Without a doubt, the most common question I have received at teachmetotalk.com about late talking since our launch in 2008 is this…
Will my late talker catch up?
If you’re parent of a late talker, I know you’re scared. I know you’re worried.
But the current research about late talking offers lots of hope!
Outcomes for children can be very positive, especially when we intentionally introduce ways to implement the very practical, very doable strategies we know help late talkers get over that hump and begin to communicate.
And that’s what I want to share with you today…
First, the research…
And then how to apply it!
Let’s begin with what we know about late talking…
What is late talking?
Late talking can be referred to with many names… speech delay, language delay, late talking so let’s look at the official definition.
A late talker is a child who isn’t using at least 50 words or any spontaneous two-word combinations by 24 months when there are no other diagnosed disabilities or developmental delays in other sensory, cognitive, or motor domains.
Let’s break down that definition to be sure you can apply this to your own child…
Many times, late talking isn’t recognized until a child has reached their second birthday. Of course, late talking can be identified anytime a child isn’t meeting developmental language milestones. Parents may notice that their child isn’t saying as many words as other babies the same age. When there are fewer than 50 words in a child’s vocabulary as a child turns two, a language delay is present since the “individual differences” in the wide variety of normal in typical language development have already sorted themselves out by this time. (We’ll discuss more about earlier language milestones in an upcoming section.)
The 50-word benchmark is important in language development because it’s when research tells us that kids have learned enough single words to begin to put them together to make their own little phrases… in other words, they are truly self-generating language.
That leads into the next important word in this definition… spontaneous. This means kids aren’t just imitating phrases… they’re mixing and matching words as they making make up their own phrases instead of saying memorized chunks or phrases such as quoting a movie scene or lines from a book. Holistic phrases like as “I did it!” or “What’s that?” or even early social words like “thank you” or “all done” also don’t count as phrases since kids learn these holistically or all as one word.
In the truest definition, kids who have already been diagnosed with medical diagnoses such as cerebral palsy or Down syndrome are not included in the category of “late talker.” Neither are those who will go on to be diagnosed with something else such as autism, intellectual disability, or even a speech disorder like apraxia, although they may initially be identified as a late talker.
To sum it up, late talkers are toddlers between 18 and 30 months old who have no other issues other than talking or their spoken language. They have typically-developing language skills – meaning they follow directions, identify pictures and body parts and understand routines. There are no issues with motor skills – they rolled over, sat up, crawled, and walked on time. There are no issues with social skills – they respond to their names and interact well with other adults and kids.
But the truth is…
Late talking is often the first indicator that a child is not meet developmental milestones as expected.
Many times, late talking is the only difference that parents have noticed by the second birthday.
What are signs that a child isn’t just a late talker and may not be as likely to catch up with language development?
There’s a broader group of kids that researchers in language development refer to as Late Language Emergence (LLE). Kids with LLE may have expressive language delays only (late talking) or they may have mixed expressive and receptive delays. This group of children not only have problems with talking or the expressive piece, but issues with understanding and comprehending language, or the receptive piece.
These are the toddlers and preschoolers who will likely not catch up and will continue to struggle with language development as they get older. Let’s look at some other signs of Late Language Emergence:
- Less than 50 words and no word combinations as mentioned above
- Limited number of consonant sounds (e.g. p, b, t, d, n, y, k, g)
- Does not link pretend ideas and actions together while playing
- Does not imitate words
- Uses mostly nouns and few verbs
- Difficulty playing with peers
- Uses few gestures to communicate
My child is younger than 2. Are there signs of language delay before 24 months?
Most language development experts agree that at 12 months, a child should be doing the following things…
- saying at least a few single words with meaning such as “mama” and “dada”
- understanding and following simple commands such as picking up a toy on request like, “Give me the ball” or “Give me a kiss.”
- responding consistently to their names
- using several gestures meaningfully such as waving to say good-bye, shaking his head yes/no, or pointing to indicate wants/needs.
- Imitating actions, gestures, sounds, and very familiar words
By 18 months, toddlers with typically developing expressive skills are using many familiar words and imitating words frequently. The minimum vocabulary size should be about 15 to 20 words. An 18-month-old with typically developing language skills says 50 words.
Why is identifying late talking so important?
Late talking is often the first indication of a developmental issue and may evolve into other disabilities, such as social communication disorder, autism, intellectual disability, learning disability, or attention-deficit/hyperactivity disorder.
Research tells us, the earlier a problem is identified, there’s a much greater chance that it will not turn into a life-long issue. By addressing the language delay, you’ll eliminate the delay or reduce the severity and impact it will have on a child’s future.
How common is late talking?
Anytime we discuss how “common” an issue is, we’re really looking at incidence and prevalence.
Incidence of late language emergence (LLE) refers to the number of new cases identified in a specified time period.
Prevalence refers to the estimated population of children who are exhibiting LLE at any given time.
Because researchers vary the definition, age, and criteria used to identify kids as late talkers or with LLE, we have different estimates. Here are the most current and consistent findings:
- Prevalence estimates of LLE for 2-year-olds primarily range between 10% and 20%.
- Late talking is noted more in males who are 3 times more likely to exhibit LLE than girls; 70% of late talkers are boys!
- Prevalence estimates based on both receptive and expressive language tend to be lower than those based on expressive language alone – 13.4% vs. 19.1%.
- LLE is more common when there’s a family history (23%) compared with those with no reported history (12%).
- LLE is higher in toddler-age twins at 38%.
Will my late talker catch up?
We started with this question and now I’ll go ahead and tell you what the research says…
The most positive projection is that between 70–80% of Late Talkers seem to catch up to their peers by the time they enter school, but there are some caveats as we will discuss below.
There are other studies that aren’t so positive. Miniscalco and colleagues (2005) reported that 82% of toddlers who failed screenings at 30 months of age were not recovering by age 6. (Capone-Singleton)
The research is overwhelmingly positive for kids with an expressive delay only. When delays are noted before 18 months of age and there are no other developmental issues, a child is very likely to catch up. These kids are referred to as late bloomers in research about language development. Late bloomers are kids who have issues only with expressive language (the talking piece) who catch up by the time they are school-age.
Do late bloomers still need speech therapy?
Yes! The main reason is that we can’t definitively say who will and won’t catch up. More about this later.
Researchers have found that when kids have difficulty learning what words mean and when they don’t use gestures and aren’t adding new words regularly, children are less likely to be able to close the gap.
If there are other issues with language, they may struggle for a while. Here’s what the research says about other risk factors for continuing delay…
Risk Factors for Continued Problems with Language Development
Researchers have identified the following factors that make it more likely a child’s language development may not catch up to peers. We’ll group them into two categories – medical and developmental factors and then family and environmental factors.
Gender: Boys are at higher risk for LLE than girls.
Motor development: Late talkers were found to have delayed motor development when there were no other diagnoses associated with motor delays as compared to peers with typical language development.
Low birth weight: Babies born earlier than 37 weeks gestation or at less than 85% optimal weight are at higher risk.
Recurrent ear infections: Early, chronic ear infections may result in language delays.
Family and Environmental Factors
Family history of late talkers: Research confirms that LLE can be genetic.
Maternal education and SES: Lower maternal education and SES is associated with a higher risk for LLE.
Family size: LLE is more common when a child has siblings.
Excessive screen time: Infant exposure to certain types of media has been associated with lower language scores in some studies, although the relationship between screen time and language development is complex!
Let’s summarize where we are…
A large number of late talkers, 70 to 80%, will likely catch up when there are no other delays.
This is super positive news for parents, particularly if a child is already using lots of gestures to compensate for the gap between what they want to say and can’t and when a child has normal language comprehension skills.
For these kids, pediatricians previously recommended a “wait and see” approach meaning that at some point in the future, speech therapy would be recommended. That recommendation is now not best practice for 5 reasons beautifully outlined in a literature review by Dr. Nina Capone Singleton, speech-language pathologist, called “Late Talkers: Why the Wait-and-See Approach Is Outdated,” as quoted below:
- A wait-and-see approach delays referral of a child for further developmental evaluation when s/he fails a language screening in toddlerhood.
LATE TALKERS CAN BECOME CHILDREN WITH LANGUAGE DISORDER OR LATE BLOOMERS.
When you delay referral as in “wait and see,” you essentially harm the kids who could have benefited from earlier intervention.
- The view that most late talkers catch up seems to be outdated because they do not necessarily meet their same-age peers in all aspects of development.
According to the research reviewed by Dr. Capone-Singleton, late bloomers have a “weak endowment” of language ability that persists even after vocabulary catches up. Even though these kids may perform within normal limits on standardized tests, many times their scores are within the low average performance range, just above cut-off scores for intervention which does not narrow or close. They continue to struggle with reading, writing, and spelling, all academic subject areas with language as their foundational component.
Another study reviewed in this research found “slow maturation for neural processing” for language among 3- to 5-year-olds who had previously been classified as late talkers. Although they may technically be discharged from speech therapy, they still require longer processing time for spoken language. Even when preschool and kindergarten classrooms accommodate different learning styles, the primary teaching method remains verbal. Teachers teach by talking. Kids are supposed to learn by listening. When a child requires more time to process language, there may be difficulty acquiring new information.
- Late talking can also impact early socialization and school readiness, and can place some late talkers at risk for life-long disability.
Children use language, by talking and responding when others talk to them, to make friends and participate in academic settings throughout childhood. Even in math class and music class, the teacher uses words to explain math or teach a new song or instrument.
- Interprofessional education and practice supports early referral for late talkers who are at risk. Screening alone will not differentially diagnose late bloomers from children with Language Disorder.
The position of the American Academy of Pediatrics is that children under 3 years of age are to be referred from the pediatrician’s office for further developmental and medical evaluation if a toddler fails developmental screening. In best practice, physicians use standardized screening of developmental milestones at 9, 18, and 30 months of age, as well as when a concern is expressed by a caregiver or is evident to the medical professional at well-child appointments.
- Advances in the science of brain development, language development and disorders, and epigenetics support early identification and intervention, not a wait-and-see approach for late talkers.
Researchers across disciplines reach the same conclusion:
The “wait-and-see” approach when a toddler is not developing language is outdated.
Counting on all late talkers to fully catch up is a widespread misconception.
While we do see great variability in language development, particularly in vocabulary size in toddlers, when a child doesn’t meet certain minimum milestones, you are better safe than sorry.
Intervention will only help. Waiting will very likely compound the negative impact of a child’s continued language delay.
Helping late talkers as early as possible can make a huge difference and increase their odds for long-term success in academic settings.
Now on to the positives…
What seems to make the most difference in outcomes for late talking toddlers?
Overwhelming, research finds that “early identification and intervention can mitigate the impact of risk factors” for continued language delay. Professionals must consider risk factors carefully when deciding to recommend or not recommend services.
For any child with delay that’s greater than 6 months, we know they need intervention.
What’s early intervention?
Early intervention can be provided through speech therapy, a developmental preschool program, and (especially, italics mine!) in parent-led programs meaning moms and dads intentionally change what they do at home to focus on language development.
I’m also going to go against the standard recommendation that many of our state early intervention programs use for determining outcomes and strategies. State EI programs focus on parent coaching or training, which is wonderful and should be the crux of any therapy program for a toddler or preschooler. But, most of the time, all of the recommendations are focused on what you can tweak during a family’s existing everyday routines. The theory is that parents are more likely to add strategies to their existing routines rather than learning something new.
While I certainly understand this logic and have focused on teaching parents exactly how to do that throughout my career, the research has found that other things make more of an impact to prevent language delays and help a child catch up with a mild lag in language development.
The best part is, the activities are not super complicated to teach families…
Protective Factors to Protect Toddlers from Language Delay
I want to discuss two protective factors that may buffer children and families from factors later language and learning problems (Collison et al., 2016), including:
- reading and sharing books with infants daily
- providing informal play opportunities
Reading to babies and toddlers is so important for language development. Obviously, parents are focused on language development during that time since they’re reading and naming pictures, but there are other benefits too:
- Reading together promotes closeness and engagement, or a one-on-one connection between parents and children. During that time with a book, parents are more likely to be less distracted or mentally “busy” as compared to other times with their child.
- The pictures in the book provide visual cues for the child to help assist with language comprehension. When a parent labels pictures, a child links meaning with the word. If a parent asks questions, the pictures often show the answer, again assisting with receptive language development.
- Book reading builds joint attention skills in toddlers. When a child and parent read a book together, both the adult and child are focused on the same thing and are sharing the experience, particularly when the adult is using strategies to increase a child’s attention and comprehension. You can find out more about those strategies in podcasts 415, 416, and 417.
The second activity listed above is providing consistent play opportunities.
Why is learning to play important?
Play skills are the best way to measure cognitive development in babies and toddlers. Play is how children learn, link information, and make associations. At first, this process is very concrete. Before a toddler can say the word “block,” he must learn about the block—how it feels in his hands (and mouth!), how the block looks, different ways he can move the block, etc. All these things occur before he is ready to associate the word “block” with the wooden square in front of him. Play is how toddlers blossom from thinking very concretely about the world around them to maturing into symbolic thinkers. That’s all language is—a set of symbols. Words represent things, people, and events. Words are symbols, and play provides a wonderful, natural opportunity for parents to use words to help a child build his or her language comprehension and language expression skills.
My best resource for teaching play, along with social interaction and engagement, is Teach Me To Play WITH You, a treatment manual written for parents with step-by-step instructions for easy and FUN games. The games in this book are my #1 starting point for ALL toddlers with language delays. We teach them first to imitate actions, then sounds, then verbal routines and early first words while playing with you. This is my #1 resource I give the parents I work with directly in our first session. Check it out here….
What about treatment ideas for late bloomers?
When there are no other delays beyond expressive language or talking, teaching a child to imitate is the most important goal. The tricky part is, you can’t always begin with words. Many kids need earlier, easier targets. I walk you through this entire process I’ve developed in my therapy manual with the “chart” which lists start to finish what you need to do to help your late talker learn to imitate and use words and phrases. Your plan is written for you! Get your info here.
I hope this presentation of the latest research about late talking leaves you empowered as a parent to make the best decision for treatment options for your child or empowered as a professional to make the best recommendations for treatment options for families of late talkers and toddlers with LLE.