Does my child have a language disorder? 6 questions speech pathologists should ask before assessment

From time to time, I get complaints about the length of my pre-assessment case history form. But I’m not shortening it.

Every question in my case history form has a purpose. Yet the answers to some questions are more important than others. When I get a case history form from the worried parents of a child, there are six key areas I zero in on as I prepare for the assessment.

Here’s why:

With language disorders, early help is the best help, so we need to know the most important risk factors/predictors. 

• About 7.5% of kindergarten-age kids – 1 to 2 in every class – have developmental language disorders (Tomblin et al., 1997).
• The earlier kids with language disorders can get help, the better (e.g. Guralnick, 2011); and early intervention is generally seen as the most effective intervention (e.g. Olswang et al., 1998).
• It’s never too late to get help for a language disorder. But, in the best of worlds, we want to find and start helping kids at risk during their toddler years. Unfortunately – as yet – there is no blood test or brain scan we can administer to know for sure whether a toddler has a developmental language disorder.

So, before a child comes in to see me for the first time, I examine the case history form filled in by the family and look carefully at these six risk factors:

Key risk factor 1: late talking as a key risk factor and predictor of language disorders

• One thing speech pathologists watch out for are early signs and symptoms of language disorders, especially limited babbling, limited gestures or late talking (Hagan et al., 2008). In particular, a lack of word combinations at 24 months is a significant predictor of language impairment (Rudolph & Leonard, 2016).
• But:
  • a lack of word combinations at 24 months only identifies about half of kids with developmental language disorders (Rudolph & Leonard, 2016);
  • many late talkers spontaneously recover by early school years, meaning they never had a developmental language disorder (e.g. Ellis Weismer, 2002); and
  • early language performance alone is not enough to identify kids who will go on to have chronic difficulties with language (Dollaghan, 2013; Leonard, 2013).
• To make things more complicated, some kids hit or exceed their early language milestones, but still go on to have developmental language disorders as preschoolers or school-aged kids (e.g. Poll & Miller, 2013).
• So:
  • just because your child is a late talker, doesn’t mean he/she has a developmental language disorder; and
  • even if your child is a late talker, he/she might still have an undetected language disorder.
• In other words, late talking alone isn’t enough to predict which toddlers will have significant and chronic language disorders. We need additional ways of spotting kids at risk.

Key risk factors 2-5: Which risk factors are as clinically significant as late talking?

Great question. And one researcher, Johanna Rudolph of the University of Texas at Dallas, has looked at in detail recently. She performed a systemic review and meta-analysis of peer-reviewed articles on risk factors. (This is the highest level of evidence, albeit subject to the strengths and weaknesses of the studies reviewed.)

Dr Rudolph identified 11 risk factors that were statistically significant predictors of developmental language disorders. Of these, four were equally or more predictive than late talking:

• children of mothers who did not finish high school;
• children with older siblings;
• boys (!); and
• children who scored ‘very low’ on their 5-minute Apgar test (named after Dr Apgar in the 1950s, but also referred to by the “backronym”*: Appearance, Pulse, Grimace, Activity, and Respiration).

Key risk factor 6: Family history of reading, language or other communication disorders

Most speech pathology researchers think there is a strong genetic element in developmental communication disorders, including language disorders. Language and reading problems tend to run in families.

For example, Rudolph and Leonard (2016) found that a lack of word combinations at 24 months combined with a family history of communication disorders resulted in the identification of almost 90% of children with developmental language disorders. This was significantly more than were identified by late talking alone.

Clinical bottom line: be aware of the key risk factors, but don’t panic!

If your child is or was a late talker, or falls into one or more of the other clinical risk categories, don’t panic! After all, just under 50% of population have at least one of the risk factors – being male (including me)!

Having one or more of these risk factors doesn’t mean that your child has a language disorder. But, as a parent, I’d rather know if my child is at a heightened risk. A discussion of risk factors is always scary, and I sincerely hope that this article doesn’t alarm anyone. The purpose of this article is not to alarm, but to inform. And, if knowledge of key risk factors increases the chance that children at risk are spotted early, assessed and (if warranted) helped, then this article has done its job!

Related articles:

• “He was such a good baby. Never made a sound!” Late babbling as a red flag for potential speech-language delays
• Why I tell parents to point at things to help late talkers to speak
• “My toddler doesn’t speak at all!” Don’t panic – get informed
• 6 principles we follow when assessing toddlers for language delays and disorders
• Child developmental language disorders
• Beyond school readiness: 7 signs that your kindergarten, Year 1 or Year 2 child may have a language delay
• How to help our secondary school teachers support teenagers with language disorders at school

Principal source: Rudolph, J.M. (2017). Case History Risk Factors for Specific Language Impairment: A Systematic Review and Meta-Analysis. American Journal of Speech-Language Pathology, 26, 991-1010.

For further, less specific, reading about risk factors, see our earlier article here.

*As a morphology nerd, I love the term “backronym”, a noun meaning “an acronym deliberately formed from a phrase whose initial letters spell out a particular word or words, either to create a memorable name or as a fanciful explanation of a word’s origin.”

Image: http://tinyurl.com/yakmvrcl

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