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A late talker is a toddler experiencing late language emergence (LLE) [1][2]. LLE can be a symptom of an intellectual disability[3]. Late talkers are children who are intellectually abled, but do not show signs of normal language development for their age [3][4]. Lack of language development, comprehension skills and challenges with literacy skills are potential risks as late talkers age[2]. Toddlers have a high probability of catching up to typical toddlers if early language interventions are put in place [5][1]. Language interventions include general language stimulation, focused language stimulation and milieu teaching[6][7][8][9][10][11]. Speech pathologists are specialists who work with late talkers and provide individualised support for each child’s unique needs[6].

Late talker
Other namesEinstein syndrome
SpecialtyDevelopmental Psychology
SymptomsLanguage delay
Risk factorsPoor language ability
TreatmentLanguage interventions: General Language Stimulation, Focused language stimulation, Milieu Teaching
FrequencyApprox.13% of two-year-olds

Language Development

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Expected language emergence

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See also: Language development

Toddlers aged 1-2 years begin to use and comprehend different types of words. Initially the most prominent types are nouns and eventually they move on to other word types such as verbs and adjectives[12]. Once a toddler has said his first word, he will begin to acquire new words at a rate of roughly one per week [13]. Words will be related to things in the toddler’s environment such as body parts, toys, clothes, etc. They will often use one word to mean many different things[12], for example, they may call all types of transport ‘car’.

Around the 15-month mark toddlers will know six words on average, [14] and begin to notice and wonder about things that are a little outside of their environment[12]. Once they reach 18 months, they refer to themselves by their name and eventually start using the pronoun ‘I’ [12]. During this stage, they will also repeat parts of sentences they hear[14]. As they get close to 2 years, toddlers start putting two words together[12] . They begin to learn the use of “no” and ask adults to tell them the name of people and new objects [14]. On average, a 2-year-old will know 50 words [14] and will then begin to learn new words at a rate of approximately one per day [13].  From 2 to 3 years of age, their vocabulary grows rapidly[14]. At 30 months old they are expected to know around 200 words and by 3 they will be able to participate in very simple conversations[14].

Late talker's language emergence

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See also: Language delay

Late language emergence (LLE) occurs when a toddler does not produce or comprehend language at the expected rate for their age[2]. About 13% of two-year old’s experience a delay in language emergence [15]. Late talkers differ from toddlers with language development disorders and disabilities in the sense that their only characteristic is that they experience limited expressive vocabulary for their age, as oppose to, lack of receptive language or cognitive abilities [3]. LLE can be an indicator of other kinds of disorders or disabilities [16]. If a late talker is not catching-up to typical talkers by the age of 4, they could have specific language impairment [17]. Expressive language screening between the ages of 18-35 months help determine if LLE is “secondary to autism spectrum disorder, intellectual disability, hearing impairment, receptive language delay, or demographic risk” [16].

When compared to typical talkers, 24-month-old late talkers do not seem to struggle with verbs and their formation, which are an important part of one’s grammatical development[17]. They struggle with nouns more than a typical talker and have difficulty combining words[17]. Late talkers perform lower than typical talkers in cognitive functioning and receptive language skills [18].

Signs

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A toddler is at risk of being a late talker if:

  • He produced abnormal babbling from 9 to 21 months of age [19][2].
  • By 15 months he is not producing six or more words [14].
  • By 18 months he does not appear to comprehend more words than he can produce [14].
  • At 18 months old he is using less than 20 words and lacks knowledge of different word-types [5].
  • At 24 months old, he is using less than 50 words and is not combining words from different word classes [5][1].
  • After producing their first word he demonstrates a lack of “complex syllable structures, lower percentage of consonants correct, and smaller consonant and vowel inventories” [2].
  • He shows a lack of comprehension and insists on communicating using gestures[2].
  • Between 2-3 years of age he is using short sentences with very simple grammar[2].

Diagnosis

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LLE could be a sign of other types of language disorders or intellectual disabilities, [16] so there is a risk of misdiagnosing a child as just being a late talker. This symptom may be secondary to: problems with their vocal tract or hearing, autism, neglect or abuse [16]. In order for toddlers to be diagnosed as late talkers, they need to see a doctor and a speech pathologist. A doctor will conduct a full medical examination [20] and a speech pathologist will do a full screening and comprehensive assessment [2]. The Language Development Survey (LDS) is a prevalent screening method used on toddlers aged 18-35 months of age[1]. This tests to see if a child’s expressive vocabulary and syntax is developing in a standard way[1]. The LDS consists of a parent or carer of the child to report on the child’s language development in regards to word combination[21]. This screening takes a total of ten minutes [21]. It also takes risk factors into consideration such as, the child’s demographic and history [21]. This test, combined with other forms of assessment, will determine whether a child is a late talker, or if their language delay is associated with another type of language disorder or intellectual disability[20].

Types of assessment

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See also: Language assessment

Assessments are carried out in order to determine the speech and language ability of a child [22].  A speech pathologist works with the parent or carer of the child to decide on the most appropriate assessment [22].

Ethnographic Interviewing

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Ethnographic interviewing is a style of assessment that consists of one-on-one interviews between the assessor and assessed[22]. It requires the assessor to ask the child open-ended questions to find information about the child’s environment[22][23]

Language Sampling

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Language sampling is utilised to obtain random samples of a child’s language during play, conversation or narration[22]. Language sampling must be used with standardized assessments to compare and diagnose a child as a late talker [22].

Dynamic Assessment

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Dynamic assessment involves testing, teaching and retesting a child[22]. Firstly, the child’s knowledge is tested. Then, the child is taught a word. Finally, the child is retested to see if he has learnt the target language. This type of assessment is useful in determining whether a child is a late talker or if his language delay is a factor of another kind of disorder[22].

Standardised Assessments

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Norm-referenced test
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A norm-referenced test consists of comparing and raking a child’s scores to others[22]. This allows a child’s results to be compared to a statistical standard. A child can be at risk of being a late talker if his test results are on the lower end of the scale compared to other test takers[22].

Criterion-Referenced test
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A criterion-referenced test consists of comparing a child’s scores to a pre-set standard[22]. A child’s scores are taken and analysed to see if they meet the criteria of a typically developing child. This test can be carried out formally or informally[22].

Observation Techniques

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Analog Tasks
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Analog tasks consist of the assessor observing the child participate in play in a staged environment that simulates a real-world situation[22]. The assessor can take note of the child’s behaviour and language performance, and use it to diagnose the child[22].

Naturalistic Observation
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Naturalistic observation involves observing a child’s interaction with others in a trivial social setting[22]. It is often used with criterion-referenced assessments to diagnose a child[22].

Systematic Observation and Contextual Analysis
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Systematic Observation and Contextual Analysis consists of observing the child in a mixture of contexts[22]. The child is observed while doing a task, playing or interacting with others. Conclusions are then drawn of his language function and problems are identified if present[22].

Culture and assessment

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When choosing tests and assessments for a child, culture is taken in to consideration. The assessments carried out on the child needs to be appropriate for the child’s cultural setting[22]. Tests cannot be translated as this affects the data and can result in a child being misdiagnosed[22]. For children who speak more than one language, assessments need to be catered to that[2]. A standardized test is not enough to diagnose a child who is bilingual[2]. Bilingual children need to be assessed using a combination of ethnographic interviewing, language sampling, dynamic assessment, standardised tests and observation techniques to be accurately diagnosed as a late talker[2].

Treatment

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The earlier interventions are put in place to help a toddler overcome LLE, the better the outcome [5]. Language interventions (with the help of speech pathologists) are needed, so late talkers eventually catch-up [2]. Some common approaches are monitoring, indirect and direct language stimulation[6].

Late talkers struggle with learning vocabulary and phonological acquisition[3]. Targeting vocabulary and increasing their vocabulary bank, will simultaneously improve their phonological development [3].

When deciding which approach to take in treating a toddler, cultural background needs to be taken into consideration[6]. Some types of intervention may work for some cultures, but may not work nor be appropriate for others [11].

Language intervention

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Late talkers can be treated with a variety of language intervention methods[24]. The earlier a child is diagnosed and treated the better his language skills will develop when growing up[25].

General Language Stimulation

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General Language Stimulation involves providing the child with an environment that is full of language stimulation[7][8]. This includes giving the child the opportunity to participate in reading books, playing, cooking and other everyday activities the child is interested in[7]. The key to this intervention is to follow the late talker’s lead[7]. Once a child is interested in a specific object the parent or carer will then take part in parallel talk, that is, talking about the object rather than directly modelling the word[7]. The parent or carer is then required to repeat the child’s utterance, regardless of how incorrect it is, and complement this with semantic and grammatical detail[7].

Focused language stimulation

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Focused language stimulation requires the parent or carer to have a list of goal words for the child to learn and produce[7][9]. The average number of target words is ten, but this will vary from child to child[11][7]. The parent or carer will then have to allow the child to be exposed to the target language as much as possible[7]. The adult has to produce the target language in a meaningful and functional context such as, in a sentence or question form[9]. The child is then prompted (not instructed) to repeat the target word[7]. If the target word is produced incorrectly, the parent follows with a recast[7]. Once the child has learnt these words the adult replaces these with new ones and the process is repeated[11].

Milieu Teaching

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Milieu Teaching involves changing the child’s environment to give him as many opportunities to talk and produce the target language[7][26]. In this intervention method it is necessary to have a set of language goals for the child to achieve[7]. Incorrect production of target language follows by the adult modelling the word for the child to imitate[7][26]. Correct production of target language follows by the adult providing a recast[7][26].

Culture and treatment

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Culture diversity is a considerable factor in choosing the right type of intervention for a child [27]. Speech pathologist are the ones responsible for choosing a treatment that is culturally appropriate for the child and his family[11]. Treatments such as General Language Stimulation, Focused language stimulation and Milieu Teaching are designed appropriately to meet the needs of the majority in the United States [11]. These methods are adapted to meet the needs of other cultures in the community for the child to have a higher success rate[11].

The nature and context of social interactions is observed when modifying a standard treatment to meet the norms of a child’s culture and background [11]. For example, in some cultures it is not common for parents to be so involved in play with their child[27][11]. The treatment is then adapted for other family members (siblings, cousins, other peers) to deliver the intervention [11]. The location where these treatments are usually provided is the family home. In many cultures this is seen as unacceptable[27]. Treatments for these kinds of situations are modified and options such as, schools are considered as a place to undertake treatment [11].

Outcomes

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Once late talkers enter kindergarten, most begin to catch-up and present language ability within the typical talker range [17][1]. Late talkers tend to demonstrate poorer language ability and be at the lower end of the normal range than typical talkers [17]. Late talkers exhibit considerably lower scorers on language measures than typical talkers once they reach adolescence [16]. Around 50% to 70% of children who experience LLE reach normal language level by the time they enter school [28]. Their chances of successfully catching up decrease when language delay is still present by the time, they are three years old [25]. This is only the case for 5-8% of preschool children [16].

References

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  1. ^ a b c d e f Prelock, Patricia A.; Hutchins, Tiffany L. (2018), Prelock, Patricia A.; Hutchins, Tiffany L. (eds.), "Understanding Late Talkers", Clinical Guide to Assessment and Treatment of Communication Disorders, Best Practices in Child and Adolescent Behavioral Health Care, Springer International Publishing, pp. 43–51, doi:10.1007/978-3-319-93203-3_5, ISBN 978-3-319-93203-3, retrieved 2020-05-24
  2. ^ a b c d e f g h i j k l "Late Language Emergence: Overview". American Speech-Language-Hearing Association. Retrieved 2020-05-24.
  3. ^ a b c d e Girolametto, Luigi; Pearce, Patsy Steig; Weitzman, Elaine (1997). "Effects of Lexical Intervention on the Phonology of Late Talkers". Journal of Speech, Language, and Hearing Research. 40 (2): 338–348. doi:10.1044/jslhr.4002.338. ISSN 1092-4388.
  4. ^ Roos, Elizabeth M.; Weismer, Susan Ellis (2008). "Language Outcomes of Late Talking Toddlers at Preschool and Beyond". Perspectives on Language Learning and Education. 15 (3): 119–126. doi:10.1044/lle15.3.119. ISSN 1940-7742. PMC 2862655. PMID 20442807.{{cite journal}}: CS1 maint: PMC format (link)
  5. ^ a b c d Lowry, Lauren (2012). "How to tell if Your Child is a Late Talker – and What to Do about It". www.hanen.org. Retrieved 2020-05-24.{{cite web}}: CS1 maint: url-status (link)
  6. ^ a b c d Girolametto Luigi; Wiigs Megan; Smyth Ron; Weitzman Elaine; Pearce Patsy Steig (2001-11-01). "Children With a History of Expressive Vocabulary Delay". American Journal of Speech-Language Pathology. 10 (4): 358–369. doi:10.1044/1058-0360(2001/030).
  7. ^ a b c d e f g h i j k l m n o Finestack, Lizbeth; Fey, Marc (2013). Late talkers : language development, interventions, and outcomes. Rescorla, Leslie; Dale, Phillip. Baltimore. pp. 283–289. ISBN 978-1-59857-253-7. OCLC 830646517.{{cite book}}: CS1 maint: location missing publisher (link)
  8. ^ a b "Language stimulation". www.education.vic.gov.au. Retrieved 2020-05-24.
  9. ^ a b c Lederer, Susan Hendler (2002). "A Focused language Stimulation Approach: First Vocabulary for Children With Specific Language Impairment". Young Exceptional Children. 6 (1): 10–17. doi:10.1177/109625060200600102. ISSN 1096-2506.
  10. ^ Gilbert Kimberly (2008-10-01). "Milieu Communication Training for Late Talkers". Perspectives on Language Learning and Education. 15 (3): 112–118. doi:10.1044/lle15.3.112.
  11. ^ a b c d e f g h i j k Wing, Christine; Kohnert, Kathryn; Pham, Giang; Cordero, Kelly Nett; Ebert, Kerry Danahy; Pui Fong Kan; Blaiser, Kristina (2007). "Culturally Consistent Treatment for Late Talkers". Communication Disorders Quarterly. 29 (1): 20–27. doi:10.1177/1525740108314862. ISSN 1525-7401.
  12. ^ a b c d e "Language development: 1-2 years". Raising Children Network. Retrieved 2020-05-24.
  13. ^ a b Tamis-Lemonda, Catherine S.; Bornstein, Marc H.; Kahana-Kalman, Ronit; Baumwell, Lisa; Cyphers, Lisa (1998). "Predicting variation in the timing of language milestones in the second year: an events history approach". Journal of Child Language. 25 (3): 675–700. doi:10.1017/S0305000998003572. ISSN 0305-0009.
  14. ^ a b c d e f g h Sharma, Ajay, (2002). Mary Sheridan's from birth to five years. Children's developmental progress. Cockerill, Helen,, Okawa, Nobuo,, Preceded by (work): Sheridan, Mary D. (Mary Dorothy)., Complemented by (work): Sharma, Ajay. (Fourth edition ed.). London. ISBN 978-0-415-83354-7. OCLC 856623146. {{cite book}}: |edition= has extra text (help)CS1 maint: extra punctuation (link) CS1 maint: location missing publisher (link) CS1 maint: multiple names: authors list (link)
  15. ^ "Mixed Results For Late-talking Toddlers". ScienceDaily. 2008. Retrieved 2020-05-24.{{cite web}}: CS1 maint: url-status (link)
  16. ^ a b c d e f Rescorla, Leslie (2013). "Late Talkers: Do Good Predictors of Outcome Exist?: Late Talkers: Do Good Predictors of Outcome Exist?". Developmental Disabilities Research Reviews. 17 (2): 141–150. doi:10.1002/ddrr.1108.
  17. ^ a b c d e Paul, Rhea, ed. (2017-09-25). Language Disorders From a Developmental Perspective: Essays in Honor of Robin S. Chapman (1 ed.). Psychology Press. doi:10.4324/9781315092041. ISBN 978-1-315-09204-1.
  18. ^ Weismer, Susan Ellis; Murray-Branch, Jamie; Miller, Jon F. (1994). "A Prospective Longitudinal Study of Language Development in Late Talkers". Journal of Speech, Language, and Hearing Research. 37 (4): 852–867. doi:10.1044/jshr.3704.852. ISSN 1092-4388.
  19. ^ Stoel-Gammon, Carol (1989). "Prespeech and early speech development of two late talkers". First Language. 9 (6): 207–223. doi:10.1177/014272378900900607. ISSN 0142-7237.
  20. ^ a b Camarata, Stephen M., (2014). Late-talking children : a symptom or a stage?. Cambridge, Massachusetts: The MIT Press. ISBN 978-0-262-31933-1. OCLC 890146450.{{cite book}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  21. ^ a b c Rescorla, Leslie; Arnie, Alley (2001). "Validation of the language development survey (LDS): A parent report tool for identifying language delay in toddlers". Journal of Speech, Language, and Hearing Research. 44: 434–445 – via ProQuest.
  22. ^ a b c d e f g h i j k l m n o p q r s t "Assessment Tools, Techniques, and Data Sources". American Speech-Language-Hearing Association. Retrieved 2020-05-24.
  23. ^ Westby, Carol; Burda, Angela; Mehta, Zarin (2003). "Asking the Right Questions in the Right Ways: Strategies for Ethnographic Interviewing". The ASHA Leader. 8 (8): 4–17. doi:10.1044/leader.FTR3.08082003.4. ISSN 1085-9586.
  24. ^ Robertson, Shari Brand; Weismer, Susan Ellis (1999). "Effects of Treatment on Linguistic and Social Skills in Toddlers With Delayed Language Development". Journal of Speech, Language, and Hearing Research. 42 (5): 1234–1248. doi:10.1044/jslhr.4205.1234. ISSN 1092-4388.
  25. ^ a b Paul, Rhea (1993). "Patterns Of Development in Late Talkers: Preschool Years". Journal of Childhool Communication Disorders. 15 (1): 7–14. doi:10.1177/152574019301500103. ISSN 0735-3170.
  26. ^ a b c Gilbert, Kimberly (2008). "Milieu Communication Training for Late Talkers". Perspectives on Language Learning and Education. 15 (3): 112–118. doi:10.1044/lle15.3.112. ISSN 1940-7742.
  27. ^ a b c "Cultural Competence: Overview". American Speech-Language-Hearing Association. Retrieved 2020-05-24.
  28. ^ Dale, Philip S.; Price, Thomas S.; Bishop, Dorothy V. M.; Plomin, Robert (2003). "Outcomes of Early Language Delay: I. Predicting Persistent and Transient Language Difficulties at 3 and 4 Years". Journal of Speech, Language, and Hearing Research. 46 (3): 544–560. doi:10.1044/1092-4388(2003/044). ISSN 1092-4388.


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