WebMD Medical News
Louise Chang, MD
July 4, 2011 -- Late talkers or children with limited number of words by age 2 may have some behavioral and emotional issues as toddlers, but these issues will not follow them through their childhood and teen years. The new findings appear in the August issue of Pediatrics.
Researchers followed more than 2,800 children from birth through age 17. The 142 children who were late talkers did show mild levels of behavioral and emotional problems at age 2, but they were not at greater risk for such issues as attention deficit hyperactivity disorder, conduct problems, anxiety, or depression as they grew up.
The findings "support a wait-and-see approach to behavioral and speech and language intervention among late talkers with otherwise normal development," conclude study authors led by Andrew J.O. Whitehouse, PhD, of the University of Western Australia in Subiaco, Western Australia.
As many as 18% of children are “late talkers,” but most will catch up by the time they enter school. The new findings may not apply to children with persistent language impairment and/or other developmental delays.
The late talkers in this study did not have any other developmental delays, intellectual disability, or hearing problems. They only showed expressive language delays.
The key is whether or not the late talker catches up, Melissa Wexler Gurfein, a speech-language pathologist in New York City, says in an email. "There is no way of knowing whether a child who has been identified as a late talker at age 2 will eventually catch up to the language skills of his same-aged peers," she says.
"It's no surprise that late talkers at age 2 may seem to have more behavioral difficulties," she says. "The frustration of not being able to communicate successfully could be a possible cause of disruptive behavior."
But as a child matures and develops more age-appropriate language skills, his frustration with communication and disruptive behaviors may resolve. "For the child who continues to demonstrate language delays as he matures, this may not hold true," she says.
"The best thing to do for a child who is identified as a late talker is to provide early intervention to help him become as successful of a communicator as he can be since there is no way to identify if he will develop the appropriate language skills to do this on his own," she says.
Children under age 3 with developmental delays, including speech delays, qualify for free evaluation through early intervention. If they are found to have any significant delays, they are eligible for free catch-up services.
Rahil Briggs, PsyD, an infant-toddler psychologist/behavioral expert at the Children' Hospital at Montefiore in the Bronx, N.Y., says that the children in this study fall into a very specific category, and the findings can't be generalized to late talkers with other developmental delays.
"A 50% delay for a kid expected to have 50 words is far different than a kid expected to have thousands of words," she says. "At age 4, if your child remains delayed, they still have enough words to get their needs met.
"A 50% delay is far more deleterious and troublesome to the 2-year-old," she says. This helps explain why late talkers with no other issues will outgrow behavioral and emotional issues linked to frustration about their inability to communicate and be understood.
"Reassuringly, the study found that expressive language delay was not a risk factor for later emotional and behavioral problems," says Andrew Adesman, MD, the chief of developmental & behavioral pediatrics at Steven & Alexandra Cohen Children's Medical Center of New York in New Hyde Park.
Most children express themselves verbally soon after birth and speak their first word or words at one year. "Between the first and second birthday, we expect children to progress from one to 50 words," he says.
"For children who are not meeting those milestones, the first question is are there are any difficulties understanding language and can they follow a simple command such as 'bring me a toy,'" he says. Other receptive language milestones include being able to point to body parts.
"The kids who we worry about most are those with receptive language delays and socialization difficulty," he says.
Briggs adds: "Concerned parents should keep a language diary and write down each new word that their child says so they do not over- or underestimate the number of words their child has when the pediatrician asks about language development," she says.
"Speak to your pediatrician or trusted child development specialist and make sure their child is hearing OK, and there is not a more serious language disorder that is not only affecting them now, but may affect them later on," she says.
The researchers did account for certain factors linked to speech and behavioral issues such as mom's age and education level, income, smoking or alcohol use during pregnancy, but they did not account for maternal depression, she says.
Maternal depression is predictor of language delay, she says. "We know that if moms are depressed they are less likely to chat up their toddlers all day," she says.
SOURCES:Whitehouse, A. Pediatrics, 2011.Andrew Adesman, MD, chief, developmental & behavioral pediatrics, Steven & Alexandra Cohen Children's Medical Center of New York, New Hyde Park.Melissa Wexler Gurfein, speech-language pathologist, New York.Rahil Briggs, PsyD, infant-toddler psychologist/behavioral expert, Children' Hospital at Montefiore, New York.
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