Speech-Language Pathology/Receptive/Expressive Delay
I'm going to do my best to be brief but thorough.
Thank you for taking the time to answer.
My son is 2 yrs and 6 months. He was a 9 week preemie resulting from Chorio. He met his milestones slightly behind even for his gestational age but I didn't notice a delay until two when he wasn't forming sentences at all. He had a good vocabulary of words and "phrases" (learned as a whole and noninterchangeable) and barely qualified for speech therapy which he started at two.She was originally concerned with the rigidity in his speech patterns and his wariness of strangers and new things plus an utter fascination with only one type of toy and thought it could be autism. Though his imaginative play seemed to come more into it's own and he stopped having issues with eye contact after a month or so. He finally started to mimic her and she started to think he was in a position to retake the expressive test as she thought he was up to the level of his peers.He received a 97 and then when she gave the receptive just as a formality (he scored appropriately the first go-round) he did not do well. She didn't give me the score but he couldn't identify the pictures of "baby sleeping, eating" ect. He didn't know his prepositions. It was obvious that he didn't understand what was asked of him at all.
So instead of exiting therapy we are now back in with a new focus on receptive language. I feel as though, however, since I was highly emotional when she brought up the original fear of autism that she won't level with me now about what we are dealing with. What causes a receptive language delay? I am certain with the new information available about his receptive language issues that the expressive makes more sense. But how could his expressive be so much higher than his receptive?
I do love my therapist, she is quite sought after in her field and she strives to be unwaveringly positive. But I just want someone to tell me straight. He doesn't appear to have the markers for autism (that I can see), his play is imaginative (puts animals to sleep, pretends to answer phone), he has great eye contact, asks for help, points, and seems to like being around other children his age. Following them and running around, at least, with the communication gap. He loves to spend time with people and is very affectionate.
But as for communication...it's strained. He still doesn't make sentences organically (not even puppy go, truck go, want more, ect). Without gestures he cannot follow a more than a single word (action verb) command. With gestures it is much better but without it is another story. I can genuinely see that he doesn't follow at all. He uses a lot of repetition and "favorite phrases" at home (oh-oh, you okay?, oh-no, I did it but the words still aren't interchangeable) as well as a ton of babble. Once he learns something it is impossible to unlearn it (puppies still say meow after a year of corrections) and there things he just won't say (milk is wa-wa and no amount of correction will change that) Though he can almost count to ten. It's a quandary.
I am not asking you to diagnose my son, of course, and do have an SLP in place. She makes me feel as though when I ask these kinds of questions that I am being negative. When I bring up a concern she usually dismisses me with, "oh, that's normal" though I don't hear or see it from other children his age. Though while we as adults may never see eye to eye, my son LOVES her. He responds to her so well that I would never consider moving him. Who he is comfortable with is more important than my questions.
But that doesn't stop me from wanting some answers and that leas me to you. What I want to know is a few things. Is receptive language delay always indicative of something more or is it just that?
Does it "resolve itself" with therapy or is this going to be a lifelong struggle with comprehension?
What are the challenges that he will face as an adolescent?
Is there still a possibility of autism without the issues of eye contact or repetitive behaviors?
What causes an expressive language score to be higher than receptive? How can that be? Isn't that like having the cart before the horse?
Again, thank you for volunteering your time and energy to calm and assist neurotic mothers like myself. Your time is most appreciated.
Dear Concerned Mother:
I will do my best to answer your questions, without knowing your child.
1. Does it "resolve itself" with therapy or is this going to be a lifelong struggle with comprehension?
Language difficulty does not usually resolve itself no, at an early age it manifests itself as a delay in development and without treatment it can have effects on academics and learning.
2. What are the challenges that he will face as an adolescent?
Possible learning difficulties.
3. Is there still a possibility of autism without the issues of eye contact or repetitive behaviors?
There is always a possibility of a spectrum disorder due to the fact that all children on the spectrum develop so differently and do not always manifest the same symptoms. Find an Autism specialist in your area and get a consult.
4. What causes an expressive language score to be higher than receptive? How can that be? Isn't that like having the cart before the horse?
This result is usually indicative of a hearing impairment or a language processing difficulty. Consult with an Audiologist to confirm or rule out either of these possibilities.
Barbara Cardeso, M.S., CCC-SLP