Thursday, April 12, 2018

Therapy Tip: Why Does My Toddler Have a Language Delay?

Hey there! It's Therapy Thursday on the blog. This is a day that I share knowledge based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs. Today's tip is:

Why Does My Toddler Have a Language Delay? 

I've been working in my state's birth-three program for over 10 years now. I have had numerous conversations with families. Often parents want general reassurance that their child's speech and language delay is not an indication of a life long problem. For some children, their delays are short term and go on to do well in school. (I know this because I have been able to follow up with some of these kids later.) Some parents will flat out ask me on my first appointment if their child has something wrong with them to explain their lack of verbal speech. Usually, autism is specifically asked about.

Many parents simply want to know why their toddler isn't talking. This is a hard question for me to answer. Sometimes, there are things in the history that can contribute to a delay in language development. I'm saying contribute to a delay because there are many factors at play in a child's life as you'll read below and it's just not always easy to absolutely find a "cause." 

There are some children who have no one single thing that I can pinpoint to as WHY they have a delay. They just do. There are some questions in life that can't be answered nice and neatly. However, there are some things can contribute to a speech and language delay requiring speech therapy.

Let's look at some.

1. Prematurity
Premature births can lead to some delays in language and other areas of development. Babies born prematurely can have delays in motor skills and language, especially if their prematurity resulted in a lengthy or complicated NICU stay. Usually, we will adjust a child's age to account for their prematurity until they are age 2. After age 2, we don't necessarily "blame" the prematurity as the reason, but it is one thing to consider. 

2. Hearing Issues
Known hearing loss will no doubt cause delays in language. Repeated ear infections can also contribute to delays in language because ear infections mean the child's hearing is not 100%. Not every child with ear infections will have a language delay, but it is one thing to follow up on and consider. If a child on my caseload has a history of ear infections, I strong recommend a hearing evaluation. If there is no history of ear infections, then I still tell parents a routine hearing screen is a good idea, but I leave it up to them to decide if/when to pursue it.

3. Environment
Some toddlers grow up in very language rich environments. Other children do not. Some babies and toddlers grow up with little interactions from their caregivers, too much time in front of screens, or too much time being contained alone in seats, swings, or playpens. Environments that offer little social interaction can contribute to a language delay.

4. Family Dynamics
Sometimes, the baby of the family talks and advances to keep up with their siblings. Other times, the baby of the family is treated like a baby. Helpful siblings will get things for the child who never has to utter a word. Family dynamics do not necessarily cause language delays but they can contribute to a child's lack of verbal speech.

5. Personality
There are some children I have on my caseload that are just quiet kids by nature. Their personality is passive or shy. This doesn't really cause a language delay, but it may be harder to get quiet-by-nature kids talking and making strides in therapy. They simply aren't as motivated to talk as some other children.

6. Delays in Other Areas
If a baby achieves motor milestones later than expected, then delayed language wouldn't be out of the ordinary. If the baby has significant feeding issues or delays in any other area of early development, then language delays may happen too. Child development is usually sequential, so we generally expect things to happen in a certain order. If some milestones happen later than expected, then that may mean language may come a bit later too. However, delays in multiple areas for more than a couple of months is something that would be worth looking into more closely to find a reason for the delays via a developmental pediatrician.

7. Underlying Diagnoses (Identified or Unidentified)
There are many underlying diagnoses that are associated with language delays. For example, Down syndrome or a brain injury are both known to have delays in language. There are some diagnoses that are not evident at birth but may become more pronounced by the time the child is 2 and not developing as expected. These are the toddlers I see with large delays in language and display other red flags that signal that something else may be the cause of the delay. Diagnoses like autism or childhood apraxia of speech, for example, may start to become visible in 2 or 3 year olds. So yes, a language delay may be because of another bigger diagnosis besides just "language delay" that may or may not have been diagnosed when the child starts speech therapy.

In all, there are many things that may contribute to a child's delay in language or explain the delay. It is often hard to exactly say "why" it is occurring and give the worried parent reassurance that their toddler will catch up and improve. Time will tell just how the child will progress. Even though we may want to understand why a child is experiencing a language delay, the important thing is to seek intervention and follow suggestions of the treating therapist.

Therapy Thursday is for educational purposes only and not intended as therapeutic advice.

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