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 ages two to seven years-old and can continue into adulthood. The reported prevalence of language delay ranges from 2.3 to 19 percent.
Language delays are distinct from speech delays, in which the development of the mechanical and motor aspects of speech production are delayed. Many tend to confuse language delay with speech delay or even just late talker. All of these have different telltale signs and determining factors. Speech delay seems to be more similar to late talker compared to language delay. Speech is the verbal motor production of language, while language is a means of communication. Because language and speech are independent, they may be individually delayed. For example, a child may be delayed in speech, but not delayed in language because they use a Sign Language. Additionally, language delay encompasses the entirety of language developmental progress being slowed and not just the speech aspects.
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. Early language delays are only considered risk-factors in leading to more severe language disorders.
Language development
The anatomical language centers of the brain are the Broca's and Wernicke's area. These two areas include all aspects of the development of language. The Broca's area is the motor portion of language at the left posterior inferior frontal gyrus and involves speech production. The Wernicke's area is the sensory portion of language at the posterior part of the left superior temporal gyrus and involves verbal comprehension.There are recognizable speech and language developmental milestones in children. For children with language delays, milestones in their language development may be different or slowed. Recent studies have shown the different milestones for children with language delay compared to children with normal language development. 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. Children can stray slightly from the confines of the expected timeline; however, if 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 very general and brief 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. The development of language remains a theoretical mystery.Around 2 months, babies can make "cooing" sounds.
Around 4 months, babies can respond to voices.
Around 6 months, babies begin to babble and respond to names.
Around 9 months, babies begin to produce mama/dada - appropriate terms and are able to imitate one word at a time.
Around 12 months, toddlers can typically speak one or more words. They can produce two words with meaning.
Around 15 months, toddlers begin to produce jargon, which is defined as "pre-linguistic vocalizations in which infants use adult-like stress and intonation".
Around 18 months, toddlers can produce 10 words and follow simple commands.
Around 24 'months, toddlers begin to produce 2-3 words and phrases that use "I", "Me", and "you", indicating possession. They are about 25% intelligible.
Around 3 years', toddlers are able to use language in numerical terms.
Based on the milestones set for typical toddlers, if the child tends to have a lot of or very long delays, they may be deemed as having language delay. However, proper testing by a professional like a speech therapist or a doctor's confirmation will be required to determine if a child has language delay. Although these milestones are the typical milestones for a child, they should not be followed strictly as they are mere guidelines.
Language development in language delay
Early developmental language delay is characterized by slow language development in preschoolers. Language development for children with language delay takes longer than the general timeline provided above. 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. They may find themselves producing language that is different from language norms in developing children.Types
A language delay is commonly divided into receptive and expressive categories. Both categories are essential in developing effective communication.Receptive language refers to the process of understanding language, both verbal and nonverbal. This may involve gaining information from sounds and words, visual information from surrounding environment, written information and grammar.
Expressive language refers to the use of sentences to communicate messages to others. It enables children to express their needs and wants to the people around them, interact with others and develop their language skills in speech and writing. Some expressive language skills include putting words together into sentences, being able to label objects in an environment and describing events and actions.
Receptive language delay
Children that are diagnosed with receptive language delay have difficulties understanding language. They may have trouble with receptive language skills such as identifying vocabulary and basic concepts, understanding gestures, following directions and answering questions. The number of language skills that children have difficulties with can differ greatly, with some having trouble with only a single skill and others having trouble with multiple.Expressive language delay
A child diagnosed with expressive language delay has trouble with language usage in some way. As this diagnosis is very broad, each child diagnosed with ELD can be very different in terms of the language skills they have problems with. Some may have difficulty with using the correct words and vocabulary, some have trouble forming sentences and others are unable to sequence information together coherently. Expressive language symptoms come in many forms and each one is treated with different methods.Presentation and diagnosis
A language delay is most commonly identified around 18 months of age with an enhanced well-baby visit. It presents itself in many forms and can be comorbid or develop as a result of other developmental delays. 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.Screening
Regular appointments with a pediatrician in infancy can help identify signs of language delay. According to the American Academy of Pediatrics, formal screening for language delay is recommended at three ages: 9, 18, and 24–30 months. Screening is a two-part process: first, a general developmental screening using tools such as the Parents' Evaluation of Developmental Status or Ages and Stages Questionnaire ; and second, specific screening for autism spectrum disorder using tools like the Modified Checklist for Autism in Toddlers. Not all patients with language delay have autism spectrum disorder, so the AAP recommends both screens to assess for delays in developmental milestones.However, the US Preventive Services Task Force has determined that there is insufficient evidence to recommend screening for language delay in children under the age of 5. Other national panels, including the UK National Screening Committee and Canadian Task Force for Preventive Health Care, have also concluded that there is limited evidence on the benefits of screening all infants for language delay.
Early signs and symptoms
There are several red flags in early infancy and childhood that may indicate a need for evaluation by a pediatrician. For example, language delay can present as a lack of communicative gestures or sounds. Language delay in children is associated with increased difficulty with reading, writing, attention, and/or socialization. In addition, an inability to engage in social exchanges is a sign of language delay at all ages.Communicative deficits at specific ages and milestones might indicate language delay, including:
- Not smiling at 3 months
- Not turning the head toward sounds at 4 months
- Not laughing or responding to sounds at 6 months
- Not babbling at 9 months
- Not pointing and using gestures at 12 months
- Not producing more than 5 words at 18 months
- Not producing more than 50 words at 24 months
- Losing language and/or social skills after 36 months
- A lack of speech
- An inability to comprehend, process, or understand language presented to the child
Consequences of language delay