Developmental Expressive Language Disorder (DELD) is a childhood communication disorder that affects a child’s ability to use spoken language effectively. Children with DELD struggle with recalling words, forming grammatically correct sentences, and expressing their thoughts and feelings through speech. Unlike speech disorders that impact the physical production of sounds, DELD involves challenges in organizing and using language. Early recognition and intervention can significantly improve outcomes, helping children achieve better communication and social development.

Developmental Expressive Language Disorder (DELD) is categorized as a subtype of language disorder and is considered developmental because it is recognized during early childhood, which is the onset stage of speech and language development. While DELD can be lifelong, the severity of it can be minimized when early intervention and support is provided.

Children with DELD typically exhibit lower age-level vocabulary, have difficulty putting together complete or grammatically correct sentences, and may struggle with recalling words while talking. The child’s nonverbal reasoning intelligence is usually in the average range and his/her comprehension of spoken language is typically better than his/her speech expression.  

DELD is not a speech disorder related to the physical capacity to produce sounds, which may include stuttering and articulation disorders; DELD instead is a difference in how a child organizes language.

A speech disorder (like stuttering or an articulation disorder) will affect a person’s ability to physically produce the sounds necessary for speech. A developmental expressive language disorder (DELD) affects a child’s ability to organize and use language in a grammatically correct and meaningful way. 

An expressive language disorder is not the result of hearing loss, an intellectual disability, or other types of developmental delays. When a child has just a DELD without any other type of diagnosis, it is called a primary language disorder. When a child has DELD along with neurodevelopmental disabilities, such as autism spectrum disorder or intellectual disability, it can be classified as a secondary language disorder.

The exact cause of a Developmental Expressive Language Disorder is often unknown, particularly when it is primary and occurs on its own. There are risk factors and potential contributing factors that have been identified: 

• Genetic Factors: Family history is a strong risk factor. Children with a family history of a language or learning disorder are at greater risk of developing a Developmental Expressive Language Disorder. Certain genetic mutations, including changes on the FOXP2 gene that relates to speech and language development, have been associated with expressive language impairments. 
• Neurological Factors: Studies in the past have indicated that Developmental Expressive Language Disorder may relate to atypical development or atypical processing in the brain, particularly areas associated with language, which include Broca’s area and Wernicke’s area. Disputed neural connections that relate to production and organization of language can affect expressive language abilities.
• Premature Birth or Low Birth Weight: Infants who are premature or have low birth weight, are at high odds of developing delays including those with expressive language. These infants may have, underdeveloped neural systems, that will influence language and speech development.
• Environmental deprivation: DELD is not influenced through poor parenting or lack of interaction, however, sometimes, extreme environmental deprivation (for example, neglect, lack of exposure to meaningful, language rich experiences, etc.) may lead to consideration if the child is developing delayed or impairments in expressive language development. 
• Co-existing Conditions: DELD may co-occur with autism spectrum disorder, ADHD, intellectual disability, or hearing loss.
• Malnutrition (Rare situations): In rare situations, it is possible for chronic malnutrition, particularly during early brain development, to affect cognitive and language ability on a level, that could lead to delay or disorder in expressive language.
• Physical Abnormalities: Diseases or disorders that compromise and or affect the anatomy and physiology of the mouth, throat, or muscles which are related to making speech sounds; for example, those who are born with cleft palate or craniofacial anomalies/disorders like, neuromuscular disorder that impacts articulation could affect a child’s ability to say words consistently and distinctly. These issues primarily impact speech disorders, however, they will potentially contribute to expressive language disorders too, if they inhibit the child’s ability to communicate at all.

Developmental Expressive Language Disorder (DELD) is not an illness like the common cold or infection that a child “catches,” it is a developmental condition. DELD is likely to be noticed by caregivers as a child grows and learns to talk. Many children follow a developmental progression of learning language that will lead to successful communication milestones. In children with DELD, the expectations of the milestones will not be met, some milestones may take longer to develop or some may never be met.

Typical Communication Milestones:

• By 12 months: Says a few simple words like, “mama” or “dada”
• By 18 – 24 months: Beginning to combine 2 words in a simple phrase
• By 2-3 years: Beginning to form short sentences with clear development of vocabulary
• By 4-5 years: Ability to tell simple stories and use complete sentences with more than “one” grammatical form and factual organization

In the development of children with DELD you might observe:

• Very few spoken words at the age of 2
• Difficulty speaking simple sentences by age 3 
• Continued challenging with sentence structure and grammatical forms well beyond the age of 4
• Difficulty communicating a story or an event in detail

Children with DELD generally will have milestones that don’t match those of their peers between the ages of 2 and 5 years; this is typically a period when children are rapidly developing their language skills. However, in the mild cases, a child won’t be identified until they enter school and they struggle to complete classroom activities and social interactions requiring verbal communication of some sort; communicating how to do things is required for almost all lessons in most schools in one way or another.

Early signs can be subtle, so it’s important for parents and caregivers to pay attention to how their child is progressing with speech and language. If there are concerns, seeking an early evaluation can make a big difference in helping the child get the support they need.

Developmental Expressive Language Disorder (DELD) is fairly prevalent among children in school, and symptoms vary widely, including severity and age of onset. One hallmark of DELD is the difficulty in expressing thoughts, needs or ideas in a clear and practical way. Expressive language challenges often persist into adolescence or adulthood, although support and therapy may decrease the impact of the challenges.

Children with DELD also struggle to get their meaning or message across. Their communication may be noticeably different than their peers.

Children with DELD may demonstrate:

• Frustration and behavioral issues due to communication challenges
• Limited vocabulary for their age
• Short or incomplete spoken sentences (e.g., “Me want ball” instead of “I want to play with the ball”)
• Frequent grammatical errors
• Word-finding difficulties with pauses, filler words, or vague terms like “thing”
• Difficulty telling coherent stories or organizing thoughts
• Struggles with academic tasks such as writing, answering questions, or class discussions

Diagnosis typically begins in early childhood, sometimes as early as age two. A speech-language pathologist (SLP) conducts assessments and may collaborate with a multidisciplinary team. Steps include:

• Collecting developmental history
• Conducting a hearing test to rule out hearing loss
• Assessing vocabulary, grammar, storytelling, and verbal fluency
• Cognitive and behavioral testing to check for co-existing conditions
• Observations across settings, such as home and school

According to DSM-5 criteria, expressive language disorder is diagnosed when a child’s expressive abilities are significantly below age expectations, impair daily functioning, and cannot be explained by other conditions.

Differential diagnosis for Developmental Expressive Language Disorder

It is important to distinguish DELD from:

• Hearing impairments
• Intellectual disability
• Autism spectrum disorder
• Learning disorders
• Other speech disorders (e.g., stuttering, articulation disorders)

Treatment of Developmental Expressive Language Disorder or DELD does not typically result in any medication, but treatment is more about assisting a child with being able to better articulate expression. The broader goal of treatment is to be able to help a child communicate their thinking with language that is appropriate in a range of settings including home, school and their peers. 

Treatment approaches include:

• Speech-language therapy: Expanding utterances, modeling correct grammar, building vocabulary, storytelling practice, and using visual supports.
• Parental involvement: Reading aloud, discussing daily activities, playing word games, and modeling correct speech without criticism.
• Educational support: Individualized Education Programs (IEPs), classroom accommodations, and school-based speech therapy.
• Communication aids: Tools such as communication boards, speech-generating devices, or PECS can support communication.
• Treatment of comorbid conditions: Coordinated care for ADHD, autism, or learning disabilities.
• Counseling and support: Helping children cope with frustration and improving social confidence.

Developmental Expressive Language Disorder is a complex but treatable condition with regard to communication which impedes the ability of a child to communicate their thoughts and emotions orally. While the cause of DELD may often be an enigma, one should not ignore early signs of DELD such as delayed speech development, sentence-length and/or sentence-completion, and problems with telling stories. 

Identifying a language disorder as this during early development, especially with the help of a speech-language pathologist, using individualized language assessment and therapy, can be impactful. Children suffering from DELD can build communication abilities as well as confidence, which, with support of parents, teachers, and other professional partners, can be fostered into positive social and academic outcomes.

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4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)