Posts Tagged ‘Early Intervention’

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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When to Visit the Audiologist, by Drs. Rivka Strom & Shirley Pollak, Audiologists

Thursday, August 26th, 2010

Hearing challenges present themselves in different ways, especially with regards to children and adults. C’mon, we all remember the frustration we felt when asked to repeat ourselves to our grandparent or neighbor once again (for the fourth time!!!)…but what about that baby who is seemingly so content and happy but also quiet because he misses half of what is being said around him….or what about the child who does not laugh at his friend’s joke because although he heard what was said, he did not hear the subtle cues in the spoken phrase. How about the child who has difficulty picking up a second language or who has to work extra hard in school to follow directions in his first language? Did you stop to think it may be resulting from a hearing loss? Did it ever occur to you that he may be hearing at different levels every day or week because of a fluctuating hearing loss due to fluid buildup in his ears?
Parents do not run to specialists for a diagnosis; they want to hear that their child is ok…but when there is a problem, they are often thankful that it was caught early so that treatment can begin in a timely manner. It is important to understand that we, audiologists, are also here to rule out hearing loss in your child. We do not want to give our patients a diagnosis; however, when we are in the unfortunate situation that we find a problem, we are here to help you accept it so that you can move on to the next step of treatment. Whether the problem is a temporary one involving medical treatment, or a more permanent one involving hearing aids or aural (re)habilitation, we are here to hold your hands and walk through this with you but most importantly of all, to make it easier for your child to hear and enjoy living in this beautiful and yes- noisy – world of ours.
It is important that parents understand what audiologists do so that they will know when audiological testing is in order. Audiologists are hearing healthcare professionals who specialize in the diagnosis, treatment and monitoring of auditory and vestibular (balance) disorders in patients of all ages. Some audiologists specialize in the pediatric or geriatric population but many work with both age groups. Starting from the newborn period, audiologists are involved in the newborn hearing screening programs. Hearing loss is among the most common birth defect, affecting approximately 4-6 babies out of every thousand born. Currently, a majority of states mandate that hospitals and birthing centers screen infants for hearing loss before they are discharged. In New York, hospitals with over four hundred births per year must screen for hearing loss. Previously, the average age of identification of congenital hearing loss occurred at approximately 2 ½ to 3 years, well past the age of initial language development resulting in significant speech and language delays, learning deficits, or even behavior problems that could have been avoided if the hearing loss was identified early. The purpose of the newborn hearing screening program is to identify a child with hearing loss by the time they reach three months of age. According to the National Center for Hearing Assessment and Management (NCHAM) detecting and treating one child with hearing loss at birth saves $400,000 in special education costs by the time that child graduates from high school.
Audiologists are also involved in the Early Intervention process as a child is being evaluated for appropriate services. An audiological evaluation is often recommended for a child who is undergoing these evaluations through the Early Intervention Program to rule out hearing loss as a contributing factor to the suspected delay. As mentioned above, it is important to understand that the effects of hearing loss on a young child do not only include a speech and language delay. Especially if the hearing loss is of a mild or mild to moderate degree, effects can include social or behavioral problems or attention and focusing issues. The effects of hearing loss vary from child to child and can be manifested in many different ways. Even if you, the mother, feel that your child hears perfectly well, it is important to follow up with audiological evaluations to rule out mild, minimal or even unilateral hearing losses. Knowledge about your child’s hearing status will only help and never hurt in the long run.
Audiologists also test pre-school, elementary or high school aged children if medically indicated, if a child does not pass a hearing screening or if a child is struggling in school. We must remember that hearing can change over time, either due to a medical and treatable condition or due to a permanent progressive condition. It is always better to be in the know so that if a problem is identified, early intervention can help to offset some of the negative effects.

Dr. Shirley Pollak has been serving the Brooklyn community in clinical practice for 18 years and leads a team of highly competent and professional audiologists providing quality care and service and the highest level of hearing instrument technology. Their knowledge and expertise combined with the latest hearing health care breakthroughs, computerization, ultramodern techniques, and state-of-the-art systems – allows them to offer accurate and successful hearing technology fittings exactly tailored to the individual needs of each patient. She also does newborn hearing screening and can be reached at: Pollak Audiological 718-474-4744 and Rockaway Audiology and Hearing Aid Center: 718-421-2782.

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