As a speech and language diagnostician, I’ve tested a lot of kids.  I’ve seen many, many patterns of language deficits, and while admittedly, my evidence for my upcoming assertion will be entirely anecdotal, often anecdotal evidence does accurately reflect reality.  My assertion:  when determining goals, language therapists should (usually) not separate receptive and expressive language.  It’s usually much more effective to separate goals by morpho-syntax, semantics, and pragmatics.

Why?  The bottom line is that most kids don’t have major differences between receptive language and expressive.  It is just extremely difficult to produce something that you can’t understand.  In this way, receptive language can be thought of as foundational, or a precursor for similar expressive language.  Usually, the converse is true too – a kid can’t understand something that he can’t produce (with some exceptions).  If you have a deficit in an area – pronouns for example – the majority of the time this deficit exists in both receptive and expressive language.  So, since this is usually the case, and since it is usually the case that with most people there are not major differences between scores (and abilities) in receptive language and expressive language, it stands to reason that the deficits themselves can be more effectively addressed by shifting the focus.

Looking at reception as a foundation for expression also gives us a means of structuring our goals to more accurately reflect deficits.  What a lot of people accept as difficulties with understanding, or following directions, really are problems with understanding (and producing) specific structures.  Verb tense, prepositions, pronouns, negatives, clauses, etc. – these are the typical culprits of comprehension problems.  And when kids have problems understanding a certain structure, they nearly always have problems producing that structure.  Importantly, the pattern of these deficits vary from kid to kid.  This means that goals for following directions usually cast too wide a net, and miss a kid’s uniquely specific problems.  (Here’s another post for more on following directions.)

The exceptions?  Yes, there definitely are exceptions.  ADHD and hearing impairment are the two main ones.  Central auditory processing disorders is another likely area where you would expect to see specific difficulties with comprehension, although scientifically speaking, the jury still seems out on this.  There are also many younger kids (typically two to four years old) who we informally describe as not having experience following directions.  These are the kids who either fight following directions or, conversely, comply so readily, that they just don’t have any experience with listening to what others are telling them to do.  These are the kids that are also often difficult to distinguish from autistic kids until they start making a lot better progress once they get into an early childhood program.  And there are also those kids who need help with specific aspects of following directions, such as providing feedback and eye contact.

As with any other area in which anecdotal evidence outpaces scientific evidence, the hope is that one day soon the researchers will catch up.  How often is it the case that either reception or expression is significantly lower than the other in language disorder?  Another good question could be scientifically answered by considering how frequently deficits in specific areas occur in both reception and expression.  Again, hopefully these questions will be answered sooner rather than later.