#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.

12 months

18 months

2 years

3 years

4 years