Which Children Should We Be Concerned About
Although some children who are late in learning to talk catch up on their own, at least half have persisting language problems. Research on late talkers indicates that children who are delayed in using words but who show good use of emotion and eye gaze, communication, gestures, sounds, understanding of words, and use of objects, are likely to catch up without intervention. These children are referred to as late bloomers. On our evaluation tools, if a child is delayed on the use of words only, but is not delayed in any of the other areas, we recommend monitoring that child's development but intervention is not warranted.
Children who show other delays in addition to delays in using words are the ones who we are more concerned about. We have found three major patterns that indicate concern.
The first pattern represents children who show delays for their age in many or most of these areas. In addition to delays in using words, they also show delays in at least 2 of the following areas: emotion and eye gaze, communication, gestures, sounds, understanding of words, and use of objects. Children in this first group may have delays in motor, cognitive, socioemotional, and/or language development or a more general developmental delay across these domains. Most of these children are unlikely to catch up on their own and their families are offered a menu of service options and/or referred to community agencies. These children are at risk for language and learning disorders, behavior disorders, mental retardation, or autism spectrum disorders. This pattern also may represent children who lack environmental stimulation that can lead to developmental delays. Children displaying this pattern are very likely to have persistent problems and require special education later in school.
The second pattern represents children who show delays in using words and sounds, but who communicate well with gestures, have good understanding of words, and play well with objects. Children in this group may have speech disorders. They need to be carefully evaluated. For these children we need to monitor their development and, depending on the severity, offer services if the child is not progressing without intervention or if the family is concerned. Usually these children do not have academic problems when they reach school age if they develop intelligible speech.
The third pattern represents children who show delays in using words and sounds and understanding words, but who communicate well with gestures and play well with objects. Children in this third group may have a hearing impairment and need to be carefully evaluated. We refer these children for a hearing evaluation, monitor their development, and offer or coordinate services if needed. Although hearing impairments can be recognized in very young children, the average age they are identified is between 12 and 25 months (Parving, 1993; Harrison & Roush, 1996). It is so important to provide amplification, if needed, as early as possible. To promote speech and language development, it is most effective to provide amplification by 6 months of age. Children with hearing impairments also may show other developmental delays typical of the first two patterns. For any child who is delayed in the use of and response to sounds and words, it is essential to have their hearing screened.
Children in all three groups are at risk for developing behavior problems because they may not be able to communicate effectively. We offer all families education programs and information on preventing and managing behavior problems in young children. Our goal is to help families and caregivers expand their child's ways of communicating before serious behavior problems develop.