Tuesday, February 16, 2016

Early Childhood Language Development (Language Development Part 2)

"Why isn’t my child talking yet?”
“She doesn’t seem to respond to anything I say.”
“I wonder if her hearing is okay, or if something else could be wrong.”
“I think his language is a little behind schedule, but will he catch up eventually? Is it okay to wait and see if he grows out of it?”
These are questions and concerns that many parents have when their children are young. Today’s blog post is going to address some of those concerns. As promised, this is a follow-up to Language Development Part 1. In Part 1, I explained my background and introduced some linguistic terms. We will continue the discussion in this post, first learning some specifics about typical language development in the first four years of life. The information that I am providing is not meant to be all inclusive, but will give you an idea of some language-based milestones to expect as your children grow and develop. It may also help you to recognize when your children are not developing typically or at the same rate as their peers. Subsequently, you will find a few warning signs of a possible language delay or disorder, which will enable you to watch for some specific behaviors as your child grows and changes. The final section of today’s post will look briefly at the differences between a language delay and a language disorder because these phrases, which are commonly used among speech and language clinicians and other service providers, can cause confusion at times. In my next post, Language Development Part 3, we will discuss some ways that you, as parents, can stimulate and encourage your child’s language development at home. Initially, I was planning to include all of the above-mentioned information in today's entry, but it became so lengthy that I decided to split it into two posts, saving the suggestions for enhancing language at home until Part 3. Be forewarned that this is still going to be a long blog post—sorry!  I don’t plan for everything that I write to be so lengthy, but I couldn’t address this issue without attempting to do so in a fairly thorough manner.
I compiled the material that follows from unmarked handouts and class notes that I kept from my grad school classes in the late 1990s (yes, I save everything). I cannot cite the sources since I do not know where the material originated from, but I do consider this information to be common knowledge within the field of speech-language pathology and readily available from many sources. In addition to the list below, there are links to more comprehensive data about developmental norms, derived from various studies, available on the American Speech-Language-Hearing Association (ASHA) website: http://www.asha.org/slp/schools/prof-consult/norms/. Below, you will find the list that I compiled of some of the developmental language milestones that you would expect to see at different ages during early childhood. Some of these are receptive language milestones and others are expressive language milestones, but I didn’t differentiate those categories in my list (please see Part 1 for an explanation of this).
0-3 Months
  • Makes eye contact briefly
  • Startles in response to loud sounds
  • Moves eyes toward the source of the sound
  • Reflexive smile
  • Makes random and reflexive sounds, including coos and gurgles with vowel sounds (ah, eh, uh), and single syllables
  • Produces different-sounding cries to communicate different needs (beginning of vocal communication)
  • Stops crying when picked up
4-6 Months
  • Actively seeks sound source, turning head toward the sound
  • Smiles in response to speech and feelings of pleasure
  • Gazes at a person’s face
  • Anticipates feeding upon the sight of bottle or mother
  • Looks in response to hearing own name
  • Smiles when making eye contact with someone who is smiling
  • Shows displeasure when an object of interest is removed
  • Babbling begins, directed toward self, others, and objects
  • “Vocal play”, including coos, chuckles, gurgles, laughs
  • Vocally expresses eagerness
7-9 Months
  • Responds to facial expressions
  • Attempts to imitate some gestures
  • Looks at some common objects when those objects are named
  • Looks at family members when named
  • Understands “no”
  • Uses m, n, t, d, b, p, z in babbling multiple syllables
  • Uses a wide variety of sound combinations and uses inflection in babbling
  • Imitates the intonation and speech sounds of others
  • Uncovers a hidden toy (the beginning of “object permanence”)
10-12 Months
  • Will give toy or object upon request
  • Understands and follows simple commands regarding body actions
  • Looks in the correct place for toys that are out of sight
  • Turns head immediately when own name is heard
  • Understands the meaning of “hot”
  • Can name or look for object that is out of sight
  • Gestures and/or vocalizes to indicate wants and needs
  • Learns to vary behavior based on the reactions of others (i.e., repeats a performance that is laughed at)
  • Vocalizes during play, vocalizes to mirror, and vocalizes loudly, with a wide variety of sounds and intonations
  • Uses all sounds during vocal play (consonants and vowels)
  • First words can be expected to occur between 10 and 18 months of age
13-18 Months
  • Follows simple one step commands
  • Points to object he or she wants
  • Begins to understand that certain objects are his own
  • Points to one to three body parts on command
  • Perceives the emotions of others
  • Uses 3-20 words
  • Says “all gone”
  • Asks for “more”
  • Names familiar objects when asked, “what’s this?”
  • Uses sentence-like intonation in jargon
  • Uses single words and may begin to use two-word phrases
  • Speech may be basically unintelligible with the exception of a few words
19 Months – 2 Years
  • Understands approximately 300 words
  • Actively listens as pictures are named
  • Points to five body parts on command
  • Responds to yes or no questions (may shake head instead of answering verbally)
  • Uses approximately 50 recognizable words
  • Uses names of most familiar objects
  • Imitates animal sounds
  • Closer to two years, will begin to verbalize toilet needs (may verbalize these needs before, during, or after the act)
  • Says own name
  • Uses two word phrases
  • Uses more words than jargon – jargon will be almost gone by two years
  • One third of words produced are nouns
  • Speaks understandably about half of the time
2 – 2 ½ Years
  • Understands approximately 500 words
  • Understands concept of “one” versus “all”
  • Identifies actions in pictures
  • Uses 200 words, and is intelligible approximately 70% of the time
  • Answers “where” questions and “what . . . doing” questions
  • Uses in/on correctly
  • Produced 3-4 word sentences
  • Plays alongside other children, but not usually with other children (parallel play)
  • Speech is approximately 70% intelligible
3 – 3 ½ Years
  • Understands approximately 1,000 words
  • Identifies hard/soft, rough/smooth
  • Identifies circle and square
  • Uses 800 words
  • Begins to ask questions – mainly “what” and “who” questions
  • Uses action words
  • Counts three objects, pointing to each one
  • Begins to use “is” at the beginning of questions
  • Uses “and” conjunction in speech
  • Uses regular plurals consistently
  • Uses “is”, “am”, and “are” in sentences
  • Produces 4 to 5 word sentences
  • Plays in increasingly imaginative ways
  • Speech is approximately 80% intelligible
3 ½ — 4 Years
  • Understands 1,500—2,000 words
  • Uses 1,000—1,500 words
  • Responds to commands involving three actions
  • Tells two events in order of sequence
  • Can tell stories, mixing real and unreal
  • Carries on detailed conversations
  • Continued refinement of speech intelligibility
  • Combines 4 to 5 words in sentences
  • Begins to understand turn-taking, but can be bossy toward others
  • Prefers to play in a group of 2-3 children
  • Uses complex sentences frequently
  • Simple past tense, present progressive “is + ing”, contractions, and pronouns used consistently
  • Asks “who” and “why” questions
After reading all of this developmental data, let’s think back about the questions that were posed at the beginning of this blog entry. What if you aren’t sure whether or not your child’s language is progressing in an appropriate and timely manner? What if you have noticed that your baby may not be developing in certain areas as quickly as her peers are, but you aren’t sure if there is an actual problem? Some children really are “late talkers” (will be addressed later), and they don’t have lasting problems with communication. So, how do you know? As stated earlier, the above list is intended to be a very general guideline, just to give you some specific milestones to look for at each age. If you feel concerned, please compare your child with these developmental milestones. Look for patterns and write down your specific areas of concern.  Keep a record of milestones your child is reaching at an age-appropriate time, as well those that are lagging behind. Also, if you are concerned about your child, please take the time to look at the more comprehensive information available on the American Speech-Language-Hearing Association website (http://www.asha.org/slp/schools/prof-consult/norms/). Based on normative data, ASHA has provided a few specific warning signs of a possible language disorder:
  • Doesn't smile or interact with others (birth–3 months)
  • Doesn't babble (4–7 months)
  • Makes few sounds (7–12 months)
  • Does not use gestures (e.g., waving, pointing) (7–12 months)
  • Doesn't understand what others say (7 months–2 years)
  • Says only a few words (12–18 months)
  • Doesn't put words together to make sentences (1½–3 years)
  • Has trouble playing and talking with other children (2–3 years)
  • Has problems with early reading and writing skills—for example, may not show an interest in books or drawing (2½–3 years)
What should you do if reading this has reinforced the concerns that you have about your child’s development? If you feel that your child may not be developing as she should, please consider seeking a speech and language evaluation sooner rather than later. Over the years, multiple studies have confirmed that an earlier start to therapy generally leads to a more positive outcome. Also, I have to stress that it is always a good idea to begin the process with a visit to the pediatrician. Discuss your child’s development with her doctor, making sure to bring up the specific issues that concern you. Your doctor will do a physical exam, and will most likely screen for delays in all areas of development. If the doctor feels that speech or language may be delayed, a hearing screening will be done as well. Depending on the age and needs of your child, the doctor may be able to do a quick hearing screening in the office, or a referral to an audiologist could be necessary. If you regularly take your child to the doctor for well child checks, screenings for developmental delays should be something that your doctor has already been doing regularly. However, sometimes less obvious problems may not be caught on those screenings, and you are the best expert on the health and well-being of your own child. Even if your child has passed the screenings at every well child check, don’t be shy about discussing your concerns with your child’s doctor or asking for a more in-depth evaluation. You may need to request a referral from your doctor for a speech and language evaluation, and that will definitely be true if you are planning to bill your health insurance. If your child is under three years old, a free evaluation from an early intervention agency should be available to you. If your child is three years of age or older, you have the option of going through your local public school system for the testing, free of charge (yes, this is available to homeschoolers), although I do understand the reasons why many homeschoolers would not choose this route. If you live close to a university with a communication disorders and sciences program, there may be a speech and language clinic on campus that will provide inexpensive services. If you are planning to go to a therapist in private practice or in a hospital system, be sure to find out ahead of time how much of the expense might be covered by your insurance. I would also suggest asking for recommendations for a speech pathologist among your friends and acquaintances ahead of time. I know that it would make me feel more comfortable to work with a therapist who was recommended by someone that I know and trust. The bottom line is that help is available, and there are usually multiple options regarding how you might decide to go about accessing it.
Now that we have looked at signs of a possible language delay in young children, I think it may be important to differentiate between the terms language delay and language disorder. These terms are sometimes used interchangeably among professionals who work with young children, and I know that some parents have felt confused about the differences between their meanings. Language delay refers to a child who is progressing through the developmental milestones of language at a slower rate than her peers; the wording implies that she will eventually “catch up”.  A language disorder, however, refers to someone with a far more persistent impairment in one of more of the five domains of language (phonology, morphology, syntax, semantics, and pragmatics). Sometimes it isn’t possible to know whether a young child has a language delay or a language disorder until that child grows older. A child’s difficulties may be labeled as a language delay initially, then later renamed a language disorder if the problems persist or intensify. In order to help explain this distinction further, I am going to include a portion of a blog post from the Special Education Guide:
How do you know when a child has a language delay versus a disorder? Unfortunately, there is not always a straightforward answer to this question. As we know, each child is unique and affected by intrinsic (i.e., biological, such as family history, birth weight, severe prenatal and/or perinatal complications) and extrinsic (i.e., environmental, including access to health care, stable residence) factors. Each child meets developmental milestones at different rates and after varying degrees of practice. However, there are widely accepted developmental norms for the acquisition of speech and language skills. When these are not attained, or attained at a slower rate than chronological age peers, questions about delay or disorder rise to the forefront.
A language delay is just that — a delay in acquisition of language skills compared to one’s chronological and cognitive/intellectual age peers. A young child with a language delay may exhibit a slower onset of usage of a language skill, rate of progression through the acquisition process, sequence in which the language skills are learned, or all of the above. Generally, early language delay (late talking) may be characterized by less than 50 words at 24 months, few word combinations at 30 months, limited use of gestures and sounds to communicate, limited symbolic play, limited understanding of word meaning and inability to follow verbal instructions. Approximately 50 to 70 percent of these youngsters (i.e., late talkers) reportedly catch up to peers and demonstrate normal language development by preschool and school age. However, there is a subset of children who continue to demonstrate persistent difficulties acquiring and using language skills below chronological age expectations (by preschool or school age) that cannot be explained by other factors (e.g., low nonverbal intelligence, sensory impairments or autism spectrum disorder) and may be identified as having a specific language impairment (i.e., language disorder).
The American Speech-Language Hearing Association (ASHA) defines a language disorder as a significant impairment in the acquisition and use of language across modalities (e.g., speech, sign language, or both) due to deficits in comprehension and/or production across any of the five language domains (i.e., phonology, morphology, syntax, semantics, pragmatics). Language disorders are heterogeneous, and the nature and severity of disorders can vary considerably.(Reposted from http://www.specialeducationguide.com/blog/language-delay-versus-language-disorder/)
I truly hope that this has been helpful. I am so excited to share ideas about enriching your child's language development at home, but this post is so lengthy that I am going to stop here for now, and save those suggestions for my next post, Language Development Part 3.Thank you for reading, and please stay tuned for Part 3, which you can expect to see very soon! Have a blessed week!

photo credit: <a href="http://www.flickr.com/photos/24742305@N00/3537327425">Reading is fun</a> via <a href="http://photopin.com">photopin</a> <a href="https://creativecommons.org/licenses/by/2.0/">(license)</a>