Assessment section of the Late Language Emergence Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.
Because late talkers remain at risk for later language and literacy problems, early assessment and periodic monitoring are essential to track language development and identify any problems that might arise. For children who present with signs and symptoms of LLE, the typical diagnostic pathway includes a broad check of speech and language developmental status, along with periodic monitoring via screening and systematic observation. If monitoring indicates persistent delays over time and/or additional developmental complications arise, a complete assessment may be warranted.
It is important that the speech-language pathologist (SLP) use screening and assessment tools that provide the most representative sample of the child's behaviors across a range of people and activities within the child's natural environments. Ideally, screening and assessment take place in the child's home or child care setting. The SLP can also gather information about the child's language skills through parent and caregiver report. Parental perspectives on the child's skills relative to the beliefs and values of the family and their culture are relevant aspects to consider.
Screening and assessment results are interpreted within the context of a child's overall development and in collaboration with family members and with other professionals as appropriate. Contextualized interpretation is important, because communication is only one aspect of children's interactions with the environment.
Careful screening by an SLP is warranted to identify young children at risk for language disorders and to determine the need for further speech-language/communication assessment or referral for other professional services. Screening is also an important component of prevention, family education, and support for young children and their families.
Screening measures may involve direct interaction with the child, parent report on a standardized instrument, or both. In fact, the validity of the screening process may increase when professional-administered measures are combined with parent-completed measures (Glascoe, 1999). For screening purposes, however, either standardized testing or parent report is adequate, provided that the measure used has adequate psychometric properties.
Screening typically includes
- gathering information from parents, caregivers, and/or preschool teachers regarding concerns about the child's language skills;
- conducting a hearing screening to rule out hearing loss as a possible contributing factor to language difficulties; for a child who is reluctant or unable to complete a hearing screening, observing his or her response to sound and noise in the environment and referring the child for audiologic assessment if there is a concern;
- using a formal screening tool, observations, and parent questionnaires and checklists to obtain information about the child's communication behaviors;
- using other language assessment methods (e.g., observing the child in play activities with familiar individuals);
- gathering information about speech sound development (e.g., via an informal language sample obtained during play activities).
Screening may result in recommendations for
- a complete audiologic assessment;
- plans to monitor speech and language development, with rescreening as appropriate;
- suggestions for encouraging language development using language stimulation activities;
- a comprehensive speech and language assessment that includes evaluation of social communication skills, symbolic play, and use of gestures;
- a referral for medical or other professional services.
If other developmental complications arise, or if periodic monitoring indicates persistent delays, a comprehensive speech and language assessment may be indicated. The comprehensive assessment takes into account the most common concerns for late talkers—failure to begin using words, absence of a "vocabulary spurt," and failure to begin combining words in the 2nd year of life—and any other communication concerns specific to the individual child. Components of the assessment may change over time, depending on the child's age and stage of development.
For late talkers who have not yet acquired verbal language, the assessment focuses on preverbal behaviors, including play, gesture, and other forms of nonverbal communication and interaction. For children who display various forms of communication (e.g., gestures, vocalizations, words), the assessment evaluates their ability to use these forms to communicate successfully with others. See ASHA's Practice Portal page on
Augmentative and Alternative Communication (AAC).
Although the scope of this page is children from 2 to 4 years of age, younger children may be referred to an SLP with concerns regarding language development. Based on the presenting symptoms, the SLP may conduct a comprehensive speech-language assessment and consider the need for early intervention. Additionally, referrals may be made to other professionals, if the symptoms suggest disorders or conditions other than, or in addition to, language delay. (See information about the
Child Find mandate.)
Pre-assessment planning. Professionals from a variety of disciplines have encouraged the use of pre-assessment planning for young children (Boone & Crais, 2001; Crais, Roy, & Free, 2006). Pre-assessment planning involves one or more professionals who meet with the child and family to gather information and plan the upcoming assessment. Common goals for planning include identifying what the family needs and wants from the assessment process, the roles that family members (and caregivers) would prefer to take in the assessment, and the child's areas of strength and need (Boone & Crais, 2001).
Assessment typically includes
- relevant case history, including
- family's concerns about the child's speech and language;
- birth, medical, and developmental history;
- history of middle ear infections;
- family history of LLE or other language difficulties;
- language history and proficiency for children who are dual-language learners, including
- language typically used in the home and community,
- other language(s) used in the home,
- circumstances in which each language is used,
- child's age when first exposed to English or the other language(s) and the amount of exposure to all of the languages in the child's environments,
- type of language experience in the child's environment (e.g., home literacy activities, conversations, television, etc.);
- hearing screening;
- oral mechanism examination (see the
Assessment section of speech sound disorders for details);
- assessment of language skills, including (for multilingual children, in all of the languages they are exposed to)
- means of communication, including
- eye gaze;
- functions of communication, including
- behavior regulation (e.g., requesting and protesting),
- social interaction (e.g., greeting),
- joint attention (showing and commenting);
- early sound development, including
- proportion of consonants,
- inventory of early versus late-developing sounds,
- multisyllabic babbling,
- inventory of syllable shapes;
- expressive vocabulary, including emerging words and word approximations (in all languages);
- rate of vocabulary growth;
- vocabulary diversity (e.g., nouns, pronouns, relational words);
- word combinations and length of utterance;
- range of meanings expressed in early word combinations;
- early grammar, including
- syntax (e.g., subject-verb and subject-verb-object sentences),
- morphology (e.g., tense markers);
- receptive vocabulary;
- comprehension of simple commands;
- pragmatics and social behavior, including comprehension of early social routines (see
social communication disorder);
- play behaviors (e.g., symbolic play and social pretend play);
- emergent literacy, including
- interest in books,
- looking at or pointing to pictures in books,
- holding a crayon or pencil and scribbling on paper.
Given the influence that families have on their children's growth and development and the fact that children's language learning takes place in the context of interacting with those close to them, it is important for the SLP to gather information about the child's interactions with his or her caregivers. Consider differing communication styles—which are influenced by social and cultural factors—that impact the caregiver-child interaction. A number of measures are available for observing these types of interactions, and they vary with respect to their psychometric properties. In addition to considering the psychometric properties of these tools, keep in mind that a number of other factors can affect the way children interact with their caregivers, including
- contextual factors (e.g., home or clinic setting);
- familiarity with the observer and the materials or toys being used;
- type of interaction (e.g., free play, book reading, or completing a particular task).
Assessment is accomplished using a variety of measures and activities, including both standardized and nonstandardized measures, as well as formal and informal assessment tools. SLPs have the obligation to ensure that standardized measures used in assessment show robust psychometric properties that provide strong evidence of their quality (Dollaghan, 2004).
An assessment battery typically includes the following procedures and data sources:
- norm-referenced tests—provide information about a child's language skills compared with those of children the same age,
- criterion-referenced tests and developmental scales—provide information about a child's behavior compared with a fixed set of predetermined criteria or developmental milestones,
- parent-completed tools and observations—gather information from parents based on observations of their child's behavior in naturalistic environments,
- play-based assessment—uses play as the context for observation and documentation of the child's behavior,
- routines-based assessment—provides descriptions of a child's participation in family-identified routines and activities,
- authentic assessment—gathers information about the functional behavior of the child in typical/natural settings from all those who interact with him or her on a regular basis,
- dynamic assessment—is used as a means to determine what the child can do alone versus with a facilitator (e.g., adult or other child).
For bilingual children, appropriate assessment in all languages is necessary to differentiate between a linguistic difference and a true communication disorder (see
bilingual service delivery). In most cases, the use of standardized tests alone is not sufficient. Test scores are invalid for individuals who are not represented in the normative group for the test's standardization sample, even if the test is administered as instructed. In these cases, the tests cannot be used to determine the presence or absence of a communication disorder. Non-normed (criterion) measures, along with observation, language sampling, ethnographic interviewing, and
dynamic assessment procedures are fundamental to differentiating a difference from a disorder (see
cultural competence and
dynamic assessment: additional ASHA resources).
For a more detailed discussion of procedures and data sources that might be utilized in assessment, see
assessment tools, techniques, and data sources.
Assessment may result in
- determination of a language delay (expressive language delay or mixed expressive-receptive delay) in the absence of a language disorder;
- diagnosis of a spoken language disorder (receptive language disorder only, expressive language disorder only, or expressive-receptive mixed);
- description of the characteristics and severity of the disorder or delay;
- determination of performance variability as a function of communicative situations/contexts;
- identification of delayed phonological development;
- identification of delayed early literacy skills;
- identification of social communication problems;
- identification of possible hearing problems;
- recommendation for ongoing monitoring and reassessment throughout ages 2 and 3 to evaluate language growth relative to peers, combined with caregiver training in language facilitation;
- recommendation for direct intervention and support;
- referral to early intervention services (Child Find) for eligibility determination;
- referral to other professionals as needed (e.g., for assessment of sensory, motor, and cognitive skills);
- determination that the child has a language difference and not a language disorder.
When interpreting the data gathered during the comprehensive assessment, be aware of the variations in early vocabulary growth and early word combinations in young children. As single indicators of later language outcomes, individual differences in acquisition of these skills before the age of 4 are not highly predictive of later language outcomes. In addition, children with receptive language delay have poorer prognoses than children with predominantly expressive delay (American Psychiatric Association, 2013).
With this in mind, the SLP differentiates normal variations in language development from language delay or language disorder and from comorbid conditions associated with language delay or disorder (e.g., autism and social communication disorder).
Strategies for sharing information depend on factors such as the purpose of the assessment (e.g., determining eligibility for services or monitoring and reassessing language skills), the assessment approach and tools used, and the preferences of the individual family and professionals.
Regardless of the strategy used, there are a number of common principles that promote a collaborative exchange of information between service providers and families.
- Include all those who can contribute to and gain from the integration and sharing of the assessment information (Boone & Crais, 2001); this includes family members and others who are likely to be members of the child's team, as well as those who can provide support to the child and family.
- Include opportunities for all members to discuss their thoughts and feelings.
- Set the tone for future interactions with service providers.
Key cultural and linguistic considerations include
- reviewing cultural and linguistic variables and factors that may influence communication (e.g., child rearing practices, perceptions of disability, rules of social interaction), in order to determine whether the communication patterns of an individual may be related to his or her cultural background (see
- determining whether the communication pattern is related to the individual's linguistic background (see
bilingual service delivery);
- understanding that differences may be related to limited exposure to and development of new cultural communication patterns;
- recognizing that assimilation and level of acculturation may influence individual communication patterns and behaviors;
- identifying a disorder as a breakdown in communication that is sufficient to negatively influence the effective use of symbols and message processing in all languages used by the speaker;
- recognizing that a dialectal variation of a communication system is rule based and should not be considered a disorder of speech or language;
- understanding that vocabulary and concept development are distributed across languages and may be connected to different speakers and contexts.
The ability to learn and use language does not appear to be negatively affected by learning more than one language (Pearson, 2013). When combined vocabularies are measured, researchers have found that bilingual children acquire vocabulary at the same rate as their monolingual peers (Hoff et al., 2012; Junker & Stockman, 2002; Pearson, 1998). Pearson (1998) found that using strategies such as conceptual scoring (i.e., scoring the meaning of a word, regardless of the language in which it is produced) when assessing linguistic skills across languages is an effective way to demonstrate that the skills of typically developing bilingual children are on a par with those of monolingual children. These findings support the belief that LLE is not a result of introducing a second language or simultaneously acquiring two languages.
If a child demonstrates difficulties in the acquisition of his or her native language and a second language, an evaluation may be warranted. Understanding the normal processes and phenomena of second-language acquisition and simultaneous bilingualism is important to ensure accurate assessment of bilingual clients.
Some children may experience a silent period during the initial phase of second-language acquisition. During this time, "the child is building up competence in the second language via listening, by understanding the language around him" (Krashen, 2009, p. 27). Speaking ability in the second language emerges once the child has developed sufficient competence via listening and understanding (Krashen, 2009). This should not be confused with LLE. Further, examination of the native language should indicate typical development in that context, and thus, the silent period is only indicative of learning processes in the second language.