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Psychologist in Sussex, England » Speech and Language Difficulties
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Speech and Language Difficulties


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Speech difficulties refer to problems with the perception or articulation of speech sounds, while language difficulties refer to a range of problems that can interfere with communication and the cognition.

Speech and language problems fall into two categories: receptive and expressive. Any child who has difficulty understanding language will also have problems with expression, but some children have good receptive skills while being unable to formulate their thoughts and feelings into spoken language. For this reason, the Diagnostic and Statistical Manual of Mental Disorders - 4th Edition (DSM-IV, 1994) gives criteria for Receptive and Mixed Expressive/Receptive Language Disorder.

Problems can occur with both categories (receptive and expressive) at several levels: phonology, syntax, semantics and pragmatics:

Receptive Expressive
Phonology problems distinguishing between sounds as in ‘van’ and ‘than’ articulatory problems e.g. ‘fink’ for ‘think’
Syntax problems extracting meaning from grammatically complex sentences e.g. thinking that ‘the cat was bitten by the dog’ means ‘the cat bit the dog’ grammatical construct interferes with meaning e.g. ‘the cat that dog bit’
Semantics understanding meaning communicating meaning
Pragmatics understanding the communicative purpose of language, including non-literal meaning as in sarcasm, irony and metaphor e.g. an autistic child may see a sign saying ‘Please knock the door’ and knock each time he passes using language in a socially appropriate way e.g. tone of voice, eye-contact, turn-taking, maintaining a shared topic

It is important to remember, when looking at the above table, that a child’s speech and language are only delayed if inappropriate for his/her age. Deviant language difficulties are those that are considered ‘odd’ for a child of any age.

Some children will be generally delayed, i.e. their development in all cognitive areas will be slower than is usual. For others, development occurs at a generally normal pace with the exception of one or more areas of speech and language. It is then the term specific language impairment, or difficulty, is used.

The above linguistic categories help us to describe, understand and assess speech and language difficulties. The reasons, or aetiology, of the problems fall into medical categories: structural defects of the speech apparatus; hearing loss; brain loss; brain damage; emotional/behavioural disorders (e.g. elective mutism); environmental deprivation (Donaldson, M. 1995. Children with Language Impairments. Jessica Kingsley, London). The difficulties can be primary, or the secondary effect of another disorder - as in the case of hearing loss.


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