‹ Conditions We Treat

Some children speak clearly, every sound crisp and understandable, yet still struggle to communicate. They may have trouble following directions, finding the right words, building sentences, or telling you about their day. When a child’s difficulty is with language itself rather than the sounds of speech, they may have a language disorder.

Language disorders are among the most common developmental conditions in childhood, and they’re also among the most treatable.

Speech vs. language: an important distinction

Parents often use “speech” and “language” interchangeably, but speech-language pathologists treat them as different systems:

• Speech is the physical production of sounds: articulation, voice, and fluency. A child with a speech sound disorder knows what they want to say but has trouble saying the sounds clearly.
• Language is the system of meaning: the words we know, how we combine them into sentences, and how we use them socially. A child with a language disorder has difficulty understanding language, expressing ideas through it, or both.

A child can have one, the other, or both. That’s one reason a comprehensive evaluation matters: the right treatment depends on where the breakdown actually is.

The three types of language disorders

Receptive language disorder

Difficulty understanding language. A child with receptive language challenges may seem to “tune out,” struggle to follow directions, answer questions off-topic, or rely heavily on routines and visual cues to figure out what’s expected. Because these children often develop clever workarounds (watching what other kids do, reading facial expressions), receptive difficulties can hide in plain sight for years.

Expressive language disorder

Difficulty using language to communicate. These children typically understand far more than they can say. They may have a small vocabulary for their age, use short or grammatically immature sentences, struggle to retrieve words they know (“that thing… the thing you cut with”), or find it hard to tell a story in a way that hangs together.

Mixed receptive-expressive language disorder

Difficulty with both understanding and expression. This is common: comprehension and expression develop together, and challenges in one often affect the other.

When a language disorder occurs without another explaining condition (like hearing loss or autism), it’s often diagnosed as developmental language disorder (DLD). DLD is remarkably common (research suggests it affects roughly 7% of children, about two students in every classroom) yet it’s far less widely known than conditions that are much rarer.

Signs of a language disorder by age

Toddlers (18 months – 3 years)

• Not using at least 20 words by 18 months or 50 words by 24 months
• Not combining two words (“more milk,” “daddy go”) by age 2
• Difficulty following simple, familiar directions without gestures
• Not pointing to common objects or body parts when named
• Frustration, tantrums, or giving up when trying to communicate

If this sounds like your toddler, see our guide to late talkers and early language development, early support makes a measurable difference.

Preschoolers (3 – 5 years)

• Sentences noticeably shorter or simpler than peers’
• Grammar errors beyond what’s typical (“him goed there” persisting past the expected age)
• Trouble answering “wh-” questions (who, what, where, why) appropriately
• Difficulty following two-step directions (“get your shoes and put them by the door”)
• Hard time retelling a simple story or describing what happened at preschool

School-age children (5+)

• Difficulty understanding classroom instructions or multi-step assignments
• Trouble organizing thoughts into clear sentences and paragraphs, spoken or written
• Word-finding difficulties: frequent “um,” “stuff,” “thing,” or talking around a word
• Struggles with reading comprehension despite adequate decoding
• Difficulty with conversation: staying on topic, taking turns, repairing misunderstandings

Language disorders don’t disappear at kindergarten. They change shape. Because school is language, untreated language disorders are strongly linked to reading difficulties, academic struggles, and social frustration. The good news: these are exactly the skills therapy targets.

What causes language disorders?

Often, no single cause can be identified. Developmental language disorder tends to run in families, suggesting genetic factors. Language disorders can also occur alongside or secondary to other conditions, including hearing loss (even mild or fluctuating loss from chronic ear infections), autism spectrum disorder, intellectual disability, premature birth, and neurological injury. A language disorder is never caused by bilingualism, “lazy” parenting, or a child being stubborn, and learning two languages does not cause or worsen a language disorder.

How language disorders are diagnosed

A speech-language pathologist diagnoses language disorders through a comprehensive evaluation that typically includes:

• Parent interview: your observations, your child’s history, and what communication looks like at home and school
• Standardized testing: comparing your child’s receptive and expressive skills to age-based norms
• Language sampling: analyzing how your child actually talks during play or conversation, which often reveals things tests miss
• Hearing screening referral: ruling out hearing loss as a contributing factor

You’ll receive clear findings, a diagnosis if one is appropriate, and a written plan of care with specific, measurable goals.

How speech therapy treats language disorders

Language therapy is highly individualized, but effective treatment shares common threads:

• For younger children, therapy is play-based. The SLP embeds targets into games and routines: modeling richer language, expanding what the child says (“doggy run” → “yes, the big dog is running fast!”), and creating irresistible reasons to communicate.
• For preschoolers, therapy targets vocabulary networks, sentence structures, question comprehension, and early narrative skills, often through books, pretend play, and structured games.
• For school-age children, therapy becomes more explicit: learning how sentences and stories are built, strategies for word retrieval, comprehension monitoring (“do I actually understand this direction?”), and the academic language that classrooms run on.
• For every age, parent coaching is central. The strategies your SLP teaches you (how you respond, expand, and pause) turn everyday routines into hundreds of practice opportunities a week.

Does online language therapy work?

Yes. Language therapy translates exceptionally well to telehealth because it’s built on interaction, not physical manipulation. Research comparing telehealth to in-person language intervention consistently finds comparable outcomes. There are practical advantages, too: children participate from the environment where they communicate most (home), parents are naturally present to learn strategies, sessions survive snow days and sick siblings, and families aren’t limited to whichever SLPs happen to practice nearby.

Stoa sessions are live and interactive: screen-shared games, digital books, movement breaks, and real toys from your own living room. For toddlers, sessions are structured as parent coaching: the SLP guides you through techniques in real time while you play with your child.

What you can do at home right now

• Follow your child’s lead. Talk about what they’re already interested in: attention is where language sticks.
• Expand, don’t correct. If your child says “car go,” respond with “yes! The red car is going fast.” You’re modeling the next step up without making talking feel like a test.
• Read together daily, and talk about the pictures rather than racing through the text. Pause and let your child fill in familiar words.
• Give language time. After you ask a question, silently count to five. Children with language difficulties often need extra processing time, and usually get interrupted before they’ve had it.
• Don’t wait and see. If your gut says something’s off, an evaluation will either give you a plan or give you peace of mind. Both beat worrying.

Frequently asked questions

Will my child grow out of a language disorder?

Some late-talking toddlers catch up on their own, but true language disorders generally don’t resolve without support. They evolve, affecting reading, writing, and social communication as school demands grow. Because it’s impossible to predict early which children will catch up, experts recommend evaluating rather than waiting.

Is a language disorder the same as autism?

No. Language disorders can occur in autistic children, but most children with language disorders are not autistic. A key difference is social connection: children with isolated language disorders typically point, share attention, and engage socially. They just struggle with the language itself. An evaluation can help clarify the picture. Learn more in our guide to speech therapy and autism.

My child is bilingual. Could that explain the delay?

No. Bilingual children may split vocabulary across languages, but bilingualism does not cause language disorders. A true language disorder shows up in both languages. Evaluations should account for all the languages your child hears.

Does insurance cover language therapy?

Most plans (including Medicaid in the states we serve) cover medically necessary speech-language therapy. Most Stoa families pay $0–$30 per visit. We verify your benefits for free before your first appointment. See our insurance guide.

How long will my child need therapy?

It varies with the child’s profile, age, and goals. Some children make their targets in a few months, others benefit from longer support as academic demands increase. Your SLP sets measurable goals from the start and reviews progress with you regularly, so you always know where things stand.

Concerned about your child’s language? Book a free consultation with a licensed speech-language pathologist, or call (517) 997-8198. We serve families across Virginia, Colorado, and Louisiana. Illinois is joining soon.

Related conditions

• Dysarthria
• Professional Communication Coaching
• Aphasia