What happens when your child seems to hear you perfectly well, yet doesn’t follow simple directions? Do they look at you blankly after you’ve asked them simple questions, even though you know their hearing is fine? Do they seem to ignore clear directions?

This scenario points to a crucial but often misunderstood aspect of language development: receptive language. At FOCUS Therapy, our Fort Myers speech therapists work frequently with families who are navigating these exact concerns, and we want to help you understand the difference between hearing and comprehending—and why that difference matters so much for your child’s development.

The Difference Between Hearing and Understanding

Let’s start with a common misconception: if a child can hear, they can understand language. Unfortunately, as a Fort Myers speech therapist can explain, it’s not that simple.

Hearing is the physical ability to detect sound. It’s the mechanical process where sound waves enter the ear, vibrate the eardrum, and send signals to the brain. A child with normal hearing can detect when someone is speaking, respond to loud noises, and turn toward sounds.

Receptive language, on the other hand, is the ability to understand and process the meaning of those sounds. It’s about comprehension — making sense of words, following directions, understanding questions, and grasping the concepts being communicated.

Think of it this way: imagine listening to someone speak in a language you’ve never studied. You can hear every word clearly, but you have no idea what they mean. That’s similar to what a child with receptive language difficulties experiences, even in their native language.

This is why a hearing test, while important, doesn’t tell the whole story. A child can pass a hearing screening with flying colors but still struggle significantly with language comprehension.

Receptive Language vs. Expressive Language: What’s the Difference?

When we talk about language development, we’re really talking about two interconnected but distinct skills:

Receptive Language (Understanding)

Receptive language involves:

• Understanding spoken words and sentences
• Following directions (simple and complex)
• Comprehending questions
• Understanding gestures and body language
• Processing information heard in conversations or stories
• Identifying objects, people, or concepts when named
• Understanding concepts like “bigger,” “under,” “first,” or “before”

Expressive Language (Speaking)

Expressive language involves:

• Using words and sentences to communicate
• Asking questions
• Naming objects and people
• Describing experiences or telling stories
• Using proper grammar and sentence structure
• Expressing thoughts, needs, and feelings
• Engaging in back-and-forth conversation

Here’s an important point many parents don’t realize: receptive language typically develops before expressive language. In other words, children usually understand more than they can say. A toddler might understand, “Go get your teddy bear” long before they can say the sentence themselves. This is completely normal.

However, when receptive language is delayed, it creates a ripple effect that touches every aspect of communication and learning.

Why Expressive Language Delays Are Spotted First

It’s much easier for parents and caregivers to notice when a child isn’t talking enough or isn’t using words correctly. Expressive language delays are far more obvious — you can hear (or not hear) the words coming out of your child’s mouth.

If a two-year-old isn’t speaking in two-word phrases or a three-year-old has a very limited vocabulary, parents typically notice and seek help. These delays are tangible and measurable.

Receptive language delays, however, are often much more subtle. A child might:

• Seem to ignore you when you call their name (leading parents to wonder about hearing or defiance)
• Not follow simple directions consistently
• Appear confused during conversations
• Struggle to answer questions
• Have difficulty with pretend play
• Display behavioral issues out of frustration

These signs can easily be misinterpreted as behavioral problems, attention issues, or even hearing loss. Many parents don’t realize their child is struggling to understand language because the child has found ways to compensate—watching what others do and copying them, relying heavily on routine, or using visual cues instead of listening to words.

According to data from the Centers for Disease Control and Prevention, among children aged 3–10 with communication disorders, approximately 13.6% experience language problems, yet many of these issues go undetected or are identified later than they should be. This is partly because receptive language difficulties can be harder to spot than expressive delays.

The Hidden Impact of Receptive Language Delays

While expressive language delays are more immediately noticeable, receptive language difficulties can be equally—or even more—impactful on a child’s development and daily life.

Here’s why:

Academic Challenges

Children with receptive language delays often struggle in school settings where following multi-step directions, understanding lectures, and comprehending written material are essential. Research published in the Archives of Disease in Childhood found that specific language impairment affects 6–8% of children at school entry, and children with receptive language difficulties face particularly challenging long-term outcomes. The study noted that only 3% of children with severe receptive language impairment at school entry had achieved normal language skills six years later, highlighting that receptive difficulties rarely resolve without intervention.

Social Difficulties

Understanding language is crucial for social interaction. Children who can’t fully comprehend what their peers are saying may struggle to make friends, participate in group activities, or understand social cues and humor. This can lead to isolation and reduced self-confidence.

Behavioral Problems

When children can’t understand what’s expected of them, frustration builds. They may appear defiant, uncooperative, or disruptive when in reality, they simply don’t understand the instructions or conversation. This can create tension at home and school.

Safety Concerns

Understanding warnings, instructions, and safety rules is crucial. A child who doesn’t fully comprehend language may not respond appropriately to “Stop!” or “Don’t touch that—it’s hot!”

Limited Learning Opportunities

So much of what children learn comes through verbal instruction and conversation. When receptive language is impaired, every learning opportunity that relies on understanding spoken language becomes less effective.

How a Fort Myers Speech Therapist Can Help

The good news is that with proper identification and intervention, children with receptive language delays can make significant progress. This is where an experienced speech-language pathologist (SLP) becomes an invaluable partner in your child’s development.

Comprehensive Assessment

A FOCUS Fort Myers speech therapist will conduct a thorough evaluation that goes far beyond a simple hearing test. This assessment typically includes:

• Standardized receptive and expressive language tests
• Observation of how your child responds to directions and questions
• Assessment of vocabulary comprehension
• Evaluation of ability to follow increasingly complex instructions
• Analysis of how your child uses context clues and compensatory strategies
• Assessment of related skills like attention, memory, and processing speed

Individualized Therapy Plans

Once the evaluation identifies your child’s specific areas of difficulty, the SLP will create a customized treatment plan. Therapy might focus on:

• Building vocabulary and concept knowledge
• Improving ability to follow directions
• Strengthening auditory processing skills
• Developing strategies for better comprehension
• Practicing question comprehension and answering
• Enhancing attention and listening skills

Family Education and Support

One of the most important roles a Fort Myers speech therapist plays is teaching families how to support language development at home. You’ll learn strategies like:

• How to simplify language without “talking down” to your child
• Ways to check for understanding without frustrating your child
• Techniques to build vocabulary through everyday activities
• How to create a language-rich environment at home
• Methods to reduce background noise and distractions during important communications

Collaboration with Other Professionals

SLPs often work as part of a team that might include audiologists, pediatricians, educators, and occupational therapists to ensure your child receives comprehensive care.

When Should You Seek Help?

Trust your instincts. If you’re concerned about your child’s language development, it’s always better to seek an evaluation sooner rather than later. Early intervention leads to better outcomes.

Here are specific signs that warrant a speech-language evaluation:

By 12 Months:

• Doesn’t respond to their name
• Doesn’t react to common sounds or words
• Doesn’t turn toward voices or sounds

By 18 Months:

• Doesn’t point to familiar objects when named
• Can’t follow simple one-step directions like “Come here”
• Doesn’t understand “no” or simple commands

By 24 Months:

• Can’t point to body parts when named
• Doesn’t understand simple questions
• Can’t follow two-step directions like “Get your cup and bring it here”
• Doesn’t seem to understand much of what you say

By 36 Months:

• Doesn’t respond to simple who, what, where questions
• Can’t follow two- or three-step directions
• Doesn’t understand basic concepts like “in,” “on,” or “under”
• Shows little interest in stories being read aloud

At Any Age:

• Regression in skills (understanding less than before)
• Significant frustration or behavioral issues that may stem from communication difficulties
• Concerns from teachers or daycare providers
• Your parental instinct that something isn’t quite right

Remember, it’s important not to take a “wait and see” approach if you have concerns. Research shows that two-thirds of children younger than three and a half years with speech and language delays will need therapy after one year without intervention. The earlier you seek help, the better the outcomes typically are.

A Message of Hope from FOCUS Therapy

If you’re reading this and recognizing your child in these descriptions, please know that you’re not alone, and there is help available. Receptive language delays are treatable, and with the right support, children can develop the comprehension skills they need to thrive.

Every child’s journey is unique. Some children make rapid progress with therapy, while others need more intensive, long-term support. What matters most is taking that first step—reaching out for an evaluation and starting the process of understanding your child’s specific needs.

At FOCUS Therapy, we see incredible transformations when families commit to the therapeutic process. We’ve watched children go from frustration and confusion to confident communication. We’ve seen kids who seemed “lost” in conversations begin to engage meaningfully with their families and friends. We’ve celebrated with parents who thought their child would never understand them, only to witness breakthrough moments of true comprehension.

Language is the foundation of learning, relationships, and self-expression. When a child struggles to understand the world being spoken around them, they need more than time—they need support, expertise, and evidence-based intervention.

FOCUS offers Fort Myers speech therapy, ABA therapy, occupational therapy, and ADOS testing. Call (239) 313.5049 or Contact Us online.

Additional Resources:

Progress Review Webinar: Hearing and Other Sensory or Communication Disorders and Vision, 2018, Office of Disease Prevention and Health Promotion

More Blog Entries:

10 Questions Parents Should Ask Their Child’s FOCUS Therapy Team