Language delay

A language delay is a language disorder in which a child fails to develop language abilities at the usual age-appropriate period in their developmental timetable. It is most commonly seen in children from two years-old to the age of seven years-old and can sometimes continue into late childhood. The reported prevalence of language delay is not agreed upon and ranges from 2.3 to 19 percent.[1]

Language is a uniquely human form of communication that entails the use of words in a standard and structured way.[2] Language is distinct from communication. Communication is a two-stage process. The first stage is the process of encoding the message into a set of words (or signs in the case of Sign Languages) and sentence structures that convey the required meaning, i.e. into language. In the second stage, language is translated into motor commands that control the articulators (hands, face, body, lungs, vocal cords, mouth, tongue, teeth, etc.), thereby creating speech.

Language delays are distinct from speech delays, in which the development of the mechanical and motor aspects of speech production are delayed. Speech is the verbal motor production of language, while language is a means of communication.[1] Because language and speech are independent, they may be individually delayed. For example, a child may be delayed in speech (i.e., unable to produce intelligible speech sounds), but not delayed in language because they use a Sign Language.

A language delay is commonly divided into receptive and expressive categories. Receptive language refers to the process of understanding language. Expressive language refers to the use of sentences (made of words or signs) to communicate messages to others. Both categories are essential in developing effective communication.

Language delays are recognized by comparing language development of children to recognized developmental milestones. They are presented in a variety of ways, as every individual child has a unique set of language skills and deficiencies that are identifiable through many different screenings and tools. There are different causes leading to language delay; it is often a result of another developmental disorder and treatment requires analysis of the unique individual causes. The condition is frequently observed early on, among two- and three-year-olds.[3] Early language delays are only considered risk-factors in leading to more severe language disorders.[3]

Language Development

There are recognizable speech and language developmental milestones.[4] Language delays are often identified when a child strays from the expected developments in the timeline of typical speech and language developmental milestones that researchers agree on.[4] Children can stray slightly from the confines of the expected timeline, but, in the case that a child is observed to be largely straying from the expected timeline, the child's caretaker should consult with a medical specialist.

Timeline of typical speech and language developmental milestones

This timeline only provides a general outline of expected developments from birth to age five, individual children can still exhibit varying development patterns as this timeline only serves as a general guideline. This timeline is only one model, other models regarding language development exist.[2] The development of language remains a theoretical mystery.[5]

Newborn baby: No language skills developed yet, but is communicating through actions and sounds such as crying.

Around 2 months, babies can make “cooing" sounds.[4]

Around 4 months, babies can respond to voices.[4]

Around 6 months, babies begin to babble and respond to names.[4]

Around 9 months, babies begin to produce mama/dada - appropriate terms and are able to imitate one word at a time.[4]

Around 12 months, toddlers can typically speak one or more words. They can produce two words with meaning.[4]

Around 15 months, toddlers begin to produce jargon,[4] which is defined as "pre-linguistic vocalizations in which infants use adult-like stress and intonation".[6]

Around 18 months, toddlers can produce 10 words and follow simple commands.[4]

Around 24 months, toddlers begin to produce 2-3 words and phases that use "I", "Me", and "you", indicating possession.[4] They are about 25% intelligible.[4]

Around 3 years, toddlers are able to use language in numerical terms.

Language development in language delay

Early developmental language delay is characterized by slow language development in preschoolers.[3] Language development for children with language delay takes longer than the general timeline provided above.[7] It is not only slower, but also presents itself in different forms. For example, a child with a language delay could have weaker language skills such as the ability to produce phrases at 24 months-old.[7] They may find themselves producing language that is different from language norms in developing children.

Presentation

A language delay is most commonly identified around 18 months of age with an enhanced well-baby visit.[8] It presents itself in many forms and can be comorbid or develop as a result of other developmental delays. It is important to remember that language delays act and develop differently individually. Language delay is different than individual variation in language development, and is defined by children falling behind on the timeline for recognized milestones.[9]

Early signs and symptoms (red flags)

Language delay in children is associated with increased difficulty with reading, writing, attention, and/or socialization.[1] Children that do not effectively compare with their peers in these abilities and have drastic difficulties should see a physician.[1] Language delay could be present itself early on as a lack of communicative gestures or sounds.

For example, communicative tools might indicate language delay symptoms, such as:

  • Not smiling at 3 months-old
  • Not turning the head towards sounds at 4 months-old.
  • Not pointing at 15 months-old.
  • More specifically, not being able to produce around 10 words at 18 months-old.[10][11][12][13]

Later symptoms include:

  • A lack of speech.[1]
  • An inability to comprehend, process, or understand language presented to the child.[1]

Identification

Many different screening tools are available to identify language delay in young children. The Language Development Survey (LDS; developed by Rescorla[14]) is a 10 minute, parent-administered and simple tool to help identify language delays in children at two years-old.[15] It is a validated, suitable, and inexpensive screening tool that enables the early assessment of language delay.[15]

There is currently insufficient evidence in literature to suggest an argument for or against routine use of formal screening instruments in to detect language delay in all children.[1] However, if a child is not meeting expected language milestones, a comprehensive developmental evaluation is necessary.[1]

Complications

Language delay is a risk factor for other types of developmental delay, including social, emotional, and cognitive delay. Even though speech and language delays may affect a smaller portion of the population in children, it still can have an incredible impact on their life and their accomplishments in the future. Some of these include problems with behavior, difficulty with reading, and other issues related to spelling and low IQ scores.[16] Some children may grow out of these deficits, even coming to excel where they once lagged, while others do not. One particularly common result of language delay is delayed or inadequate acquisition of reading skills. Reading depends upon an ability to code and decode script (i.e., match speech sounds with symbols, and vice versa). If a child is still struggling to master language and speech, it is very difficult to learn another level of complexity (writing). Thus, it is crucial that children have facility with language to be successful readers.

Neuroscientist Steven Pinker postulated in 1999 that a certain form of language delay (dubbed "Einstein syndrome" by economist Thomas Sowell in 2001) may be associated with exceptional and innate analytical prowess in some individuals, such as Albert Einstein, Richard Feynman and Edward Teller.[17]

Causes

Language delays are the most frequent developmental delays, and can occur for many reasons. A delay can be due to being a “late bloomer”, “late talker”, or a more serious problem. The most common causes of speech delay include

Such delays can occur in conjunction with a lack of mirroring of facial responses, unresponsiveness or unawareness of certain noises, a lack of interest in playing with other children or toys, or no pain response to stimuli.[18][19] There are other causes to language delay.

  • Autism (a developmental disorder) - There is strong evidence that autism is commonly associated with language delay.[20][21] Asperger syndrome, which is on the autistic spectrum, however, is not associated with language delay.[22]
  • Being a twin or a younger sibling increases the chance of speech and language delays. Reasons for this are thought to include less one-on-one time with parents, premature birth with twins, and the companionship of their twin sibling reducing their motivation to talk to others.[23] With being a younger sibling, it can also be linked to less one on one time with their parents or guardians. Older siblings also tend to talk for their younger siblings, giving them less opportunities to grow their language skills.[24]
  • Gender and family history: Correlation with male sex, previous family history, and maternal education has been demonstrated.[25]
  • Genetic abnormalities - In 2005, researchers found a connection between expressive language delay and a genetic abnormality: a duplicate set of the same genes that are missing in sufferers of Williams-Beuren syndrome. Also so called XYY syndrome can often cause speech delay.[26]
  • Neonatal Brachial Plexus Palsy - There exists a high prevalence of early language delay exists among toddlers with neonatal brachial plexus palsy.[27]
  • Poverty - Poverty is a risk factor for language delay as a result of a lack of access appropriate therapies.[28] Socioeconomic adversities correlate with delayed language development.[29]
  • Psychosocial deprivation - The child doesn't spend enough time communicating with adults, such as babbling and joint attention. Research on early brain development shows that babies and toddlers have a critical need for direct interactions with parents and other significant care givers for healthy brain growth and the development of appropriate social, emotional, and cognitive skills.[30]
  • Television viewing - Excessive television viewing is associated with delayed language development. Children who watched television alone were 8.47 times more likely to have language delay when compared to children who interacted with their caregivers during television viewing.[31] Some educational television shows, such as Blue's Clues, have been found to enhance a child's language development.[32] But, as recommended by the American Academy of Pediatrics, children under the age of 2 should watch no television at all, and after age 2 watch no more than one to two hours of quality programming a day. Therefore, exposing such young children to television programs should be discouraged, especially television shows with no educational value.[32] Parents should engage children in more conversational activities to avoid television-related delays to their children language development, which could impair their intellectual performance. However, in a study conducted by Dr. Birken of the Hospital for Sick Children, it was found that watching television while interacting with a parent of caregiver is actually beneficial for children who are bilingual. The study spanned four years, from 2011 to 2015, and was based on parent report and clinician observation. Over the four years it was found that if a bilingual child had interaction with an adult while watching television they did not suffer language delay and it in fact helped them develop English, their second language.[33]
  • Symptoms of stress: Stress during pregnancy is associated with language delay.[34]

Treatment

Studies have failed to find clear evidence that a language delay can be prevented by training or educating health care professionals in the subject. Overall, some of the reviews show positive results regarding interventions in language delay, but are not curative.[35] To treat an already existing language delay a child would need Speech and Language Therapy to correct any deficits. These therapists can be found in schools, clinics, through home care agencies, and also colleges where Communication Sciences and Disorders are studied. Most young children with language delay recover to a normal range by five years of age.[3]

Aside from these, it is still encouraged for the child's parent to get involved. A few ways that a parent could get involved with helping to improve a child’s language and speech skills includes speaking to their child with enthusiasm, engaging in conversations revolving what the child is focusing on, and reading to their child frequently.[36]

Social and play skills appear to be more difficult for children with language delays due to their decreased experience in conversation. Speech Pathologists utilize methods such as prompting to improve a child's social skills through play intervention. While recent studies have consistently found play intervention to be helpful, further research is required in order to determine the effectiveness of this form of therapy.[37]

In regards to demographic factors causing language delay, specifically poverty, system-level changes improve access to treatment for children with language delay and allow them therapies.[28]

See also

References
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Further reading
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