Cognitive Delay: What It Means for Language Development
#1 Factor Indicating that a Toddler’s Language Delay is “More Than Late Talking”
Earlier this week I started a series of posts called “Is This More Than Late Talking?” In this series, we’re exploring the factors that indicate that a child is struggling with a developmental issue beyond an expressive language delay, more commonly referred to as late talking or speech delay.
In the first post, I provided the list of these factors. Over the next few weeks, I’ll provide a short summary of each of these areas including:
- brief explanations of the specific skill and why it matters for language development
- what to look for – signs to indicate a developmental difference in that area
- possibilities for what this delay could mean (from a diagnostic perspective)
- things you can do at home to jump start this area of development
Today we’re looking at the first factor on this list:
DELAYED COGNITION
When I explain cognition to the families I’m working with, I say that cognitive skills include how a child thinks, learns, remembers, and pays attention. Therapists may add terms like “processing” and “planning.” Parents may think about these brain-based skills as “how smart a child is.”
WHY IS COGNITION IMPORTANT FOR LANGUAGE DEVELOPMENT?
Cognitive and language development are closely related. Until a child is over the age of 3, it’s very difficult to separate cognition from language development, especially receptive language. Remember that receptive language is also known as auditory comprehension, or the words a child hears and understands. If a child doesn’t understand the language he hears, he may appear to ignore what others say to him and doesn’t follow directions.
Here’s the correlation:
When a toddler has a delay in cognitive skills, his receptive language skills are also delayed. When a young child’s receptive language skills are delayed, his expressive skills are delayed too. Remember that expressive language means what a child says (or expresses with alternative methods like using gestures, signs, pictures, or a device.)
Did you follow those last lines?
If a child’s cognitive skills are delayed, his receptive language skills are delayed, and then his expressive skills are delayed too.
(**Exceptions to this pattern are also atypical. If a child’s expressive skills exceed his receptive skills, or when he says more than he understands, it’s generally due to echolalia or merely “echoing” language. Echolalia is often associated with autism.**)
This factor, delayed cognition, can be the “reason” a toddler isn’t talking.
WHAT TO LOOK FOR
A diagnosis or a specific event in a child’s life may predict the presence of a cognitive delay. Cognitive delays can be attributed to any number of conditions including:
- genetic diagnoses such as Fragile X or Down syndrome
- complications during a mom’s pregnancy and at birth including prematurity, infections, trauma, and medical conditions such as loss of oxygen
- environmental extremes such as neglect, institutionalization, or malnutrition
Sometimes the cause for a child’s cognitive delay is multi-factorial, meaning there are several contributing factors. Sometimes, the exact cause is never determined.
Cognitive skills include things like finding items that are hidden (object permanence), understanding how objects work (cause and effect or operating toys), solving problems (such as how to get an object that’s out of reach or fitting a puzzle piece into the correct slot), imitating actions he sees and words he hears, and language-like skills such as naming objects and following directions. If you’re interested in looking at a list of specific cognitive milestones, I’ve included links at the bottom of this post.
Cognitive delays are suspected when a child misses milestones in several developmental domains. For example, the child is (was) a late walker, is now a late talker, and upon closer inspection, is missing other key social skills too. (Please know this is not always the case. A child can walk late and talk late and still have normal cognitive skills!)
DIAGNOSTIC IMPLICATIONS for Cognitive Delay
In previous generations, a child’s cognitive delay was referred to as “mental retardation” or “brain damage.” Now diagnoses like intellectual disability or global developmental delay (which includes other areas of development too) have replaced that terminology, but the meaning has not changed.
Kids with cognitive delays have difficulty learning language, problems with academics, and are always later to acquire the self-help or life skills that make children more independent as they grow up, such as potty training or learning to dress themselves.
Delayed cognition is usually chronic or long-term. Treatment will ALWAYS help, but the child may never completely catch up.
WHAT YOU CAN DO TO HELP A CHILD WITH DELAYED COGNITIVE SKILLS
The first and most significant recommendation I make to families of children with delayed cognition is to continue to have expectations that this child will be able to learn! Our parenting and teaching methods must be adjusted to accommodate a child’s needs and learning style, but he or she WILL be able to make progress! That’s an important mindset for parents (and grandparents!) to adapt as soon as possible.
Secondly, know that teaching new skills will take more time. Repetition and repeated opportunities for learning the same concepts or new words is the most important strategy for very young children with cognitive delays. As I’ve said to parents of kids I’ve worked with, “Let’s think about teaching him to talk as a marathon and not a 50-yard dash. Our pace needs to be steady because we’re in this for the long haul. Speech therapy for this child won’t be over in a few months or even in a year or two.”
Sometimes a therapist may be reluctant to share this kind of brutally honest information with a parent because frankly, it’s hurtful, and we don’t want to take hope away. However, in not sharing the full extent of a child’s issues, I think that we’re essentially withholding information. I don’t want to be that kind of professional (or that kind of person).
Lastly, I’ll put in one more plug for intervention. Intervention may look different over the course of a childhood for a kid with cognitive delays, but in early toddlerhood and throughout the preschool years, I believe that specialized developmental services are critical. This period is when we can make the MOST difference in a child’s outcome. It’s when our brains are most “ready” for growth.
Parents of a child with a cognitive delay will also benefit dramatically from having a professional or team of professionals teach them ways to address their own child’s needs at home so that intervention isn’t a once or twice a week thing when a child attends therapy or goes to preschool. By working with therapists and teachers who have had experience treating other children with similar backgrounds, you’ll be able to trust that you’re doing everything you can to help.
WRAP UP
In summary, a toddler with delays in cognition will have difficulty acquiring a broad range of developmental skills including learning how to talk, how to understand, and how to process and then use incoming information. His or her challenges will overlap additional areas of development (especially academics and self-help skills). Although the delays are likely long-term, treatment will help tremendously.
If you’re a parent, I hope that this information will help you understand what may be going on with your own child. If you’re a therapist, this is the kind of information that doctors and other professionals may not be sharing with parents of a child with a language delay related to delays in cognition. It’s up to us to help families understand the depth of a child’s issues and provide hope that therapy, along with consistent parental commitment, can make a huge difference!
Keep watching for additional posts in this series! Next we’ll discuss difficulty with joint attention.
Laura
Product Recommendations from teachmetotalk.com for Helping Toddlers with Language Delays
Kids with cognitive delays will have difficulty learning to understand and use language. My best resources for parents include:
Teach Me To Listen and Obey (2 DVD Set) focuses on receptive language or what a child understands. If a child is over 18 months and doesn’t follow simple directions, receptive language delays are highly suspected. In this DVD for adults, you’ll learn important comprehension milestones and receive recommendations for working on these skills at home and during therapy sessions. You’ll SEE video clips of me working with children with language delays during speech therapy sessions so that you can duplicate the activities.
Teach Me To Talk the DVD focuses on expressive language or what a child says. In this DVD, you’ll see the 6 beginning strategies I teach parents of late talkers. The DVD is filled with video clips of children with a wide range of abilities from 12 months to 3 years. It’s the starting place for most parents (and therapists!) who want to learn real life ways to work with a toddler with language delays.
If you’re more of a reader or if you want detailed goal lists for both receptive and expressive language matched with activities to use with toddlers and preschoolers, take a look my book at Teach Me To Talk: The Therapy Manual. There’s a chapter on cognition that’s a fantastic guide for both therapists and parents of children with cognitive delays. This book was written for speech-language pathologists, but many parents use it as their basis for “at home” therapy.
For therapists (and ULTRA committed parents who are working with their children intensely or parents who don’t have access to services and need professional-level information), my CE course that best addresses receptive language is Early Speech-Language Development: Taking Theory to the Floor. In this comprehensive 12-hour course on DVD, all areas of language development (social, receptive, expressive, and intelligibility) are addressed. It’s approved for ASHA credit for speech-language pathologists (and if you’re in IL, it’s preapproved for EI credit!)
Links to Cognitive Milestones
Follow these informative links to the Center for Disease Control website with lists of skills and pictures to show you what’s normal for a child’s age range. Remember that most babies will have easily achieved the skills listed there – meaning that the standards listed are set at a minimal level to account for a wide range of “normal.” (In other words, the bar is pretty low.) This means that if a child hasn’t met all the skills on these lists or especially exhibits the concerns in the bottom “Act Early” boxes, there is a definite reason to speak to your child’s doctor or healthcare professional.
Sign Up for your
Free Book
Subscribe
Subscribe to the Podcast in iTunes
Browse Products
Featured Product
Recent Posts
Teach Me To Talk Testimonials
Happy Therapists, Teachers, Parents & Children
"Hello Miss Laura,
First, I would like to thank you for all you do for us moms who are lacking support in the autism community, and thank you for providing tons of information and resources to help our bright children. I myself benefited so much from watching your videos and reading your daily emails. I cannot stress enough how much all this information helped my toddler. Of course, getting an autism diagnosis for your child is extremely scary (she was diagnosed at 2 years old) and I was depressed and did not know what autism was, how it affected children, and how to teach children struggling with this condition. However, your videos helped me to find light in my child and now I am your biggest fan! I rewatch your videos over and over again to make sure I didn't miss anything that can help my daughter. I even purchase two books- Autism workbook and Teach me to Play. My toddler was completely non-verbal, she didn't know how to imitate, no eye contact, no pointing.. you name it she didn't have any skills and I didn't know how to teach her! And that is until I discover ed You- my toddlers (Fairy: smiling_face_with_3_hearts:)!
Now she is little sweet 2.5 years old and she says "mama" (I cried when she said that magic word), she waves bye bye or hi, she points, she gives "high 5", her joint attention is great and overall she is doing so much better! And that's all because I have been doing everything you described in your books and videos! I. My mind I always play "repetition, repetition and repetition", teaching her everything through play that she so much enjoys!!! I can write forever explaining how much I taught her through yr videos and books! And the most amazing thing is that her speech therapist is a big fan of yours as well so it worked out perfectly since we understand each other and work based on your teachings! The therapist even owns the same books I own ...I am so grateful that my toddler has such an amazing therapist; especially the one that understands autism and is ready for a real challenge! God bless you for all you do and I cannot wait for my toddler blossom.. you gave me hope and lit the light inside me. And I'm determined to work with my girl :)"
"Dear Laura Mize and Team,
Thank you so much for all your hard work and publishing books! Our 17-month-old toddler suddenly exploded into speaking and imitating everybody's gestures and sounds, just a week or two after we 'completed' all activities that are listed under 11 pre-linguistic skills! Your method really works!"
Grateful customer.
"Hi Laura!
I absolutely LOVE all of your workbooks, especially your Autism Workbook. Starting with Social Games has been a game changer for many of my littles with ASD and their families. It's been the best way for them to finally connect and sustain shared attention and engagement, leading to longer social interactions, through play!"
Jodie, Dev, Therapist
"Hi Ms. Laura,
Thank you so much for the videos you have posted on your youtube channel. They are so direct, informative, and helpful. Thank you for being a resource for me to become a better therapist."
Dianne
"Hi Laura - I just wanted to say I received my copies of the Apraxia workbooks yesterday and I LOVED workbook 1 (not ready for 2). I'm on chapter 8 and going through the questions carefully so I'm prepared to help my son. I knew it was a great book when you acknowledged the fact that sometimes therapists and doctors don't bring a positive and supportive vibe when diagnosing. I remember being terrified at the mention of apraxia and ASD by both because they had these very concerned looks and made it seem like it was a death sentence. I know now (in LARGE PART, THANKS TO YOU AND YOUR VIDEOS) that it doesn't have to be!! I see a future for him now. You SINGLE-HANDEDLY, through your books and videos have empowered me to help my son after the doctors and therapists have gone home. You've given me strategies, play ideas, plans on how to keep moving forward. I don't always do things right, but I know I'm on the right track and I love that I can reference, and re-reference your books to help me keep going. As I was reading the book, I was so proud of myself because I've used strategies from your previous books and it felt good because I could check off a lot of the skills that you discuss. So, thank you for all your previous books as well!!"
"Gosh, I love all of your emails/podcast/website, just everything!! I work in early intervention as a behavior analyst and am learning so much from you!"
Thank you!
Hailey
"Laura,
I love your work! I am a professor of early childhood special education and a speech language pathologist! I have worked to help children learn to communicate and I know how valuable the information you share is for both early interventionists and pediatric speech language pathologists!
Thank you for systematically organizing and explaining essential steps for young children to learn and develop. You are having a great impact on our profession, the ECE profession and families!"
Sincerely,
David
"Thank you.
If this is Laura herself reading this email let me take this opportunity to thank you from the bottom of my heart for all that you have put forth for us professionals. I own every manual (except the autism manual) and have watched every course on DVD. I have listened to countless podcasts. All of what I’ve come to be as an Early Intervention speech therapist was absolutely to your credit. With your resources at my side I have never needed to scramble for answers and strategies and above all the clear language I use when communicating with parents. My fun, animated affect and key phrases I use have been learned through watching your example. So….thank you! May you be blessed."
Chaya
"I just wanted to thank you so much for your incredible help! You are so kind and lovely and every time I implement something you've taught in your manuals or videos it is always a success, I cannot thank you enough. I really appreciate how specific you are in giving us examples of wording to use and how to use a toy in therapy with your videos, it is exactly what I need to properly help my little students. I also really appreciate your list of books of list of toys. I have seen my little students make significant progress thanks to you. I'm looking forward to watching more of your videos, taking more of your CEU's, and reading more of your materials. From the bottom of my heart: thank you so much again!!"
Lauren
"Dear Laura,
What an inspiration!
Thank you for helping me be a better Developmental Therapist. I often listen to your podcasts which help me help families.
Your enthusiasm, professionalism and
the sheer volume of information is so great.
You are part of my team.
I just wanted you to know I appreciate you."
Margaret
"Dear Laura,
Thank you for your generosity in sharing so much knowledge in such a clear and enthusiastic way.
As a retired audiologist with a fabulous and language delayed grandson, I used your podcasts and outstanding publication, The Autism Workbook, to inspire and guide me over the past year.
It works!! He went from barely verbal, no gestures, didn't respond to his name etc etc to a verbal, social, curious, ready to imitate anything, fill in the blanks on familiar "set" speech, generate his own totally appropriate and mostly understandable sentences...not just short phrases anymore... full little paragraphs...about imaginary things, what he did during the day, what he wants. True communication!
You make a powerful difference in this world! ❤"
"Laura Mize, you are a Godsend. I don’t know how one human can have so many helpful things to say in a beautifully organized way, so often. Always amazes me when another super helpful email comes from you, and for free. With free YouTube videos and cheap CEUs. THANK YOU!!!"
Sheila, Canada
"I purchased the book on autism and have watched the #400s series podcasts. Laura Mize has been more effective in teaching autistic tendencies, than many professors, shadowing professions, and the 100s of books, articles and classes or videos, or live workshop speakers, have been at teaching effective practices for a child with ASD. Some of the many lessons she has taught, which I will now use, to be a more effective Interventionist, include but are not limited to: red flags, typical behaviors, self-stimulating behaviors, not taking away toys, rather showing child to play with toy appropriately. She gives examples of child's actions, "inappropriate," explains the reason for: why the child is engaging in these behaviors and how they can be replaced with more appropriate, effective fuctional and age-appropriate skills."
"I’m sure Laura gets these messages all the time, but I thought I’d share. I stumbled across Laura‘s "Autism or Speech Delay?" YouTube video when I really needed it. This video finally listed and explained some of the red flags my son was showing for autism. I share the link anytime a parent is questioning in my FB autism group. This mother I don’t even know said Laura's video changed her life. I know exactly how she feels because It changed families too. Thank you to everyone at Teach Me To Talk."
LINDSAY
"Good Morning Laura,
I received your book (The Autism Workbook) yesterday and it is absolutely amazing! As I evaluate young children (0-3) for developmental delays and write plans for them with their parents, there are a ton of ideas that are ready to use. Others that reinforce what I have been doing, and saying, all along. Thank you so, so much for writing this incredible book and pulling everything together in one place!"
FRANCINE IN MICHIGAN
"Thank you very much for sharing your knowledge, experience, and guidance.
I’m a parent who bought the autism workbook and it’s the only clear resource I found to make a change in my son. I’m really thankful to Ms. Laura for helping out people like us all over the world."
"Laura Mize, all I have to say is that ALL YOUR STRATEGIES WORK."
ANNE, YouTube viewer
"We have 7 SLPs in our preschool (public) program for special needs children (ages 3-5) and we use your courses, books, and techniques every day! :-) We have seen our preschoolers make such great gains!"
"I just received Teach Me to Play With You, and it is ALREADY WORKING! WOW!
Girl…my son is 3 years old, and he NEVER asks for something using words. We were playing “Get Your Belly” (from Teach Me to Play WITH You), and after several times, he laughed and screamed "BEWIEEE!!!" It was a hoot. And I can't believe he said it! I have played with him like this before, but this time I took your advice and acted CRAZY!! I will act like a total lunatic if it will get him to talk to me! Now I can give him "the look" from across the room, and he will say it. That manual is so amazingly practical, and it is a GODSEND right now! Thank you SO MUCH!”
"I wanted to send you a quick email to say thank you. I started watching your videos/podcasts about 4 months ago. My son has gone from losing words he previously used, only having about 7 words at his 2 year check up in August (assessed at a blended 10 month language level) -- to now having so many words, increased social engagement, following commands, spontaneously requesting things, and naming letters & numbers (not in order) as well as colors. We had our monthly meeting with our SLP through the state infants & toddlers program and it felt like we were just bragging the whole time, but I knew in the back of my head it was because I have been using strategies you taught me.
We still have so much work to do with our sweet boy, but I know in my heart he would not have succeeded without the education you provided. I will continue to read your emails & watch videos as we go along this journey and face challenges, but credit is due to you, Laura.
Thank you so much, endlessly."
KATIE
"I just want to tell how fortunate I feel to have found your website and you!! I became a special instructor in EI almost a year ago and I started with hardly any applicable training. I felt so lost and confused as how to help the kids I work with learn how to use words and play. Honestly, I didn't even understand the importance of play, although I always played with my kids. But, once I started to watch your podcasts and get some of your manuals I felt a weight had been lifted off my shoulders and that I could finally teach these kids and their families something of value from a real therapist and based on research!. Thank you so much for seeing the need to help other EI service providers and providing a forum to share your knowledge and years of valuable experience. I'm sure you get a lot of these emails every week if not every day, but I wanted to make I could add to those notes of gratitude!! THANK YOU again!!"
SS
"Just wanted to say a HUGE thank you for these emails and your books, I have them all and they have seriously saved and improved my sessions with my kiddos. Huge thank you."
REBECCA
"I was very frustrated with how speech therapy was going for my child. I would take him and drop him off and not hear much of anything from his therapist and teachers other than, "He had a good (or a bad!) day." Your materials were invaluable for us because I learned how to work with him on his speech. I learned how to teach him to talk and play. I learned how to pay attention to his cues and work with him to teach him to communicate. Without it, I have no doubt he still wouldn’t talk."
BRITNEY
"Hi! I just wanted to say (from an SLT perspective) how incredibly useful I am finding absolutely all of your articles, blogs and resources - I only discovered your site last month and have just received all your books which I feel I am learning more than on my entire university training course!! But also the way in which you give specific, realistic, fun, encouraging ideas for working with parents is really just fantastic, I only wish I have your site sooner! Thanks so much from the UK! Kind regards."
HANNAH
"I just wanted to reach out to say thank you for making things a little easier to manage for me this year. I made the transition from school SLP to private therapist about a year ago. While the change was welcome, it was a lot, and I was just getting my footing in the clinic when I began teletherapy full time. Your website has been a huge lifeline in helping me work with late talkers and coach their parents in an accessible but effective way, even remotely. I look forward to getting your emails each week. I am floored by the amount of valuable, free information that your website provides, and I’m looking forward to investing in your workbooks soon. A sincere thank you for all you do!"
ALLISON
"You are an inspiration! I am truly grateful for the way you put into words and writing how to do what we do as SLPs. At this time in my 13 years of practicing, I find your encouragement keeps me going. As a single mom, I find it a stretch to buy materials these days and I am so thankful for the freebies you so generously share that help me teach my families. I don’t have much time to put together lists or quick references for parents!! Much gratitude!!"
ANDREA
Laura thank you so much. Btw, you have transformed my therapy- I have become such a competent and strong therapist after watching probably like 350 of your videos and podcasts over the past few years. And I am a seasoned therapist with almost 25 years experience. (Yes prob 350 episodes ha!) But there was still a lot I learned from you. I have such a thorough understanding of birth to 3 development and how to properly incorporate appropriate therapeutic goals, techniques and strategies now, thanks to you. Kelly
Hi Laura,I want to thank you so much for the resources you provide, my daughter has delayed speech and though she qualifies for CDS. Honestly the most progress she has made in her speech/language development has been after I implemented your 5 top strategies for delayed talkers! She is now almost 2.5 and her vocabulary is well over 75 (I haven’t counted recently, could be over 100) words when at 2 she barely had four words. Honestly the last few months have been a transformation for her.
Ann
