Podcast 13: The Value of Early Intervention for Late Talking Children

Transcript

Welcome to ASHA Network News, a continuing series that highlights issues of interests to ASHA members.

Diane Paul: Welcome to ASHA Network News. Our program today focuses on late talking children and implications for speech language pathology practice. We will feature principals of early intervention based on new documents that ASHA recently developed. We have as our guests Dr. Leslie Rescorla and Dr. Rhea Paul. Dr. Rescorla, our first guest, is Professor of Psychology, Director of the Child Study Institute and Director of Early Childhood Programs at Bryn Mawr College in Pennsylvania. Dr. Rescorla developed the Language Development Survey, a screening tool for language delay in toddlers.

We've all heard that Einstein didn't talk until he was 3 years old. And we've heard about pediatricians who tell parents, "Don't worry, he'll outgrow it," when parents express concerns about their late talking child. Recent research about late talking children directly addresses misconceptions about language delays.

Dr. Rescorla has an article that will be published in ASHA's Journal of Speech, Language, and Hearing Research entitled, "Age 17: Language and Reading Outcomes in Late-Talking Toddlers: Support for a Dimensional Perspective on Language Delay." Dr. Rescorla, what does your research tell us about the long-term risks for late-talking children?

Dr. Leslie Rescorla: Well I think that there are two important messages that come out of the research that I conducted. The first is that children who are slow to talk at two, between two and two and a half, who have no other delays or disabilities, that is they have normal language comprehension, they have normal non-verbal abilities, they have typical personality development, they have normal hearing, and they come from families which provide supportive language environments, that those children will generally perform in the normal range in expressive language skills by the time they're about six years old. So our children certainly haven't all outgrown their delay by three, about half of them were still quite delayed at three, but by four about three quarters of them have caught up, by five, all but about 15% of them have caught up. So the good news is that these children function pretty much in the normal range. By the time they get to school they become normal readers, and they have good academic achievement and don't in general require special education services. On the other hand, the study also very clearly showed that the children that were slow to talk were significantly less advanced in their language skills than comparison children who came from the same social class background and had the same level of non-verbal ability when they were toddlers, and that this pattern of weaker language skills was evident when the children were five and six, when they were nine, when they were thirteen, and through age 17, which was the final follow-up. So what I think the study shows is that these children don't turn out to have a language disorder, they don't even turn out to really be language disabled, but they turn out to have somewhat weaker, statistically significantly different language skills than children from the same background who had normal language acquisition when they were toddlers.

Diane: Now what does your research suggest about theories of language development?

Dr. Rescorla: Well I think the study also has some important things to add to that question. What I discuss in the paper is that there are really two contrasting ways that we can think about language problems. We can think of language disorder, language delay as kind of a categorical, almost like a disease entity, and we think of that as that this is a sort of a separate condition that has maybe some very specific biological cause, like measles or something like that. And the contrasting approach which is the approach that I take, and which I think our research supports, is what we call the dimensional approach. And that approach suggests that language abilities are a complex set of skills, there are many things that go into being good at language, and that these abilities and these sub-skills are sort of normally distributed in the population in such a way that some children are going to be really strong, and in most of them or in all of them are going to have really super language skills. Some children are going to be good at some and not so great at others and they are going to be more typical in their development. Some children are going to be a little bit weaker, and a few of them maybe will late talkers who, as I said, kind of outgrow their delay but still be a little weak as they get older. And then some are really going to have poor endowment in some of these areas and so they are going to have continuing language disorders which are evident to anyone as they get older and acquire more aggressive intervention. So I see it as kind of a continuum or a spectrum with late talkers being the closest to typical or normal functioning, but still a little bit toward the lower tail of language endowment, relative to the rest of the population.

Diane: Thank you. I want to invite Dr. Rhea Paul now to join our conversation.

Dr. Rhea Paul: Hi Diane.

Diane: Hi Rhea. Dr. Paul is Professor Amerada at Southern Connecticut State University and Professor and Director of the Communication Disorder Section of the Developmental Disabilities Program at the Yale Child Studies Center. She is currently engaged in a five-year research program on communication issues for young people with autism funded by a mid-career development award from the National Institute on Deafness and other Communication Disorders. She's also principal investigator at the Yale Autism Center of Excellence and Dr. Paul is a fellow of ASHA. Dr. Paul, you too are a pioneer in conducting studies of late talking children. What does your research show about the outcomes of late talkers and preschoolers with specific language impairment?

Dr. Paul: Well I think that Professor Rescorla's work is very illuminating in helping us to understand late talking children, and she has taken the work that was been done in the 80's and 90's a very important step forward. What my early work, following children to age seven, showed and what Professor Rescorla's extension of this work into adolescence has now taught us is that the majority of children who are late to start talking will outgrow this slow start and they'll learn to read, and they'll be able to function adequately throughout their school years. And this should be a message that we can give to parents to really reassure them that most late takers will do okay. There are some important reservations for this picture though, and I think Dr. Rescorla alluded to some of them. First, the results of our research apply to children whose delays are in expressive language only. Parents who have concerns that go beyond talking, such as problems with seeing or hearing or problems with motor development, social interaction, or behavioral and emotional concerns, should really be assertive about obtaining in-depth assessment for their toddlers. Secondly, these results apply only to children who come from supportive families, stable caretaking environments that are provided by adults who aren't themselves undergoing extreme stress. And by extreme stress I mean things like poverty, substance abuse, or mental illness. Families with children who are late talkers that have these sorts of risk are families that are going to need more intensive help to get their children on the right track.

Diane: Dr. Paul, ASHA's Committee on the Role of Speech Language Pathologists and Early Intervention recently developed a series of four documents that review research on intervention and highlight some key early intervention principals. Now some of these late talking children will need early intervention. Dr. Paul, as a member of that committee that developed those documents, I'd like you to speak to some of these guiding principals. The first one is that services are family centered and culturally and linguistically responsive.

Dr. Paul: Yes, I think this tells us that when services are necessary for a child under three the intervention team really has to work intimately with the family to help determine what are the most important skills that this child needs to learn in this family, in the environment in which they live. We need to think about language the child needs to learn as a first language. It may be English; in some families it may be another language and how can we address that need. And finally we need to think about ways to make the intervention coherent with the family's own child rearing style and values, so this principal just tells us that we need to work closely with families to make sure that the services we provide make sense to them, and fit in with the way they raise their children.

Diane: Thanks. Now the second principal is that services are developmentally supportive and promote children's participation in their natural environment.

Dr. Paul: This means that all the early intervention services we provide need to help children with disabilities do what other children the same age are doing. Play with the same kind of toys, not special toys, use the same kinds of words, not strange baby-talk words, and we also need to find ways to help children function in the everyday environments that other toddlers find themselves in. By that I mean at home, in daycare centers, on playgrounds, at churches, anywhere children of this age would normally be found, we want children in early intervention to learn ways of functioning.

Diane: And then the third principal is that services are comprehensive, coordinated and team based.

Dr Paul: For us as speech language pathologists this means that early intervention specialists from different backgrounds and disciplines need to work together, that because we know most about speech and language development, we need to help out colleagues understand the ways in which speech and language skills support all other areas of development. Sometimes we need to share our skills with others, and sometimes we need to demarcate what we're best at doing. In general it means that early intervention providers, including the family as part of the team need to work together to make sure the child's needs are being met.

Diane: And then finally, the fourth principal is that services are based on the highest quality evidence that is available.

Dr Paul: This simply tells us that as speech language pathologists we have an obligation to keep up with current research. It tells us that even though our own and experience and our own intuitions may guide us toward certain modes of practice, we want to back those intuitions up with scientific, systematic studies that show us which methods work best for which children. We all need to keep in touch with our professional organizations and journals and continuing education opportunities to make sure that we're providing the most scientifically advanced forms of intervention available to our clients.

Diane: Dr. Paul, how can speech language pathologists help parents when they come to them about language delays?

Dr. Paul: Well first I think we should reassure parents that most children who are late to start talking will be able to function within the normal range in school. Language skills may not be there strongest area, or their favorite subject, so for example they may be better at art, or science or math than they are at English. It could affect their vocational choices too, so that children with a history of late talking may turn out to prefer to work for example in design, or engineering or accounting, rather than choosing a career that involves a lot of writing or public speaking. But in general, these children are unlikely to show graduation rates or college attendance figures that differ very much from those of their peers in the same socio-economic group.

Second, I think we should encourage parents of late talkers to seek a comprehensive, multi-disciplinary evaluation to rule out other concomative disorders. We know that children who have receptive language problems or areas of other difficulties are less likely to outgrow their disorder.

As Dr. Riscorla's work indicates, children who are late talkers may have a weaker language endowment, and in this case it can help for parents to provide some enrichment in the child's language environment early on. They can use techniques like shared book reading, or be taught focused stimulation or other communication techniques, and all these can provide a rich language environment that may have some facilitative effects. Finally, I encourage the parents to have the child's language development monitored by a speech language pathologist and to initiate direct intervention if significant growth isn't seen by age three.

Diane: Thank you so much, and Dr. Rescorla, do you have any closing thoughts?

Dr. Rescorla: Yes, I wanted to just add one more point, that is to underscore the importance of determining in the evaluation of a toddler whether or not the language comprehension skills are normally developed or not, so I think our research suggest, and other research indicates that children who have comprehension as well as expression delays are at much greater risk, and I think that intervention has to be more aggressive, it has to be earlier because children who have poor comprehension are extremely likely to develop poor listening skills and are more likely to also develop social and emotional and behavioral problems than children who are just a little bit slow to talk, and so I think that determination of whether the receptive language skills are normal or not are really important to do when the child is around two, and if the language comprehension skills are also delayed, in addition to the fact that the child isn't talking, and isn't combining words, those are the benchmarks that we use around two, and I think intervention really needs to start focusing on the comprehension piece very intensively. Comprehension and gesture are very important as the foundation for expressive language, and so I think that speech language pathologists can really work with families to help children improve their listening and learn to recognize familiar words and phrases in their environment and respond to them appropriately, and to begin to use gestures as well as sounds and vocalizations and words to express their wishes and desires.

Diane: Thanks a lot. And thank you both for taking the time to be on ASHA Network News. In closing, it's important to let our listeners know that ASHA's new early intervention documents, which highlight assessment and intervention principles, speech-language pathologist roles, and research are available at http://www.asha.org/policy/. This podcast will be available on ASHA's web site, and you'll find a link to all of ASHA's podcasts on the home page. You can also read Dr. Rescorla's article now on ASHA's web site. You just go to "Journals," and find "Papers in Press". Thank you so much for listening.

Be sure to check www.asha.org periodically for the latest from ASHA Network News.

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