“My child has not started talking” – A Language Delay or Developmental Language Disorder?

Language is one of the central skills facilitating child development. By definition, language is “the principal method of human communication, consisting of words used in a structured and conventional way and conveyed by speech, writing or gesture” (given by Oxford Languages – Google’s English dictionary). It is acquired through a series of developmental processes. An issue with any developmental process involved in language acquisition causes a language delay or disorder.

What affects language development

Language acquisition is affected by several internal and external factors. An interaction between genetic and environmental risk factors, or a combination of them can affect the brain development during the pre- and post- natal periods. This may cause neurologic disorders, intellectual disabilities and other developmental problems causing language disorder. Other common factors affecting language development include hearing impairment, structural abnormalities, drug abuse/ intoxication, family history of speech & language problems or absence of stimulation. These factors may affect the verbal production of language (speech disorder) or the conceptual processing of communication (language disorder).

The ‘terms’ can be confusing

[Note: Do not use these terms as labels. You should understand that no condition, disease or disorder becomes the identity of a person]

Over the years, the contribution of researchers and inputs from practicing professionals have helped us in understanding these conditions in great detail. The difference in perspectives have led to the usage of different terms in practice.

The most common distinction that professionals prefer to use is ‘language delay’ and ‘developmental language disorder’. A slower rate of language acquisition in comparison to a child’s peer group is referred to as ‘language delay’. When there is a significant functional impairment caused by biomedical reasons leading to poor prognosis, it is called ‘Developmental Language Disorder’.

Language delay is further distinguished as transient language delay and persistent language delay. A transient delay may have a very few language difficulties that may resolve on its own as children grow. However, researchers also highlight the possibility of an ‘illusionary recovery’ in these cases.

This means that the child may seem to catch up with the typical language development trajectory but may continue to be at risk for language difficulties in certain areas. On the other hand, the persistent delay may cause a significant difficulty in developing vocabulary or grammar, that do not resolve on their own. These differences may be noted to be more quantitative than qualitative – meaning, when professionals use quantitative assessment measures, it will be evident and not otherwise. Another term used to refer to this condition is ‘Late Language Emergence (LLE)’ – when children are identified with a delayed language onset, no other disability identified and no developmental delays in cognition and motor skill.

There are also rare conditions that only causes an ‘Expressive Language Delay’. It refers to delayed vocabulary acquisition, delay in sentence structure development and problems in articulation.

What if it is not addressed?

Language promotes a child’s learning behavior and school readiness. It also helps in self-regulation of behaviors, emotions and social interaction. An inadequate language development will lead to poor self-regulation causing internalization of symptoms like anxiety or depression. When it is externalized, it may be observed as aggression. The other problems that arise when it is not addressed are:

  • Risk of developing significant communication problems
  • Affects academic achievement
  • Makes psychosocial adjustment (adapting to one’s environment) extremely difficult

What to look for?

There is no need to be alarmed, whatsoever. Keep observing the child’s development for a period of time. If you notice any of the signs given below, do not hesitate to consult with a professional.

  • Not communicating using gestures/ signs or words for needs or interaction by 12 months of age
  • Not using at least 50 different words by age of 2 years
  • Not able to use simple phrases by combining at least two words or more; or not instantaneously copying phrases heard
  • Does not seem to understand or react to very simple commands like ‘pick that glass’, do not touch’ etc. by 2 years
  • Not able to say or understand longer phrases or sentences by 3 years
  • Not asking questions by 3 years of age
  • Struggling to initiate conversation by age of 4 years
  • Not attempting or able to learn new words and try combination of words to form longer phrases or sentences by age 4-5 years
  • Struggling to use tense or words with multiple meanings by 4 – 5 years
  • Leaving out important words or not able to comprehend short stories
  • A regression in speech or if the child stops talking – at any age

Plan of action

Take professional helpSpeech-Language Pathologists are language development specialists. They will run a complete test battery approach to understand the cause of the delay, how much delay is present and help you out with ways to overcome the problem. Since rehabilitation is a team approach, you may also be referred to other professionals like occupational therapist, psychologist or physiotherapist (based on the need) to give your child the best care possible.

  • Ruling out an underlying cause – Consulting with a pediatrician/ physician for a preliminary evaluation of development is also warranted. Once they finish the evaluations and plan their line of treatment in case of a neurological disorder, brain injury or structural abnormalities, they will most likely refer you back to the language development specialist.
  • DO NOT WAIT – I cannot stress this point enough! When you wait for your child to ‘grow out of it’ or because a family member of the child started talking late, you are increasing the potential risk for persistent language delay. While every child has his/her own trajectory of development, you cannot brush aside a possibility of a developmental problem. Consulting with your healthcare providers (mainly, a SLP) is your best option in this case and it has to be at the earliest. Early identification provides opportunity for early intervention, improving the outcomes.

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