The Pitfalls and Possibilities for Early Identification of Language Impairments in Children: A Review for Clinicians and Researchers

Overview

Children are not typically diagnosed as having a language disorder until approximately two-years-old, and oftentimes even later. When a young child is identified as having a language disorder, it is difficult to determine at that point whether the child is simply late to start talking but will be relatively quick to catch up, or whether he or she will have a long-lasting language problem. This article provides an overview of research relating to the early identification of language impairments. It summarizes the literature relating to differentiating between late talkers and children who are truly language impaired. It also includes an overview of the relationship between babbling and language development and gestures and language development, as there is much evidence to indicate that both canonical babbling and gestures are important precursors to language development and both are useful as early indicators of language impairment. A more thorough understanding of this literature will improve clinical practice with regard to assessment of and intervention for young children with language impairments and will help bridge the gap between empirical evidence and clinical practice.

Language Problems First Identified

A variety of factors contribute to the difficulty with early identification of language disorders. One factor is the large variation in the early behaviors of children who are typically developing. For example, most children begin to use single words when they are approximately 12 months old; however, the typical age range of the emergence of single words spans several months, from approximately 10 to 15 months. This wide range of variability in normal development in young children makes it difficult to determine when a child is not developing typically. Therefore, unless a child is at high risk for a language impairment at birth because of a specific diagnosis (such as Down syndrome), language difficulty typically goes unnoticed until children are toddlers, after they have missed several linguistic developmental milestones.

Late Talkers Catch Up, Children with Language Impairments Don't

Recently there has been a great deal of research devoted to late talkers, a group of children who in spite of otherwise typical development are late to develop language but who subsequently catch up to their peers (Paul, 1991, 1993; Paul, Hernandez, Taylor, & Johnson, 1996; Paul & Jennings, 1992; Rescorla, 2002, 2005; Rescorla, Roberts, & Dahlsgaard, 1997; Rescorla & Schwartz, 1990; Thal & Bates, 1988; Thal & Tobias, 1992; Thal, Tobias, & Morrison, 1991; Williams & Elbert, 2003). Much of the research has been devoted to investigating the linguistic outcomes of these children (Paul, 1991, 1993; Rescorla, 2002; Rescorla et al., 1997; Rescorla & Schwartz, 1990; Thal et al., 1991; Ellis Weismer, Murray-Branch, & Miller, 1994). Current research suggests that approximately half of late talkers will catch up to their peers and develop age-appropriate language skills, usually by the time they enter school (Paul, 1991, 1993; Rescorla, 1990; Rescorla & Schwartz, 1990; Thal et al., 1991). Paul (1993) reported that approximately 40% of the late-talking toddlers she followed had good expressive outcomes at age three and Rescorla and Schwartz (1990) reported that of the 25 children with language delays they followed, approximately half had good outcomes when assessed between three and four years old. Thal et al. (1991) followed up on 10 toddlers with language delays, toddlers who were participants in a previous study, and found that one year later, six of the children had caught up while four continued to demonstrate language problems.

Although many toddlers late to develop language outgrow their difficulties, many do not. Studies have shown that for those children who continue to demonstrate language difficulty during the preschool years, they are at significant risk for continued language problems that last throughout childhood with difficulties spiraling to other areas of a child's life including academics and socialization (Aram, Ekelman, & Nation, 1984; Aram & Nation; 1980, Nippold & Schwarz, 2002; Rescorla, 2002; Stark, Bernstein, Condino, Bender, Tallal, & Catts; 1984; Tomblin, Zhang, & Buckwalter, 2003). In one of the earliest studies to examine the long-term outcomes of preschoolers with language disorders, Aram and Nation (1980) examined the language and academic outcomes of 63 preschoolers four or five years after initial diagnosis, and found that 40% of the children had continued language deficits and 40% had difficulty with academic achievement, particularly in reading and math. Aram, Ekelman, and Nation (1984) conducted a 10-year follow-up of 27 children diagnosed with language impairments as preschoolers and found that the majority of the children continued to evidence deficits in oral language along with difficulty with academics and socialization. Other researchers have made similar findings (Hall & Tomblin, 1978; Paul & Cohen, 1984).