We use models of language to try to understand how the brain processes language. These models are often reflected in assessment. You may have seen a report where language was divided in the areas of Language Content, Form, and Use. There is a description of the language vocabulary and knowledge under Content, a description of grammar and sentence structure under Form, and a discussion of social communication skills under Use.

Although useful to describe a student’s functioning, this break-down does not reflect how language is being processed in the brain, and it leads to artificial divisions in language tasks. As such, you may see artificial and isolated goals on a program plan – “the student will recognize and produce more complex sentences containing a subordinate clause” or “the student will demonstrate knowledge of grade-level vocabulary”.

The problem here is that the resulting therapy or activity also becomes artificial. Composing sentences with sub-ordinate clauses over and over will marginally improve comprehension or one’s ability to express one’s self.

Flashcard drills with grade level vocabulary will improve access to curricular knowledge, but may do very little for oral lecture or reading comprehension, where those new vocabulary words are used in complex sentence structures, or used in a way that relates and assumes prior knowledge and the ability to connect to it.

The reality is that language is an integrated process. For example, your overall comprehension will depend not only on your word knowledge (Content), but also your ability to recognize and process sentence structure complexity (Form), as well as your ability to make inferences about the sentence, connect to information beyond the sentence, or connect to information not explicitly stated in the sentence (Use). In other words, there is an inter-play between these language elements; for any given sentence there can be challenge in any (or all!) of these above areas, and you really cannot isolate the challenge to one “skill” or one area of the brain. Rather, it is the integration and consolidation of all of these elements of language that will impact performance.

Similarly, language is often broken up and described as “receptive language” to refer to comprehension or language understanding, and “expressive language” to refer to language output. Again, these terms can be somewhat helpful to conceptualize the tasks that a student is having difficulty with, but they are a false dichotomy – an artificial splitting of something that is inseparable.

For example, I know many people who use vocabulary words expressively that they don’t fully understand receptively! Similarly, difficulty organizing your thoughts to explain yourself likely relates to your overall ability to process language, your vocabulary knowledge, and your knowledge of word and sentence level grammar. These skills will also impact your comprehension from time to time. They cannot REALLY be divided at the language level.

I have never seen a child that could very articulately express themselves and then not understand anything when spoken to. It is also very rare that a child can understand EVERYTHING they are hearing but then not express themselves.

Of course, there are conditions such as stroke, traumatic brain injury, Selective Mutism, and Childhood Apraxia of Speech that may cause something like this to manifest; but then, what are seeing isn’t a true language disorder – it is a separate condition, and we are much better off to plan specific therapy that relates to the diagnosis rather than generalize it as “expressive language disorder”.

Once again, this false dichotomy can lead to assumptions, such as “the child understands everything they hear but can’t express themselves”. As such, therapies tend to be too broad and not focus on the specific problem – or tend to focus exclusively on speaking/writing tasks without addressing underlying knowledge, processing, and organization.

Research is showing us a better way. Task analysis is revealing that there are 2 separate levels of language processing that we use in language and literacy tasks. The two levels of processing are sound/word level and sentence/discourse level.

Of course, there is still interplay between them, especially in literacy, but we can begin to see separation where you can have disorder in one, and not the other. And this reflects effective performance in some aspects of learning, and not in others. And low and behold, this is what we tend to see in our students – patterns of unexpected difficulty or “disability” that only show up in certain activities; and these children tend to be undiagnosed, misdiagnosed, or diagnosed late.

What we see is that children with difficulty at the sentence/discourse level of processing tend to get identified because they don’t know as much as other children, or learn it more slowly. This is easier for us to “see” as parents and teachers, and tends to reveal itself with traditional assessments that a Psychologist or Speech – Language Pathologist administers. These test results are easy to interpret, and the disorder rarely gets missed.

Child have an Undiagnosed Language Children with disordered sentence/discourse processing often don’t learn concepts well; they have difficulty following directions; and they tend to show difficulty both in comprehending spoken language as well when reading. They may score low on vocabulary assessments.

Once identified, these children may receive a diagnosis of Receptive Language Disorder, Expressive Language Disorder, or both; they may be described with difficulty in Language Content and or Form. They may additionally have difficulty with Language Use, depending on their Social Functioning (a lot of kids can be quite successful socially without saying much using non-verbal language)!

A quick side-bar on reading comprehension: I’m not sure there is such a thing as a “reading comprehension problem”. I have never seen a child who exhibited difficulty ONLY in reading comprehension. If there ARE problems with reading comprehension, there are 2 things that must happen: You must thoroughly assess ORAL language comprehension with an apples-to-apples task (equivocal written and oral comprehension tasks) and you must assess reading decoding ability.

Simply put, if there is a problem with reading comprehension, there is also a problem with oral comprehension. And if not, then the child is having difficulty READING.

A cursory assessment won’t do. The brain is a MARVEL at compensating and finding ways to “get by” that mask a lot of surface-level assessments.

When we assess further – if we look at expressing word relationships, categorization, verbal reasoning, problem-solving, predicting, and inferring – the true deficit in this language profile will reveal itself.

So, we see poor comprehenders at the sentence/discourse level of processing. We may also see difficulty with organizing and expressing thoughts in spoken or written language, and difficulty with organizing and/or making connections. In addition to an underlying language disorder, co-morbid diagnoses such as ADHD and Autism Spectrum Disorder may manifest with difficulties at this level.

Regarding the sound/word level of processing, this is a profile I see over and over again. It is often identified very LATE, or NOT AT ALL until the child comes to my clinic.
The trend I notice is an abundance of children who seem to have good overall comprehension, and seem to have a decent vocabulary, and can express themselves verbally, but then they don’t learn to READ.

Upon assessment, “receptive” and “expressive” language appear fine, or there are pockets of deficit but the overall scores within average ranges. Vocabulary scores usually land in the average range. They score well on verbal comprehension measures.

These children learn from listening in class and can follow verbal directions. However, reading aloud is difficult, spelling is inaccurate, and there is low reading comprehension (because they can’t read)!!

Traditionally, vocabulary is assessed with the Peabody Picture Vocabulary Test, or the Expressive One Word Picture Vocabulary Test. We look at a child’s ability to label a picture, or to point to a picture that matches a word. We tend to assess concepts that lend themselves to pictures, meaning we don’t assess more abstract concepts!

Again, children within this profile are learning word meaning through intact processing at the sentence/discourse level. So, they are learning from lecture, experience, and context. They ace traditional vocabulary tests. Their problem is not in simple word meaning.

We also tend to test these children on language comprehension with sentences and pictures. However, because these children have intact sentence/discourse level processing, they can accurately answer the question “Which ocean is warmer, the Pacific or the Atlantic?” after hearing an informational passage read aloud.

However, these are the same children that will mistakenly tell you that they travelled to the “specific” ocean for their holiday! There IS an underlying deficit in word structure knowledge and word identification!

What is going on here? The problem lies in the sound/word level of processing. And where that shows up is in the ability to process information at the sub-word level. These are children that will show speech sound substitutions and omissions when they are young – saying “tat” for “cat” or “poon” for “spoon”. As they develop, the sound sequencing abilities start to fill in, but you may still catch errors such as “amblience”, “hosibal”, or “resternaut”.

Where these children struggle is with isolated words, when there is no supporting context. They struggle with single-word reading. They struggle with spelling. They may struggle with speech. They may have difficulty with word recall or naming. And it is hard, because they are missing or mis-perceiving information about the sound structure that makes up the word.

Sound like your child? Ask them to break a word into syllables. Ask them to tell you how many SOUNDS are in a word (most will answer with the number of letters)! Ask them to tell you which vowel sound they heard. Ask them if it was a long or a short vowel. Ask them to tell you the word, sound-by-sound in sequence (k-a-t for “cat”). If you run into ANY difficulty here, you have found the source of the problem: the sound/word level of processing.

Did your child have a dickens of a time learning pronouns? Trying to tell the pronoun concepts apart, and use the correct pronoun form in the right sentence position? Did your child say “runned” and “broked” and “mouses” and have difficulty processing the WORD-LEVEL grammar that dictates the forms of these words?

Did they mis-match grammar such “her was”, “the boys is”, “the girl am” etc.?

Do they miss or omit little grammar words in their writing, such as “a”, “the”, “is”, “am”?

When they read, do they ADD these little grammar words that aren’t actually there? Do they look at the first letter of a word, and then guess something that could fit the sentence structure, but looks NOTHING like what is on the page?

You have found your culprit. The sound/word level of processing underlies almost ALL of literacy difficulties, because in literacy we are processing words sound-by-sound and letter-by-letter. We are not looking word-by-word and sentence-by-sentence.

As children get more proficient, we do become “whole word” processors and develop and retain “sight” words; however, children will not get to this point until they can process at the sub-word level. They cannot tap into their intact processing until they can put the sounds/letters together to identify and recognize WORDS. Once the word activates in the brain, they can begin to tap into their intact word meaning – but not before.

That’s the tragedy in all of this. There are usually some strong, intact language skills, but they are USELESS until activated; and if you can’t read, you can’t activate them. If we could these children to identify words, to the whole-word level of processing, they would likely be off to the races! (Spoiler alert … we CAN, with intuitive instruction)!

The real tragedy: in schools, children endure hour upon hour upon hour of Leveled Literacy Intervention – a reading tool that focuses on having children identify “whole words” in text.

Within LLI, children are encouraged to “think about what would make sense” and to “look at the pictures”. From these cues, they can use their sentence/discourse level processing to limp through the passage and survive the activity. But they don’t learn a THING about how to read!

The next day, and the next week, and the next YEAR, they are STUCK on the same level, because no one is teaching them how to read sound-by-sound, letter-by-letter. Instead, they are cueing them through each word, each sentence, each paragraph, with the intention that the child can comprehend when they get to the end.

Of course they can comprehend! They have intact sentence/discourse level processing. These children DO NOT need cueing on visual memory and word meaning – these skills are INTACT. What they CAN’T do is read letters, letter-groups, and words. These children need instruction on sound processing and letter patterns. And they are NOT getting it through this program.

Sadly, all of this school time is wasted. And a good chunk of children’s self-esteem, confidence, persistence, and willingness gets wasted too.

Research shows us that “sight words” in these children do not form from this “exposure” therapy. It DOES form from teaching in the source of their errors – at their specific level of processing – sound/word level instruction.

These children are being taught to compensate with their strengths – their visual memory for words, and their intact word-meaning knowledge when reading. They are being taught to make “educated guesses” about words based on the context, the sentence structure, the pictures, and the overall “big picture” of what the story is about.

They are not being taught to read.

Why? The underlying LANGUAGE DISORDER is unidentified.

In summary, I advocate for describing language across two levels of processing – the sound/word level and the sentence discourse level.

I advocate for moving beyond surface, cursory assessments that really only look predominantly at the sentence/discourse level of processing. I also advocate for moving away from artificial descriptive terms such as receptive and expressive language, or language content, form, and use.

Sadly, many people do not recognize that reading and writing are just language tasks that have been put to paper. If there is a problem in reading or writing, there is an underlying LANGUAGE problem 99% of the time.

It further frustrates me that many people do not recognize sound processing as part of the language system. Research shows us that not only is sound processing intricately connected to language networks, it underlies almost all developmental language tasks. It may be THE most important part of the language system, and it goes UNASSESSED far too often.

Many people think of sounds, and then think of speech, and think sounds are SEPARATE from language. This thinking is archaic and detrimental.

My hope is that you can recognize red flags for underlying language disorders in children – difficulties comprehending, organizing, expressing, problem solving, demonstrating a logical thought process, reading, writing, spelling, and saying words CORRECTLY (rather than CLEARLY) with the correct sounds in the correct order.

Got concerns? Rightly so! Get to work and advocate for more comprehensive language assessment. You will finally get the answers to explain your child’s or student’s learning challenges.

Also, check our video on Does your child have an underlying language disorder.