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Language Delay

How speech pathology treats delayed language development

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If your child is a late talker does it mean that they have a language delay? But what if they are your second or third child and their older siblings do all of the talking for them?
 
While you know they understand everything that is being said. But they don’t seem to be saying that much yet.
 
They will just catch up, right?
 
Or, perhaps this is a problem? What can speech pathology do to help..?
“Children who have not yet reached their age-appropriate speech and language milestones”
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What is a language delay?

Language delay has been given many different names over the years. E.g. “Late language emergence” “early language delay” and “late talkers”. A lot of different terms describe a group of kids who are late to talk. In other words, these are kids who have not yet reached their speech and language milestones.
 
In speech pathology, we refer to a child who has delayed language as:
 
  • a 12-month-old who is yet to say their first word and uses mostly gestures to communicate (e.g. pointing, waving)
  • an 18-month-old who has less than 50 words
  • A 2-year-old who has less than 200 words or is yet to join words to make short phrases.  

What causes it?

There are a number of factors that may contribute to late talking or delayed language. Specifically, including hearing, family history, a child’s personality, and language exposure.
 
There is no one cause for “late-talking”. Most importantly, it must be remembered that late talking is no one’s “fault”. Additionally, supportive intervention by parents and speech pathologists can make a significant difference in a child’s communication skills.

What does it look like?

Considerable research has gone into understanding the communication milestones for children. As speech pathologists, we are often met with many questions about children who are late talkers. At the same time, we know parents are often given conflicting advice. Which supports both early intervention and the “wait and see” approach.
 
Significantly, many studies now agree that spoken language skills are important indicators of future reading ability. For this reason, children need strong language skills by the time they are 4 or 5 years old. At the same time that pre-literacy learning begins in the Preschool Early Years Learning Framework.
 
Research indicates that 20-25% of kids who are late to talk at 1-2 years old also enter Kindergarten with below-average language skills[1][2]. With this in mind, it is important to understand children’s language skills. This includes what they understand (receptive) and how they put their thoughts into words (expressive). Because this has a strong correlation with their ease and success in learning how to read[3][4].
 
Rather than hoping for the best, we recommend seeking the support of a speech pathologist. To help you develop a supportive program for your child. Early identification is vital to supporting language development.
“There is no one cause for “late-talking”… and no-one’s “fault” and supportive intervention by a parent, carer or speech pathologist can make a significant difference”
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Milestones

Age
Expressive Language
By this age, your child should use:
Receptive language
By this age, your child should understand:
12 months
  • Mama and Dada meaningfully
  • Babble combinations that sound like sentences but not using real words yet
  • Imitate animal noises
  • Use a word to call a person
  • Imitate the name of familiar objects
  • Say first real word
  • Point to two body parts on themselves
  • Respond to “no”
  • Give objects when asked
  • Look at the person saying their name
  • Look at objects mentioned in the conversation
  • Gesture in response to questions
18 months
  • 50 different words
  • Talk rather than use gesture
  • Imitate words overheard in conversation
  • Asks “What’s that?”
  • Ask for “more”
  • Names at least 7 familiar objects
  • Point to 6 body parts or items of clothing
  • Find familiar objects that they can’t see
  • Point to pictures in a book e.g. “Point to the cat”
2 years
  • 50 – 300+ words
  • 2 words together frequently
  • 3-word phrases occasionally
  • New words regularly
  • Their name to refer to themselves
  • Present tense: jumping
  • Pronouns: my, me
  • Listens to simple stories
  • Answers what, who, and where questions e.g. “What’s the dog doing?”
  • Relationships between 2 words e.g. daddy’s car

When to seek help for language

At Talkshop Speech Pathology we recommend beginning therapy if your child is 6 or more months behind their expected developmental milestones. While the evidence is mixed in terms of which areas of communication are the best indicators for long-term difficulties. The following three key factors have been identified as the most important communication markers: degree of expressive language (use of language) delay, degree of receptive language (understanding of language) delay, and degree of gestural impairment[5].

You should seek support if your:

12 month old:

  • not making eye contact
  • not babbling
  • not using gestures like pointing and waving

18 month old:

  • has 10 words or less
  • uses gestures more than words

2-year-old:

  •  has 50 words or less
  • is not joining 2 words together

Many children who are late to talk eventually catch up with their peers. However, research has not revealed the early indicators to identify which children will not catch up without intervention. As the milestone gap widens, likely, the duration of a speech therapy program to close the gap will also increase. Research does support that a program of speech therapy can achieve significant improvements at any stage of a language delay. However, early intervention reduces the developmental impacts of a language delay in many other areas of a child’s development.

“Rather than hoping for the best, it is recommended to seek the support of a speech pathologist”
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How can speech pathology help?

Assessment

All professional speech therapy programs begin with an assessment. Assessments use standardised measurement tools. Firstly, this allows us to identify your child’s strengths and weaknesses. But more importantly, it establishes a baseline to measure their therapy progress.
 
For young children, we use play assessment. For this reason, both parents and speech pathologists are active in the assessment. During the assessment, we review spoken language. Including the number and types of words while simultaneously reviewing speech sounds. We also measure non-verbal communication. Specifically reviewing pointing, play skills, eye contact, and joint attention. As well as parallel play skills and initiation of interaction.
 
Following the assessment, we provide a comprehensive therapy management plan. Which identifies key goals to focus on during the therapy blocks.

Therapy

Beginning therapy for kids who are late to talk is exciting. Generally, families attend weekly sessions. During speech pathology sessions you can expect a mixture of play and education. In particular, we focus on supporting parents’ confidence in providing therapy at home. Therefore giving you the skills to enrich your day-to-day language environment at home. While at the same time maximising ways to model and stimulate speech and language.
 
Example therapy goals for a child using single words:
  • Firstly, to increase the number of action words (verbs) to support the use of two words together.
  • Secondly, to expand the range of vocabulary. Increasing the variety of words through child-directed play.
  • Finally, to increase understanding (comprehension) of language through book reading and play strategies.

Who we work with

During early language therapy, speech pathology supports your confidence to practice at home. At this early age, we know parents are the most important people in a child’s life. You will be the agents of change and learning! Learning to use therapy strategies at home means even the most mundane tasks can become a chance for learning.
 
Talkshop speech pathologists regularly work with both close and extended families. In addition, we welcome Grandmas, Grandads, Aunts and Uncles to attend therapy sessions. We know regular practice and language exposure is vital to support language development. Meaning the more opportunities for learning the better. Likewise, we also work with your child’s pre-school, daycare/school.
 
Our Speech Pathologists are Hanen registered providers. Consequently, we use both child and adult learning strategies during therapy sessions. For the purpose of supporting both you and your child to develop your skills.
 
We are NDIS registered and are able to work with children with complex diagnoses. Talkshop supports children with diagnosed developmental language disorder (DLD), global delay, autism, other congenital disorders affecting language development. Furthermore we work with children requiring augmentative and alternative communication aids (AAC).
“We use both child and adult learning strategies to support both you and your child to develop your skills”
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Book an Initial Consultation

Our FREE Discovery Session is ideal for anyone with any questions relating to speech, stuttering, language, literacy, social skills, swallowing, and voice.

This is an opportunity for us to give some information on how to monitor your concern and give you advice on how to start self-managing any issues immediately.

Discovery Sessions can help you understand if an assessment or therapy is needed, how Speech Therapy would work, and if appropriate, help you book in.

References

1 Cable, A, L. & Domsch, C. (2011) Systematic review of the literature on the treatment of children with late language emergence. International Journal of Language Communication Disorders. https://www.ncbi.nlm.nih.gov/pubmed/21401813. Accessed 11 Jan. 2019.

2 National Senate enquiry on speech and language skills, https://www.aph.gov.au/Parliamentary-Business/Committees/Senate/Community-Affairs/Speech-Pathology/Report/c03

3 Scarborough H.S. (2009) Connecting early language and literacy to later reading (dis)abilities: Evidence, Theory & Practice. In Fletcher-Campbell F., Soler J., Reid G. (2009) Approaching difficulties in literacy development: Assessment, Pedagogy and Programmes. https://www.researchgate.net/publication/306200560-Connecting-early-language-and-literacy-to-later-reading-disabilities-Evidence-theory-and-practice. Accessed 11 Jan. 2019.

4 Dorothy V Bishop 1, Margaret J Snowling1, Paul A Thompson1, Trisha Greenhalgh2, CATALISE-2 consortium  – CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development. Phase 2. Terminology. https://www.ncbi.nlm.nih.gov/pubmed/28369935. Accessed 11 Jan. 2019.

5 Dale, P.S., Price T.S., Bishop D.V.M, & Plomin R. (2003) Outcomes of early language delay: I. Predicting persistent and transient language difficulties at 3 and 4 years. Journal of Speech, Language, and Hearing. 46.3. https://ora.ox.ac.uk/objects/uuid:4f84b707-c146-41a4-ade3-da5854df6d35. Accessed 11 Jan. 2019.

Additional Resources

McLeod, S., & McKinnon, D. (2007). Prevalence of communication disorders compared with other learning needs in 14,500 primary and secondary school students. International Journal of Language & Communication Disorders, 42, 37–59.

Gersten, R., Fuchs, L. S., Williams, J. P., & Baker, S. (2001). Teaching reading comprehension strategies to students with learning disabilities: A review of research. Review of Educational Research, 71, 279–320.

http://www.hanen.org/Helpful-Info/Articles/Combining-Words-Together.aspx

http://www.hanen.org/Helpful-Info/Articles/Parents%E2%80%99-role-in-language-intervention.aspx