Late talking children

Late talker also called late language learner or late language emergence, is a delay in normal language development in children with no other diagnosed disabilities or developmental delays in other cognitive or motor domains. Late talkers or late language emergence is diagnosed when language development trajectories are below age expectations. Toddlers who exhibit late language emergence are referred to as “late talkers” or “late language learners”. Children’s language comprehension and production emerge between 12 and 24 months of age ¹. Some otherwise healthy children require more time to begin talking, a condition described as “late language emergence”. The reasons for such variation at the toddler stage of development are relatively unexplored. Variations in family or maternal resources are thought to play a role, although actual outcomes are mixed. More recently, genetic studies have focused on possible inherited risk for late language emergence ². Late talker is widely assumed to be the first diagnostic symptom of children with language impairments. Tager-Flusberg and Cooper ³ called for studies of early identification of specific language impairment, “with particular emphasis on predicting which late talkers develop specific language impairment”.

Late talkers may present with expressive language delays only or mixed expressive and receptive delays ⁴. Children with only expressive delays exhibit delayed vocabulary acquisition and often demonstrate slow development of sentence structure and articulation. Those with mixed expressive and receptive language delays exhibit delays in language comprehension and in oral language production.

Some researchers distinguish a subset of children with late language emergence as “late bloomers.” They posit that late bloomers catch up to their peers in language skills by 3 to 5 years of age. At onset, it is difficult to distinguish late talkers from late bloomers, as this distinction can be made only after the fact. However, there is some research to suggest that late bloomers use more communicative gestures than age-matched late talkers who remained delayed ⁵, thereby compensating for limited oral expressive vocabularies ⁶. Research also indicates that late bloomers are less likely to demonstrate concomitant language comprehension delays when compared with children who remain delayed ⁵.

Late talkers may be at risk for developing language and/or literacy difficulties as they age. Late talkers who have receptive and expressive delays are at greater risk for poor outcomes than late talkers whose comprehension skills are in the normal range ⁷.

The risk of being a late talker at 24 months was significantly associated with being a boy, lower socioeconomic status, being a non-singleton, older maternal age at birth, moderately low birth weight, lower quality parenting, receipt of day care for less than 10 hours/week, and attention problems. Being a late talker increased children’s risk of having low vocabulary at 48 months and low school readiness at 60 months. Family socioeconomic status had the largest and most profound effect on children’s school readiness.

Late language emergence may also be an early or secondary sign of disorders, such as specific language impairment, social communication disorder, autism spectrum disorder, learning disability, attention deficit hyperactivity disorder, intellectual disability, or other developmental disorders. In order to make a differential diagnosis, it is critical to monitor the global development of a child in domains that include, but are not limited to, cognitive, communication, sensory, and motor skills.

Incidence of late talker refers to the number of new cases identified in a specified time period. Prevalence refers to the estimated population of children who are exhibiting late talker at any given time.

Estimates vary according to the definition and criteria used to identify late talker, as well as the age and characteristics of the population.

• Prevalence estimates of late talker in 2-year-old children primarily range between 10% and 20% ⁸.
• In 18- to 23 months old toddlers, the percentage of late talkers is estimated to be 13.5%. This rate rises to 16%-17.5% in 30- to 36 months old children ⁹.
• Prevalence estimates based on both receptive and expressive language tend to be lower than those based on expressive language alone (13.4% versus 19.1%) ⁸.
• Prevalence estimates are higher for children with a positive family history for late talker (23%) compared with those with no reported history (12%) ⁸.
• Males are 3 times more likely than females to exhibit late talker ⁸.
• Higher prevalence rates of late talker have been noted in a population of toddler-age twins (38%) with a greater proportion in monozygotic twins (48.1%) compared with dizygotic twins (32.6%) ¹⁰.

Children having difficulties with language need help as early as possible. You’re the best judge of your child’s language development. If you’re concerned, trust your instincts and speak with your doctor, your child’s teacher or a speech pathologist. If this professional isn’t concerned about your child, but you’re still worried, seek another opinion.

If you think your child is having trouble with language, talk to a professional – for example:

• teachers or educators at your child care center, preschool or school
• a speech-language pathologist
• an audiologist
• a doctor or pediatrician
• a child and family health nurse
• a psychologist.

If you think your child’s main problem is understanding and using language, you might want to visit a speech-language pathologist. Speech pathologists can use language tests to assess how your child uses words and responds to requests, commands or questions.

If you think your child might be hard of hearing or have a hearing impairment, it’s best to have your child’s hearing checked by an audiologist. Hearing loss could interfere with your child’s language development and communication.

Late talkers causes

The causes of late talker in otherwise healthy children are not known. However, several variables such as genetic or biological factors are thought to play a role. Language delay might run in families.

Language delay is more likely for:

• boys
• children who have a close family member with a history of a language delay or communication disorder
• children who have a developmental disorder or syndrome like autism spectrum disorder or Down syndrome
• children with ongoing hearing problems and ear infections.

Sometimes, delays in communication skills can be signs of more serious developmental disorders including hearing impairment, developmental delay, intellectual disability and autism spectrum disorder. You know your child better than anyone else. If you’re worried, talk to a health professional.

Risk factors for late talker

Based on research comparing late talkers with typically developing peers on variables linked with language development, a number of risk factors for late talker have been proposed, including:

Child factors

• Gender—boys are at higher risk for late talker than girls ⁹;
• Motor development—late talkers were found to have delayed motor development (in the absence of disorders or syndromes associated with motor delays) when compared with typically developing children ¹¹;
• Birth status—children born at less than 85% of their optimum birth weight or earlier than 37 weeks gestation were found to be at higher risk for late talker ⁸;
• Early language development—language abilities at 12 months appear to be one of the better predictors of communication skills at 2 years ¹².

Family factors

• Family history—late talkers are more likely to have a parent with a history of late talker ¹³;
• Presence of siblings—late talkers are less likely than children without late talker to be an only child; these findings may reflect decreased maternal resources available to the child ⁸;
• Mother’s education and social economic status of the family—lower maternal education and lower social economic status of the family are associated with higher risk for late talker ⁸; maternal education and family social economic status are thought to be related to the amount of support (resources) available to the child for language learning ¹⁴.

Early identification and intervention can mitigate the impact of risk factors (Guralnick, 1997, 1998; National Research Council, 2001; Thelin & Fussner, 2005). Therefore, it is important for speech-language pathologists to recognize these risk factors when identifying late talker and considering service delivery options.

Protective factors

The National Joint Committee on Learning Disabilities suggests a number of protective factors that may buffer children and families from factors that place them at risk for later language and learning problems. These include:

• access to pre-, peri-, and postnatal care;
• learning opportunities, such as:
  • exposure to rich and varied vocabulary, syntax, and discourse patterns;
  • responsive learning environments that are sensitive to cultural and linguistic backgrounds;
  • access to printed materials;
  • involvement in structured and unstructured individual/group play interactions and conversations;
  • engagement in gross and fine motor activities;
  • access to communication supports and services as needed.

Late talkers symptoms

A language delay is when a child has difficulties understanding and/or using spoken language. These difficulties are unusual for the child’s age.

The difficulties might be with:

• saying first words or learning words
• putting words together to make sentences
• building vocabulary
• understanding words or sentences.

Some language delays are associated with conditions like autism spectrum disorder, Down syndrome or deafness and hearing impairment. Many happen on their own.

Signs and symptoms among monolingual English-speaking children with late talker are based on parent-report measures. An extensively used set of criteria for late talker is an expressive vocabulary of fewer than 50 words and no two-word combinations by 24 months of age ¹⁵. However, it is essential to review these criteria at regular intervals (e.g., every 6 months) to assess language growth and to determine whether the child is in fact a late talker, whether language skills fall outside of developmental trajectories, or whether signs and symptoms clearly indicate a language disorder.

In making the determination, it is also important to consider other language development factors, including rate of vocabulary growth, speech sound development, emerging grammar, language comprehension, social language skills, use of gestures, and symbolic play behaviors ¹⁶.

For example, when compared with toddlers of the same age with typical language development, late talkers may demonstrate:

• phonological differences once they do produce their first words, including less complex/mature syllable structures, lower percentage of consonants correct, and smaller consonant and vowel inventories ¹⁷;
• delayed comprehension and communicative use of symbolic gestures ¹⁸;
• use of shorter and less grammatically complex utterances—particularly for toddlers with expressive and receptive delays ¹⁸;
• comprehension of fewer words ¹⁸.

Research also suggests that delays and differences in babbling before the age of 2 can predict later delays in expressive vocabulary, limited phonetic repertoire, and use of simpler syllable shapes ¹⁹.

Late talkers speech diagnosis

Because late talkers remain at risk for later language and literacy problems, early assessment and periodic monitoring are essential to track language development and identify any problems that might arise. For children who present with signs and symptoms of late talker, the typical diagnostic pathway includes a broad check of speech and language developmental status, along with periodic monitoring via screening and systematic observation. If monitoring indicates persistent delays over time and/or additional developmental complications arise, a complete assessment may be warranted.

It is important that the speech-language pathologist use screening and assessment tools that provide the most representative sample of the child’s behaviors across a range of people and activities within the child’s natural environments. Ideally, screening and assessment take place in the child’s home or child care setting. The speech-language pathologist can also gather information about the child’s language skills through parent and caregiver report. Parental perspectives on the child’s skills relative to the beliefs and values of the family and their culture are relevant aspects to consider.

Screening and assessment results are interpreted within the context of a child’s overall development and in collaboration with family members and with other professionals as appropriate. Contextualized interpretation is important, because communication is only one aspect of children’s interactions with the environment.

Screening

Careful screening by an speech-language pathologist is warranted to identify young children at risk for language disorders and to determine the need for further speech-language/communication assessment or referral for other professional services. Screening is also an important component of prevention, family education, and support for young children and their families.

Screening measures may involve direct interaction with the child, parent report on a standardized instrument, or both. In fact, the validity of the screening process may increase when professional-administered measures are combined with parent-completed measures ²⁰. For screening purposes, however, either standardized testing or parent report is adequate, provided that the measure used has adequate psychometric properties.

Screening typically includes:

• gathering information from parents, caregivers, and/or preschool teachers regarding concerns about the child’s language skills;
• conducting a hearing screening to rule out hearing loss as a possible contributing factor to language difficulties; for a child who is reluctant or unable to complete a hearing screening, observing his or her response to sound and noise in the environment and referring the child for audiologic assessment if there is a concern;
• using a formal screening tool, observations, and parent questionnaires and checklists to obtain information about the child’s communication behaviors;
• using other language assessment methods (e.g., observing the child in play activities with familiar individuals);
• gathering information about speech sound development (e.g., via an informal language sample obtained during play activities).

Screening may result in recommendations for:

• a complete audiologic assessment;
• plans to monitor speech and language development, with rescreening as appropriate;
• suggestions for encouraging language development using language stimulation activities;
• a comprehensive speech and language assessment that includes evaluation of social communication skills, symbolic play, and use of gestures;
• a referral for medical or other professional services.

Comprehensive assessment

If other developmental complications arise or if periodic monitoring indicates persistent delays, a comprehensive speech and language assessment may be indicated. The comprehensive assessment takes into account the most common concerns for late talkers—failure to begin using words, absence of a “vocabulary spurt,” and failure to begin combining words in the 2nd year of life—and any other communication concerns specific to the individual child. Components of the assessment may change over time, depending on the child’s age and stage of development.

For late talkers who have not yet acquired verbal language, the assessment focuses on preverbal behaviors, including play, gesture, and other forms of nonverbal communication and interaction. For children who display various forms of communication (e.g., gestures, vocalizations, words), the assessment evaluates their ability to use these forms to communicate successfully with others.

Based on the presenting symptoms, the speech-language pathologist may conduct a comprehensive speech-language assessment and consider the need for early intervention. Additionally, referrals may be made to other professionals, if the symptoms suggest disorders or conditions other than, or in addition to, language delay.

Pre-assessment planning

Professionals from a variety of disciplines have encouraged the use of pre-assessment planning for young children ²¹. Pre-assessment planning involves one or more professionals who meet with the child and family to gather information and plan the upcoming assessment. Common goals for planning include identifying what the family needs and wants from the assessment process, the roles that family members (and caregivers) would prefer to take in the assessment, and the child’s areas of strength and need ²².

Assessment typically includes:

• relevant case history, including:
  • family’s concerns about the child’s speech and language;
  • birth, medical, and developmental history;
  • history of middle ear infections;
  • family history of late talker or other language difficulties;
  • language history and proficiency for children who are dual-language learners, including:
    • language typically used in the home and community,
    • other language(s) used in the home,
    • circumstances in which each language is used,
    • child’s age when first exposed to English or the other language(s) and the amount of exposure to all of the languages in the child’s environments,
    • type of language experience in the child’s environment (e.g., home literacy activities, conversations, television, etc.);
• hearing screening;
• oral mechanism examination;
• assessment of language skills, including (for multilingual children, in all of the languages they are exposed to):
  • means of communication, including:
    • vocalizations,
    • words,
    • gestures,
    • eye gaze;
  • functions of communication, including:
    • behavior regulation (e.g., requesting and protesting),
    • social interaction (e.g., greeting),
    • joint attention (showing and commenting);
  • early sound development, including:
    • proportion of consonants,
    • inventory of early versus late-developing sounds,
    • multisyllabic babbling,
    • inventory of syllable shapes;
  • expressive vocabulary, including emerging words and word approximations (in all languages);
  • rate of vocabulary growth;
  • vocabulary diversity (e.g., nouns, pronouns, relational words);
  • word combinations and length of utterance;
  • range of meanings expressed in early word combinations;
  • early grammar, including:
    • syntax (e.g., subject-verb and subject-verb-object sentences),
    • morphology (e.g., tense markers);
  • receptive vocabulary;
  • comprehension of simple commands;
  • pragmatics and social behavior, including comprehension of early social routines;
• play behaviors (e.g., symbolic play and social pretend play);
• emergent literacy, including:
  • interest in books,
  • looking at or pointing to pictures in books,
  • holding a crayon or pencil and scribbling on paper.

Given the influence that families have on their children’s growth and development and the fact that children’s language learning takes place in the context of interacting with those close to them, it is important for the speech-language pathologist to gather information about the child’s interactions with his or her caregivers. Consider differing communication styles—which are influenced by social and cultural factors—that impact the caregiver-child interaction. A number of measures are available for observing these types of interactions, and they vary with respect to their psychometric properties. In addition to considering the psychometric properties of these tools, keep in mind that a number of other factors can affect the way children interact with their caregivers, including:

• contextual factors (e.g., home or clinic setting);
• familiarity with the observer and the materials or toys being used;
• type of interaction (e.g., free play, book reading, or completing a particular task).

Assessment is accomplished using a variety of measures and activities, including both standardized and nonstandardized measures, as well as formal and informal assessment tools. speech-language pathologists have the obligation to ensure that standardized measures used in assessment show robust psychometric properties that provide strong evidence of their quality ²³

An assessment battery typically includes the following procedures and data sources:

• norm-referenced tests—provide information about a child’s language skills compared with those of children the same age,
• criterion-referenced tests and developmental scales—provide information about a child’s behavior compared with a fixed set of predetermined criteria or developmental milestones,
• parent-completed tools and observations—gather information from parents based on observations of their child’s behavior in naturalistic environments,
• play-based assessment—uses play as the context for observation and documentation of the child’s behavior,
• routines-based assessment—provides descriptions of a child’s participation in family-identified routines and activities,
• authentic assessment—gathers information about the functional behavior of the child in typical/natural settings from all those who interact with him or her on a regular basis,
• dynamic assessment—is used as a means to determine what the child can do alone versus with a facilitator (e.g., adult or other child).

For bilingual children, appropriate assessment in all languages is necessary to differentiate between a linguistic difference and a true communication disorder. In most cases, the use of standardized tests alone is not sufficient. Test scores are invalid for individuals who are not represented in the normative group for the test’s standardization sample, even if the test is administered as instructed. In these cases, the tests cannot be used to determine the presence or absence of a communication disorder. Non-normed (criterion) measures, along with observation, language sampling, ethnographic interviewing, and dynamic assessment procedures are fundamental to differentiating a difference from a disorder.

Assessment may result in:

• determination of a language delay (expressive language delay or mixed expressive-receptive delay) in the absence of a language disorder;
• diagnosis of a spoken language disorder (receptive language disorder only, expressive language disorder only, or expressive-receptive mixed);
• description of the characteristics and severity of the disorder or delay;
• determination of performance variability as a function of communicative situations/contexts;
• identification of delayed phonological development;
• identification of delayed early literacy skills;
• identification of social communication problems;
• identification of possible hearing problems;
• recommendation for ongoing monitoring and reassessment throughout ages 2 and 3 to evaluate language growth relative to peers, combined with caregiver training in language facilitation;
• recommendation for direct intervention and support;
• referral to early intervention services for eligibility determination;
• referral to other professionals as needed (e.g., for assessment of sensory, motor, and cognitive skills);
• determination that the child has a language difference and not a language disorder.

Late talkers speech therapy

The goal of language intervention is to stimulate overall language development and to teach language skills in an integrated fashion and in context, so as to enhance everyday communication and enhance the family’s ability to support the child’s development. Services and supports are individualized for each child and family.

For toddlers and preschoolers with late talker, the speech-language pathologist can help remediate problems and potentially prevent future difficulties and the need for subsequent school-based services ²⁴. When intervention is indicated, the frequency and degree of intervention can vary along a continuum from indirect to direct speech-language services.

When making treatment decisions, it is critical to identify the nature and severity of the language delay and its overall effect on communication, the presence of risk factors, and the child’s global developmental skills.

• When no other developmental delays or disabilities have been identified or are suspected, the typical course for a late talker is regular monitoring or monitoring combined with indirect language stimulation.
• When language delays persist over time, or are present with other identified or suspected delays or disabilities (e.g., intellectual disabilities, autism spectrum disorder, hearing impairment), direct speech and language services are indicated; the speech-language pathologist coordinates services with other professionals working with the child.

Each child has a unique language profile that may be influenced by the language(s) spoken at home, cultural background, and family constellations. It is important to consider these factors when developing an intervention plan. For more information on culturally and linguistically appropriate service delivery.

Regular monitoring and indirect intervention

Indirect intervention consists of activities to stimulate language development. Typically, the speech-language pathologist provides ideas and sample activities for parents and caregivers to engage in with the child. Enrichment activities, such as book sharing and play groups, are encouraged. An approach that utilizes and encourages multiple modes of communication (e.g., speech, gestures, signs, and pictures) is also encouraged.

The speech-language pathologist may continue to monitor the child on a regular basis during this time and consult with parents and caregivers as needed. For some children, the speech-language pathologist may provide families with more focused language stimulation activities (e.g., language models designed specifically for that child) and monitor on a more frequent basis.

Interaction styles that have been shown to stimulate language competence and enhance communication in young children include ²⁵:

• providing responses directly related to a child’s communication act or focus of attention,
• providing language models for the child,
• providing models of nonverbal communication behaviors (e.g., gestures and eye gaze),
• imitating or expanding the child’s actions or words,
• reinforcing the child’s communication attempts,
• giving the child adequate time to initiate communication and respond to adults.

Direct treatment

It is essential that treatment be founded on the highest quality evidence available. Goals are frequently selected with consideration given to developmental appropriateness and the potential for improving the effectiveness of communication and academic and social success. Effective early intervention ensures that services are:

• comprehensive, coordinated, and team based;
• family centered and culturally and linguistically responsive;
• developmentally supportive and promote children’s participation in their natural environments.

Working with families

A key component to the success of intervention with toddlers is working closely with families. Individuals with Disabilities Education Improvement Act (IDEA) (2004) requires that families have the opportunity to share concerns and priorities that may guide or influence treatment. Based on the work of Bailey ²⁶ and Winton ²⁷, the following key activities can guide the gathering of this type of information:

• identifying the family’s concerns and what they hope to accomplish with their participation with service providers and the service system;
• determining how the family perceives the child’s strengths and needs related to their family values and within the family structure and routines;
• identifying the priorities of the family and how service providers may help with these priorities;
• identifying the family’s existing resources related to its priorities;
• identifying the family’s preferred roles in the service delivery decision-making process;
• establishing a supportive, informed, and collaborative relationship with the family.

A family-centered approach aligns with the federal mandate to provide services in natural environments. Collaborating with parents/caregivers regarding routines and everyday activities helps to:

• identify culturally appropriate learning opportunities that occur in the home, community, or school;
• determine the communication goals for the child;
• learn about the child’s preferences and interests;
• identify and implement techniques for intervention.

Treatment approaches and options

There are a number of different approaches and strategies for working with toddlers with language delay and disorder. Interventions can vary along a continuum of naturalness ²⁸, ranging from contrived or drill-based activities in a therapy room (clinician directed), to activities that are play based and include everyday activities in natural settings (child centered), to those that use activities and settings that combine both approaches (hybrid). One example of a hybrid approach is dialogic reading, an interactive technique in which adults prompt children with questions and engage them in discussions while reading together ²⁹.

Augmentative or alternative communication methods may be considered as a temporary means of communication for late talkers. Research shows that use of augmentative and alternative communication may aid in the development of natural speech and language ³⁰.

Whichever technique is used, the cultural background of the child and his or her family is also considered. There are many cultures for which play-based therapies and child-directed play may not be appropriate. In the cultures of some individuals, “It may be even less natural to engage in child-led play-based interactions, as this is sometimes inconsistent with social roles and expectations” ³¹. This relays the importance of providing services in a manner that best fits the child’s needs, given the cultural environment in which he or she lives. Similarly, interventions focused on labeling and rehearsing information can be culturally inappropriate for some families.

Intervention for preschoolers (ages 3–5)

In typically developing preschool children, language is developing at a rapid pace; their vocabularies are growing, and they are beginning to master basic sentence structures. For children with language difficulties, this process may be delayed. For children in this population, areas targeted for intervention typically include:

• Phonology
  • improving significantly impaired intelligibility—particularly if it results in frustration in communicating and/or masks problems in semantics and syntax—including:
    • increasing consonant repertoire,
    • improving accuracy of sound production,
    • decreasing use of phonological processes;
  • enhancing phonological awareness skills, such as:
    • rhyming;
    • blending and segmenting spoken words at the following levels:
      • syllable (2 syllables in pancake: pan and cake),
      • onset and rime (2 onsets: p and c; 2 rimes: an and ake),
      • phoneme (6 phonemes: p+a+n+c+a+ke)
    • deletion of whole words, syllables, and phonemes in spoken words, phrases, and/or sentences.
• Semantics
  • increasing size of vocabulary, including:
    • verbs, pronouns, conjunctions;
    • basic concept vocabulary;
  • increasing understanding and use of a wider range of semantic relationships (e.g., agent-action, agent-object, possessor-possession, attribute-entity, recurrence).
• Morphology and syntax
  • facilitating acquisition and use of age-appropriate morphemes—in particular, auxiliary verbs, articles, pronouns;
  • increasing sentence length and complexity;
  • increasing use of varied sentence types.
• Pragmatics
  • increasing flexibility of language for various contexts;
  • using imaginative play activities to practice newly acquired language skills;
  • improving conversational skills, including:
    • initiating and maintaining communication;
    • turn taking, topic maintenance, and topic shifts;
    • requesting and making conversational repairs;
  • developing narrative skills.
• Literacy
  • building emergent literacy skills, including:
    • print awareness,
    • book awareness,
    • understanding simple story structure,
    • letter knowledge,
    • matching speech to print.

Intervention for elementary school children (ages 5–10)

The focus of language intervention for elementary school children with language difficulties is to help the child acquire the language skills needed to learn and succeed in a classroom environment. Interventions are curriculum-based, that is, goals address language needs within the context of the curriculum where these skills are needed.

Interventions may also address literacy skills (e.g., improving decoding, reading comprehension, and narrative and expository writing), as well as metacognitive and metalinguistic skills (e.g., increasing awareness of rules and principles for use of various language forms, improving the ability to self-monitor and self-regulate) that are critical for the development of higher-level language skills.

For children who speak a language other than English in the home, it may be necessary to use the home language as a mechanism for transitioning the child to using the language of the school. Planning and implementing an effective language intervention program is often a coordinated effort involving the speech-language pathologist, classroom teacher(s), and other school specialists.

Areas targeted for this population typically include:

• Phonology
  • enhancing phonological awareness skills,
  • eliminating any residual phonological processes.
• Semantics
  • improving knowledge of vocabulary, including knowledge of curriculum-related vocabulary,
  • improving depth of vocabulary understanding and use, including:
    • subtle differences in meaning,
    • changes in meaning with context,
    • abstract vocabulary,
    • figures of speech;
  • understanding figurative language and recognizing ambiguities in language (e.g., words with multiple meanings and ambiguous sentence structures);
  • monitoring comprehension, requesting clarification;
  • paraphrasing information.
• Morphology and syntax
  • increasing the use of more advanced morphology (e.g., monster/monstrous, medicine/medical, school/scholastic);
  • increasing the ability to analyze morphologically complex words (e.g., prefixes, suffixes);
  • improving morphosyntactic skills (e.g., use of morphemes in simple and complex clauses, declarative versus questions, tag questions and relative clauses);
  • improving the ability to understand and formulate more complex sentence structures (e.g., compound sentences; complex sentences containing dependent clauses);
  • judging the correctness of grammar and morphological word forms and being able to correct errors.
• Pragmatics
  • using language in various contexts to convey politeness, persuasiveness, clarification;
  • increasing discourse-level knowledge and skills, including:
    • academic discourse,
    • social interaction discourse,
    • narrative discourse,
    • expository discourse,
    • use of cohesive devices in discourse;
  • improving the ability to make relevant contributions to classroom discussions;
  • improving the ability to repair conversational breakdowns;
  • learning what to say and what not to say;
  • learning when to talk and when not to talk.

Intervention for adolescent students (ages 11 through high school)

As students enter their adolescent years, curriculum demands increase. Children with language disabilities may have difficulty meeting increased demands of secondary school. Although basic language skills are still taught, it may not be possible to close the gap between skill level and grade level. At this point, interventions tend to focus on teaching ways to compensate for language deficits. Student involvement is important at this age to foster a feeling of collaboration and responsibility for developing and achieving intervention goals and to learn self-advocacy skills for the classroom (e.g., requesting priority seating in front of classroom).

Instructional strategies approaches that focus on teaching rules, techniques, and principles to facilitate acquisition and use of information across a broad range of situations and settings are often used with older students. Enhancing metalinguistic and metacognitive skills is fundamental to learning new strategies. The emphasis is on how to learn, rather than what to learn. Classroom assignments are often used to teach strategies for learning academic content. Some instructional strategies are discipline-specific, and others are generalizable across disciplines ³². Examples include strategies for using:

• context to deduce meaning and infer and identify main ideas;
• deciphering of morphologically complex words associated with different academic course work (e.g., history, literature, chemistry, algebra);
• checklists and graphic organizers to plan assignments (e.g., book reports, presentations, research papers);
• spell check and grammar check to edit written work composed in an electronic format;
• digital technologies (e.g., Internet, collaboration sites) to access and evaluate information, share and collaborate with classmates, produce shared products, etc.

Transitioning youth and post-secondary students

Difficulties experienced by children and adolescents with language impairment can continue to impact functioning in post-secondary education and vocational settings. When compared with typically developing peers, fewer individuals with language impairment complete high school or receive an undergraduate degree ³³. The majority of young adults with specific language impairment who pursue education after high school seek vocational rather than academic qualifications ³⁴. In addition, individuals with speech and language impairment tend to be employed in lower-skilled jobs than their typically developing peers ³⁴.

The data on educational and vocational outcomes for individuals with speech and language disorders highlight the need for continued support to facilitate a successful transition to young adulthood. These supports include, but are not limited to, the following:

• Transition Planning—the development of a formal transition plan in high school that includes career goals and educational needs; academic counseling (including discussion about requirements for admission to post-secondary schools); career counseling; opportunities for work experience; and community networking
• Transition Goals—goals for successful transitioning to post-secondary school or employment that can include preparing a resume; completing a job or college application; effectively presenting skills and limitations during an interview; expressing concerns to authority figures about academic or job performance; stating or restating a position to effectively self-advocate in academic and employment settings
• Disability Support Services—individualized support for college-level students that can include accommodations, such as extended time for tests and the use of assistive technology (e.g., to help with reading and writing tasks)
• Vocational Support Services—include testing to identify vocational strengths, career counseling, vocational training, job search assistance, and job coaching

Secondary school personnel can assist the student in transition by ³⁵:

• including students and parents in planning,
• being sensitive to culture and values of the student and family,
• educating students about their rights and helping them develop self-advocacy skills,
• helping the student and family in the selection of an appropriate post-secondary school setting and assisting with the application process,
• informing students and families about services in post-secondary settings (e.g., disability support services and academic counseling),
• providing current documentation needed to access services (including academic accommodations) in a post-secondary setting,
• helping students identify the need for supports and any accommodations and assistive technologies.

Late talkers prognosis

Approximately 50% to 70% late talkers are reported to catch up to peers and demonstrate normal language development by late preschool and school age ³⁶. In a study by Rice, Taylor, and Zubrick ³⁷, the prevalence of language impairment at age 7 was 20% for children with a history of late talker compared with 11% for controls. That is, only one in five late talkers had language impairment at age 7.

Although many late talkers go on to perform within the normal range on expressive and receptive language measures by kindergarten age ³⁸, their scores on such measures continue to be lower than those of children with a history of typical language development, matched for socioeconomic status ³⁹.

For example, school-age children who had been identified as late talkers demonstrated ⁴⁰:

• lower scores at age 5 on language measures that tap complex language skills, like narrating a story;
• poorer performance on measures of general language ability, speech, syntax, and morphosyntax at age 7;
• poorer performance on reading and spelling measures at ages 8 and 9;
• lower scores on aggregate measures of vocabulary, grammar, verbal memory, and reading comprehension at age 13;
• lower scores on vocabulary/grammar and verbal memory factors at age 17.

Delayed language comprehension has been shown to be a significant predictor of language outcomes in late talkers ³⁸. Deficits in comprehension are associated with language deficits at later ages ⁵.

For some children, late talker may be an early indicator of specific language impairment. Children who continue to have poor language abilities below chronological age expectations (by late preschool or school age) that cannot be explained by other factors (e.g., low nonverbal intelligence, sensory impairments, or autism spectrum disorder) may be identified at that point as having specific language impairment ⁴¹.

1. Zubrick SR, Taylor CL, Rice ML, Slegers DW. Late language emergence at 24 months: an epidemiological study of prevalence, predictors, and covariates. J Speech Lang Hear Res. 2007;50(6):1562-1592. doi:10.1044/1092-4388(2007/106) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3521638
2. Dale PS, Price TS, Bishop DVM, Plomin R. Outcomes of early language delay: I. Predicting persistent and transient delay at 3 and 4 years. Journal of Speech, Language and Hearing Research. 2003;46:544–560.
3. Tager-Flusberg H, Cooper J. Present and future possibilities for defining a phenotype for specific language impairment. Journal of Speech Language and Hearing Research. 1999;42(5):1275–1278.
4. Late Language Emergence. https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935380&section=Overview
5. Thal, D. J., Tobias, S., & Morrison, D. (1991). Language and gesture in late talkers: A one year follow-up. Journal of Speech, Language, and Hearing Research, 34(3), 604-612.
6. Thal, D. J., & Tobias, S. (1992). Communicative gestures in children with delayed onset of oral expressive vocabulary. Journal of Speech, Language, and Hearing Research, 35(6), 1281-1289.
7. Marchman, V. A., & Fernald, A. (2013). Variability in real-time spoken language processing in typically developing and late-talking toddlers. In L. A. Rescorla & P. S. Dale (Eds.), Late talkers: Language development, interventions, and outcomes (pp. 145-166). Baltimore, MD: Brookes.
8. Zubrick, S. R., Taylor, C. L., Rice, M. L., & Slegers, D. W. (2007). Late language emergence at 24 months: An epidemiological study of prevalence, predictors, and covariates. Journal of Speech, Language, and Hearing Research, 50(6), 1562-1592.
9. Horowitz, S. M. Irwin, J. R. Briggs-Gowan,M. J. Bosson Heenana, J. M. Medoza, J., & Carter, A. S. (2003). Language delay in a community cohort of young children. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 932-940.
10. Rice, M. L., Zubrick, S. R., Taylor, C. L., Gayan, J., & Bontempo, D. (2014). Late language emergence in 24-month-old twins: Heritable and increased risk for late language emergence in twins. Journal of Speech, Language, and Hearing Research, 57, 917-928.
11. Rescorla, L. A., & Alley, A. (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.
12. Reilly, S., Wake, M., Bavin, E. L., Prior, M., Williams, J., Bretherton, L., Eadie, P., Barrett, Y., Ukoumunne, O. C. (2007). Predicting language at 2 years of age: A prospective community study. Pediatrics, 120(6), e1441-e1449.
13. Ellis Weismer, S., Murray-Branch, J., & Miller, J. F. (1994). A prospective longitudinal study of language development in late talkers. Journal of Speech, Language, and Hearing Research, 37(4), 852-867.
14. Hoff-Ginsberg, E. (1994). Influences of mother and child on maternal talkativeness. Discourse Processes, 18, 105-117.
15. Paul, R. (1991). Profiles of toddlers with slow expressive language development. Topics in Language Disorders, 11(4), 1-13.
16. Wetherby, A., Allen, L., Cleary, J., Kublin, K., & Goldstein, H. (2002). Validity and reliability of the Communication and Symbolic Behavior Scales Developmental Profile with very young children. Journal of Speech, Language, and Hearing Research, 45, 1202-1218.
17. Mirak, J., & Rescorla, L. (1998). Phonetic skills and vocabulary size in late talkers: Concurrent and predictive relationships. Applied Psycholinguistics, 19(1), 1-17.
18. Thal, D. J., Marchman, V. A., & Tomblin, J. B. (2013). Late-talking toddlers: Characterization and prediction of continued delay. In L. A. Rescorla & P. S. Dale (Eds.), Late talkers: Language development, interventions, and outcomes (pp. 169-201). Baltimore, MD: Brookes.
19. Fasolo, M., Majorano, M., & D’Odorico, L. (2008). Babbling and first words in children with slow expressive development. Clinical Linguistics and Phonetics, 22(2), 83-94.
20. Glascoe, F. P. (1999). Using parents’ concerns to detect and address developmental and behavioral problems. Journal for Specialists in Pediatric Nursing, 4(1), 24-35.
21. Crais, E. R., Roy, V. P., & Free, K. (2006). Parents’ and professionals’ perceptions of the implementation of family-centered practices in child assessments. American Journal of Speech-Language Pathology, 15, 365-377.
22. Boone, H., & Crais, E. R. (2001). Strategies for achieving family-driven assessment and intervention planning. In Young exceptional children monograph series, no. 3. Missoula, MT: Division for Early Childhood of the Council for Exceptional Children.
23. Dollaghan, C. (2004). Evidence-based practice in communication disorders: What do we know, and when do we know it? Journal of Communication Disorders, 37, 391-400.
24. American Speech-Language-Hearing Association. (1991). Prevention of communication disorders tutorial. Asha, 33(Suppl. 6), 15-41.
25. Yoder, P. J., & Warren, S. F. (2001). Intentional communication elicits language-facilitating maternal responses in dyads with children who have developmental disabilities. American Journal of Mental Retardation, 106, 327-335.
26. Bailey, D. B., Jr. (2004). Assessing family resources, priorities, and concerns. In M. McLean, M. Wolery, & D. B. Bailey, Jr. (Eds.), Assessing infants and preschoolers with special needs (3rd ed., pp. 172-203). Upper Saddle River, NJ: Pearson Education.
27. Winton, P. (1996). Understanding family concerns, priorities, and resources. In P. McWilliam, P. Winton, & E. Crais (Eds.), Practical strategies for family-centered early intervention (pp. 31-53). San Diego, CA: Singular.
28. Fey, M. (1986). Language intervention with young children. San Diego, CA: College-Hill Press.
29. Zevenbergen, A. A., & Whitehurst, G. J. (2003). Dialogic reading: A shared picture book reading intervention for preschoolers. In A. van Kleeck, S. A. Stahl, & E. B. Bauer (Eds.), On reading books to children: Parents and teachers (pp. 177-200). Mahwah, NJ: Erlbaum.
30. Lüke, C. (2014). Impact of speech-generating devices on the language development of a child with childhood apraxia of speech: A case study. Disability and Rehabilitation: Assistive Technology, 11, 80–88.
31. Wing, C., Kohnert, K., Pham, G., Cordero, K. N., Ebert, K. D., Kan, P. F., & Blaiser, K. (2007). Culturally consistent treatment for late talkers. Communication Disorders Quarterly, 29(1), 20-27.
32. Faggella-Luby, M., & Deshler, D. (2008). Reading comprehension in adolescents with LD: What we know; what we need to learn. Learning Disabilities Research & Practice, 23(2), 70-78.
33. Johnson, C. J., Beitchman, J. H., & Brownlie, E. B. (2010). Twenty-year follow-up of children with and without speech-language impairments: Family, educational, occupational, and quality of life outcomes. American Journal of Speech-Language Pathology, 19(1), 51.
34. Conti-Ramsden, G., & Durkin, K. (2012). Postschool educational and employment experiences of young people with specific language impairment. Language, Speech, and Hearing Services in Schools, 43(4), 507-520.
35. National Joint Committee on Learning Disabilities. (1994). Secondary to postsecondary education transition planning for students with learning disabilities. In Collective perspectives on issues affecting learning disabilities: Position papers and statements (pp. 97-104). Austin, TX: PRO-ED.
36. Dale, P. S., Price, T. S., Bishop, D. V., & Plomin, R. (2003). Outcomes of early language delay: Part I. Predicting persistent and transient language difficulties at 3 and 4 years. Journal of Speech, Language, and Hearing Research, 46, 544-560.
37. Rice, M. L., Taylor, C. L., & Zubrick, S. R. (2008). Language outcomes of 7-year-old children with or without a history of late language emergence at 24 months. Journal of Speech, Language, and Hearing Research, 51(2), 394-407.
38. Ellis Weismer, S. (2007). Typical talkers, late talkers, and children with specific language impairment: A language endowment spectrum. In R. Paul (Ed.), The influence of developmental perspectives on research and practice in communication disorders: A festschrift for Robin S. Chapman (pp. 83-102). Mahwah, NJ: Erlbaum.
39. Rescorla, L. A. (2002). Language and reading outcomes to age 9 in late-talking toddlers. Journal of Speech, Language, and Hearing Research, 45, 360-371.
40. Rescorla, L. A. (2009). Age 17 language and reading outcomes in late-talking toddlers: Support for a dimensional perspective on language delay. Journal of Speech, Language, and Hearing Research, 52, 16-30.
41. Archibald, L. M., & Gathercole, S. E. (2007). The complexities of complex memory span: Storage and processing deficits in specific language impairment. Journal of Memory and Language, 57, 177-194.