High Level Language Disorders

Disclaimer: This information sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

What is it?

Language - Is the understanding and use of words and sentences to convey specific thoughts or meaning in connected speech. Higher level language abilities include the child's ability to conceptualise, manipulate and judge the content and meaning of language. These skills allow a child to discuss, think and talk about language as an object that can be analysed.

The ability to use these skills requires an underlying understanding of all of the meaningful linguistic units in language eg. phonology, syntax, semantics, morphology and pragmatics.

What are high level language problems following brain injury?

These are difficulties that manifest when the length, detail and the complexity of expressive and receptive language increases. High level language difficulties can often affect a child's ability to summarise information, make inferences, glean the main idea or predict outcomes from language. Quite often children can seem quite rigid or concrete in their understanding or use of language, and often lack the flexibility required to understand humour, sarcasm, multiple meanings or non-literal meanings in language.

High level language skills can be effected across all modes of communication or in one specific area, these areas include: reading, writing, speaking and understanding.

High level language difficulties are generally further confounded by any cognitive defects that may have resulted from the brain injury. In particular, speed of information processing, memory for events and previous conversations, as well as, concentration and an awareness of the problem may directly impact on a child's higher level language abilities.

What are the symptoms?

Children may have problems in the following areas:

• understanding or using words with multiple meanings eg. duck, check, shed etc
• understanding or using ambiguity
• understanding or using humour and sarcasm
• using a variety of sentence forms to convey the same meaning
• judging the appropriateness of words or language units
• awareness of the necessary genres or various request forms in social language
• recognising language as a set of individual meaningful units
• judging the correct use of grammar
• segmenting language ie. or words into sounds and sentences into words
• summarising meaning and content either receptively or expressively
• not keeping up with his/hers classmates either academically or socially

Who do I see and how is it diagnosed?

A Speech Pathologist will be able to assess whether a child is experiencing higher level language difficulties or if they are having other difficulties with their speech and language development.

A paediatric speech pathologist experienced in looking after children with brain injury is highly recommended.

The local brain injury service will usually have a speech pathologist or be able to advise you to find a suitable speech pathologist.

What is the treatment?

The speech pathologist will perform a formal speech assessment to further identify the problems and strengths in relation to language function.

An assessment and input from a Neuropsychologist can also be helpful in identifying any other cognitive problems that may impact on higher language functioning.

School based language intervention is also recommended to teach the child strategies in copying with their difficulties. Special education teachers can help set up an individualised education program.

Rehabilitation Department The Children's Hospital at Westmead Cnr Hawkesbury Rd & Hainsworth St, Westmead Locked Bag 4001, Westmead, 2145 Tel: (02) 9845 2132 - Fax: (02) 9845 0685 http://www.chw.edu.au/rehabilitation/