Professional Corner

Julie Loe

Late Blooming or
Language Problem?

Parents are smart. They listen to their child talk and know how he or she communicates. They also listen to his or her playmates who are about the same age and may even remember what older brothers and sisters did at the same age. Then the parents mentally compare their child's performance with the performance of these other children. What results is an impression of whether or not their child is developing speech and language at a normal rate.

If parents think that development is slow, they may check out their impression with other parents, relatives, or their pediatrician. They may get an answer such as "My son was slow too. Now he won't shut up" or "Don't worry, she'll outgrow it."

But, suppose (s)he doesn't? I'd feel so guilty waiting and then finding out that I should have acted earlier. Waiting is so hard, especially when I'm concerned and only want what's best for my child. What's a parent to do? How will I know foe sure what to do?

You won't know for sure. Although the stages that children pass through in the development of speech and language are very consistent, the exact age when they hit these milestones varies a lot. Factors such as the child's inborn ability to learn language, other skills the child is learning, the amount and kind of language the child hears, and how people respond to communication attempts can slow down or accelerate the speed of speech and language development. This makes it difficult to say with certainty where any young child's speech and language development will be in 3 months, 6 months, or 1 year.

There are, however, certain factors that may increase the risk that a late-talking child in the 18-to 30-month-old age range, and with normal intelligence, will have continuing language problems. These factors include:

	Receptive language, understanding language generally precedes expression and use. Some studies that have followed-up late-talking children in this age range after a year have found that age-appropriate receptive language discriminated late bloomers from children who had true language delays. Other researchers doing follow-up studies included only children whose receptive language was within normal limits, because they believed that delay in this area was likely to produce worse outcomes.
	Use of gestures. One study has found that the number of gestures used by late-talking children with comparably low expressive language can indicate later language abilities. Children with a greater number of gestures used for different communication purposes are more likely to catch up with peers. Such a result is supported by findings that some older children who are taught non-verbal communication systems show a spontaneous increase in oral communication.
	Age of diagnosis. More than one study has indicated that the older the child at time of diagnosis, the less positive the outcome. Obviously, older children in a study have had a longer time to bloom than younger children but have not done so, indicating that the language delay may be more serious. Also, if a child is only developing slowly during an age range when other children are rapidly progressing (e.g., 24-30 months) that child will be falling farther behind.
	Progress in language development. Although a child may be slow in language development, he or she should still be doing new things with language at least every month. New words may be added. The same words may be used for different purposes. For example, "bottle" may one day mean "That is my bottle," the next, "I want my bottle," and the next week ' "Where is my bottle? I don't see it." Words may be combined into longer utterances ("want bottle," "no bottle"), or such longer utterances may occur more often.
	It should be re-emphasized that negative aspects of these factors increase the risk of a true language problem but do not mandate its presence. For example, one research group found that one of their 25- or 26-month-old children with the worst receptive language had the best expressive language outcome 10 months later. On the other hand, children on the positive side of these factors may turn out to show less progress than predicted. The research group found that the child with the poorest outcome had the best receptive language and the largest vocabulary at the beginning of the study.
	Individual children may not behave like children in a group. Group data can only be used to predict what most children who are very similar to the children in a study might do. Predictions, by their very nature, are not always correct.

So, what's a parent to do?

Parents don't have to rely on the predictions of others or to guess that their child will be just like a friend's and eventually catch up in language development. If parents are concerned about their child's speech and language development, they should see a speech-language pathologist for a professional evaluation. The speech-language pathologist can administer tests of receptive and expressive language, analyze a child's utterances in various situations, determine factors that may be slowing down language development, and counsel parents on the next steps to take.

The speech-language pathologist may give suggestions on stimulating language development, and ask that the parent and child return if parental concern continues. Or, the speech-language pathologist may want to schedule a re-evaluation right then. In more severe cases, the speech-language pathologist may want the parent and child to become involved in an early intervention program. These programs typically consist of demonstrating language stimulation techniques for home use, and more frequent monitoring of the child's progress. In the most severe cases, a more formal treatment program may be recommended.

Waiting to find out if your child will catch up will still be hard, but you won't feel guilty that you did not do everything you could.

Reprinted with permission from the American Speech-Language-Hearing Association

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