Expressive language

Also called Language production, Output

Getting a message out of your head and into someone else's, by speech, sign, symbol, typing or pointing. The means doesn't matter; the message does.

What it is

Expressive language is the output side: choosing words, putting them in order and delivering them so someone else gets the message. Speech is one delivery method. Sign, writing, pointing to symbols, typing on a big-key keyboard and pressing a speech-generating device are all expressive language too.

That distinction is the whole point. A person who cannot speak may have rich expressive language waiting for a route out. A person who speaks fluently may have very little to say. Therapists separate speech (the sounds) from language (the words and grammar) for this reason, and it's worth learning to do the same.

Who it can help

Everyone whose message isn't getting out: the toddler who understands but points and grunts, the child with developmental language disorder whose sentences come out scrambled, the adult with aphasia hunting for a word, the non-speaking person of any age who has never been given a means.

It's not a label for a diagnosis. "Expressive language difficulty" describes what's happening, not why, and the why can be motor, neurological, developmental or simply that nobody has yet offered a way.

How it works

Expression has three jobs running at once. Retrieval: finding the word (word-finding difficulties are a breakdown here). Formulation: ordering the words and adding the grammar (grammar and syntax). Delivery: speaking, signing, selecting or typing. Any of the three can be the bottleneck, and they need different help.

In typical development, first words arrive around a year, the two-word stage around two, and sentences of four or five words by around three. Mean length of utterance is the number therapists use to track it. In AAC, the same stages apply and the same targets are reasonable, but only if the vocabulary on offer makes them possible. A board with nothing but nouns caps expression at one word, whatever the person could say.

Getting started

Model more than you ask. If a child says "car", you say "big car" or "car going" (expanding and recasting). Don't demand the repeat. And comment rather than quiz: "you've got the red one" beats "what colour is it?" every time (commenting rather than questioning).

For someone who doesn't speak, put a means in front of them today, not after the assessment. A core board printed on paper, or the Talk board, which has 308 symbol cards and a keyboard, and works offline in a browser. Then use it yourself while you talk, so they see the words being used before anyone expects them to use them (aided language stimulation).

Count what they express, not just what they say. A point, a sign, a pulled hand and a pressed symbol are all expressive language and all deserve a response.

Where to get help

Speech and Language UK for children, including a free parent helpline. Afasic for families of children with language disorders. For adults, the Stroke Association and Say Aphasia. The NHS route is a speech and language therapist; where AAC is needed, local AAC services sit behind them.