Thursday, July 28, 2011

Should your late-talker get speech therapy? Depends on who you talk to.

There's a debate a brewin' in the world of early intervention.  Seeing as how we work with young children, we're generally pretty easy-going folks. But that doesn't mean we don't have our professional disagreements. And this is one of them.

It all started with this study, which was published in the journal of Pediatrics and released into the press in July. The Australian study followed 142 late-talkers as they aged; the researchers measured problem behavior at the ages of 2,5,8,10,14, and 17. They found that, despite having poorer behavior at age 2, the late-talkers exhibited no significant behavioral concerns at any of the follow up ages.  Articles about the study were written up in the press and ran with headlines such as "Late Talkers Do Fine As They Grow Up." Many of the articles also suggested that the "wait and see" approach for late-talkers might be the best option after all. 

That wasn't the end of it though. The Hanen Centre, a non-profit organization that focuses on helping parents learn to teach their children to communicate, responded.  They put out this press release, cautioning parents to be wary of these overly simplistic headlines. As it turns out, the study had looked at the emotional and behavioral outcomes of the late-talkers only.  The Hanen press release noted that, while it was reassuring that late-talkers appeared to have no long lasting emotional or behavioral difficulties, the study simply did not measure whether or not the late-talkers had persistent language delays or other academic difficulties. The Hanen Centre press release urged parents to seek help for their late-talkers early.

So what do I think of all this? I can see both perspectives.  I do think that, in some cases, we over-serve children with expressive language delays.  Many late-talkers really will be just fine, even without formal speech-language therapy.  Have you seen the film Babies?

A colleague of mine wisely pointed out that, despite their varied backgrounds, all of these babies--those who were quizzed with flashcards in their kitchens, and those who spent their babyhood dancing in fields next to goats-- probably still somehow grew up, developed the necessary skills they needed to function in their world, and flourished. Sometimes--sometimes--I think that we in the Western world do families more harm than good by focusing so much on what the child is not doing  instead of letting the family just love the child for who she is. I know we do much good in our field, but I worry that sometimes, against our very best intentions, we steal moments from families that could be spent dancing through life with their children.

BUT (and this is a big but), there is sound rational behind our tendency to push back against the "wait and see" philosophy.  First, talking late is a risk factor for other, more significant diagnoses, such as autism and apraxia of speech.  There are ways to tell if a late-talker is at risk for a larger delay, but it is often hard for parents, and even physicians, to differentiate between those children who have an expressive language delay only (and are therefore, just "late-talkers"), and those who may have a bigger diagnosis that warrants early intervention.  The "wait and see" approach, when applied too broadly and blindly, can lead to children being missed, to parents who are blind-sided by a diagnosis later in their child's life and are frustrated that they didn't get a chance to act on behalf of their child at a younger age, and to problems that could have potentially been mitigated through early intervention.

Further, as the Hanen press release points out, most late-talkers will catch up.  70-80% of those who are truly just late-talkers will outgrow their language delay. But not all will.  And therein lies the rub:   we just don't know yet how to tell which late-talkers will catch up on their own. We do know, however, that the children who don't catch up on their own are at significant risk for later language-based academic difficulty. And we know that the strategies we have to help late-talkers can work, especially when they are used at young ages.

So what would I do if I were the parent of a late-talker?
  • First, I'd make sure that the child was "just" a late-talker.  This can be more complicated than in sounds (Take a peek at this post, which describes the things that I would look at as a pediatric speech-therapist to help me determine of a toddler was a late talker). If I were not well versed in the world of young children, I'd probably ask my pediatrician for an evaluation through my local early intervention program, if for nothing else than to confirm that my child was, indeed, just a "late-talker."
  • If I did get an evaluation from my early intervention program, I would ask them to teach me the strategies for working with my child and help me learn to integrate them into my day.
  • I would read about and try out the different strategies for working with late talkers here, on Child Talk! (You had to know I'd plug this blog, right?). 
  • I would check out books such these, two of my very favorite books on working with children who have communication delays:

  • Finally, I'd make sure to balance any and all of the above with lots of love, laughter, and dancing.

    Learn more about....

    Early Intervention

    Whitehouse, A., Robinson, M., & Zubrick, S. (2011)." Late Talking and The Risk for Psychological Problems During Childhood and Adolescence." Pediatrics: 128 (2): e1-e10.

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  1. You are so bang on with this Becca! It is so hard to know if he will just come along on his own, if the behaviours he's exhibiting are a result of frustrations from communication problems, or if there is more there.

    I am in the school of erroring on the side of caution, and think that having the speech therapy to help him along is never a bad thing, and in fact it encourages self confidence and tools for both he and I to use to make life a little easier for all of us.

    Thanks for another great post!

  2. Thanks for the comment Claire! Good to hear from you. :) It's a delicate balance for sure... I do think that parents like you are in the best position to make decisions for their children and that that we (as the "professionals") really need to just carefully overview the options and then let parents find their own way. :)

  3. Becca, do you find that sometimes parents go overkill? Do you ever see the parent that wants as much therapy as possible so their child gets it faster? I would like to get Cash the therapy he needs, and his therapist recommended twice a week, is there a benefit to more or less? (btw, I'm not that parent! haha)

  4. Nice Post Becca. This will be a good post for me to refer parents to. Thanks.

  5. Hi Claire!

    Sorry it took me so long to got busy for a moment. And your question is a great one, with no clear answer, so I had to give it some thought before answering. I still don't know that I have a great answer for you, but I'll try my best.

    Yes, I think parents sometimes want as much therapy as possible in the hopes that their child will acquire skills faster....and sometimes this thought is valid--some kids, at some points in their lives, will acquire skills faster if they have more intense therapy (the research on autism seems to suggest this is true for autism; best practice for apraxia of speech is thought to be up to 5X week for 20-30 minutes per session).

    BUT...(big but again)...there are many children for whom *more* doesn't lead to *faster*. Sometimes, we can do things to speed up development a bit, but we still have to "ride the curve" of the child's own development, too. Sometimes more therapy is just more stress on the family, which isn't good for anyone!

    AND we are also starting to rethink how we define "therapy" as we consider the idea that, especially for children under the age of three, opportunities for learning happen all the time, throughout the day, in typical and routine activities, with loved ones. This makes us think that perhaps children get MORE "therapy" (opportunities for learning) when we teach parents to integrate strategies into their day, vs. getting official "therapy" twice a week. You know?

    But this is all up for debate...and people are pretty passionate about what they think. That's why I think that the best we can do at this point is explain as much as we can, the best that we can, to parents and then let them be the final decision maker.

    So, if a therapist wants your kiddo to get therapy twice a week, I would ask why she thinks this would be beneficial and what the other options are. I'm not saying it's not appropriate--it certainly could be! But I, as a parent, would ask lots and lots of questions to understand the why behind the therapist's recommendations. And I would certainly make sure that she's teaching you what to do with him at home as part of any treatment program (but that's just my bias!). :)


  6. Well said and such practical advice! I'm in the 'Err-on-the-side-of caution' camp and I definitely encourage families to learn to use the simple strategies I suggest instead of needing to see more of me. Families get a lot more bang for their buck if they do the work themselves because seeing an SLP once a week is not going to do much for a late talker.