Late Talkers: “Wait and See” Isn’t Best Practice
Late talkers are toddlers (18-35 months) with delayed expressive language but intact cognition and no sensory impairments. The commonly accepted benchmark is "fewer than 50 words and no word combinations by 24 months," affecting 9-21% of toddlers depending on sampling methods.
But here's what might surprise you: we can't actually predict which late talkers will have long-term difficulties.
Dale et al.'s (2003) large-scale study found that expressive language at age 2 was a poor predictor of later delays, with many false positives (kids who seemed delayed but caught up) and false negatives (kids who seemed fine but later struggled). Researchers concluded that "the accuracy of prediction from 2-year measures was too poor to be of practical utility."
The CATALISE consortium, representing 59 experts across multiple disciplines and countries, reached consensus that many late talkers catch up without special help, but research has shown it is difficult to predict which children will go on to have longer-term problems (Bishop et al., 2016). Even with risk indicators, the prediction of outcomes for individual children remains unreliable.
Additionally, Erikson (2021) suggests there is insufficient evidence to support using parent vocabulary checklists as screening tools for later language difficulties. The tools we've relied on simply don't work as predictors.
The Research Problem We Don't Discuss
Much of what we "know" about late talker outcomes comes from seriously flawed research. Most studies examining late talker outcomes have used small-scale longitudinal designs with highly selective sampling (typically just 25-35 participants from white, middle-to-upper-class, two-parent, monolingual English-speaking families).
These studies tend to show more dramatic effects compared to large-scale population studies because they specifically recruit distinct groups of "late talkers" and "timely talkers," creating artificially large differences between groups. In real populations, many more children hover right around the cutoff points.
The "70-80% Catch Up" Myth
You've likely heard the statistic that 70-80% of late talkers "catch up with peers" while 20-30% have persisting challenges. This widely cited figure is subject to the same sampling limitations described above, and researchers have questioned where this statistic even originated.
The reality is more complex even children who appear to "catch up" on standardized measures often continue to perform below their typically developing peers throughout development, suggesting that "recovery" may be more apparent than real.
Research Supports Early Action
Experts have challenged the traditional "wait and see" approach, and clinical practice guidelines for developmental language disorders emphasize that only approximately one-third of late talkers catch up by their third birthday, one-third develop DLD, and another third maintain some language deficits (Neumann et al., 2024).
These guidelines recommend that if a language delay is detected at standard screening (21-24 months), the child's language development should be monitored within the next 3 months, with early intervention beginning in the third year of life for late talkers. Importantly, early intervention may reduce the number of subsequent therapy sessions required.
Risk Factors
The key risk factors that increase concern beyond late talking alone. (Bishop et al., 2016)(Neumann et al., 2024):
Family history of DLD (most robust predictor)
Low parental education level
Low nonverbal cognitive abilities of the child
Male gender
Delayed pointing at 12-18 months
No two-word combinations by 30 months
A New Decision-Making Framework
Since we can't reliably predict outcomes, our decisions should focus on three key factors:
Family Priorities What are the family's concerns and goals? Family-centered services mean engaging in shared decision-making rather than simple risk calculations.
Functional Impact How does delayed language affect daily life? Is the child showing frustration with communication? Are there social-emotional challenges impacting participation? Functional impact needs to be prioritized when identifying children's needs.
Cumulative Risk Are multiple risk factors present? A cumulative risk approach where multiple factors indicate greater need for support.
Responsive Support: A Better Alternative
Instead of categorizing kids into "wait and see" or intervention categories, support should be graduated based on current needs rather than future predictions.
This framework offers flexible support that can range from:
Minimal: Monitoring approach with reassessment after six months is recommended given current prediction limitations. Parent education about developmental expectations
Moderate: Structured parent training programs
Intensive: Direct therapy when functional needs exist and multiple risk factors are present
Moving Beyond Binary Thinking
Rather than blanket "wait and see" or automatic intervention, we need a more nuanced approach that examines our biases about development. Modern parenting culture suggests faster is always better, but this can pathologize normal variation. We need to honor normal developmental variation while providing appropriate support when families need it.
This requires us to:
Acknowledge we can't predict outcomes reliably
Provide education about developmental variability
Offer support when functional needs exist
Scale intensity based on family priorities and child participation
Honor the beautiful variability of different developmental paces
Critical questions to guide this approach:
Who is saying there's a problem?
Are we honoring normal developmental variation?
What functional needs exist right now?
Is the family adequately represented in the research we're referencing?
Are we celebrating neurodiversity and each child's strengths?
Research demonstrates that prediction is poor, but responsive support helps. Early intervention benefits children regardless of ultimate diagnosis, supporting a proactive but graduated approach. Let's focus on meeting families where they are rather than where we think they should be, providing the right level of support at the right time based on current needs and family priorities.
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Bishop, D. V., Snowling, M. J., Thompson, P. A., Greenhalgh, T., & CATALISE Consortium. (2016). CATALISE: A multinational and multidisciplinary Delphi consensus study. Identifying language impairments in children. PLOS ONE, 11(7), e0158753.
Dale, P. S., Price, T. S., Bishop, D. V., & Plomin, R. (2003). Outcomes of early language delay: I. Predicting persistent and transient language difficulties at 3 and 4 years. Journal of Speech, Language, and Hearing Research, 46(3), 544-560.
Eriksson, M. (2021). The predictive value of early language skills: A systematic review. International Journal of Language & Communication Disorders, 56(2), 366-387.
Neumann, K., Kauschke, C., Fox-Boyer, A., Lüke, C., Sallat, S., & Kiese-Himmel, C. (2024). Clinical practice guideline: Interventions for developmental language delay and disorders. Deutsches Ärzteblatt International, 121, 155-162.Description text goes here
