Treatment section of the Late Language Emergence Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.
The goal of language intervention is to stimulate overall language development and to teach language skills in an integrated fashion and in context, so as to enhance everyday communication and enhance the family's ability to support the child's development. Services and supports are individualized for each child and family.
For toddlers and preschoolers with LLE, the speech-language pathologist (SLP) can help remediate problems and potentially prevent future difficulties and the need for subsequent school-based services (ASHA, 1991). When intervention is indicated, the frequency and degree of intervention can vary along a continuum from indirect to direct speech-language services.
When making treatment decisions, it is critical to identify the nature and severity of the language delay and its overall effect on communication, the presence of risk factors, and the child's global developmental skills.
- When no other developmental delays or disabilities have been identified or are suspected, the typical course for a late talker is regular monitoring or monitoring combined with indirect language stimulation.
- When language delays persist over time, or are present with other identified or suspected delays or disabilities (e.g., intellectual disabilities, autism spectrum disorder, hearing impairment), direct speech and language services are indicated; the SLP coordinates services with other professionals working with the child.
Each child has a unique language profile that may be influenced by the language(s) spoken at home, cultural background, and family constellations. It is important to consider these factors when developing an intervention plan. For more information on culturally and linguistically appropriate service delivery, see
bilingual service delivery.
Indirect intervention consists of activities to stimulate language development. Typically, the SLP provides ideas and sample activities for parents and caregivers to engage in with the child. Enrichment activities, such as book sharing and play groups, are encouraged. An approach that utilizes and encourages multiple modes of communication (e.g., speech, gestures, signs, and pictures) is also encouraged.
The SLP may continue to monitor the child on a regular basis during this time and consult with parents and caregivers as needed. For some children, the SLP may provide families with more focused language stimulation activities (e.g., language models designed specifically for that child) and monitor on a more frequent basis.
Interaction styles that have been shown to stimulate language competence and enhance communication in young children include
- providing responses directly related to a child's communication act or focus of attention,
- providing language models for the child,
- providing models of nonverbal communication behaviors (e.g., gestures and eye gaze),
- imitating or expanding the child's actions or words,
- reinforcing the child's communication attempts,
- giving the child adequate time to initiate communication and respond to adults.
(Girolametto, Weitzman, Wiigs, & Pearce, 1999; Kaiser, Hester, & McDuffie, 2001; Wilcox, 1992; Yoder & Warren, 2001)
It is essential that treatment be founded on the highest quality evidence available. Goals are frequently selected with consideration given to developmental appropriateness and the potential for improving the effectiveness of communication and academic and social success. Effective early intervention ensures that services are
- comprehensive, coordinated, and team based;
- family centered and culturally and linguistically responsive;
- developmentally supportive and promote children's participation in their natural environments.
Working With Families
A key component to the success of intervention with toddlers is working closely with families. IDEA (2004) requires that families have the opportunity to share concerns and priorities that may guide or influence treatment. Based on the work of Bailey (2004) and Winton (1996), the following key activities can guide the gathering of this type of information:
- identifying the family's concerns and what they hope to accomplish with their participation with service providers and the service system;
- determining how the family perceives the child's strengths and needs related to their family values and within the family structure and routines;
- identifying the priorities of the family and how service providers may help with these priorities;
- identifying the family's existing resources related to its priorities;
- identifying the family's preferred roles in the service delivery decision-making process;
- establishing a supportive, informed, and collaborative relationship with the family.
A family-centered approach aligns with the federal mandate to provide services in natural environments. Collaborating with parents/caregivers regarding routines and everyday activities helps to
- identify culturally appropriate learning opportunities that occur in the home, community, or school;
- determine the communication goals for the child;
- learn about the child's preferences and interests;
- identify and implement techniques for intervention.
Treatment Approaches and Options
There are a number of different approaches and strategies for working with toddlers with language delay and disorder. Interventions can vary along a continuum of naturalness (Fey, 1986), ranging from contrived or drill-based activities in a therapy room (clinician directed), to activities that are play based and include everyday activities in natural settings (child centered), to those that use activities and settings that combine both approaches (hybrid). One example of a hybrid approach is dialogic reading, an interactive technique in which adults prompt children with questions and engage them in discussions while reading together (Zevenbergen & Whitehurst, 2003).
Augmentative or alternative communication methods may be
considered as a temporary means of communication for late talkers. Research
shows that use of AAC may aid in the development of natural speech and language
(Lüke, 2014; Romski et al., 2010; Wright, Kaiser, Reikowsky, & Roberts,
2013). See ASHA's Practice Portal on Augmentative and Alternative Communication.
Whichever technique is used, the cultural background of the child and his or her family is also considered. There are many cultures for which play-based therapies and child-directed play may not be appropriate. In the cultures of some individuals, "It may be even less natural to engage in child-led play-based interactions, as this is sometimes inconsistent with social roles and expectations" (Wing, et al., 2007, p. 23). This relays the importance of providing services in a manner that best fits the child's needs, given the cultural environment in which he or she lives. Similarly, interventions focused on labeling and rehearsing information can be culturally inappropriate for some families.
For more information about language intervention and a description of specific treatment approaches, see the
Treatment section of spoken language disorders.
Eligibility For Services
To gain access to early intervention services, a child first must qualify for intervention according to state agency guidelines. Some late talkers will qualify for special education services based on the results of an evaluation conducted by school district personnel to satisfy
the Child Find mandate. Speech and language services may be indicated for children identified as having, or being at risk for, communication impairment.
If the child is determined to be eligible for services, an Individual Family Service Plan (IFSP) is developed in accordance with
Part C of IDEA, which covers children from birth to 3 years of age. The IFSP is a written plan for providing early intervention services that
- are based on the evaluation and assessment;
- include a statement of the child's present levels of physical development (including vision, hearing, and health status), cognitive development, communication development, social or emotional development, and adaptive development;
- are implemented as soon as possible after parental consent has been obtained for the early intervention services;
- are reviewed periodically (every 6 months) and annually.
When a child reaches the age of 3, he or she transitions from preschool to school-based services, in accordance with
Part B of IDEA, which ensures that all children with disabilities receive a free and appropriate public education (FAPE). At this point, an Individualized Education Program (IEP) is developed. For more information about eligibility for services in the schools, see
ASHA's eligibility and dismissal in schools,
IDEA Part B Issue Brief: Individualized Education Programs and Eligibility for Services, and
2011 IDEA Part C Final Regulations. Also see ASHA's
Learning Disabilities and Young Children: Identification and Intervention.
Transition from Individual Family Service Plan (IFSP) to Individualized Education Program (IEP)
One of the goals of IDEA (2004) is to ensure a seamless transition process for families moving from one program to another as well as timely access to appropriate services. It is stipulated that there be a transition plan that includes participation by representatives from each program, as well as family members.
The SLP offers assistance to families and team members, appropriate to his or her role. For example, when the SLP functions as the IFSP service coordinator, he or she has direct responsibility for oversight of transition activities and will need to be knowledgeable about a wide range of resources in the community. Alternatively, as a member of the IFSP team, the SLP assists the family and the other team members by helping make the transition process as smooth and as positive as possible for the family.
SLPs and a variety of other professionals, in collaboration with families and caregivers, may be involved in the selection and delivery of services and supports for young children. It is essential that these professionals have the capacity to collaborate effectively and, collectively, possess knowledge of typical and atypical patterns of development in the domains of cognition; communication; emergent literacy; and motor, sensory, and social-emotional functioning. Following is a list of the roles of some of the professionals who, in addition to the child's pediatrician, may be involved in early intervention:
- audiologist—specializes in the nonmedical management of hearing and related problems (e.g., balance);
- early childhood general and special education teachers—plan and provide educationally relevant interventions and other services based on the IEP or IFSP;
- interpreter—assists families who speak languages other than English (see
collaborating with interpreters, transliterators, and translators);
- neurodevelopmental pediatrician—assesses developmental domains (speech and language, motor, sensory, and social-emotional), assists in the selection of appropriate educational setting, and advocates for intervention;
- occupational therapist—helps children improve fine motor skills and acquire the ability to perform daily activities and achieve independence;
- physical therapist—helps children develop gross motor skills and coordination; they also provide services aimed at preventing or slowing the progression of conditions resulting from injury, disease, and other causes
- school psychologist—collaborates with educators, parents, and other professionals to create safe, healthy, and supportive learning environments that strengthen connections between home and school;
- speech-language pathologist—assesses, diagnoses, and provides intervention services and supports for individuals with speech, language, literacy, cognitive-communication, social communication, and swallowing problems.
Other professionals who may be involved include childcare providers, educational diagnosticians, educational therapists, reading specialists, social workers, child and developmental psychologists, pediatric neurologists, and child psychiatrists.
Service Delivery section of the Late Language Emergence Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.
In addition to determining the type of speech and language treatment that is optimal for children with LLE, SLPs consider other service delivery variables—including format, provider, dosage, and timing—that may impact treatment outcomes.
- Format: whether a person is seen for treatment one-on-one (i.e., individual) and/or as part of a group
- Provider: the person providing treatment (e.g., SLP, trained volunteer, caregiver)
- Dosage: the frequency, intensity, and duration of service
- Timing: the timing of intervention relative to the diagnosis
- Setting: the location of treatment (e.g., home, community-based, school)