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Does My Child Understand Me?

When responses seem off-key, there may be a delay in receptive-language function.
 

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James is a bright, active 4 year old who loves to talk. This chatterbox is great at expressing himself — yet his mom has noticed something that concerns her. "He talks up a storm, but sometimes I'm not sure he fully understands what other people say to him," she explains. "This seems to limit his ability to follow directions and interact with other children." James's mom, understandably, is looking for ways to help him.
 
What James's mother describes is fairly common. I've seen a number of children just like James who speak clearly and well, but who don't always respond appropriately when spoken to. A child like this might say, "I want to go outside." But when you say back to him, "Oh, that sounds like fun. Would you like to go on the swings?" he may start talking about the toy he's holding in his hand.
 
It's tricky: It's comparatively easy to diagnose a child who is not verbal at all, or who has obvious delays in spoken language. But when the child is like James, who is very verbal but whose responses strike an odd chord, it's a challenge to diagnose him as having a language problem. It sometimes seems like he's just marching to his own drummer (perhaps he just didn't feel like answering when asked if he wanted to go on the swings). But it may be that he has a delay in receptive language: Perhaps he's not able to understand everything that is said to him. This can result if the child has some unevenness in the way different parts of his nervous system are developing. His expressive functions (ability to talk) may be developing faster than his receptive ones (ability to comprehend), so it's these that need a little help catching up.
 
Rule Out Hearing Problems
When there are suspected receptive-language problems — indeed, when there are any language-development problems — it's always a good idea to first make sure your child can hear properly. Consider getting an audiological evaluation — a fancy term for a comprehensive hearing test — even if your child is obviously able to hear most things. Some children hear loud sounds at certain frequencies, but not at others. Other children may be oversensitive to certain frequencies. A high-pitched voice, or the background chatter in a busy preschool, may make it hard for these children to listen properly, even though they are able to hear and process sounds in a one-on-one situation. There are a number of other medical problems that can contribute to receptive-language delays, so it's wise to recommend that the child have a general pediatric evaluation as well.
 
Simple Practice Strategies
Assuming that hearing and any other physical problems are ruled out, there are a number of things you can do to help your child develop receptive-language skills. Keep in mind that the goal is to build up to having long conversations in which your child responds appropriately each time. These strategies can help:

  • Talk about everyday events. When your child is chatting about something, ask questions or make comments that she has to understand in order to go on with the discussion. Be careful not to make your questions or remarks too difficult, or she'll just clam up. Center your talks on things your child is interested in (going to the park, her favorite cartoon character) so that she'll be motivated to try to comprehend what you're saying.
     
  • Encourage thinking skills. Ask multiple-choice questions such as, "When you go outside, do you like to play, pick up your toys, or go to sleep?" Two choices are obviously silly, while one is a good choice. Always give the good choice first; otherwise, your child may just repeat the last thing he hears. Asking in this way prompts your child to process what he's heard.
     
  • Play a "follow directions" game. For example, if your child asks for a cup of juice or a treat, say, "Oh, let me help you get that. But first you have to pull me up from my chair. Then you have to show me where it is." Keep making requests — things she needs to do for you first, starting with only one thing, then two things, and so on. Again, the idea is to motivate her to tune into what you're saying. In order to get what she wants — the juice or the treat — she has to understand your requests.
     
  • Hunt for treasure. Hide something that your child likes and give him clues as to where to find it. Begin with simple clues, such as "What's in the green box right behind you?" Gradually offer more complicated clues: "It's behind the big plant on the stairs, near the radiator." It's also helpful to integrate visual clues with verbal clues to nudge receptive language along. You might show pictures of where something is hidden (perhaps using your digital or cell phone camera) as well as tell him where it's hidden. Eventually, see if your child can find the object by relying on verbal clues alone.

If your child fails to make adequate progress after you work with her, consult a speech pathologist. This professional will do a formal assessment and identify where the problem lies. If your child shows other delays, such as in her fine- and gross-motor skills or her cognitive or social capabilities, you'll want to have an overall developmental evaluation done.
 
It can be easy to overlook receptive language delays, since they can be subtle and more difficult to identify. Nonetheless, the ability to process language is extremely important. With time, the proper encouragement, and perhaps therapy, your child should find that his receptive-language skills improve greatly.

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