Mixed receptive-expressive language disorder: what is it?

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

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Mixed receptive-expressive language disorder: what does it consist of?

The mixed disorder of receptive-expressive language, also called “receptive dysphasia”, is a language disorder that is characterized because both receptive and expressive language are below the normative according to age, evolutionary level and ability child’s intellectual (if we compare it with their reference group).

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

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

As a result of the aforementioned, in the mixed disorder of receptive-expressive language there are difficulties in communication that may involve both verbal and nonverbal language (for example, gestures). At the prevalence level, this disorder appears in approximately 3% of the child population.

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Diagnostic criteria

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

1. Scores below expected

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

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

  • Difficulties in understanding specific words, phrases or types of words (such as spatial terms)
  • The same difficulties that appear in expressive language disorder (where only it is affected).

2. Performance interference

Criterion B of the mixed disorder of receptive-expressive language states that the deficits that appear in receptive and expressive language create interference in academic or work performance, or social communication .

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

On the other hand, to be able to diagnose mixed receptive-expressive language disorder, the boy or girl must not meet the criteria for a TGD. That is, the diagnosis of TGD would cancel out the diagnosis of mixed receptive-expressive language disorder .

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

Finally, in the event that there is another previous diagnosis (for example: intellectual disability, environmental deprivation, sensory deficit or speech motor …), the deficiencies that appear in the 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 what expressive and receptive language consist of.

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 he answers me, I am evaluating his expressive language.

2. Receptive language

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

Difficulties in expressive language

As we have seen, the main characteristic of mixed receptive-expressive language disorders are difficulties in both expressive and receptive language. In expressive language, how do these difficulties manifest themselves?

The child’s vocabulary is substantially limited (that is, it has little vocabulary). In addition, difficulties arise in producing fast and fluid motor sequences. There are also difficulties in remembering words or producing phrases of length or complexity typical of evolutionary age . Finally, there is a general difficulty in expressing ideas.

Difficulties in receptive language

As for the receptive language of the mixed disorder of the receptive-expressive language, a difficulty to understand specific words, phrases or specific types of words appears. That is, broadly speaking, the child has 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
  • Impaired auditory memory
  • Deficits in auditory sequential memory

Subtypes of the disorder

There are two major subtypes of mixed receptive-expressive language disorder: evolutionary 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 the name implies, the disorder is acquired by a brain injury or accident . In these cases, the course is variable, and depends on the location of the injury, the severity of the injury, the age of the child at the time of the injury, etc.

Other classifications: DSM-5 and CIE

We have seen how the mixed receptive-expressive language disorder is situated within the 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 mixed disorder of receptive-expressive language, in the DSM-5, would become the language disorder.

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


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