Background: This review analyzed the literature on toddlers (generally around 2 years old) available at the time in order to compile characteristics that would enable early intervention (EI) providers to distinguish between children who are “late talkers” but will likely catch up to their peers without therapy (as the majority do) and those who truly have a language disorder.
Methodology and Participants: N/A
Conclusion: The authors found characteristics across language domains that were indicators to provide therapy rather than give the child time to catch up to his peers on his or her own. While studies have found contradictory results regarding the predictive value of a production-comprehension gap, the authors settled on a 6-month delay in expressive and receptive vocabulary to be indicative of the need for therapy. Phonologically, several studies demonstrated that a reduced phonemic repertoire and a decreased percent of consonants correct indicated the risk for continued language delay. Toddlers with decreased ability to imitate two-word combinations were also more likely to continue to exhibit language delay. In play, a toddler who exhibits symbolic play likely has a higher probability of catching up versus a toddler who engages in play that consists mostly of grouping and manipulation. The ability to use combination gestures or gestures that expand the meaning of one-word utterances is another indicator that can discriminate between toddlers who later caught up and those who continued to be delayed. Finally, children who continued to exhibit language delay differed from those who caught up with respect to their social behavior. Those who did not catch up tended to have behavioral problems, preferred interacting with adults rather than peers, and they seldom initiated the interactions when they did interact with peers. In addition to these indicators, risk factors also contribute to the decision to provide therapy. Risk factors put the child at high risk of language delay regardless of indicators, thus strengthening the need to provide therapy if they exist in conjunction with indicators. These risk factors included otitis media and a family history of speech and language disorders. Additionally, low socioeconomic status (SES) and parent interaction styles have also been correlated to decreased probability of catching up to peers by the early school years. It is important to note however, that SES and parent interaction styles are cultural differences that are not indicative of a disorder. They are indicative of a difference between child rearing practices of children from culturally and linguistically diverse homes and the child rearing practices of middle SES, Standard American English (SAE) speaking families that form the majority of normative samples in standardized tests. A clinician may opt to provide parent training in these circumstances on how the parents could support language development to prepare their child for school, but it would be inappropriate and unethical to label a child as language impaired if one of the main factors is SES or cultural differences.
Relevance to the Field: The fact that none of the indicators discovered in the literature review include the use of standardized tests demonstrates the need for more holistic assessment and evaluation practices. Evaluators should not and do not need to rely on standardized tests to make decisions regarding therapy. This study provides some key indicators that clinicians can look for in determining the need for speech and language services. It is important to note, however, that all these indicators (e.g., vocabulary, phonology, play, etc.) should be compared to the child’s speech community and not to norms of children from other backgrounds (i.e., different SES, SAE norms when the client speaks a dialect or is bilingual).
Olswang, L .B., Rodriguez, B., & Timler, G. (1998). Recommending intervention for toddlers with specific language learning difficulties: We may not have all the answers, but we know a lot. American Journal of Speech-Language Pathology, 7, 23-32.