Language Delay

The term language delay is commonly used to identify a child who is acquiring language, but at a slower rate than typically developing peers, so failing to meet normative standards. The delay may be in the domains of receptive language (comprehension), expressive language (production), or both. It has typically been used to refer to children in early childhood, before they reach school age, which is when a child with language difficulties may be diagnosed with a developmental language disorder. Low expressive vocabulary has often been used as the indicator for a delay in language acquisition in toddlerhood. Language delay has been reported as affecting up to 20% of 2- to 4-year-olds, though prevalence rates vary depending on measures, child age, and cut points used. This entry discusses the impact of persistent language problems on a child, attempts to identify risk factors associated with language problems, and the challenges in predicting child language outcomes and establishing when and how to intervene.

There are a number of identifiable language milestones that both parents and health professionals use to monitor a child’s development in the early years. The development of receptive language skills will normally precede that of expressive language skills in typically developing children. By the end of the first year, a typically developing child may understand up to 50 words. One of the most significant language milestones for parents—and also one of the earlier signs of expressive language development—is the production of a child’s first word, which commonly occurs around the first birthday. The next major milestone in expressive language, which often occurs late in the second year of life, is the production of two-word combinations. The presence of both first words and early word combinations during this second year suggests that a child has established the foundations of language acquisition.

While language milestones may be used as a guide to track how a child’s language is developing, language development is a continuous process, with a large amount of normal variation in its timing across early childhood. However, if problems emerge when a child is acquiring language, this can present a major concern. Early language problems may have major ramifications for later life, resulting in poorer academic achievement, behavioral and psychiatric problems, increased risk of unemployment, and poorer health literacy.

[Page 992]A substantial body of work illustrates the long-lasting impact that persistent language problems may have on child development and well-being. Toddlers with a language delay at around 2 years of age have been shown to have poorer language skills by adolescence when compared to typically developing peers. In addition, up to 75% of children with an early expressive language delay will have reading difficulties at age 8. Not only can a language delay result in poorer academic and vocational outcomes, but language delays can also be associated with behavioral, social, and emotional problems. The behavioral, social, and emotional comorbidities of early language problems have been shown to persist well into adulthood, although this is likely to be sensitive to the level of initial problem.

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