Parents often worry when their child reaches 18 months or 2 years of age and does not talk much or at all. Some children exhibit late language emergence, also known as late talking or a language delay. Approximately 10-20% of 2-year-old children exhibit late language emergence. A late-talking toddler is typically defined as a 24 month old who is using fewer than 50 words and no two-word combinations. While research shows that late talkers catch up to peers by elementary school, approximately one in five late talkers will continue to have a language impairment at age 7. For some children, the late emergence of language may indicate a persistent language disorder, also called a specific language impairment. For other children, late language emergence may indicate a related disorder such as a cognitive impairment, a sensory impairment, or an autism spectrum disorder. Many parents wonder if their late-talking toddler will catch up naturally or whether speech-language therapy is recommended.
The following signs may indicate that a child will not naturally “catch up” in language and therefore may require therapeutic intervention:
- Language production: The child has a small vocabulary and a less diverse vocabulary than peers. A child who uses fewer verbs and uses primarily general verbs, such as make, go, get, and do is at risk for a persistent language disorder.
- Language comprehension: The child has deficits in understanding language. The child may be unable to follow simple directions or show difficulty identifying objects labeled by adults.
- Speech sound production: The child exhibits few vocalizations. The child has limited and inaccurate consonant sounds and makes errors when producing vowel sounds. The child has a limited number of syllable structures (e.g., the child uses words with two sounds, such as go, up, and bye instead of words with three to four sounds, such as down, come, puppy, black, or spin).
- Imitation: The child does not spontaneously imitate words. The child may rely on direct modeling and/or prompting to imitate (e.g., an adult must prompt with, “Say ‘dog,’ Mary” instead of a child spontaneously imitating “dog” when a parent says “There’s a dog”).
- Play: The child’s play consists mostly of manipulating or grouping toys. The child uses little combination or symbolic play, such as using two different items in one play scheme or pretending that one item represents another.
- Gestures: The child uses very few communicative gestures, especially symbolic gestures. The child may use pointing, reaching, and giving gestures more than symbolic gestures such as waving or flapping the arms to represent a bird.
- Social skills: The child has a reduced rate of communication, rarely initiates conversations, interacts with adults more than peers, and is reluctant to participate in conversations with peers.
The following risk factors exist for long-term language disorders:
- Otitis media (middle ear infection) that is untreated and prolonged
- Family history of persistent language/learning disabilities
- Parent characteristics including less maternal education, lower socioeconomic status, use of a more directive instead of responsive interactive style, high parental concern, and less frequent parent responses to child’s language productions
For children displaying any of the above signs or risk factors, a comprehensive speech-language evaluation is recommended.
- Paul, R. (2007). Language Disorders from Infancy through Adolescence: Assessment & Intervention. Elsevier Health Sciences.
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