Mixed receptive-expressive language disorder: what is it?

Language and communication are of great importance, especially in childhood and 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: mixed receptive-expressive language disorder. We will know what it consists of, what are its diagnostic criteria, how it manifests itself, what subtypes exist and, finally, what are its characteristics.

    Mixed receptive-expressive language disorder: what is it?

    Mixed receptive-expressive language disorder, also called “receptive dysphasia”, is a language disorder characterized by receptive and expressive language is below the norm according to age, level of development and intellectual ability of the child (if we compare it with its reference group).

    In other words, the performance in these two areas is affected and is lower than normal. This results in difficulty expressing ideas and difficulty understanding what others are saying.

    It is a more serious disorder than expressive disorder (where only expression is affected) or receptive disorder (where only comprehension is impaired).

    Accordingly, in mixed receptive-expressive language disorder communication difficulties arise which can involve both verbal and non-verbal language (For example gestures). In terms of prevalence, this disorder appears in about 3% of the infant population.

      diagnostic criteria

      In order to be able to diagnose a mixed receptive-expressive language disorder, it is necessary to meet the diagnostic criteria for it. The DSM-IV-TR (Diagnostic Manual of Mental Disorders) specifies the following criteria:

      1. Scores below expectations

      Criterion A specifies that the scores obtained using evaluations of the development of the two types of language, receptive and expressive, being these extracted from standardized tests and administered individually, are significantly lower than those obtained from standardized assessments of non-verbal intellectual ability.

      In criterion A, in addition, the following manifestations are specified, which appear in mixed receptive-expressive language disorder:

      • Difficulty 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 for mixed receptive-expressive language disorder states that impairments that appear in receptive and expressive language, they interfere with academic or professional performance, or with social communication.

      3. It is not a generalized developmental disorder (GDD)

      On the other hand, to be able to diagnose a mixed receptive-expressive language disorder, the child does not have to meet the criteria for a TGD. In other words, that is to say the diagnosis of TGD would negate the diagnosis of mixed receptive-expressive language disorder.

      4. If there is another disorder, the deficiencies are excessive

      Finally, in the event of another previous diagnosis (for example: intellectual disability, environmental deprivation, sensory or motor speech deficit, etc.), the impairments that appear in the language exceed those that are usually associated with this type of disorder. . . In other words, a preliminary diagnosis would not explain these difficulties.

      Expressive and receptive language

      In order to better understand what is involved with receptive-expressive mixed language disorder, we need to 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 express ideas. If, for example, I ask a child what a certain object is and he answers me, I assess his expressive language.

      2. Receptive language

      Receptive language, on the other hand, it has to do with understanding language. If, following the example above, I ask a child to give me a certain object, from a set of them, then I assess receptive language.

      Expressive language difficulties

      As we have seen, the main feature 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 significantly limited (i.e. he has little vocabulary). In addition, difficulties appear to produce fluid and rapid motor sequences. they also appear difficulty remembering words or producing sentences of length or complexity typical of the evolutionary age. Finally, there is a general difficulty in expressing ideas.

      Receptive language difficulties

      When it comes to receptive language in mixed receptive-expressive language disorder, there is basically a difficulty understanding specific words, phrases, or types of words. In other words, roughly speaking, the child presents difficulty understanding what is said to him.

      Other associated alterations

      Beyond the above, there are other alterations or deficits associated with mixed receptive-expressive language disorder. These are:

      • Discrimination issues
      • attention problems
      • Auditory memory deficits
      • Auditory sequential memory deficits

      Disorder subtype

      There are two main subtypes of mixed receptive-expressive language disorder: active and acquired. His journey is different, as we will see below.

      1. Evolutionary

      The evolutionary subtype appears from birth. These are usually more serious cases, which are detected earlier (around 2 years). However, when it comes to milder cases, they are detected a little later (at 4 years).

      2. Acquired

      In the acquired subtype, as the name suggests, the disorder is acquired by an injury or accident in the brain. In these cases, the course is variable and depends on the location of the injury, its severity, the age of the child at the time of the injury, etc.

      Other classifications: DSM-5 and CIE

      We have seen how mixed receptive-expressive language disorder fits within DSM-IV-TR, as a language disorder. however, the new version of the manual, the DSM-5, introduces changes and unifies the problems of comprehension and expression, Within a single disorder called “language disorder”. In this way, the receptive-expressive mixed language disorder, in DSM-5, would become the language disorder.

      In contrast, in ICD-10 (International Classification of Diseases, WHO), mixed receptive-expressive language disorder does not exist as such; instead, an expressive disorder or a receptive disorder is usually diagnosed (the most serious is diagnosed).

      Bibliographical references:

      • American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Panamericana.
      • American Psychiatric Association (APA). (2002). DSM-IV-TR Diagnostic and Statistical Manual. Barcelona: Masson.
      • Mules, F., Etchepareborda, M., Díaz-Estel, A. and Ruiz, R. (2006). Language and neurological development disorders. Review of clinical features. Journal of Neurology, 42 (Suppl 2): ​​S103-S10.
      • WHO (2000). CIE-10. International Classification of Diseases, tenth edition. Madrid. Panamericana.
      • Perelló, J., Guixà, J., Leal, M., Peña, J. and Vendrell, JM (1984): Perturbations of language. Barcelona, ​​scientific and medical.

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