC's case (and maybe in all patients' cases, I'm not sure), the specific weaknesses involve processing speed and short-term memory. Inattentive-type ADHD and anxiety are common co-morbidities, which makes sense. we take DC to the developmental peds at Kennedy Krieger in Baltimore. Not the shortest drive from Fairfax County, but we only have to go once or twice a year, and they take insurance and are excellent. Good luck!

OP here - correction; auditory working memory.

At any rate, a full testing will show you the specific weaknesses and help you understand the diagnosis and treatment options. Should be crossfunctional (speech, neuro, hearing, OT).

[Anonymous]

Anonymous wrote:Same as dyslexia? A subset of dyslexia or thing unto itself? DS Diagnosed on Friday and still trying to understand. Functionality effected is around reading accuracy and writing output- translating high cognitive ability and inference towards written and organized output. He’s a voracious reader, yet tests way below average on phonological recognition etc.

I am not sure exactly what I am even asking or if it matters - just trying to understand if they are one in the same, categorically distinct?

Also, how much to share with him? 5th grader. Smart. Finally feeling more confidence about school but challenges are likely ahead.

Thanks.

How are other aspects of reading -- fluency? comprehension? spelling?

I think you can have MERLD without dyslexia. How was the phonological weakness assessed? How does it impact him -- speech? spelling? or seemingly not at all?

I would definitely share. By 2nd grade my DS could already see that he was different from peers, that really ate away at his self-esteem because without an explanation, he assumed he was stupid. When we were able to explain, that provided a lot of relief and an explanation for types of instruction for DC that were different from how other kids learned, but which worked for DC and showed him he could learn to read too. Our explanation was simple -- the doctor did a lot of tests that showed us how your brain works. Your brain is good at X, Y and Z, but you have to work harder to do A, B, and C. School is a factory which is organized to teach A, B, C kids, that's why you need your own kind of instruction that's good for X, Y, Z kids. Everyone learns differently. Everyone has things they learn easily and other things they have to work hard to learn. If the person who did your assessment offers a read-out to kids, I would definitely take them up on it, as a kid might take the news better from a Dr. than a parent and be more willing to ask questions.

Who did your assessment -- SLP or psychologist? Do you have any suspicion of ADD/Inattentive or executive dysfunction? That is an underlying aspect of our DC's MERLD. I think MERLD and reading issues can be tough to sort out; there's a lot of overlap, especially if there is a phonological deficit. IME, a very bright kid can compensate in reading for a long time without reading by phonics. Sometimes they collapse at later stages when words become more complex. I would have expected to see that by 5th grade, as your kid is presumably reading unfamiliar multi-syllabic words. You really have to look at reading closely -- is he really getting all the nuance and detail? Is he reading about stuff that he doesn't have any background knowledge and can't use that to fill in gaps but still understands everything in detail -- that's a good sign. Or is he reading about stuff he already knows or series books that are very familiar and he just gets the overall plot but not subtleties and detail. My MERLD kid is smart, and he fooled teachers about reading for most of elementary. I could see subtle difficulties which are now much more problematic in HS.

Another aspect of the MERLD, IMO, is the impact expressive difficulties have on social relationships. This increases with age. At 5th grade, boys are still playing sports and games together, but as they grow older, there is more talking and negotiation and subtle social signals in language that my DS misses. That has caused a lot of problems at school and with other kids and parents. But, since DC is bright and has a great vocabulary and is willing to talk to strangers, when DC doesn't respond appropriately to a conversation, people assume it is some kind of disrespect or malingering, instead of a language problem.

Look carefully at the language testing. For us, that explained a lot of the detail in how DS's MERLD impacted writing specifically. First, he has terrible handwriting and poor letter formation, so writing is effortful. Second, the poor phonological knowledge impacted spelling. Then, the ADD/Inattentive and executive dysfunction impacts the organization of writing. The expressive deficits affect the ability to brainstorm ideas for writing and to easily paraphrase what has been written in text and to vary sentence structure. Also, weaknesses in semantic categorization make it difficult for DC to actually see which topics or ideas go together in one paragraph. The executive dysfunction makes it difficult to put writing in a logical sentence or paragraph structure. And, problems with reading comprehension mean that DC has difficulty relating a prompt to the text, especially if the text is longer than a page or so. Novels or other book length readings in MS and HS are hard because he cannot remember enough of the text, and he lacks the ability to go back and skim for information (probably due to phonological/decoding weakness).

Not sure where you are in school, but we really found that public school (MCPS) does not know at all how to educate kids with dyslexia and dysgraphia. Although i recommend you get an IEP if you don't already have one, because it provides legal protections and accommodations, I would not rely on public school for effective special instruction. Look for a tutor who is skilled in teaching phonology, decoding and spelling (if the latter is an issue) and someone else who can teach writing. It's much better to remediate that NOW and in middle school or high school will be much more difficult than need be.

[Anonymous]

OP here - thank you. I really appreciate the time you took to share these thoughtful and extremely helpful details. Very, very helpful and illuminating.

Yes, he has ADHD so posters are spot on in that question. The diagnostics were administrated by private school geared towards learning differences so I trust the test and diagnoses. The communication around the delivery was unclear however - and what you share makes sense. He’s very smart and has been able to compensate and “hide” I think.

Not sure what’s ahead for us. He’s in a very mainstream, “competitive” private school. For now, it’s working. Part of me wonders for how long and what cost to his self esteem.

[Anonymous]

You need to get a full neuropsych at this point between the ADHD and reading. MERLD and reading/dyslexia are two separate issues. Kids can have both or one. My MERLD kid was reading before talking and I know several kids like that as they were able to decode the written language first and are very visual kids. It is possible for MERLD to be caught later but this doesn't sound like it was done by an SLP or someone who really specializes in it. It sounds like this is more of a reading/comprehension issue. I would get a private evaluation and tutoring or therapy. Kids can learn to compensate and hide it but you don't want your child hiding things as then you cannot correct it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Same as dyslexia? A subset of dyslexia or thing unto itself? DS Diagnosed on Friday and still trying to understand. Functionality effected is around reading accuracy and writing output- translating high cognitive ability and inference towards written and organized output. He’s a voracious reader, yet tests way below average on phonological recognition etc.

I am not sure exactly what I am even asking or if it matters - just trying to understand if they are one in the same, categorically distinct?

Also, how much to share with him? 5th grader. Smart. Finally feeling more confidence about school but challenges are likely ahead.

Thanks.

How are other aspects of reading -- fluency? comprehension? spelling?

I think you can have MERLD without dyslexia. How was the phonological weakness assessed? How does it impact him -- speech? spelling? or seemingly not at all?

I would definitely share. By 2nd grade my DS could already see that he was different from peers, that really ate away at his self-esteem because without an explanation, he assumed he was stupid. When we were able to explain, that provided a lot of relief and an explanation for types of instruction for DC that were different from how other kids learned, but which worked for DC and showed him he could learn to read too. Our explanation was simple -- the doctor did a lot of tests that showed us how your brain works. Your brain is good at X, Y and Z, but you have to work harder to do A, B, and C. School is a factory which is organized to teach A, B, C kids, that's why you need your own kind of instruction that's good for X, Y, Z kids. Everyone learns differently. Everyone has things they learn easily and other things they have to work hard to learn. If the person who did your assessment offers a read-out to kids, I would definitely take them up on it, as a kid might take the news better from a Dr. than a parent and be more willing to ask questions.

Who did your assessment -- SLP or psychologist? Do you have any suspicion of ADD/Inattentive or executive dysfunction? That is an underlying aspect of our DC's MERLD. I think MERLD and reading issues can be tough to sort out; there's a lot of overlap, especially if there is a phonological deficit. IME, a very bright kid can compensate in reading for a long time without reading by phonics. Sometimes they collapse at later stages when words become more complex. I would have expected to see that by 5th grade, as your kid is presumably reading unfamiliar multi-syllabic words. You really have to look at reading closely -- is he really getting all the nuance and detail? Is he reading about stuff that he doesn't have any background knowledge and can't use that to fill in gaps but still understands everything in detail -- that's a good sign. Or is he reading about stuff he already knows or series books that are very familiar and he just gets the overall plot but not subtleties and detail. My MERLD kid is smart, and he fooled teachers about reading for most of elementary. I could see subtle difficulties which are now much more problematic in HS.

Another aspect of the MERLD, IMO, is the impact expressive difficulties have on social relationships. This increases with age. At 5th grade, boys are still playing sports and games together, but as they grow older, there is more talking and negotiation and subtle social signals in language that my DS misses. That has caused a lot of problems at school and with other kids and parents. But, since DC is bright and has a great vocabulary and is willing to talk to strangers, when DC doesn't respond appropriately to a conversation, people assume it is some kind of disrespect or malingering, instead of a language problem.

Look carefully at the language testing. For us, that explained a lot of the detail in how DS's MERLD impacted writing specifically. First, he has terrible handwriting and poor letter formation, so writing is effortful. Second, the poor phonological knowledge impacted spelling. Then, the ADD/Inattentive and executive dysfunction impacts the organization of writing. The expressive deficits affect the ability to brainstorm ideas for writing and to easily paraphrase what has been written in text and to vary sentence structure. Also, weaknesses in semantic categorization make it difficult for DC to actually see which topics or ideas go together in one paragraph. The executive dysfunction makes it difficult to put writing in a logical sentence or paragraph structure. And, problems with reading comprehension mean that DC has difficulty relating a prompt to the text, especially if the text is longer than a page or so. Novels or other book length readings in MS and HS are hard because he cannot remember enough of the text, and he lacks the ability to go back and skim for information (probably due to phonological/decoding weakness).

Not sure where you are in school, but we really found that public school (MCPS) does not know at all how to educate kids with dyslexia and dysgraphia. Although i recommend you get an IEP if you don't already have one, because it provides legal protections and accommodations, I would not rely on public school for effective special instruction. Look for a tutor who is skilled in teaching phonology, decoding and spelling (if the latter is an issue) and someone else who can teach writing. It's much better to remediate that NOW and in middle school or high school will be much more difficult than need be.

My MERLD child looks very different. But, listen tooth's and remediate but get a better evaluation first. MERLD has no impact on my child's reading or writing. Some this is accurate for strictly a MERLD kid, but this is multiple disorders, not just one.

[Anonymous]

Anonymous wrote:OP here - thank you. I really appreciate the time you took to share these thoughtful and extremely helpful details. Very, very helpful and illuminating.

Yes, he has ADHD so posters are spot on in that question. The diagnostics were administrated by private school geared towards learning differences so I trust the test and diagnoses. The communication around the delivery was unclear however - and what you share makes sense. He’s very smart and has been able to compensate and “hide” I think.

Not sure what’s ahead for us. He’s in a very mainstream, “competitive” private school. For now, it’s working. Part of me wonders for how long and what cost to his self esteem.

You need a full neuropsych. The testing was probably accurate to a degree but not comprehensive enough.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here - thank you. I really appreciate the time you took to share these thoughtful and extremely helpful details. Very, very helpful and illuminating.

Yes, he has ADHD so posters are spot on in that question. The diagnostics were administrated by private school geared towards learning differences so I trust the test and diagnoses. The communication around the delivery was unclear however - and what you share makes sense. He’s very smart and has been able to compensate and “hide” I think.

Not sure what’s ahead for us. He’s in a very mainstream, “competitive” private school. For now, it’s working. Part of me wonders for how long and what cost to his self esteem.

You need a full neuropsych. The testing was probably accurate to a degree but not comprehensive enough.

NP. Also, if a school did it they may have chosen tests based on what they usually give their students. Sometimes places like that even develop their own "assessments". That's different from a standardized battery given by a psychologist. Which might explain why the feedback they gave you was a little unclear.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Same as dyslexia? A subset of dyslexia or thing unto itself? DS Diagnosed on Friday and still trying to understand. Functionality effected is around reading accuracy and writing output- translating high cognitive ability and inference towards written and organized output. He’s a voracious reader, yet tests way below average on phonological recognition etc.

I am not sure exactly what I am even asking or if it matters - just trying to understand if they are one in the same, categorically distinct?

Also, how much to share with him? 5th grader. Smart. Finally feeling more confidence about school but challenges are likely ahead.

Thanks.

How are other aspects of reading -- fluency? comprehension? spelling?

I think you can have MERLD without dyslexia. How was the phonological weakness assessed? How does it impact him -- speech? spelling? or seemingly not at all?

I would definitely share. By 2nd grade my DS could already see that he was different from peers, that really ate away at his self-esteem because without an explanation, he assumed he was stupid. When we were able to explain, that provided a lot of relief and an explanation for types of instruction for DC that were different from how other kids learned, but which worked for DC and showed him he could learn to read too. Our explanation was simple -- the doctor did a lot of tests that showed us how your brain works. Your brain is good at X, Y and Z, but you have to work harder to do A, B, and C. School is a factory which is organized to teach A, B, C kids, that's why you need your own kind of instruction that's good for X, Y, Z kids. Everyone learns differently. Everyone has things they learn easily and other things they have to work hard to learn. If the person who did your assessment offers a read-out to kids, I would definitely take them up on it, as a kid might take the news better from a Dr. than a parent and be more willing to ask questions.

Who did your assessment -- SLP or psychologist? Do you have any suspicion of ADD/Inattentive or executive dysfunction? That is an underlying aspect of our DC's MERLD. I think MERLD and reading issues can be tough to sort out; there's a lot of overlap, especially if there is a phonological deficit. IME, a very bright kid can compensate in reading for a long time without reading by phonics. Sometimes they collapse at later stages when words become more complex. I would have expected to see that by 5th grade, as your kid is presumably reading unfamiliar multi-syllabic words. You really have to look at reading closely -- is he really getting all the nuance and detail? Is he reading about stuff that he doesn't have any background knowledge and can't use that to fill in gaps but still understands everything in detail -- that's a good sign. Or is he reading about stuff he already knows or series books that are very familiar and he just gets the overall plot but not subtleties and detail. My MERLD kid is smart, and he fooled teachers about reading for most of elementary. I could see subtle difficulties which are now much more problematic in HS.

Another aspect of the MERLD, IMO, is the impact expressive difficulties have on social relationships. This increases with age. At 5th grade, boys are still playing sports and games together, but as they grow older, there is more talking and negotiation and subtle social signals in language that my DS misses. That has caused a lot of problems at school and with other kids and parents. But, since DC is bright and has a great vocabulary and is willing to talk to strangers, when DC doesn't respond appropriately to a conversation, people assume it is some kind of disrespect or malingering, instead of a language problem.

Look carefully at the language testing. For us, that explained a lot of the detail in how DS's MERLD impacted writing specifically. First, he has terrible handwriting and poor letter formation, so writing is effortful. Second, the poor phonological knowledge impacted spelling. Then, the ADD/Inattentive and executive dysfunction impacts the organization of writing. The expressive deficits affect the ability to brainstorm ideas for writing and to easily paraphrase what has been written in text and to vary sentence structure. Also, weaknesses in semantic categorization make it difficult for DC to actually see which topics or ideas go together in one paragraph. The executive dysfunction makes it difficult to put writing in a logical sentence or paragraph structure. And, problems with reading comprehension mean that DC has difficulty relating a prompt to the text, especially if the text is longer than a page or so. Novels or other book length readings in MS and HS are hard because he cannot remember enough of the text, and he lacks the ability to go back and skim for information (probably due to phonological/decoding weakness).

Not sure where you are in school, but we really found that public school (MCPS) does not know at all how to educate kids with dyslexia and dysgraphia. Although i recommend you get an IEP if you don't already have one, because it provides legal protections and accommodations, I would not rely on public school for effective special instruction. Look for a tutor who is skilled in teaching phonology, decoding and spelling (if the latter is an issue) and someone else who can teach writing. It's much better to remediate that NOW and in middle school or high school will be much more difficult than need be.

My MERLD child looks very different. But, listen tooth's and remediate but get a better evaluation first. MERLD has no impact on my child's reading or writing. Some this is accurate for strictly a MERLD kid, but this is multiple disorders, not just one.

I am the PP who wrote the long MERLD description. I agree that different MERLD kids will look different depending on their individual profile. MERLD is a very broad diagnosis. Our kid's specific MERLD manifestation is probably impacted by ADD Inattentive and a long history of early ear infections that probably impacted early learning related to speech sounds and made reading/phonology/spelling more difficult than in another MERLD kid.