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.

References
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.

Self-regulation is critical to a child’s learning and development. Self-regulation is a person’s ability to maintain their arousal level and a level of alertness that is appropriate for the demands of the environment. Children and adults use various strategies and techniques to maintain self-regulation throughout their daily lives. Many of these strategies are sensory based and help our nervous systems sustain physiological regulation in order to participate in social activities, daily living activities, and other age appropriate activities. Sensory processing is a key ingredient to a child’s self-regulation.

Sensory information that our bodies process includes:

• Proprioceptive input: Gives our bodies information of body position and where our body is in space.
• Vestibular input: Provides information to our body about movement and changes in head position.
• Tactile input: Sense of touch through our bodies, hands, and mouth; allowing us to interpret what we feel.
• Auditory input: Sense of hearing, allowing us to interpret what we hear.
• Visual input: Sense of vision, allowing us to interpret what we see.

Our bodies take in sensory information from the environment and process that information, resulting in a behavior in response to the environment. When children have difficulty processing sensory information or have difficulty adequately registering the sensory information, difficulties in self-regulation can result.

Just a few examples of how adults sustain regulation on a daily basis using sensory strategies include:

• Chewing gum to help sustain attention.
• Going out for a massage or engaging in physical exercise when feeling stressed.
• Lying under a heavy blanket when relaxing and falling asleep.
When a child has difficulty with self-regulation, it can impact the child’s ability to participate in school activities, in activities of daily living, social activities, etc. For example, if a child has difficulty sustaining an optimal level of arousal and is very active they will potentially have difficulty listening to classroom instruction, difficulty following the classroom routine, etc. Another example is a toddler who has difficulty tolerating transitions and difficulty self-soothing. This toddler may have difficulty utilizing tools or strategies to assist with self calming, like engaging in a calming movement activity, getting a hug for comfort, knowing what to expect through a visual schedule, etc.

Here are a few questions to consider when looking at a child’s functioning and determining whether difficulties with self-regulation may be contributing to your child’s learning potential:

• Does your child have difficulty staying seated or sitting still during tabletop tasks?
• Does your child have difficulty transitioning between activities?
• Does your child have difficulty sustaining attention to a conversation, activity, or task?
• Does your child have difficulty self-soothing when upset?
• Does your child have difficulty filtering excessive noise resulting in difficulty sustaining attention?
• Does your child have difficulty following multi-step directions or multi-step activities without requiring assistance?
• Does your child have a low activity level?
• Does your child seem to get lost while completing a task, delaying his/her ability to complete it in a timely manner?

These are only a few questions related to possible self-regulation difficulties. If difficulties with self-regulating is impacting daily life and your child’s ability to participate in age related activities to their fullest potential, an occupational therapy consultation or evaluation may be beneficial. Occupational therapy can assess a child’s individual sensory needs and self-regulation capacity to assist with increase in functional independence.

Here are a few examples of techniques that an occupational therapist could utilize to assist you and your child with their self-regulation:

• Create social stories: creating a story about the child and identifying their arousal level (our bodies move slow, just right, and fast).
• Creating a sensory diet that is specific to the child’s sensory system and needs, to help provide needed sensory input to maintain regulation.
• Increasing a child’s self-awareness and ability to identify their own arousal level.
• Providing sensory rich experiences for the child to engage in to increase opportunities for the child to receive the sensory input that they may need.
• Engaging in sensory based community activities that provide the sensory information that the individual child may benefit from.

Dr. Neeha Patel is a licensed occupational therapist who offers a holistic approach to therapy, drawing from evidenced-based practice techniques, sensory integration theory, neurodevelopmental treatment, family-centered care, and a play-based approach. She is Sensory Integration and Praxis Tests (SIPT) certified, and has extensive experience helping children from birth to 16 years old with sensory processing delays, fine and visual motor delays, social skills, pre-writing and handwriting skills, as well as in their primary activities of daily life. She has worked with varying diagnoses including autism spectrum disorders, learning disabilities, developmental delays, developmental coordination disorder, cerebral palsy, disruptive behavior disorder, and down syndrome. Neeha has special interest and completed her doctoral work in the area of cultural sensitivity when working with children and their families. Neeha offers home, school, or community visits in Brooklyn and Manhattan (Upper West Side, Midtown, Chelsea, Clinton, West Village, Soho, Tribeca, Union Square, Murray Hill, Gramercy Park, Upper East Side).

Emily and Sarah, speech language therapists, are available to run summer social skills groups in your home. If you are interested in a summer social skills group, Sarah is available weekday mornings and early afternoons. Contact her at sarah@brooklynletters.com.

One family is willing to have the social skills group in their Park Slope home and they are available Wed. 12-3pm.

Here’s more info. about Emily’s two social skills groups she is running soon:

Social Skills Group – 3 to 4 year olds run by Emily

We have two 3 ½ year olds signed up for a social skills group. Both children have speech and/or language delays, and need help practicing their social skills in a focused facilitated group setting. We are looking to add at least one more child to this group.

Dates/Times: Tuesdays starting July 12th from 3:00-4:00pm (lasting 6-8 weeks, TBD)

Location: Homes in Vinegar Hill and Carroll Gardens (will alternate each week)

What we’ll be working on: Using eye contact to let others know we are listening; Understanding and maintaining personal space; Initiating play with other children; Asking for help when needed; Cooperating, sharing, taking turns and working as part of a group; Exploring a variety of feelings through books and games.

Cost: For a group of 2 children, rates are $65 per child, per session. For a group of 3 children, rates are $50 per child, per session. Payment will be collected every 2 weeks, and rates will be adjusted if additional children are added over the course of the summer.

Social Skills Group – Ages 4 to 5 run by Emily

We have one 4 ½ year old interested in joining this social skills group, and we are looking for one to two additional participants.

Dates/Times: Tuesdays starting July 12th from 1:00-2:00pm (lasting 6-8 weeks, TBD)

Location: Park Slope (or could alternate between Park Slope and your home)

What we’ll be working on: “Thinking” with our eyes and using eye contact to let others know we are listening; Understanding and maintaining personal space; Initiating play in a variety of ways with other children; Responding when conflict arises during play; Cooperating, sharing, taking turns and working as part of a group; Identifying “expected” and “unexpected” behaviors and learning how these behaviors impact other people’s feelings.

Cost: For a group of 2 children, rates are $65 per child, per session. For a group of 3 children, rates are $50 per child, per session. Payment will be collected every 2 weeks, and rates will be adjusted if additional children are added over the course of the summer.

*Please contact Emily Harms, M.S., CCC-SLP if you are interested in joining this group or if you would like more information. You can reach her by email at emily@brooklynletters.com or by phone at (347) 850-4152. www.brooklynletters.com

“Mommy, the princesses won’t let me play with them.”
I pulled over and got into the back seat of the car with my 4-year old daughter.
“What do you mean?” I desperately asked her, trying to conceal the panic in my voice . . .

She then launched into the details of how, during recess at her preschool, the boys and girls divided into gender-specific groups: “Star Wars” and “Princess.” My poor girl, a fan of the Star Wars films, found herself in the nether-region of such “gender play” and was effectively banished by both Han Solo and Sleeping Beauty.

Over the next few weeks, I was transformed.

The next thing I knew, I–a pacifist and a social worker–was taking names and forming opinions about these 4-year old girls who, much to my chagrin, were on the receiving end of my dirty looks at drop off the next day and the days that followed. My feelings and passive-aggression towards the parents of these “perpetrators” was no less shameful.

I then began down the rabbit hole of self-blame: If only I had scheduled more playdates with girls. If only I wasn’t selfish in wanting to spend time play-dating with my friends, most of whom had boys. If only I hadn’t been a tomboy myself. If only I had somehow been a better parent, this would not be happening. She was an outcast, and it was all my fault.

In the weeks that followed, I withdrew from my regular mommy-friends and sought out play dates with the girls who had “rejected” my child in an effort to prove to them once and for all that my little girl was awesome and worthy of play. These efforts were not only unsuccessful (due primarily to scheduling conflicts), but backfired terribly. The feelings of rejection! The anxiety! The depression! The shame!

The reality was, my daughter hadn’t a clue. It was I who suffered the slings and arrows of this tragedy. She was fine. I was a mess.

After several weeks of this craziness, I took a step back to reflect. The inner chaos I was feeling had several layers. First, the Mamma Bear Instinct: protect my child from hurt at all costs. Ok. I’ll give myself that one. But it was more than that. I was fueled not only by my protective instinct, but by my own history. My own pain. My own experience of being an outcast, feeling banished, not fitting in. My own rejection from the princesses. My own desire to opt for the headstrong Princess Leah over Princess what’s-her-name who always needs to be rescued. Rescued. It wasn’t my daughter who needed rescue from this social calamity. It was me.

I then went back to all I knew about child development, and the fact that children at this age need to have their own social experiences. This is how they develop social skills, conflict resolution and communication skills, and foster self efficacy and self esteem. If I intervene here, she will not learn to fight her own battles and navigate the social matrix that is going to be the rest of her life. She needs to do this herself. My job is to be there to support her, comfort her, encourage her and guide her. Not to manipulate her for my own comfort.

Good lord! I thought the nursing, sleep deprivation and diaper changing of the early years were tough! None of those what-to-expect-when-you’re-expecting books said anything about this one!

Once I came out of my fog and regrouped, I began to share my ever-so-humbling experience, and found that many parents shared similar thoughts and feelings. I also began to formulate a theory based on my experience as both a psychotherapist and a parent. In psychotherapy, “countertransference” refers to the feelings the therapist has in response to (as triggered by) the client. It is the therapist’s responsibility to be aware of these feelings and to be diligent not to react to them, as they typically interfere with effective treatment.

The countertransference of parenting, then, refers to our tendency to react to our children based not only on what we perceive to be in their best interest, but also out of our own needs and past experiences. Mindful Parenting is the process of enhancing our awareness of these issues in an effort to be the best parents we can be. By ‘getting out of our own way’ and relying on our instincts and knowledge, we can foster our children’s independence and growth. Thus, once we are aware of our ‘triggers,’ we can tune in more effectively to our children and utilize our parenting skills more adaptively.

So how is this done? How, in the throes of emotional turmoil do I–as a parent–take the time to reflect, when all I want to do is act on my impulse rescue (or fix or change)?

The answer for today is this: Hindsight is twenty-twenty. Take a minute to reflect on some of the incidences your child has had where you felt driven to intense action (or feeling). What was happening? How did you feel about it? How did you react? Did the event remind you of something you experienced in your own childhood? Think about the situation again from an objective point of view. Would you have behaved (or felt) any differently about the situation if you took yourself (your history) out of the equation?

It is important to note that the initial goal of this process is less about resolving these issues, but more about creating a framework for understanding your own reactions so that you might approach these situations differently the next time. It is also an opportunity to tune into your ‘younger self’ and to recognize when she (or he) is being triggered and might be in need of some additional attention or self care. This might be where therapy comes in, or simply a chat with a supportive partner, relative or friend. At the end of the day, the more supported and nurtured we are, the more loving and mindful parents we can be.

*Please note that it could take up to 24 hours to publish your post.

Fara is a psychotherapist with a private practice in Park Slope where she specializes in working with children, adolescents, parents and families, coping with trauma, addictions, anxiety and depression. Utilizing both traditional psychotherapy and creative arts therapy in her work, she provides individual, couples and family counseling and has developed and implemented psychotherapy, psycho-education and creative arts therapy groups for children, adolescents and adults. She can be reached at: fara@brooklynletters.com or by phone at 917-359-3335.

My name is Craig Selinger, and I am a speech language pathologist, also known as a speech therapist, who lives in Park Slope, Brooklyn. Starting in September, I will work full-time in the area; no more back and forth Manhattan commuting. My services include child speech, language, and feeding therapy and language remediation, e.g. reading and writing.

I am very excited to launch Brooklyn Letters! Seven months of steady work on the website and now it is live. Brooklyn Letters will be a dynamic forum: updated blogs, articles, and resources. We want to create services based upon your needs. Here are some future ideas/plans:

UPDATES

BROOKLYN Letters TEAM

Dr. Annette Hernandez and I will soon be adding more professionals to our team.

BLOG

Every member of the Brooklyn Letters team will contribute to our interdisciplinary blog. Check-in monthly for new entries.

Other ideas about the blog:
1) Contacting professors/researchers to make research more accessible to the public.
2) Extending our interdisciplinary blog to other pediatric professionals in the New York City area. If you would like to contribute to our blog, please email me your name, phone number, area of expertise, and the topic you would like to write about. I am limiting blog entries to one page and one per month. Each month will have a different professional contributor.

RESOURCES

Did I miss an important resource? Please email me the link, and I will consider adding it.

LOCAL

We have a FREE Brooklyn (Park Slope and nearby neighborhoods) private business and local pediatric professional (for those offering unique services) directory.

GROUP SERVICES

If you are interested in small group services (3 children) please fill out this form and email it back to me. I teach language learning, literacy, and social skills to small groups. Creating these groups is cumbersome due to the difficultly coordinating schedules and matching learning needs. My goal is to organize compatible small learning groups.

HIRING PROFESSIONALS

If you are a pediatric professional interested in home-based services in the Park Slope and/or and nearby communities, please email me your résumé.

FEEDBACK FROM YOU

How can we improve this site? Email me your ideas.

FUTURE

I am very excited to see how Brooklyn Letters will help contribute to Brooklyn, and watch it help parents from around the world learn more about their child’s development.

THANKS

Many thanks to Brent and Teresa (my amazing website designers), Amy Way (photographer), the families that allowed me to be photographed with their children, Evan, Noreen, Chino, and Maryam. It was a team effort and I appreciate everyone’s important contributions and endeavors!

RECENT NEWS

We are now offering speech, language, and feeding services/therapy in Bay Ridge, Dyker Park and Dyker Heights, and Bensonhurst! If you are interested in Kristi, a speech language pathologist, coming to your home, contact Craig at craig@brooklynlearning.com

We will be expanding our speech, language, and literacy services to your home in Queens- Sunnyside, Woodside, Long Island City, Astoria, and we will be expanding our speech and language services to your home in Williamsburg, Greenpoint, Bushwick.

We welcome Emily Harms, M.S. CCC-SLP- a speech language pathologist that comes to your Manhattan home. She travels to Gramercy Park, Midtown, Murray Hill, Flatiron District, Chelsea, Nolita, Soho, Greenwich Village, West Village, Battery Park City, Financial District, Lower East Side, East Village, Williamsburg

Please contact Craig for more information craig@brooklynlearning.com

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Craig Selinger is a pediatric speech language therapist with a private practice in Park Slope, Brooklyn. He works with babies and pre-adolescents with speech, language, feeding delays and difficulties. In addition, he provides specialize tutoring services (reading, writing, speaking, and listening) for struggling learners and those with unique differences. His speech, language, literacy, and feeding team travels to your home and your child’s school throughout Brooklyn, Manhattan, and Queens. Contact: craig@brooklynlearning.com, 347-394-3485, www.brooklynlearning.com.