Language Outcomes of Late Talking Toddlers at Preschool and Beyond

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• A variety of studies indicate that children who are initially identified as late talkers, as a group, demonstrate language skills that are largely within the normal range by kindergarten entry with respect to performance on norm-referenced, standardized language measures (Ellis Weismer, 2007; Paul, 1996; Rescorla & Lee, 2000; Whitehurst & Fischel, 1994). Although late talkers’ performance on global tests of expressive and receptive language fall broadly within normal range by kindergarten entry, these findings tell only part of the story, as standard scores tend to be significantly lower than those of matched peers (Ellis Weismer 2007; Rescorla 2000, 2002). For example, Ellis Weismer (2007) investigated the language outcomes of 40 late talkers as compared to 43 typically developing peers at 5 ½ years of age who were initially enrolled in a longitudinal investigation of language development at 24 months. Results indicated that 3/40 late talkers demonstrated performance at least one standard deviation below the mean with respect to Speaking Quotient (i.e., expressive language composite score) on the Test of Language Development – Preschool, 3rd Edition (TOLD-P3, Newcomer & Hammill, 1997) when compared to national norms. Further, all children were at or above normal range with respect to performance on the Listening Quotient (i.e., receptive language composite score) of the same measure. While this evidence might suggest that the majority of late talkers resolve their language difficulties by early school age, considering performance relative to that of matched peers yields different results. Although the overall language abilities (i.e., standard scores and percentile ranks) of children who are initially identified as late talkers may be within normal limits with respect to national norms, late talkers continue to demonstrate specific areas of deficit, including grammar in particular. For example, Ellis Weismer (2007) compared the mean performance of the same group of toddlers described above (minus the three who had scores greater than one standard deviation below the mean) to toddlers with normal language development. Within this comparison, the group of late talkers demonstrated scores within normal range on both the listening and speaking quotients of the TOLD-P3. However, their scores were significantly lower than the group with typical language development. Specific difficulties were noted in sentence imitation, a measure of syntax and grammatical morphology. Findings in this direction are consistent with previous investigations that have shown normal range but lower performance in late talkers as compared to peers (Paul, 1996; Rescorla 2000, 2002). Girolametto, Wiigs, Smyth, Weitzman, and Pearce (2001) also investigated the long-term language outcomes of children identified as late talkers at two years of age. This study focused on a sample of 21 late talkers as determined by vocabulary in the lower 5th percentile on the CDI at two years of age. All late talkers participated in a parent language training program for 11 weeks at age two with 13 of 21 participants also receiving additional speech-language therapy. This group of late talkers was compared at five years of age to a group of peers matched for chronological age, gender and race/ethnicity. Results indicated that 3/21 late talkers scored greater than 1.25 standard deviations below the mean on at least two subtests of the TOLD-2 (Newcomer & Hammill, 1988) or Renfrew Bus Story test (Cowley & Glasgow, 1994). In addition, performance of the late talking group was significantly lower for the Grammatic Completion and Oral Vocabulary subtest of the TOLD-2. Within a story telling task, the late talkers were significantly lower in MLU as well as measures of narrative level and percentage of cohesion. Rescorla, Dahlsgaard, and Roberts (2000) tracked the language outcomes at ages three and four of a group of children initially identified as late talkers in toddlerhood in comparison to a group of typically developing peers. Children within this study demonstrated normal receptive language skills. Findings revealed that although late talkers made greater progress in MLU and productive syntax than the children with normal language abilities from age three to four, they remained significantly below typical peers. At age three more than half of the late talker group remained delayed in syntax. However, by age four, only 29 % of the late talkers continued to demonstrate significant delays when compared to their normal language peers. Further, the relationship and patterns of development of syntax was similar for the two groups, with the late talker group appearing to be delayed rather than disordered. The idea that as a late talker it is possible to catch up to your peers with respect to your language development is not unfounded. Some children who are initially identified as late talkers do indeed begin school with language skills that are at or above age level. Within Ellis Weismer’s (2007) sample of 40 late talkers, ten demonstrated age level performance on all measures that were administered at 5 ½ years of age. Specific resiliency factors in early childhood that contribute to such an outcome are in need of further investigation. Go to: Language Outcomes Beyond Kindergarten Limited findings also exist for the period beyond kindergarten entry for children who are initially identified as late talkers. The reasons for this may be largely practical rather than theoretical, given the resources that are required to track the same sample of children over a large window of time. Paul, Hernandez, Taylor, and Johnson (1996) followed a group of late talkers identified between 20 and 34 months of age and a group of matched controls over time. Receptive language abilities varied within this sample. Findings revealed that 74% of the children who were initially identified as late to talk were within normal limits with respect to syntax and morphology at kindergarten entry (i.e., Developmental Sentence Scores (DSS; Lee, 1974) above the 10th percentile in narrative language samples). Within this investigation, these children were classified as “recovered” and were differentiated from the children who remained delayed. This group of children demonstrated significantly lower scores on the expressive scale of the Test of Language Development at age seven than their typically developing peers, though both groups demonstrated scores within normal limits (TOLD, Newcomer & Hammill, 1988). This finding suggests that children who are late to talk continue to demonstrate weakness in language when compared to typical peers. Though not significant enough to be classified as a delay, this subclinical weakness in language could significantly impact academic success. Rescorla (2002) completed an extensive longitudinal investigation of the language development of a group of children who were initially identified as late talkers into early school age and beyond. Of a group of 34 late talkers and 32 controls, all of whom had age-appropriate receptive language at study entry, only 6% of the late talkers had scores on at least two subtests of the TOLD within an impaired range at six years of age. However, as a group, late talkers were significantly lower in vocabulary skills at six, seven and eight years of age and in grammar (i.e., grammatical morpheme use and sentence formulation) at ages six and eight. In addition, significant group differences were found in aggregate measures of reading (i.e., decoding, comprehension, spelling, and written language) at ages eight and nine, though none had a formally diagnosed reading impairment. These findings again point to persistent but subtle language weaknesses that may not be apparent when simply considering scores on formal language measures. Manhardt and Rescorla (2002) also analyzed the oral narrative abilities of a subset of 31 late talkers and 23 typical peers from the study described above at ages eight and nine. Findings revealed significant difficulty in the use of narrative structure for children who were late talkers, in contrast to the findings of Paul et al., described above. Late talkers scored lower on measure of syntax, story grammar and evaluative information when compared to typical peers, though their CELF-R scores were in the average range. These data are consistent with the notion that while most are not delayed enough to warrant a label of language impairment, late talkers continue to demonstrate weakness in language beyond kindergarten as compared to peers. When one considers the impact of language on many, if not all areas of academic achievement, it is critical that these children continue to be monitored for educational success. Additional language data from 28 late talkers and 25 comparison children from the original Rescorla sample were collected at age 13 (Rescorla, 2005). As was the case with previous findings, late talkers scored largely within developmental limits. Late talkers demonstrated most difficulty with measures that tapped into vocabulary and grammar (i.e., Test of Adolescent and Adult Language, Listening Vocabulary, Listening Grammar and Reading Grammar; TOAL-3, Hammill, Brown, Larsen & Wiederholt, 1994). In addition, late talkers were significantly lower on aggregated measures of terms of vocabulary, grammar, verbal memory and reading comprehension. However, late talkers performed similarly to age peers on measures of reading mechanics and writing. The studies that were outlined above all included relatively small numbers of participants, and looked at group outcomes as a whole. Although these types of investigations are informative and can serve as a starting point for consideration of language growth in late talkers, advanced statistical techniques can also inform our view of late talkers by providing information about growth trajectories. A recent study by Rice and colleagues (2007) utilized growth modeling to investigate the language outcomes of 128 children with a history of late talking as compared to 109 typically developing peers at seven years of age. Findings revealed that although the late talkers demonstrated skills within the average range on a global measure of language functioning, a significantly greater percentage of children in the late talking group demonstrated skills that were more than one standard deviation below the mean in spoken language, syntax and morphosyntax (Rice, Taylor, & Zubrick, 2007). Go to

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