Posts Tagged ‘developmental delays’

Late Talkers: A Variation of Normal Development? By Michelle MacRoy-Higgins, Ph.D., CCC-SLP

Friday, February 24th, 2012

In adjusting the eligibility criteria for speech only children in Early Intervention, the New York State Health Department frequently stated that “late talkers were a variation of normal development.” The more stringent eligibility was intended to decrease services to “late talkers” because it believed that these children would catch up to their peers over time. The following information reflects research and resources compiled by Michelle MacRoy-Higgins, Ph.D., CCC-SLP, Assistant Professor, Communication Sciences Program, Hunter College-CUNY, who has researched the topic of late talkers and presented at the 2010 ASHA convention on the topic.

Who are Late Talkers?
The late talkers reflect 15% of the toddler population and are identified around two years of age when children produce fewer than 50 words and do not combine words. The late talker also has normal hearing, cognitive, sensory and motor development. A typical child at two years of age would be using over 300 words and putting together 2-4 word sentences.

Why Late Talkers are Not a Variation of Normal Language Development
Language characteristics of the late talkers are not reflective of typical language development in the areas of:

1. Word learning
Receptive language (understanding): Late talkers do not learn (point to) new words as accurately as their peers. (Ellis Weismer & Evans, 2002; MacRoy-Higgins, Schwartz, Shafer & Marton, 2009)
Productive language (expressive vocabulary): Once late talkers say words, they are slow to add more words to their vocabularies; they do not systematically add words to their vocabularies as observed in typically developing toddlers (MacRoy-Higgins et al., 2009).

2. Phonology (sounds)
The sounds in the words that they do say show delays and disordered patterns. For instance, late talkers produce atypical sound errors, atypical sound patterns and show little change in development over time as compared to language-matched peers (Williams & Elbert, 2003)

3. Morphology/syntax (grammar and word combinations)
Once late talkers begin to combine words they show delayed and disordered patterns. For instance, late talkers produce more errors than their language-matched peers (Thal et al., 2004)

4. Social skills
At risk for social/behavioral disorders. Late talkers are less social than their peers; quality of parent-child relationships in late talkers is judged to be more stressful than parent-child relationships in typically developing toddlers (Irwin, Carter & Briggs-Gowan, 2002)

Are there Long-Term Implications for Late Talkers?
The research has indicated that late bloomers show improvement in language skills but that they perform significantly poorer than their peers in reading/literacy, syntax and morphology (word combinations/sentences and grammar) and vocabulary deficits are observed through 17 years of age.
Toddlers with Specific Language Impairment (SLI) demonstrate significant difficulties with all aspect of language (understanding, expression and literacy/reading).

Why is it Important to Provide Speech and Language Services to Late Talkers?
Approximately one-half of toddlers who are late talkers will be labeled as having Specific Language Impairment in preschool/elementary school. Those that show improvement (late bloomers) continue to perform poorer than their peers in language and literacy skills throughout elementary and secondary school.

Late talkers are not a variation of normal development because at age two they show disordered patterns of
• Vocabulary acquisition (understanding and naming)
• Phonology (sound system)
• Grammar
• Social skills

Why is Early Intervention so Important for Late Talkers?
An early foundation in oral language skills is paramount for the development of literacy and reading skills. Late talking toddlers are at significant risk for academic difficulties and therefore would benefit from language intervention as early as their language disorder is identified.

Is Language Intervention for Late Talkers Effective?
Language intervention for late talkers is effective. Late talkers receiving intervention by a Speech-Language Pathologist over a short period of time showed improved language skills (vocabulary, production of sentences, speech sound production) as compared with late talkers who did not receive intervention (Robertson & Weismer, 1999), and these results suggest that if untreated, late talkers will not improve their language at the same rate as their typically developing peers, with the significant risk of lifelong language difficulties impacting academic achievement, reading and literacy.

Ellis Weismer S., & Evans, J.L. (2002). The Role of Processing Limitations in Early Identification of Specific Language Impairment. Topics in Language Disorders, 22(3), 15-29.

Irwin, J.R., Carter, A.S., & Briggs-Gowan, M.J. (2002). The Social-Emotional Development of ‘Late-Talking’ Toddlers.Journal of the American Academy of Child & Adolescent Psychiatry. 41(11), 1324-1233.

Leonard, L.B. (2000). Children with Specific Language Impairment. Cambridge, MA: MIT Press.

MacRoy-Higgins, M. Schwartz R.G., Shafer, V.L., & Marton, K. (2009). Word learning and phonological representations in children who are late talkers. (Doctoral Dissertation), Graduate Center, CUNY, New York, NY.

Rescorla, L. (1989). The Language Development Survey: A screening tool for delayed language in toddlers. Journal of Speech and Hearing Disorders, 54, 587-599. 22.

Rescorla, L. (2009). Age 17 Language and Reading Outcomes in Late-Talking Toddlers: Support for a Dimensional Perspective on Language Delay. Journal of Speech, Language, and Hearing Research. 52, 16–30.

Robertson S.B. & Ellis Weismer, S. (1999). Effects of Treatment on Linguistic and Social Skills in Toddlers With Delayed Language Development. Journal of Speech, Language, Hearing Research. 42, 1234-1248.

Thal, D.J., Reilly, J., Seibert, L., Jeffries, R., & Fenson, J. (2004). Language Development in children at risk for language impairment: Cross-population comparisons. Brain and Language, 88, 167-179.

Williams, A.L., & Elbert, M. (2003). A Prospective Longitudinal Study of Phonological Development in Late Talkers. Language, Speech and Hearing Services in Schools, 34, 138-153.

Dr. Michelle MacRoy-Higgins has worked as a Speech-Language Pathologist for nearly 15 years. In addition to being a private practitioner, Michelle is an Assistant Professor in the Communication Sciences program at Hunter College (CUNY) and teaches graduate students in the areas of language development, language, phonological, articulation, motor speech and swallowing disorders in children. Michelle has worked clinically in a variety of settings including home-based, preschool, elementary school and private practice clinics; and has enjoyed working with a variety of children presenting with language, phonological, articulation, and feeding disorders ranging in age from birth through adolescents. Michelle’s clinical and research expertise is with children who are late talkers. She enjoys working with children and their families to develop individualized and evidenced-based treatment, while having fun and encouraging communication success.

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Supporting Your Child’s Sensory Development At Home by Lynn-Marie Herlihy, MS, OTR/L, Occupational Therapist

Wednesday, June 8th, 2011

Part 1: The Visual, Auditory and Tactile Senses

As a new parent to an 9-month old boy, I busy myself reading child development books and checking online resources, to assure myself that he is meeting his developmental milestones each month. While we are playing and having fun, I am assessing his emerging gross and fine motor skills, listening to his burgeoning language, and marveling at his cognitive gains. As an Occupational Therapist (OT), I have been encouraged to see that the books and online articles often reference the sensory skills that are developing in our babies; skills which continue to develop in children until their early teenage years. In this entry, I will discuss ways to support your child’s visual, auditory and tactile skills from an OT perspective. These are ideas that are easy to implement at home, and which can be enjoyed by children who are typically developing as well as assist those who are experiencing delays.


Definition: Our visual system allows us both to see and to interpret what we see. Developmentally, it is important for recognizing people, shapes, colors, and eventually letters and numbers. Socially, it helps us to read body language and facial expressions. For example, we must use our vision to guide our movement through the world safely and effectively.

Infants: Provide the baby with high contrast black and white images, bright colors (especially red and yellow), simple geometric designs, mirrors, and slow-moving mobiles. One of baby’s favorite things to look at is the human face (especially mom and dad). Books with pictures of faces are often interesting to babies and will stimulate their vision. As your baby grows, you can help their vision mature by presenting slowly moving items so that they have to track the item as it moves throughout their field of vision (first try horizontal movements, then vertical, then circular).

Preschool: Help your child learn shapes, colors, and begin letter and number recognition through activities like puzzles, blocks, and books. Children gain valuable “practice” with their visual system through activities such as rolling a ball, stacking blocks, pointing to pictures in a book, coloring and cutting with scissors.

School age: Higher-level visual skills are developing at this age, including figure-ground, visual discrimination, and visual memory. Hidden picture books (figure-ground), matching worksheets (discrimination), and games like Memory are all great for this age group. In addition to the school tasks of reading and writing, children can work on their eye-hand coordination at this age through mazes, connect-the-dots, and word searches.
For more information about the development of vision, visit the website of the American Optometric Association. It provides great information about what changes occur at each age and stage and development:


Definition: We use our auditory system (or sense of hearing) to identify both the quality and location of sounds in our environment. For example, our auditory sense alerts us so that we turn our heads when a car is approaching.

Infants: A baby is born with a very well-developed sense of hearing. Your baby can recognize (and prefers) the sound of parent’s voices. Talking to your baby is one of the best ways to help your baby’s auditory system develop. This can include your own singing, too! As young as one month, babies can remember sounds, such as a repeated lullaby. Parents should also talk to their babies as they go through their day, narrating what you are doing is a great way to introduce language. Babies respond to repetition, and to high frequency sounds (which is why many prefer female voices). As your baby begins to make her own sounds, repeat them back to her as this lays the foundation for the turn-taking of spoken language. Music, of course, is another strong auditory input that babies enjoy. This can be anything from classical music, to nursery rhymes and songs, to any music that mom and dad like! You can help your baby refine her sense of hearing by having her find (localize) a moving sound (slowly move a rattle or noisy toy). As your baby grows, introduce the following auditory/language concepts during play: animal sounds, names of colors, and counting (fingers, toes, blocks, etc.)

Preschool: Continue to explore music through playing simple instruments, learning finger songs, and singing. Playing with puppets and using different voices (high, low, silly, etc.) is a fun activity, and it also engages the child in pretend play. Have your child point to pictures in a book as you read it. Listen for and identify sounds in the environment (“that’s a car horn”, “hear the birds chirping”, etc.). Work on giving one-step, then two-step directions. As always, continue to talk to your child during your daily routines and continue to read books.

School age: At this age, you can help your child continually improve their auditory skills by giving him three- and four-step directions. Addressing the concept of voice volume may be an issue as children enter school, where they are asked to be quiet for long stretches of the day. Instead of expecting children to understand the term “inside voice”, a visual aid may be helpful. You can make a simple chart with the following information: 0 = silent, 1 = whisper, 2 = talking, 3 = yelling. Act out each volume with your child. Then, explain the rules of your home regarding when it’s OK to use each (i.e., yelling may be OK during play, or during an emergency; a whisper should be used at nighttime, etc.) One final piece of OT advice regarding school-age children and auditory input relates to that dreaded word…homework. My advice is to know how your child responds to noises and be aware how this impacts his/her focus during homework. Some children will require a quiet work space, away from distractions such as radio, TV, siblings, phone calls, or even a parent cooking dinner. However, other children thrive on “background noise” to help them. These kids may do well working at the kitchen table, or wearing headphones with music playing as they work.

To learn more about how your child’s hearing develops from in utero throughout childhood; visit the home of the American Speech-Language and Hearing Association:


Definition: This is our sense of touch, which plays an important role in a child’s motor and social development. The tactile system provides information about the shape, size, and texture of objects. This information helps us to understand our surroundings, manipulate objects, and use tools proficiently. For example, you are using your tactile system when you reach into your pocket and find a quarter among several coins.

Infants: Touch helps promote parent-child attachment by giving your baby a sense of safety, security and love. Developing awareness of the nature and quality of a variety of tactile input also gives infant valuable information about the world around them, thus aiding their cognitive and fine/gross motor skills. Offer infants a variety of safe textures to explore (plastic or wooden toys, stuffed animals, soft blankets, “crinkly” toys, feely books, tactile mats, and tactile balls). Give her an infant massage (with or without lotion). Lightly rub her feet and clap her hands together. Expose her to different textures and sensations, such as a vibrating toy, a soft cloth, a feather, a scratchy piece of sandpaper or bumpy ball. Be sure to tell her what the textures are as you show them to her. Allow for some “naked time” every day, so that your child can feel textures on her arms, legs, back and belly. (If you are daring, you can go without a diaper for a while!) Also, be sure to have some supervised “tummy time” every day, so that your baby does not become too sensitive on her stomach (This position is necessary in order to prepare for crawling and develop upper body stability and strength).

Preschool: One activity preschoolers often enjoy is a sensory table (or at home, you can make a “sensory bin”). Fill a large plastic bin with a mixture of dried rice and beans, then you can hide small toys or “treasures”, puzzle pieces, or simply cups and spoons for empty-fill. Other fun suggestions include: modeling clay, Play-Doh, and finger paints. Don’t be afraid to let them get messy! They are working on developing their tactile awareness, as well as the small hand muscles needed for later activities such as handwriting. Finally, taking a nature walk to pick up and explore various outdoor items (leaves, rocks, petals, dirt, etc.) is a great way to enjoy a nice day, while promoting this important sense.

School age: The sense of touch is highly developed in this age. A few ways to challenge your older child to use and perfect this sense are: draw letters on his back with your finger and have him guess, fill a cloth bag with common objects and have him identify things (one at a time) without looking in the bag. Activities such as arts and crafts, stringing beads, and lacing cards can help children continually improved their tactile skills.

The neurological process that interprets sensations from the body and its environment is called Sensory Integration. The brain’s ability to process sensory information makes it possible to use the body effectively within any given environment.

The quick screening checklist below will help you assess your child’s sensory development. If you answer “yes” to one or more of these questions, your child may be experiencing difficulties with sensory integration:
• Was your child unusually fussy, difficult to console, or easily startled as an infant?
• Is your child over-sensitive to stimulation? Does he/she over-react to touch, taste, sounds, or odors?
• Does your child strongly dislike baths, haircuts, or nail cutting (screaming, crying, “melting down”)?
• Does your child use too much force when handling objects, coloring, writing, or interacting with siblings or pets?
• Does your child seem to have weak muscles? Does she tire easily? Does she prefer to lean on people or slump in a chair?
• Was your baby slow to roll over, creep, sit, stand, or walk, or to achieve other motor milestones?
• Is your child clumsy? (Does she fall frequently, bump into furniture or people, and have trouble judging position of body in relation to surrounding space).
• Does your child have difficulty following instructions or sequencing the steps for an activity?
• Does your child avoid playground activities, physical education class, and/or sports?
• Does he/she not enjoy age-appropriate motor activities such as jumping, swinging, climbing, drawing, cutting, assembling puzzles, or writing?

For further information on Sensory Integration and for children diagnosed (or suspected) of a Sensory Processing Disorder:

Check out Kids Health website for further information on the development of senses, as well as other great information:

If your child is experiencing difficulty with any of these areas of development, please contact your pediatrician and/or an Occupational Therapist to assess if there is an underlying problem. Children develop at their own pace, with a wide range of normal regarding skill acquisition. If he/she has difficulty in several areas of sensory development, it may indicate a Sensory Integration Dysfunction.

Stay tuned for Part Two of this discussion, which will address the ‘hidden’ senses that are developing in your child.

Lynn-Marie Herlihy is an Occupational Therapist in private practice in Park Slope, Brooklyn. She has over 12 years experience treating children from birth to school-age, with a variety of sensory and motor deficits, developmental delays, and learning issues. You can also visit her website at

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Infant and Toddler Nutrition by Richard Kahn, M.S., Registered Dietitian

Tuesday, August 3rd, 2010

Infant and toddler nutrition is a complicated subject and complexity leads to communication breakdowns. One common miscommunication occurs between parents and pediatricians. The pediatrician gives your child clean bill of health. Great! Yet, your child never eats vegetables and prefers white bread to whole grain or just eats 4 or 5 foods. That cherished goal of a perfect diet is dashed not only by the child but, in addition, the physician is not that concerned. You may be mystified, frustrated or even angry, but the physician sees that the child is eating enough based on the growth chart, even though your child may be technically underweight. That physician judges that the child’s height and weight are adequate, the skin, hair and lips look fine, the child is energetic. In clinical short hand, the doctor looks at appearance, height and iron. If your child is consistently getting taller, despite difficulties, enough protein, carbohydrates and fats are entering your child. An iron sufficient child is getting enough iron, a marker nutrient, and the proteins and vitamins that go into hemoglobin production and hence enough of everything.

The focus on carbohydrates, fats and proteins is macronutrient nutrition, the most level of nutrition because macronutrients represent basic needs and calories. From the point of view of macronutrient nutrition, the vitamins, minerals and other important micronutrients, such as antioxidants, fiber and essential fatty acids, take care of themselves because they are in common foods. Macronutrients are measured in grams. When parents focus on nutrition, they tend to worry about macronutrients, eating enough, and micronutrients, eating well. Micronutrients are measured in milli- and micrograms. A milligram is one thousandth the size of a green Monopoly house. Other nutrients such as Vitamins A and D are measured in International Units, a measure of potency but still a small amount.

Parents naturally want to provide a complete diet. The combination of facts and feelings is almost too powerful to resist, not to mention, the power that comes from being older and bigger. The parent’s desire, however, may be different from the child’s once the food is on the plate.

Different desires create the second communication breakdown. The previously fine mealtimes disappear when the parent’s desire to nurture meets the child’s desire for independence. While parents worry about micro and macro nutrients, your toddler is looking for you to acknowledge a different need that could be called developmental or life cycle nutrition. In developmental nutrition, food satisfies hunger and the desire to develop mastery. The differing goals between parent and child are behind most feeding problems. The natural parenting desire to provide macro and micronutrients gets separated from the child’s desire to self feed. The breakdown is not unlike your nutrition disconnect with your pediatrician. Different ideas of nutrition can collide. Just ask Dean Ornish and Dr. Atkins.

The infant’s desire to feed his or herself kicks in at around 6 months. That desire to develop can manifest in refusing baby food or by pushing the spoon away. Your exploring child has figured out that you are not eating pureed carrots but something else, something far more interesting and you are feeding yourself. Your baby who cannot walk or crawl is beginning to separate and the drive for independence often occurs first at mealtime. Standard developmental milestone guides say that children can use a cup at around 6 months, finger feed around 7 or 8 months and use a spoon sometime after that. That’s great if your child follows along. Educated parents look to that kind of guide as a ruler, but your child is the best guide. Guides do not take into account that some children quickly copy older children or favorite adults sooner than anticipated, especially if your relationship is great. Even when a developmental delay clouds the picture, children who refuse to be fed by others are exhibiting standard behaviors known to people who help parents who are just struggling too much at mealtimes. If your child is giving you a hard time, your child probably thinks you are giving him or her a hard time.

When mealtimes collapse into struggles, arents may feel alone, rejected or forced to engage in dramatic actions when their child does not eat. Such feelings of parents are universal, as are the problems. The World Health Organization (WHO) has taken up the task of helping parents feed their children because feeding struggles are worldwide. Visit the WHO website to find the latest recommended practices. For WHO, after 6 months the best guide on feeding your child is your child. Just pay attention to the trinity of feeding practices: the cup, finger foods and the spoon. Your child will let you know how they want to eat, fingers, spoons or even let y ou feed them if there is no fights and lots of smiles. If your cultural preference is for eating by hand feeding or chopsticks, your child has already figured that out, too. Once you begin to experience refusals and too many games at the table it is time to help your child develop new skills. Then you will have smiles. If mealtimes are not pleasant for you, they are certainly not engaging for your child. If you cannot make mealtimes more productive, speak to a professional who knows about feeding behavior and nutrition.

“>Richard Kahn, PhD, RD, is a NYC pediatric nutritionist in private practice specializing in the needs of young children. Reach him at or

BLOGS: Wheelchairs and Cookies, Making up for Lost Time and Lost Weight, Getting a ‘D’ for Over Supplementation and Infant and Toddler Nutrition

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Emotional Learning by Annette Hernandez, Ph. D., Clinical Psychologist

Thursday, July 15th, 2010

Emotional Learning in the Pre-Verbal Child

Emotional learning has become a hot topic these days in the field of child development. Psychology experts are researching the ways we develop an emotional vocabulary and how we express, recognize, and manage our emotions. Recent studies suggest that individuals exposed to emotional learning early in life, have happier and more successful lives in the future. While it is not always practical or feasible to enroll all our kids in a formal Social and Emotional Learning (SEL) program, there are simple things we can do to help our kids label their emotions. As adults, we are probably all familiar with the notions that simply stating our feelings out loud helps to diffuse those feelings and “center” us. For example, examine the following scenario. You become upset that your partner forgets to put the cap on the toothpaste after using it. Rather than saying, “it’s kind of frustrating when you forgot to put the cap back on the toothpaste, it leaks all over the place, the cat knocks it over, the kids get it on their clothing, etc. etc.”; you hold onto your frustration hoping it will go away, only to find yourself blowing up when he/she does something equally as frustrating and seemingly insignificant later in the day. If you express your emotion, in the moment…in a calm voice, looking the person in the eye, and using an appropriate level of physical contact (such as a hand on the other person’s shoulder); you convey your emotion providing a release for yourself and you are communicating with the other person. While the action described above may be relatively easy for an adult to do, how does it work for a young child, particularly one that is pre-verbal.

Young pre-verbal children are prone to tantrums or “meltdowns”, in part due to the fact that they are not able to express their emotions. You can help your child during these moments by giving a voice to their feelings. Picture the next scenario…it is getting close to dinner time and you’re preparing dinner which will be ready in 10 minutes. Your hungry toddler wants a cookie he spotted in the cupboard as you were reaching for your cooking supplies. He begins to cry pointing at the cookie. You refuse his request and he persists in his request eventually escalating into a screeching wail. Many parents will attempt to explain to the child that he cannot have a cookie before dinner with an explanation as to how cookies will spoil his appetite. The problem with this scenario is that this response (though reasonable for a ten year old) does not recognize or, more importantly, label the toddler’s emotion in that moment. A simple and effective way to use this opportunity to develop emotional learning in this circumstance would be to a)label the emotions, b)label what is causing the emotion, and c)offer an alternative option to the child, and d) establish physical contact. The parent in this circumstance has to stop what they are doing at that moment and apply the steps above. For example, kneel or bend down to establish eye contact with the child, and say to the child in a calm voice, “I know you really want that cookie (cause of the emotion) and it makes you really sad and mad (label the emotion) that I won’t give it to you”…”I can give you a carrot or piece of apple now (alternative option) and we will have dinner soon”, and give the toddler a hug or backrub (physical contact). The wording and behaviors listed above can be modified to fit a number of situations. In most circumstances, you may not get an immediate response but consistency and an even-tempered approach is sure to give your child the building blocks of emotional learning.

Annette is a licensed clinical psychologist. She has a private practice in Park Slope and works with children with developmental delays and treats children/adolescents suffering from traumatic stress, depression, anxiety and related disorders. She incorporates cognitive-behavioral interventions with diverse clinical populations. She offers individual psychotherapy that focuses on building a child’s existing strengths and developing new ways of coping with difficult situations. She can be reached at: or by phone at 917-519-3082.

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