Mixed Receptive-Expressive Language Disorder: What is it?

Language and communication are of great importance, especially in childhood and in the early developmental stages, 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 its diagnostic criteria are, how it manifests itself, what subtypes exist and, ultimately, what characteristics it presents.

• Related article: "The 14 types of language disorders"

Mixed receptive-expressive language disorder: what is it?

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

That is, the performance in these two fields is affected, and is below normal. This translates into difficulties expressing ideas and difficulties understanding what others are saying.

This is a more serious disorder than Expressive Disorder (where only expression is affected) or Receptive Disorder (where only comprehension is impaired).

As a result of the aforementioned, in mixed receptive-expressive language disorder difficulties appear in communication that can involve both verbal and non-verbal language (eg gestures). At the prevalence level, this disorder appears in approximately 3% of the child population.

• You may be interested in: "The 6 types of aphasia (causes, symptoms and characteristics)"

Diagnostic criteria

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

1. Scores below expectations

Criterion A specifies that scores obtained by evaluations of the development of the two types of language, the receptive and the expressive, being these extracted from standardized tests and administered individually, they fall substantially below those obtained by standardized assessments of nonverbal intellectual ability.

Criterion A also specifies the following manifestations, 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 this is affected).

2. performance interference

Criterion B of Mixed Receptive-Expressive Language Disorder states that deficits that appear in receptive and expressive language, create interference with 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 a PDD. That is to say, the diagnosis of PDD would overturn the diagnosis of mixed receptive-expressive language disorder.

4. If another disorder is present, deficiencies are excessive

Finally, in the event that there is another previous diagnosis (for example: intellectual disability, environmental deprivation, deficit sensory or motor speech...), the deficiencies that appear in language exceed those usually associated with this type of disorders. That is, the previous diagnosis would not explain these difficulties.

expressive and receptive language

In order to better understand what mixed receptive-expressive language disorder implies, we must differentiate between expressive and receptive language.

1. expressive language

Expressive language has to do with speech at the motor level.. That is, it is the language used to communicate and to express ideas. If, for example, I ask a child what a certain object is, and they answer me, I am evaluating her expressive language.

2. receptive language

Receptive language, on the other hand, It has to do with language comprehension.. If, following the previous example, I ask a child to give me a certain object, among a set of them, in this case I am evaluating the 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 are these difficulties manifested?

The child's vocabulary is significantly limited (ie, has little vocabulary). In addition, difficulties appear to produce fluid and fast motor sequences. also appear Difficulty remembering words or producing sentences of developmental age length or complexity. Finally, there is a general difficulty in expressing ideas.

Receptive language difficulties

Regarding the receptive language of the mixed receptive-expressive language disorder, there is fundamentally a difficulty in understanding words, phrases or specific types of words. In other words, broadly speaking, the child presents Difficulty 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:

• discrimination issues
• 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. Its course is different, as we will see below.

1. Evolutionary

The evolutionary subtype appears from birth. They are usually more serious 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).

2. Acquired

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

Other classifications: DSM-5 and ICD

We have seen how the mixed receptive-expressive language disorder is located 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 he calls "Language disorder". In this way, mixed receptive-expressive language disorder, in the DSM-5, would become 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 of this, either the expressive disorder or the receptive disorder (the most severe is diagnosed) is usually diagnosed.

Bibliographic references:

• American Psychiatric Association –APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Pan American.
• 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(Suppl 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.