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language risk factors

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

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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:

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

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

Power in knowledge: child language risk factors

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As you can probably tell from our blog, we’re firm believers in sharing as much information as possible with parents and others about developmental language delays and other communication problems – including the limitations of the current evidence base.

We know some language disorders are caused by medical problems, e.g. brain injuries, genetic disorders, hearing impairments and other disabilities.  But many developmental language problems – such as specific language impairment or SLI – have no known cause.

In the absence of a cause, researchers have spent decades looking for correlations between language delays and other factors.  From this research, speech pathologists can identify a number factors or “red flags” that increase – or appear to increase – the risk that a given child may have a language delay. These include:

  • Male gender: Boys are between 2-3 times more likely than girls to have language delays (Campbell, Dollaghan, & Rockette et al., 2003; Kwiatowski & Shriberg, 1993);
  • Family history: A family history of speech-language disorder is a major risk factor for continued language delay (Campbell et al., 2003; and Weismer, Murray-Branch & Miller, 1994);
  • Little babbling: Not babbling much as a baby, is correlated with a greater risk for continued language delays (Olswang, Rodriguez & Timler, 1998; and Eilers, Neal & Oller, 1996);
  • Late talking:  Having fewer than 50 words for a child aged 2 years is a risk indicator for later language impairments (Stokes, 2010).  About half of late talkers without receptive language (comprehension) problems “outgrow” their delay; whereas others do not (Stoel-Gammon, 1991; and Williams & Elbert, 2003);
  • Very low birth weight;
  • Birth order;
  • Genetic and/or neurological disorders;
  • Sensory disorders;
  • Atypical developmental disorders;
  • Severe toxic exposure;
  • Chronic medical illness;
  • Severe infectious disease;
  • Chronic glue ear (otitis media); and/or
  • abuse, major trauma or neglect.

It’s important to remember:

1.  these are just risk factors – issues that that have been shown to co-occur with language delays for some children.  We know males are more at risk.  We’re almost certain there’s a strong genetic component.  Common sense would tell you that traumatised children are more likely to have language delays than children who haven’t experienced trauma, though many kids who’ve suffered abuse or neglect have no language problems whatsoever.  So, in short, we have a very long way to go before we can point specific factors that cause language delays in specific children.

2. for some risk factors, we don’t yet understand why or how they are risks.  For example, we don’t know if older or younger children are more at risk of language delay (there’s research supporting both positions).  There’s also conflicting evidence about the long-term effects of middle ear infections/otitis media on language development.  We’ll look at some of these risk factors in more detail in later posts.

The good news is that loads of great research is being conducted as we write, including a fantastic longitudinal study in Victoria that’s already produced some invaluable research on typical language development and delays.

So watch this space!

Related article:

Additional source: Kanapathy & Weimer, 2012.

Image: http://tinyurl.com/lx9vuv8

 

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

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