By Joanna Campbell

What are Expressive Difficulties?

Expressive difficulties are any difficulties affecting the output of language,, either spoken or written.

Expressive difficulties in spoken language can include:

  • Poor topic maintenance – The person cannot stay on topic appropriately.
  • Perseveration – The person continuously returns to a particular topic.
  • Circumlocution – The person uses many words when fewer would do.
  • Disorganisation – The person struggles to express their thoughts in a logical order. 
  • Dysfluency – The person may stammer or find it difficult to produce smooth speech.
  • Word finding difficulty – The person cannot always access the words they need.

Expressive difficulties can arise from underlying problems with language, but attention and emotional regulation issues can also have an impact. For example, perseveration may occur as a result of preoccupation with a certain topic which is causing anxiety.

How do expressive difficulties impact on effective participation at court?

Expressive difficulties may reduce the quality (completeness, coherence and accuracy) of the person’s instructions to their legal team and oral evidence to the court. For example, responses may be vague, incomplete or irrelevant to the question that has been asked, the person may struggle to find the words they need to explain themselves properly, or episodes of dysfluency may prevent them from getting their message across effectively.

How do I screen for expressive difficulties?

Ask your client open-ended questions (e.g. “Tell me…”) about a neutral event (such as what they did at the weekend). Consider:

  • Do they continuously stray onto tangents or return to a particular topic? 
  • Do they “jump around” between different ideas or lose their train of thought? 
  • Do they use words incorrectly or insert vague words like “thingy”?
  • Do they stop and re-start sentences a few times? 
  • Are there lots of pauses and gaps in their speech? 
  • Do they fail to address the specific question you have asked? 
  • Is it hard to get to the “fine grained detail” of their account? 
  • Overall, can you follow what they are saying?

How do I refer to TIC if my client has expressive difficulties?

If you notice any of the above difficulties, you can refer to TIC for an intermediary assessment by visiting our website homepage (, clicking the “Make a Referral” button, and completing our simple referral process.

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