FAQs for the IALP Child Language Committee
- Why is it important to treat children with language delay/disorder in early childhood?
- What could be the effects of language development delay?
- My 5 year old was diagnosed with ADHD; will this affect his ability to learn to read?
- Our 3 year old is still not talking much, and our physician suspects that he has autism. What makes him think that? Are late talkers different or the same as children with autism?
- We are a multilingual family: What language should the SLP use when intervening with our language-disordered child?
- What early reading approach would work best with our globally delayed child?
- My son is two years old and produces about 20 words. He is very communicative and seems to understand language. Should I worry about his development? Should I take him to a speech-language therapist?
- My daughter was just diagnosed as having verbal apraxia of speech. Can you explain me what is it?
- Why doesn't my child talk like his peers?
- What could be the effects of language development delay?
- Will speech therapy help my child progress and catch up with his peers?
- Lack of speech is the main symptom in autism?
- Could you please explain what is pragmatic disorder?
- How do I know my child is developing language normally (typically)?
- What are the primary markers of language impairment?
- Why is it important for my child to be exposed to print?
Research shows that the brain has a critical window for language development between the ages of two and four. Early childhood is a time when language skills develop very rapidly. Brain circuits associated with language are more flexible before the age of 4 and environmental influences have their biggest impact before the age of four. Consequently, early intervention for children with delayed language attainment should be initiated before this critical age.
O’Muircheartaigh, J., Dean, D.C., Dirks, H., Waskiewicz, N., Lehman, Jerskey, B.A., Deoni, S. (2013). Interactions between white matter asymmetry and language during neurodevelopment. Journal of Neuroscience, 33, 16170-16177.
Studies have examined academic, social/emotional, behavioral, and employment outcomes of persons with histories of language impairments in childhood. Children with history of language impairments typically experience more academic difficulties in school. Relative to children without language impairments, they experience clinically significant increases in the severity of diverse emotional, behavioral, and ADHD symptoms. Persons with histories of language impairment are about twice as likely as typical peers to show clinical levels of emotional and behavioral problems and slightly less than twice as likely to have ADHD. In the immediate postschool years, they fare less well in education and employment than typical peers. They are more likely to be employed in elementary and unskilled service occupations whereas typically developing peers more likely to be engaged in skilled employment or professional work.
Conti-Ramsden, G., & Durkin, K. (2012). Postschool educational employment experiences of young people with specific language impairment. Language, Speech, and Hearing Services in Schools, 43, 507-520.
Johnson, C.J., Beitchman, J.H., & Bronlie, 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, 51-65.
O’Kearney, R. & Yew, S.G.K. (2013). Emotional and behavioral outcomes later in childhood and adolescence for children with specific language impairments: Meta-analysis of controlled prospective studies. Journal of Child Psychology and Psychiatry, 54, 516-524.
Many children with ADHD, a neuro-developmental problem, are also high risk for language-learning disabilities. Their inability to regulate their behaviour (e.g. attend and shift attention, and modulate their emotions), poor development of awareness and thinking about how they think and learn, and the presence of memory problems do lead to difficulties and delays in learning to read, spell, and write, and so have a negative impact on all academic functions. ADHD is NOT a consequence of poor parenting. It is signature to a difference in neurological functions. These interfere with efficient word recognition, the basis for reading; when oral language issues are present these children also grapple with comprehension of what they read.
An important step in combating a possible reading difficulty is improving their listening habits. This includes listening behaviours such as training the child to consistently respond as soon as someone speaks to them, watch the person’s eyes, and let the speaker finish her sentence without interrupting. Next, teach children to fall in love with books, and attend to stories read to them until the end of the story/book. Stories read dialogically- using the book as a springboard to conversation between the adult and child, helps train the child to respond and ask questions about the story so to show interest, and makes him aware that written words have meaning. Also, teach the child to follow directions correctly. Help them remember how to give a message to another person, all the steps in a direction, and say and follow the daily routine at home and school). Make certain the child can recognize people on the phone, play with sounds, and participate in rhyme games. When you are in a noisy area, turn and speak to your child close up and face-to-face to help with improving auditory skills and word learning. The next step toward avoiding or minimizing a reading difficulty is actually providing the child with early reading opportunities. This teaching should take place as soon as possible, and it should start in the home. A Speech-Language Pathologist well trained in early reading instruction can help in supporting the family in early reading stimulation.
Both late talkers and children with autism show delays and difficulties in acquiring the language code. This is made up of two systems, understanding and speaking, and interacting components: grammar and the structure of words, the vocabulary and the meaning of the language, and the pragmatic aspect or how to use language to communicate one’s own thoughts and needs (self-talk) and communicate with others, i.e., exchange messages and ideas.
However, before verbal language is acquired children learn how to communicate without words. These are the necessary ingredients for communication development.
- The child’s ability to focus attention on the activity at hand is the bedrock for speech, language, and cognitive development. It is important to determine how much adult direction is needed to hold the child’s focus of attention. Some children manage their own attention: they are able to select, attend to, and change activities without adult direction. A problem is present when a great deal of effort is needed to try and refocus the child on adult-selected activities;
- A high degree of distractibility is also detrimental to language acquisition and learning.
- Imitation ability must be in place, as it is a necessary precursor to communication development; and
- Turn-Taking, also an imitative skill is the key to effective communication. Without physical and verbal turn-taking conversations are not possible.
Another vital component of human communication is the ability to connect emotionally to our parents/caregivers. Emotional connectedness in interactions actually appears before other developments. It allows babies to ‘fall in love with’ their caretakers, and motivates them to communicate. Children with Autism Spectrum Disorders, including the entire range of intelligence levels, show a core of deficits in building relationships that are due to their neurological differences. The core deficits refer to problems in the ability for empathy, the capacity to see the world from another person’s perspective in both physical and emotional contexts, joint or shared attention, the capacity for affective reciprocity- i.e. take pleasure in the interaction with the caregiver and in sharing our enthusiasm with them, and functional pragmatic language or how to use language in a social-emotional positive manner.
It is in this component that children on the autism spectrum are most different from typical late takers. Your physician probably based her or his conclusions on information you provided regarding all these aspects of communication and relationship building. It is very important that you have your child evaluated by a team of well trained professionals to confirm this conclusion, and following the diagnosis, seek interventions that can best stimulate your child’s communication, pragmatic language use, social-emotional development, and relationship abilities in a natural manner. These will help your child seek interactions with family and other children, and learn to enjoy being and interacting with them without the promise of an external reward.
The question of which language to use in intervention is worrisome to parents and clinicians alike, and the response is not simple. The question is driven mainly by concerns that the child with the language disorder cannot manage more than one language, or that using the other language will further delay the child. Both are based on a limited resource view of the child’s language learning capacity.
According to Gutierrez-Clellen (1999), clinicians’ decisions are based on their own view of bilingual or multilingual language development. The view that the child’s languages tend to develop independently of each other will encourage advice to use the school language, often the language of the majority of the region, to the exclusion of the home languages. On the other hand, if clinicians view language development as interrelated, a bilingual approach will be recommended. In this approach, both the school language and the home language are used in treatment. Another consideration is the availability of clinicians proficient in the child’s home languages, and these are often rare.
First, studies with language delayed children and bilingual education showed no added harm and even some cognitive advantages compared to language disordered children treated and educated in only one language, and at the end they end up with two languages. Secondly, Felt-Mate and Kay-Raining Bird (2008) showed that even children with serious language acquisition problems such as those with Down syndrome were able to develop functional second language skills. Indeed, some are trilingual as well. On the other hand, studies of school success showed educational advantages for those proficient in their school languages, even in regions of poverty.
Why should home language be used for treatment? Separating the child from home languages may interrupt the connectedness and benefits of attachment to immediate and extended family members since the home language is the vehicle for the family’s emotional, social, and cultural inheritance. It is therefore prudent to provide the family with the necessary guidelines and training for stimulating the home language in the natural setting of the home, using natural strategies, and employing all family members in this process. In addition, in today’s global economy and worker mobility, knowledge of several languages (multilingualism) provides a competitive economic advantage. What are the advantages of using the school language for treatment? Proficiency in the school language facilitates the process of learning to read and write in the school language. Furthermore, since the school language is often the language of the majority, it helps the child to eventually integrate into the larger milieu.
In sum, the clinician should provide intervention in the school language (include both oral and literacy needs), and help the family implement stimulation strategies in the family languages (including the use of books in that language). However, a warning is required here: the child’s progress or intervention outcome should not be measured by comparing the child to a monolingual speaker of each of the languages, but rather to other children who speak the same language combinations.
Globally delayed children are those who do not reach developmental milestones at the expected age in most/all of their developmental areas, for example, motoric, balance, coordination, sensory integration, and especially in speech and language. Reading is a process based on oral language. Reading is not a natural process and there is no brain tissue dedicated to reading. The child cannot learn to read by watching others read but in typical development, the child learns to speak by being immersed in oral language and communication contexts. Reading processes ‘kidnap’ oral language neurology for its development. The purpose of reading is to comprehend the author’s messages or information- that is, once words, sentences, and texts are recognized, the brain transforms the written messages into ‘oral language’ so that it becomes meaningful. This is a complex and difficult task for any child as it requires high level cognitive (thinking) and linguistic development.
In alphabetic languages (e.g. Arabic, Danish, English, Hebrew) the reader must discriminate accurately the speech sounds of the language (understand that words are made up of different mouth movements and that each produces a specific sound), and decipher correctly the letter sequences that represent the sounds of the word. When children come to the reading task with delays in speech and language, their foundations for typical reading development are not in place. They therefore require an early approach that can avoid the ‘analytical-synthetic’ route to recognizing words. They need instruction in recognizing whole words by attaching them to ‘pictures’ or symbols that stand for whole words, and at the same time teach them to understand the meaning of the words. Learning to read takes a long time so that instruction in reading should proceed as soon as possible rather than wait for language to be in place. Here are some programs and tools based on this approach.
Bridge to Reading (OISE Press, University of Toronto, Canada- designed for English speakers/learners) is a ‘developmentally based instruction approach that works well with children with global delays as it aims to ‘bring the world of print within grasp of all school children’. For those with severe speech delay, the program teaches communicative gestures that are then paired with visual pictures and the written word. Children who are able to express themselves, are taught to ‘read out loud’ the symbols and their written forms, and also learn to recognize the written word without the picture symbol, giving them access to reading. The Ball-Stick-Bird Reading program (Renee Fuller- meant for English speakers/learners) teaches the child to read and write by showing how each letter is formed, teaching its sound, and how to write it. The mechanics of reading instruction are suitable for developmental levels of two – three year olds, but the content covers a much larger range. Finally, the Widgit Company (see website) provides a symbol system to accompany written words (in English and French). The bank contains 12,000 symbols which can be used to represent over 40,000 words and phrases. Symbols are a way to understand, learn, and communicate so to overcome the barrier that written texts represent to children and people of all ages and abilities. The symbols can be added to texts specifically designed for the child’s level of development as those in Bridge reading so to enhance both oral language and reading development simultaneously. The symbols are suitable for all languages with Left-To-Right writing systems. Below is a Widgit sample of symbols connected to a sentence.
Free online resources for symbol readers are available on the World Wide Web. For example Askability.org.uk is provided by the Children's Society and it contains a range of topical material for children and young people. Symbolworld.org is also a free website dedicated to symbol users of all ages. It enables symbol users to access information independently, and it contains a huge variety of articles, stories, and information.
7. My son is two years old and produces about 20 words. He is very communicative and seems to understand language. Should I worry about his development? Should I take him to a speech-language therapist?
Many toddlers, about 15%, present with limited expressive vocabularies despite typical development. The above case describes the most frequent clinical scenario we as speech and language scientists and therapists face. These children are initially referred to as "late talkers. Most of the time toddlers with early expressive language appear to "catch up" with other peers around the age of 36-42 months. However for some other children with protracted linguistic skills, an early language delay signals persistent language and academic challenges that extend beyond school years. An assessment by a speech and language therapist is recommended for many reasons including the establishment of prognostic factors that will help the parent understand the language outcome of the child. Specifically, factors that will determine if the child will grow out of this delay include good level of receptive language level, number of phonemes produced correctly, use of gestures in requesting, good symbolic play skills, history of ear infections and negative family history of language and/or learning disabilities. Overall, late talkers have good progress. However, each child's unique and individual language profile should be monitored frequently (via bi-monthly follow up assessments) until the child's third birthday, in order to discern persistent from transient language delay.
Bishop, DVM, Holt, G., Line, E., et al. (2012). Parental phonological memory contributes to prediction of outcomes of late talkers from 2 months to 4 years: a longitudinal study of precursors of specific language impairment. Journal of Neurodevelopmental Disorders, 4:3, 1-12.
Petinou, K., Constandinou, A., & Kapsou, M. (2011). Linguistic outcomes in late talkers. Journal of Greek Linguistics, 11, 220-238, Rescorla, L. (2011).). Late talkers: Do good predictors of outcome exist? Developmental Disabilities research Reviews, 17: 141-150.
Childhood apraxia of speech (CAS) is a childhood (pediatric) speech sound disorder in which the ability to plan and program fine, rapid and voluntary movement for speech production is impaired. CAS may occur as a result of known neurological impairment, in association with a genetic syndrome or a complex developmental disorder, or as an idiopathic neurogenic speech sound disorder with unknown origin. The main characteristics of CAS includes: (a) inconsistent errors on consonants and vowels in repeated productions of syllables or words, (b) lengthened and/or disrupted coarticulatory transitions between sounds and syllables, and (c) inappropriate prosody, which may include difficulties in stress production in words and sentences. In many cases the segmental repertoire of the child is restricted and improves slowly with treatment. Children with CAS are at risk for problems in expressive language, and the acquisition of phonological foundations for literacy (reading and writing). It is important that children with CAS will participate in frequent treatment sessions, between three to five times per week. In some severe cases there is a need for augmentative and alternative communication and assistive technology.
American Speech-Language-Hearing Association (2007). Childhood Apraxia of
Speech [Technical Report]. Available from www.asha.org/policy.
Strand, E., & Skinder, A. (1999). Treatment of developmental apraxia of speech:
Integral stimulation methods. In A. Caruso & E. Strand (Eds.), Clinical
management of motor speech disorders in children (pp. 109–148). New York:
McNeill, B.C., Gillon, G.T., and Dodd, B. (2009). Effectiveness of an integrated
phonological awareness approach for children with childhood apraxia of speech (CAS). Child Language Teaching and Therapy, 25(3), 341-366.
All children want to talk; the ability to speak constitutes the entry to our world. Therefore, it is very rare, if ever, that a child will intentionally refuse to develop speech or language.
Many of the children who start talking late catch up with their peers (late talkers). Nevertheless, it is important to be vigilant because 5-9% of young children demonstrate difficulties in speech development. A delay in speech development can be temporary (transient) or more persistent. Speech delay may be caused by a difficulty in speech and/or language development.
Speech is a motor activity that depends on the ability of the speech organs to produce speech sounds accurately and fluently. Abnormalities in the structure or mobility of the muscles of the speech organs, or a general delay in development, may harm speech development.
Language is a cognitive knowledge of words and rules such as inflections (word-word-s; ask-ask-ed) or syntax (the ability to generate sentences). Delay in language development could be attributable to various causes such as hearing loss (transient or persistent), cognitive delay, emotional problems, autism, brain damage, or a specific language impairment without associated problems.
Early diagnosis by a speech therapist is important in order to find out whether there is a problem, and if so, what its cause may be. Treatment is tailored to the type of problem. Persistent deficiency can impair the child's development in many areas including academic achievements and acquisition of reading and writing. The earlier you begin to treat the problem, the more likely it is to improve.
Language allows us to communicate with the people around us for various purposes such as family life, social life, expressing emotions, expressing ideas, learning, understanding what is being said on the radio or TV, and entering the labor market. Moreover, both reading and writing are based on language; and therefore, a delay in language development can also affect the ability to read and write, and may consequently impair academic development. Therefore, a delay in language development may harm many areas of life including cognitive development, social life, the ability to learn and acquire a profession, and the ability to work and become an independent person economically, socially, and emotionally. Thus, it is not surprising that children with delayed speech or language development may be very frustrated, and may demonstrate violent behavior.
Appropriate treatment can contribute greatly to a child's language development. Many children progress and catch up with his peers. However, the problem sometimes requires prolonged treatment; not every problem can be fully solved. Usually, speech therapy takes place 1-3 times a week, sometimes less, and therefore, parents who cooperate in the therapeutic process can contribute significantly to the success of the treatment. Parents can be trained to treat their child and work with him/her.
No, the lack of speech or the delay in speech development usually is the symptom that worries parents and they are looking for help. According to diagnostic criteria for autism the main symptoms are the existence of special interests, stereotyped behaviors and lack of social communication abilities. This means that children with autism have a problem in social interaction with other people and mostly with peers, with or without the use of speech.
Pragmatics is one of the aspects of language, such as syntax, grammar, phonology etc. Pragmatic means the use of language in social environment. Children with pragmatic difficulties face problems in understanding and using non-verbal cues of communication, difficulties in conversation, understanding humor and metaphors, and also difficulties in understanding the context of communication action. Pragmatic difficulties could be part of a diagnostic category, such as Autism, but also could be a separate diagnostic category such as Social Communication Disorder.
Adams, C., Baxendale, J., Lloyd, J., & Aldred, C. (2005). Pragmatic language
impairment: Case studies of social and pragmatic language therapy. Child
Language Teaching and Therapy, 21(3), 227 – 250.
Ketelaars, M. P., Cuperus, J., Jansonius, K., & Verhoeven, L. (2010). Pragmatic
language impairment and associated behavioral problems. International
Journal of Language and Communication Disorders, 45(2), 204 – 214.
Typical language development includes a wide range of normal progress. For example, by the age of 2 years old, one toddler can produce 80 different words and the other 200 different words. Still, both of them are within norm for their age. However, in many cases parents want to have an impression on their child's abilities in the linguistic domain. The table below can give a general impression of the main milestones in typical language development. If you have questions or concerns, you are advised to consult with a speech & language pathologist.
|Age of acquisition||Expected Language abilities||"Red flags" (concerns)|
|Birth to 6 months||
-response to sound and voice
-social interest in faces and people
-Startles at loud voices
-Response to voice (smiles or coos)
-production of cooing like voices
-Production of voices changing in loudness and pitch (4-6 months).
-Lack of response to sound
-Lack of interest in faces and people
-Lack of any drive to communicate after 4 months of age
-Turns head towards sound
-sometimes responds to his/her name
-babbling (e.g., "bababa, babi gadu")
-limited amount of vocalization
-stops producing sounds
-babbling with more consonants
-Comprehend verbal routines ("wave bye-bye")
-starts to use pointing
-starts to use gestures (e.g., wave, nod, points, reach, lift arms)
-Uses voice to get help and attention
|No babbling by 9 months|
-Points to body parts or objects to show comprehension
-responds more consistently to its name
-Understands familiar words and phrases
-produces at least between 20-50 words by 18 months of age
-do not use words, add words, or lost of most words
-No first words by 15 months
-No consistent words by 18 months
-Comprehends simple sentences
-point to pictures in response to words
-Identify objects when named
-uses more and more words including verbs
-Imitate words spoken by others
-Request information (e.g.,"what's that?")
-No symbolic play such as doll or truck play
-Less than 50 words in expressive vocabulary by 24 months
|Age of acquisition||Expected Language abilities||"Red flags" (concerns)|
-Understands some personal pronouns
Understands some prepositions (in, on)
Listens to 5-10 minutes story
-produce simple sentences
Less than 100 expressive words at 30 months
-No use of utterances at 24 months
-no sentences at three months
-Half of the utterances are intelligible to the family after 24 months
-takes part is a short conversation
-asks and answers
Uses pronouns (I, you, my, this that)
-Understand concepts (big-little, high-low)
-speaks in sentences
No use in sentences
-Not speaking clearly or well by age 3
-uses diverse types of sentences (simple, compound, complex)
-answer yes/no, what and which questions
|-Consistent use of only short simple sentences|
-Follow three step command
-Answers How much, How long, What if?
-Knows colors and count at least 4 items
-Reasons with why and because
-Talks about the imaginary
-uses question words
-Inability to express thought and ideas
-Difficulty understanding or answering questions
-Express ideas, thought, feelings and beliefs
-produces more logical personal stories
-understand reasoning questions (e.g., "what happens if…")
-show interests in rhyming, letters, reading and writing
-remember and can retell a short story
- has difficulties in telling a short story
-do not understands reasoning questions
-has difficulty in naming (e.g., colors, objects by category)
-avoids conversation at home or at kinder garden.
Bishop, D. V. M. (1997). Uncommon understanding: Development and disorders of language comprehension in children. Hove, England: Psychology Press/Erlbaum (UK) Taylor & Francis.
Guasti, M.T. (2002) Language Acquisition: The Growth of Grammar. MIT Press.
Moeller, M.P/ (2003). Differential diagnosis table: Pedialink program, Early hearing detection and intervention module; American Academy Pediatrics
Specific language impairment (SLI) occurs when a child has difficulty with language expression or comprehension that is not associated with any other problem. In other words, the language difficulty is not caused by any neurological, intellectual or motor impairment. Some of the primary markers of SLI are: a limited vocabulary, difficulty understanding of the rules for putting words into sentences, and difficulty employing rules for using language in social situations such as how to start or end a conversation, or how to relaying past experiences in ways that others can understand. Difficulty in language can also include limited or inability to accurately use grammatical inflections (e.g., plural markers [s], possessive markers [‘s], past tense markers [ed], verb forms such as am, is, are, was and were).
Joanisse, M. F., & Seidenberg, M. S. (1998). Specific language impairment: A deficit in grammar or processing? Trends in Cognitive Sciences, 2(7), 240-247. doi:http://dx.doi.org/10.1016/S1364-6613(98)01186-3
Emergent literacy refers to the types of reading and writing activities that children are exposed to before they learn to read in a conventional manner. Parents and caregivers who expose their children to print are teaching their child that print has meaning. Many parents begin exposing their child to print very early in the child’s life – sometimes right after the child is born. Children can be exposed to print in a variety of ways such as through books, signs, recipes, menus, and lists made by parents, etc. By engaging in emergent literacy activities children learning about reading and writing, and become aware that print can be used to communicate meaning, learn that sounds in words can be manipulated, and begin to recognize letters and other symbols among other skills. This knowledge about reading, writing and print serves as a foundation for the development of more sophisticated and conventional literacy later on.
For more about ways to support your child’s emerging skills in literacy refer to:
Ezell, H., & Justice, L. (2005). Shared storybook reading: Building young children’s language
and emergent literacy skills. Baltimore, MD: Paul H. Brookes.
Justice, L., & Kaderavek, J. (2002). Using shared storybook reading to promote emergent
literacy. Council of Exceptional Children, 34(4), 8 – 13.