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Receptive Language Disorder (Comprehension and Understanding)

Children with receptive language disorder have difficulties with the comprehension of language, understanding words, sentence structures or concepts. Sometimes in these cases the child’s expressive language may give the impression they are functioning at an age appropriate level, but their understanding may be compromised. The child with a receptive language disorder or delay may appear to understand because they are able to pick out key words in sentences and follow non-verbal clues such as pointing or eye gaze of the speaker. If you are concerned that your child is has langauge problems, or is having difficulty understanding language, start by checking their hearing. You can also try a couple of tests yourself – give them simple instructions that are out of context, such as ‘Please get you coat and boots’ when it is not time to leave the house (remember to give no non-verbal cues such as pointing or eye gaze). Simple tests like this are not perfect but they may help you to assess whether the child can understand your words. If you have concerns regarding your child’s receptive language development visit your local speech and language pathologist / therapist for a language assessment and advice, and the possibility of speech and language therapy.

 

There are things parents can do to help their children. Talk about things as you do them so the child learns to link words with actions. Play with your child! Play helps develop speech and language skills. When playing, let your child take the lead and expand on their words and sentences, but do not dominate the play or request your child names things all the time. The child should feel that they are under no pressure to perform. Avoid complex concepts and try and use more visual examples such as picture timetables. Keep your language simple, your sentences short and clear, emphasizing key words and showing the child what to do as you tell them.

 

Milestones for receptive language development

As with expressive language the development of a child’s communication skills vary enormously. Some children will develop certain skills quicker than others, and some children will vary significantly in the development of certain skills compared to their peers, even if there are no related problems. The table below is just a guideline and many experts vary considerably on what they believe to be the normal stages of development. You will see that many skills mentioned in the table below are repeated over several age groups as children are all different and some take longer to develop these abilities. So just use this chart as a very general guideline rather than read too much into it. There also may be some difference between boys and girls and when they develop certain skills.

To try and make this chart easier to read I have created a fictitious child called Bill. Bill was lucky, he had a childhood free of any illness or accidents and he had pro-active parents who played with him and gave him lots of quality 1:1 attention.
Milestones for receptive language Age  0 – 12 months
Birth – 3 months – Responding. At this age Bill will not be understanding what is being communicated but will begin to respond to the face of a familiar person by quietening or smiling.

4 – 6 months – Making sense of sounds. At this age, Bill is starting to make some sense of the world around him and beginning to localize the sound source, respond to his own name, discriminate between familiar carer and a stranger’s voice, and between angry and friendly tones. Bill will also start to explore, reaching out for objects and bringing objects to his mouth.

7 – 9 months – Understanding. Bill will start to respond to others and communicate with arm gestures and vocalisations. We may also see the beginnings of cause and effect understanding and as this develops he will repeat the same actions as he realises he has control of events. Bill may be able to recognise a couple of words by localising objects when named. An activity may be stopped when he hears the words “no-no” or his name is called. He also begins to recognize the names of familiar people.

9-12 months – Understanding and Interacting. Bill is now becoming a more interactive communication partner, giving objects, pointing and showing. His understanding of common words is increasing, he has an awareness of familiar people and situations and he understands phrases in set contexts e.g. “ready, steady, go!” Bill is also exploring more and more and is able to move objects from one hand to another and sometimes able to hold one object and pick up another with a different hand. His ability to follow simple commands is also increasing (e.g. “put that down”, “stop that”) although he is likely to get visual and intonation cues which will help him understand these commands.

 

Milestones for receptive language 12 – 18 months
Receptive understanding is now ahead of expressive language so Bill will understand more words than he can produce learning a new word every week. At 18 months some babies may understand up to 50 words and recognise many environmental sounds. Bill will also recognise objects and know what they are used for e.g. spoon for stirring or eating. Bill will start to be able to match identical objects. Bill will look for objects removed from his line of vision, knowing that when an object is out of sight it does not mean that it ceases to exist (the beginnings of object permanence). He will have learnt that some events are predictable and that an action causes a response e.g. flipping a light switch will turn on / off the light. He will learn the names of his body parts and be able to point to them on request and his ability to recognise familiar phrases will increase (especially when accompanied with gesture), often picking out key words in the middle of the sentence.

 

Milestones for receptive language 18 – 24 months
By this age Bill is understanding many single words and a few two word combinations. His receptive vocabulary is far in excess of his expressive vocabulary and he is possibly understanding 250 – 300 words. There is also an understanding of some “wh” questions (what/where/who) and he can point to major body parts, clothing items, toys and food when asked and is discriminating between songs. Bill is beginning to understand personal pronouns (my, mine, you) and starting to understand that things fit into categories (animals, food etc). His understanding and use of objects becomes more appropriate, with an ability to use simple conventional objects in an appropriate manner, e.g. hitting pegs with wooden hammer. Bill imitates some adult behaviour, plays simple games and points to objects in pictures. Object permanence is now well demonstrated and Bill is able to find familiar objects when not in sight. Bill’s understanding of cause and effect is also developing further, which makes certain toys more fun.

 

Milestones for receptive language 24 – 30 months
Along with the growth in expressive language Bill’s understanding of language is growing at a fast rate. He is following 2-step instructions easily and understanding sentences containing simple prepositions – in/on/under and different sizes (big / little). His understanding of pronouns also increases and he can differentiate between he / she / they / we. Bill probably now understands the meanings of between 500-900 words, which is far in excess of the words he actually uses expressively. Bill is also developing other skills, he can match identical pictures and shapes and is understanding number concepts one and two. Bill is well aware of cause and effect now and knows that pressing buttons and pulling strings make things happen.

 

Milestones for receptive language 30 – 36 months
Bill is comprehending commands at a 3-word level and language of more complexity. He is also able to indentify objects by use, e.g. “Which one do we drink out of? Sleep in? Sit on?”. He understands the concept of “one” and “one more” and matches colours and shapes, and objects to pictures. As Bill’s knowledge of concepts are developing he is learning how to sort, sequence (completes 3 piece interlocking puzzle), categorize and attempting simple counting. Bill’s awareness of time is also developing and he understands today, yesterday, tomorrow.

 

Milestones for receptive language 36 – 48 months
Bill’s comprehension is now at a 3-4 word level, he can process complex sentence structures and understands 1500 – 2000 words. As he reaches 4-years old he can follow a command with 3 directions, can track a 6 word sentence and can retell a short story. Bill is making inferences and can understand the consequences of his and other people’s actions. His understanding of concepts and how his world works becomes more developed over his 4th year of life he will learn to understand many more abstract concepts:
•    Concepts such as quality / texture / quantity / day / night / empty / full / same / different.
•    Locational prepositions – next to
•    Comparatives – I am taller than you
•    Understands odd one out, which one is missing
•    Concepts of “one,” “many,” “big,” “little,” “same,” “different,” “empty,” “full,” “clean,” “dirty,” etc.
•    Concepts of time such as “night” and “day”.
•    Understands difference in past / present and future
•    Answers “what is missing questions” and identifies objects missing from a scene
•    Understands day / morning / afternoon / night
•    Makes comparisons of speed and weight
•    Attempts to answer problem solving questions – “what if”
Bill can now sequence a 3-piece picture story, he will stay with one activity for eight or nine minutes and his concentration and attention skills have developed so he can sit and listen to a 15 minute story.

 

Milestones for receptive language 48 – 60 months
Bill is now understanding up to 2000 words. Bill is also developing another important skill, he has metalinguistic awareness, that is, he is able to think about and comment on what he (and others) are saying. His understanding and thought processes continue to develop and his comprehension is now at a point where he can follow and process instructions containing 4+ information carrying words, or an 8 word sentence. He can follow 3-step commands when items/objects are not present. His story retell capabilities increase and he can retell a story from memory using 5 sentences. Bill can hold a message in his head and deliver it to another person. Bill has learning to count, and can count objects to 4 or 5. He can sequence 3+ pictures and understands opposite concepts. He can name the primary colours on request and identifies crosses, triangles, circles, and squares, and makes comparisons of speed and weight.His imagination is now feeding into his speech and he speaks of imaginary conditions with “pretend” or “I hope.” He can focus on a single activity for 11-12 minutes and he helps plan activities. His understanding of time concepts increases and he can follow language such as “early in the morning,” “next month,” “next year,” “noontime” and the difference between past present and future and day, morning, afternoon, night. His awareness of concepts related to spatial arrangements, e.g., “in front of,” “behind,” “far,” and “near” also increases.

 

Milestones for receptive language 60 – 72 months
Bill can state his birthday, full name and address. He stays with one activity for 20 minutes and uses problem solving and complicated reasoning to solve a task. Bill can make logical relationships and solves problems verbally. He also demands increasingly detailed explanations of things, sometimes to the point the adult is unable to answer. His classification of objects has also increased in complexity and he classifies by form, colour, use, or composition, e.g., “You eat with a fork.” “A fork is made of metal.” He continues to learn and understand new concepts such as “more” and “less.” He describes people, places or things using attributes. He names a time of day associated with an activity and recites days of the week and uses simple money concepts. Bill is using 2000 words, but understands 6000, and continues to ask the meaning of new words. He can listen and attend for longer periods of time which is a skill he requires as he is now attending school. Bill has a good grasp on reality and understands the difference between reality versus fantasy.

 

Milestones for receptive language 72 months +
Bill’s understanding of the world around him increases especially as he is now attending school. He has to listen, process and learn, often only by listening to information. However, his auditory memory and processing skills are such that he does not have difficulties taking on board and storing new information.

For a more detailed overview of child development and milestones – Click Here.

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