The scope of this page is late language emergence in children from 2 to 4 years of age.
See the Late Language Emergence Evidence Map for summaries of the available research on this topic.
Late language emergence (LLE) is a delay in language onset with no other diagnosed disabilities or developmental delays in other cognitive or motor domains. LLE is diagnosed when language development trajectories are below age expectations. Toddlers who exhibit LLE may also be referred to as "late talkers" or "late language learners."
Children with LLE may have expressive language delays only, or they may have mixed expressive and receptive delays. Children with expressive delays show delayed vocabulary acquisition and often show delayed development of sentence structure and articulation. Children with mixed expressive and receptive language delays show delays in oral language production and in language comprehension.
Children with LLE may be at risk for developing language and/or literacy difficulties. (See ASHA’s Practice Portal pages on Spoken Language Disorders and Written Language Disorders.) Children with LLE who have receptive and expressive delays are at greater risk for poor outcomes than children with LLE whose comprehension skills are in the normal range (Marchman & Fernald, 2013).
LLE may evolve into other disabilities, such as
In order to make a differential diagnosis, consider hearing loss and monitor the child’s global development as well as cognitive, communication, sensory, and motor skill development.
Some researchers distinguish a subset of children with LLE as late bloomers. Late bloomers are children with LLE who catch up to their peers. At the onset, it is difficult to distinguish children with LLE from late bloomers because this distinction can be made only after the fact.
Some research suggests that there may be some early differences. For example, late bloomers used more communicative gestures than age-matched children with LLE who remained delayed (Thal & Tobias, 1992; Thal et al., 1991), thereby compensating for limited oral expressive vocabularies (Thal & Tobias, 1992). Late bloomers also were less likely to demonstrate concomitant language comprehension delays when compared with children who remain delayed (Thal et al., 1991).
Incidence of late language emergence (LLE) refers to the number of new cases identified in a specified time period.
Prevalence refers to the estimated population of children who are exhibiting LLE at any given time.
Estimates vary according to the definition and criteria used to identify LLE, as well as the age and characteristics of the population.
Signs and symptoms among monolingual English-speaking children with late language emergence (LLE) are often based on parent-report measures. An extensively used set of criteria for LLE is an expressive vocabulary of fewer than 50 words and no two-word combinations by 24 months of age (Paul, 1991; Rescorla, 1989).
It is essential to review these criteria at regular intervals (e.g., every 6 months) to assess language growth and to determine if language skills fall outside of developmental trajectories and whether the child demonstrates LLE.
It is also important to consider other language development factors, including rate of vocabulary growth, speech sound development, emerging grammar, language comprehension, social language skills, use of gestures, and symbolic play behaviors (Olswang et al., 1998; Wetherby et al., 2002).
For example, when compared with toddlers of the same age with typical language development, late talkers may demonstrate
Research also suggests that delays and differences in babbling before the age of 2 years can predict later delays in expressive vocabulary, limited phonetic repertoire, and use of simpler syllable shapes (Fasolo et al., 2008; Oller et al., 1999; Stoel-Gammon, 1989).
Approximately 50%–70% of children with LLE are reported to catch up to peers and demonstrate normal language development by late preschool and school age (Dale et al., 2003; Paul et al., 1996). The prevalence of language impairment at the age of 7 years was 20% for children with a history of LLE compared with 11% for controls (Rice et al., 2008). That is, only one in five children with LLE had language impairment at the age of 7 years.
Although many children with LLE go on to perform within the normal range on expressive and receptive language measures by kindergarten age (Ellis Weismer, 2007; Rescorla, 2000, 2002), their scores on such measures continue to be lower than those of children with a history of typical language development, matched for socioeconomic status (Paul, 1996; Rescorla, 2000, 2002).
For example, school-age children who had been identified as demonstrating LLE also demonstrated
For some children, LLE may be an early indicator of language impairment. See ASHA’s Practice Portal pages on Spoken Language Disorders and Written Language Disorders. Receptive language skills, expressive vocabulary size, and socioeconomic status appear to be the best predictors of language outcomes (see Fisher, 2017, for a review of relevant research).
The causes of late language emergence (LLE) in otherwise healthy children are not known. However, several variables are thought to play a role.
Based on research comparing children with late language emergence with typically developing peers on variables linked to language development, a number of risk factors for LLE have been proposed, including child and family factors, elaborated as follows.
For children younger than 18 months, screen media use (other than video chatting) is discouraged (American Academy of Pediatrics, 2016). Infant exposure to certain types of media was associated with lower language scores, although the relationship between media and language development is not fully understood (Zimmerman et al., 2007).
Early identification and intervention can mitigate the impact of risk factors (Guralnick, 1997, 1998; National Research Council, 2001; Thelin & Fussner, 2005). Therefore, it is important for speech-language pathologists to recognize these risk factors when identifying LLE and considering service delivery options.
There are a number of protective factors that may buffer children and families from factors that place them at risk for later language and learning problems (Collison et al., 2016), including:
The National Joint Committee on Learning Disabilities (2007) also identifies a number of protective factors. These include
Speech-language pathologists (SLPs) play a critical role in providing services to families and their children who are at risk for developing, or who already demonstrate, delays or disabilities in language-related play and symbolic behaviors, communication, language, and speech. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); prevention and advocacy; and education, administration, and research. See ASHA’s Scope of Practice in Speech-Language Pathology (American Speech-Language-Hearing Association [ASHA], 2016b).
Appropriate roles for SLPs include
When further assessment is indicated on the basis of screening results, appropriate roles of the SLP include
See ASHA’s Practice Portal pages on Spoken Language Disorders and Early Intervention. See also ASHA’s resources on interprofessional education/interprofessional practice [IPE/IPP], person- and family-centered care, and family-centered practice.
As indicated in the ASHA Code of Ethics (ASHA, 2016a), SLPs who serve this population should be specifically educated and appropriately trained to do so. They require knowledge of typical language development, the variability within typical development, and the normal variations in interactive styles associated with successful communication. It is essential that SLPs consider the influence of sociocultural factors on communicative interactions and language development. See ASHA’s Practice Portal page on Cultural Competence.
See the Assessment section of the Late Language Emergence Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.
Because children with late language emergence (LLE) 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 development, along with periodic monitoring via screening and systematic observation. If delays persist over time or if additional developmental problems arise, a complete assessment may be warranted.
Ideally, screening and assessment take place in the child’s home or in a childcare setting. Many individuals are not represented by assessment norming samples (e.g., dual language learners), and the resulting scores may not be valid (Banerjee & Guiberson, 2012; Guiberson & Banerjee, 2012). Thus, multiple sources of information are necessary to assess for LLE. The speech-language pathologist (SLP) can also gather information about the child’s language skills through parent and caregiver report and interviews, developmental observations, and language sampling. See ASHA’s resource on assessment tools, techniques, and data sources.
Screening and assessment results are interpreted within the context of a child’s overall development and in collaboration with family members and 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 helps to identify young children at risk for language disorders and to determine the need for further speech and language 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 and/or parent report on a standardized instrument. 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
Screening may result in recommendations for
If periodic monitoring indicates persistent delays, a comprehensive speech and language assessment may be indicated.
Consistent with the World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) framework (ASHA, 2016a; WHO, 2001), a comprehensive assessment is conducted to identify and describe
See ASHA’s International Classification of Functioning, Disability, and Health (ICF) for examples of assessment data consistent with the ICF framework for various clinical disorders.
Professionals from a variety of disciplines have encouraged the use of pre-assessment planning for young children (Boone & Crais, 1999; Crais et al., 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, 1999). See ASHA’s resources on person- and family-centered care and collaboration and teaming.
The comprehensive speech and language assessment considers the most common concerns for children with LLE, including
For children with LLE 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 exhibit various forms of communication (e.g., gestures, vocalizations, words), the assessment evaluates their ability to successfully use these forms for functional communication.
Children learn language in the context of interacting with those close to them. Therefore, it is important to gather information about the child’s interactions with family members and caregivers as well as to be aware that communication styles are influenced by social and cultural factors (see ASHA’s Practice Portal page on Cultural Competence).
See ASHA’s Practice Portal page on Bilingual Service Delivery.
See ASHA’s Practice Portal page on Childhood Hearing Screening.
Spoken Language Assessment (Expressive and Receptive)
See ASHA’s Practice Portal page on Spoken Language Disorders.
Play Behavior and Social Communication Assessment
See ASHA’s Practice Portal page on Social Communication Disorder.
Speech Sound Assessment and Emergent Literacy Language Assessment
See ASHA’s Practice Portal pages on Speech Sound Disorders: Articulation and Phonology and Written Language Disorders.
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). Competency-based tools, self-report questionnaires, and norm-referenced report measures (e.g., parent, teacher, and significant other) are frequently used. Analog tasks that mimic real-world situations and naturalistic observations can be used to gather information about an individual’s communication skills in simulated social situations or in everyday social settings.
See ASHA’s resource on assessment tools, techniques, and data sources for general information about assessment options. Keep in mind that several factors can affect the way children interact with their caregivers, including
For bilingual children, assessment in all languages is necessary to differentiate between a linguistic difference and a true communication disorder (see ASHA’s Practice Portal page on Bilingual Service Delivery). The use of standardized tests alone is not sufficient and may not be appropriate. 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 ASHA’s resource titled Dynamic Assessment and ASHA’s Practice Portal page on Cultural Competence).
Assessment may result in
When interpreting data from the comprehensive assessment, it is important to be aware of variability in early vocabulary growth and early word combinations in young children. As single indicators of later language outcomes, individual differences in the acquisition of these skills before the age of 4 years 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 these factors in mind, the SLP will need to differentiate normal variations in language development from language delay or language disorder and from comorbid conditions associated with language delay or disorder (see ASHA’s Practice Portal pages on Autism Spectrum Disorder, Social Communication Disorder, and Intellectual Disability).
Approaches for sharing assessment information depend on the purpose of the assessment (e.g., determining eligibility for services or monitoring language skills), the assessment approach and the tools used, and the preferences of the family.
The following are common principles that promote a collaborative exchange of information:
See also ASHA’s Practice Portal page on Counseling For Professional Service Delivery.
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 about language development. Depending on the presenting symptoms, the SLP may conduct a comprehensive speech and language assessment to determine the need for early intervention. The SLP might also refer the child to other professionals, if the symptoms suggest disorders or conditions other than—or in addition to—language delay. See ASHA’s Practice Portal Page on Early Intervention and information about the Child Find mandate.
Key cultural and linguistic considerations include
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. Monolingualism is not necessary and should not be advised as a response to LLE. A strong model in any language helps build a linguistic foundation that will aid in the acquisition of other 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.
See the Treatment section of the Late Language Emergence Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.
Language intervention for toddlers and preschoolers with late language emergence can vary along a continuum from indirect to direct services. Speech-language pathologists (SLPs) are involved in direct treatment and are often involved in monitoring and indirect intervention. SLPs can help remediate problems and potentially prevent future difficulties and the need for subsequent school-based services.
The goal of language intervention is to stimulate overall language development and to teach language skills in an integrated fashion and in context. This approach promotes effective everyday communication and enhances the family’s ability to support the child’s development.
The level of service (i.e., indirect or direct) is individualized for each child and family. When making these decisions, it is critical to identify the nature and severity of the language delay, its overall effect on communication, the presence of risk factors, and the child’s global developmental skills.
Each child has a unique language profile that may be influenced by their cultural background, the language(s) spoken in the home, and the family constellation. It is important to consider these factors when developing an intervention plan. For more information on culturally and linguistically appropriate service delivery, see ASHA’s Practice Portal page on Bilingual Service Delivery.
A key component to successful intervention with toddlers is working closely with families. The Individuals with Disabilities Education Act (IDEA; 2004) requires that families have the opportunity to share any concerns and priorities that might guide or influence treatment.
There are a number of key activities that can guide the gathering of this type of information (Bailey, 2004; Winton, 1996).
These activities include the following:
A family-centered approach aligns with the federal mandate to provide services in natural environments. Collaborating with parents and caregivers about routines and everyday activities helps to
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. The SLP encourages enrichment activities (e.g., book sharing and play groups) and multimodal communication (e.g., speech, gestures, signs, and pictures).
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).
Interaction styles that stimulate language competence and enhance communication in young children include
Direct intervention consists of activities designed and implemented by an SLP. Direct intervention may be indicated for children identified as having, or being at risk for, communication impairment. The family and SLP select goals that are developmentally appropriate and that offer the potential for improving communication and promoting academic and social success.
Effective intervention promotes the child’s participation in natural settings and is
Treatment approaches for children with language delay or disorder can vary along a continuum of naturalness (Fey, 1986). They include
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).
Other strategies may include involving extended family, siblings, or other children and engaging in structured didactic learning tasks led by the care provider (Guiberson & Ferris, 2018, 2019).
Augmentative and alternative communication methods may be considered as a temporary means of communication for children with late language emergence. Research shows that the use of augmentative and alternative communication may in fact aid in the development of natural speech and language (Lüke, 2014; Romski et al., 2010; Wright et al., 2013). See ASHA’s Practice Portal page on Augmentative and Alternative Communication.
The SLP considers the cultural background of the child and their family when selecting the best treatment approach. For example, 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). See ASHA’s Practice Portal page on Cultural Competence.
It is not necessary or beneficial to recommend monolingualism for multilingual children who show language delays. Bilingualism has not been shown to inhibit language development or therapeutic outcomes in the presence of language disorders (Bird et al., 2005; Hambly & Fombonne, 2012; Valicenti-McDermott et al., 2013). All languages that an individual uses are important culturally and socially. Discouraging the use of one of those languages may be a disservice to the child’s functional communication and language development in different contexts (Cruz-Ferreira, 2011).
For more information about language intervention and a description of specific treatment approaches, see the Treatment section of ASHA’s Practice Portal page on Spoken Language Disorders.
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 on the basis of an evaluation conducted by their school district (see Child Find). 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
When a child reaches the age of 3 years, they transition from preschool to school-based services, in accordance with Part B of IDEA. At this point, an individualized education program is developed. See ASHA’s Practice Portal page on Early Intervention for details. See also ASHA’s resources titled IDEA Part C Issue Brief: Transitions (Including Part C to Part B/Exiting Part C) and IDEA Part B Issue Brief: Individualized Education Programs and Eligibility for Services.
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 can have different roles during this transition period. When the SLP functions as the IFSP service coordinator, they directly oversee transition activities. As such, they need to be knowledgeable about a wide range of resources in the community. When the SLP functions as a member of the IFSP team, they assist the family and other team members by helping make the transition process as smooth and positive as possible.
SLPs and other professionals, in collaboration with families and caregivers, are typically involved in the selection and delivery of services and supports for young children. It is essential that all professionals involved in the process collaborate effectively with other team members and be knowledgeable about typical and atypical patterns of development in the domains of
Depending on the needs of the child, the interdisciplinary team can include
Other professionals who may be involved include bilingual specialists, English Language Acquisition teachers, childcare providers, educational diagnosticians, educational therapists, reading specialists, social workers, child and developmental psychologists, pediatric neurologists, and child psychiatrists.
See ASHA’s resources on collaboration and teaming and interprofessional education/interprofessional practice (IPE/IPP).
In addition to determining the optimal speech and language approach for the child with late language emergence, SLPs consider other service delivery variables—including format, provider, dosage, and setting—that might affect treatment outcomes.
Format refers to the structure of the treatment session (e.g., one-on-one or group).
Indirect intervention will, by its nature, involve key individuals in the child’s everyday life. This can include one-on-one activities with the child and parent or caregiver or group activities within the family or within a school setting that may include siblings, peers, and teachers.
If the child is receiving direct intervention, services are typically structured within the context of the child’s home, community, group care settings, or school. The format will include key people in those settings (e.g., parents, teachers, care providers, siblings, and peers).
Telepractice can also be used to deliver face-to-face services remotely. See ASHA’s Practice Portal page on Telepractice.
Provider refers to the person providing the treatment (e.g., SLP, trained volunteer, caregiver).
For children who receive indirect intervention, the SLP typically provides ideas and sample activities for parents and caregivers to engage in with the child. The SLP monitors the child on a regular basis during this time and consults with parents and caregivers as needed.
Children and families receiving direct intervention might have multiple service providers from different disciplines. This transdisciplinary team includes a primary service provider, who serves as the primary point of contact for the family, and other professionals who support the primary service provider through consultations, team meetings, coaching, or training (Shelden & Rush, 2013).
Dosage refers to the frequency, intensity, and duration of service.
Dosage depends a great deal on the needs of the child and their family and caregivers. Regardless of whether the child receives indirect or direct intervention, some families and caregivers will need more frequent contact and more concrete support (Bagnato et al., 2011). Others prefer longer intervals between contacts to allow more time to use strategies, practice new skills, and gain confidence in their abilities (Dunst et al., 2014; Keilty, 2010; Roberts et al., 2016).
Setting refers to the location of treatment (e.g., home, community-based).
Factors such as geographical location, child and family needs and available resources, and family preferences will help determine where services and supports occur (Dunst et al., 2014; Searcy, 2018).
To the extent possible, intervention services and supports are provided in natural environments, including the child’s home and community settings. The natural environments for services and supports may change over time as family and child needs change. Some children may receive services in more than one setting.
This list of resources is not exhaustive and the inclusion of any specific resource does not imply endorsement from ASHA.
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Content for ASHA's Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Late Language Emergence page.
In addition, ASHA thanks the members of the Ad Hoc Committee on the Roles and Responsibilities of Speech-Language Pathologists in Early Intervention whose work was foundational to the development of this content. Members of the Committee were M. Jeanne Wilcox (chair), Melissa A. Cheslock, Elizabeth R. Crais, Trudi Norman-Murch, Rhea Paul, Froma P. Roth, Juliann J. Woods, and Diane R. Paul (ex officio). ASHA Vice Presidents for Professional Practices in Speech-Language Pathology Celia Hooper (2003–2005) and Brian B. Shulman (2006–2008) served as the monitoring officers.