Language delays in multilingual children: what are they and what to do about them

[ 0 ] 13/09/2022 | liza

Chapter 7. Language delays in multilingual children: what are they and what to do about them by Dr. Mary-Pat O’Malley-Keighran

Click here for the index and access all the chapters.

The first important thing to know is that speaking two or more languages does not cause any speech and language delays or disorders. If your child has a problem with speech or language, it’s not because they’re multilingual. Being multilingual doesn’t make speech and language problems worse. Children who have autism or Down syndrome can and do become multilingual. If your family needs two or more languages to communicate and connect, then that’s what they need. Never follow the advice to drop a language in the belief that it will simplify things. It won’t. It might even make things worse as you cut off one set of language skills. Like trying to only use your right hand and not your left. Your multilingual child’s language development is distributed across the languages. Meaning that sometimes, they will know words in one language but not the other. Balance is an illusion because language doesn’t work that way.

Here are five amazing facts about your bilingual baby’s brain and language development:

#1 Your baby starts to hear at around 26 weeks of your pregnancy. Now, of course, this isn’t exactly like hearing on the outside! Sound has to pass through skin and muscle and amniotic fluid. But research shows that babies can tell the difference between sounds like /b/ and /z/ before they are even born. Distinguishing one language from another in a bilingual baby is robust at birth. They show language preferences at birth and shortly after for languages they heard while still on the inside! Your bilingual baby’s language journey starts before they’re born!

#2 Newborn babies show a preference for stories that were read to them before they were born. They also show a preference for their mother’s voice at birth. Only a few days after birth, newborn babies respond differently to language and to non-language sounds. Very young infants prefer to listen to speech over non-speech sounds.

#3 Babies are born with the ability to distinguish between and produce all of the sounds in all of the world’s languages! That’s around 600 consonants and 200 vowels! Starting at about 6 months of age, this ability gradually starts to narrow to the languages in their environment.

#4 Babies learn language rules earlier than you think! All languages have rules for what sounds can go together to make syllables and words. Like in English, we don’t have words that start with /nd/. But Swahili has words that begin with this combination of consonants. At 9 months of age, babies have been found to show a preference for what is called legal combinations of sounds in their languages.

#5 Babies don’t just learn languages by listening. Looking at your face is important too. There’s research to show that 6 and 8-month-old bilingual babies could distinguish between French and English speakers just by looking at speakers on videos with the sound turned down.

And here are three important things to remember about how language works in multilingual children. Keeping these in mind will save you a lot of heartache! (Thanks to Kathryn Kohnert for pointing them out in her 2010 paper listed in the resources at the end of the chapter).

#1 Language skills tend to be distributed across languages and vary over time. This means that it’s natural for multilingual children to know a word in only one of their languages. It’s not a case of two or three monolingual speakers of each language in the one child. A simple example is where they have words to do with home and family and community in the language used there and then they learn words to do with maths and science and geography and so on at school. It’s important to know this because it means you need to think about all of the words your child has in all of their languages. And it means that if they’re seeing a speech and language therapist, they need to have all of their languages tested. When their language is tested, it’s not unusual for multilingual children to do better on some things than on others. So, they might be good with vocabulary and story-telling in the home language and not so good at these in the community language, especially when they’ve just started school.

# 2 The languages interact with each other. Basically, the languages do seem to be stored separately in multilingual children’s brains, but they interact with each other. Multilingual people tend to mix languages and switch between them to different degrees. Children aren’t confused when they mix. You can only mix things that are separate, to begin with, and if you look closely, the mixed things they say are grammatically correct. It might be that they didn’t have the word they wanted in one language, so they pop in the equivalent word from another language – pretty cool when you think about it.

#3 Everyone’s different and every multilingual situation is unique. In the research, even when children are matched closely in groups, there’s a lot of variation between individual children in the group and how they perform on language testing. And there’s also a lot of variation between groups of carefully matched multilingual children who speak the same languages. That’s because there is a range of factors that affect language development which is unique for every family. Things like the number of languages spoken, the ages at which children are exposed to the different languages, the opportunities they have to use the languages, their own motivation which can change over time, how similar or different the languages are, the social value attached to the languages and so on. Assessment of multilingual children’s speech & language skills needs to take these three factors into account. Here’s an example of the kind of variation I mean: a boy’s expressive vocabulary can vary from 79 words to 511 words at 24 months of age and still be considered within normal limits!

You need to know the difference between speech and language too. Speech means the actual sounds your child is using like /p/ or /s/, how they are pronouncing words (saying tar when they mean car or boon when they mean spoon), having an accent, how their voice sounds, whether are they stuttering and so on.

Language is about understanding what you’re saying to them, following instructions, their vocabulary, how many words they’re using, the different kinds of words they’re using (nouns, verbs, adjectives, prepositions) combining words together to make phrases and sentences, telling stories, jokes, switching between languages and so on. You need to know about language comprehension and expression or expressive language. Comprehension is what a child understands. You say ‘Get your coat and hat and scarf’ (without pointing to them or without having said ‘We’re going for a walk’) and they go get them for example. Expression is what they say- the words they use- not how they pronounce them but words and phrases like: mama gone, look mama, birdie, I do it, and so on.

In this chapter, I’m going to focus on language problems in multilingual children. If you’d like to read more about speech problems in multilingual children, be sure to visit my blog at www.talknua.com. You can read about them here and here and here.

So, when it comes to your child’s language development, you might be worried that your child is slow to start talking or that she doesn’t seem to use a lot of words. You might have come across expressions like late talkers, late language learners or language delay or late language emergence. I’m going to use the term late talkers as that’s what the American Speech, Language, & Hearing Association is currently using. Let’s take a look at what the current research has to say.

What exactly is late talking?

Leslie Rescorla, a researcher in this area, says expressive language delay is like fever: it’s a symptom found in many conditions like children with hearing loss or cleft palate. That makes diagnosing children who are late to talk challenging. But here we’re talking about late talkers who don’t have other conditions like autism or Down syndrome. Children who are late talkers can be late in expression only, or they can have a delay that is a mixture of a delay in comprehension and expression.

Basically, children are considered late talkers when they are between 18 and 35 months old, understanding what you say to them but they’re using a limited number of words (It’s called having limited expressive vocabulary). This means that they don’t use a lot of words or a lot of different kinds of words (nouns, verbs, prepositions) and word combinations. To be considered a late talker, all other areas of development need to be typical – things like their play and when they walked, hearing, and so on. However, life isn’t always as straightforward as the research and some late talkers might have a delay in understanding as well. Overall, the outlook is good for late talkers with most of them moving into the average range on language tests by preschool. Early identification is important. A slow start to vocabulary is more likely to be short-lived if it’s identified before 18 months and is the only issue your child has. At 24 months, 50-70% of children could catch up to their peers. But, one study showed that 82% of toddlers who failed language screenings at 30 months were not recovering by age 6. In general, children who were late talkers do continue to do more poorly on language testing in school. This means they’re at risk for language disorders. (These are called Specific Language Impairment (SLI) or Developmental Language Disorders (DLD). These problems are persistent language problems that tend to be diagnosed after age 4).

What might this look like in your child though? Well, if your child is 24 months old and does not yet use 50 words or two-word combinations, they’d be considered late talkers. Elizabeth Peña, another established researcher, says that between 18-20 months, you should expect your child to be using AT LEAST 10 words, and those words would be distributed across the languages. So they might have more words in one language than the other. It’s the total amount you’re interested in.

First words usually come any time from 8 – 15 months depending on what you read. At first, growth is slow with 18-month-old children learning about 10 new words per month. (Don’t get too hung up on the numbers though. There’s so much variation between children when it comes to early language development that there are only rough guides. And it’s also important to think about what they’re using the words for. It’s all about communication – so are they requesting something like tickling to be repeated or stopped, are they protesting, rejecting something, commenting, and so on). Between 17 & 20 months, there’s a rapid vocabulary spurt as they approach the 50-word mark and they learn several new words daily. Not all children go through this vocabulary spurt though. Most of the ages and stages that you come across are based on monolingual children but the milestones are similar for bilingual children. Children make progress at different rates but it is important to see steady progress.

How common is late talking?

Again, estimates vary but ASHA reports that between 10-20% of children at the age of 2 present with slow onset and development of their expressive language. In 18- to 23-month-old toddlers, the percentage of late talkers is estimated to be 13.5%. This rate rises to 16%-17.5% in 30- to 36-month-old children. If we’re talking about children who have problems with understanding and using language, then the rate is about 13.4%. If children have a family who has had a speech or language problem, then the rate is 23% compared to those with no family history (12%). Boys are three times more likely than girls to have late language emergence.

The estimated proportion of late talkers who go on to develop persistent language problems varies widely from 6%- 44% depending on the study. It’s also important to remember that late talking is a characteristic or feature of a child’s development. It’s not a disorder or a diagnostic or a label. It’s a description. And remember too that the most likely outcome for individual children who are late to talk is that they will catch up to their typically developing peers.

Do they grow out of it?

Another hard question to answer but about 50% of late talkers do score in the normal range by age 3 on vocabulary measures and in the normal range of grammar and conversational skills by school age. Late bloomers is the name given to children who catch up in the 3-5-year-old period. (Approximately 50% to 70% of late talkers are reported to catch up to peers and demonstrate normal language development by late preschool and school-age.) There’s some research suggesting that late bloomers use more communicative gestures than age-matched late talkers who remained delayed. Using communicative gestures allows them to compensate for limited oral expressive vocabulary. Research also indicates that late bloomers are less likely to have language comprehension delays (in addition to the expressive language delay) when compared with children who remain delayed. In one study, the presence of language impairment at age 7 was 20% for children with a history of late language emergence compared with 11% for controls. That is, only one in five late talkers had language impairment at age 7. One of the best resources I’ve come across for gestures is First Words Project. You can find a list of 16 gestures that your child should be using by 16 months. You’ll need to think about which ones are part of your culture and which ones aren’t. You can find out all about them here.

BUT and it’s a big one, there’s research showing that children who had expressive language delay between 24 and 31 months of age had weaker language skills throughout their adolescence. Even though they had language scores in the average range, they were still performing more poorly than their peers on vocabulary, grammar, and verbal memory. And there’s also research showing that where children have delays in understanding and expression together, they can struggle with learning to read. How much a toddler understands may be a better predictor of expressive language outcome than how much she or he says. Late talkers are at relatively low risk for language or learning disorders. And the majority of children with SLI/DLD are not former late talkers. Being a late talker is a risk factor for language or learning disorders but it is neither a clinical condition nor a certain sign of disorder to come. One author, Rhea Paul recommends that late talkers who also have trouble with language comprehension or understanding should receive intervention while children who don’t struggle with comprehension should receive only occasional monitoring of language growth.

It’s still difficult though to predict accurately which late talkers are likely to have long-term problems. Children who aren’t combining words at 24 months appear to have worse outcomes than children who don’t produce any words at 15 months (this is not a perfect predictor though -so frustrating- I know!).

Outcomes tend to be poorer for children who have problems with comprehension as well as expression, who don’t communicate using gestures, and who don’t imitate body movements. Laura Mize is an American pediatric speech and language therapist with loads of great free resources on her website Teach Me To Talk.

Prediction gets more accurate as children get older: in 4-year-olds, the greater the number of areas of language that are affected, the more likely it is that the problems will persist into school age. Areas of language mean comprehension, grammar (like sentence structure, word structure), and story-telling. If your child still has language problems at age 5 and over, these problems do tend to persist. Children who start school with oral language problems are at risk of reading problems and poor academic attainments. The gaps in their language tend not to close over time. Again if comprehension and non-verbal ability are affected, the language outcomes tend to be poor.

And you can’t know in advance if your child’s going to be a late bloomer. It’s definitely not a good idea to take a chance on the possibility of them growing out of it. It’s hard to predict who will grow out of it and who won’t. The children who are at the greatest risk of not growing out of it are those where there’s a family history of language delay, where their comprehension is also delayed, and where they use few gestures. The best gestures for language development are ones that add meaning. What does that mean? It’s shaking their head while saying ‘water’. In effect, they’re saying ‘no water’ or ‘I don’t want water’. The gesture expands the meaning of the word. Shaking your head while saying ‘no’ doesn’t expand the meaning of the word.

One research paper that looked at 20 studies involving 2134 children, found that the significant predictors of expressive language outcomes included expressive vocabulary size at toddlerhood (up to age 36 months), language comprehension, and socioeconomic status (usually measured by looking at parents’ levels of education and mothers’ level of education in particular. Predictors that were not significant were the child’s gender, using phrases, and having a family history of speech & language problems.

Why do some children start to talk later than others?

No clear answer to this question yet. Early language development varies from one child to another. But, things that late talkers tend to have in common are things like a family history of early language delay, being a boy, being born at less than 85% of their optimal birth weight, or at less than 37 weeks of pregnancy.

What if we have home languages that are different from the language used in my child’s school?

In this situation, let’s say you speak Polish at home and your child starts preschool with very little English. Or you arrive in an English-speaking country and your child starts school with very little English. It’s important to remember that language learning takes time. A long time! And you need to think about what aspects of language you mean. So being able to have a conversation with a friend while you play a game is different from the language you need in order to be able to do maths problems for example. If you’re learning the school language as a second or additional language, you’re not at the same starting point as children who have learned only that language since birth. And it’s not helpful to compare your child to monolingual children. That’s like comparing apples and oranges & it’s not accurate. If your child hasn’t had enough exposure to the school language, they may need support with it but not because they have a language disorder.

When should I see a speech & language therapist (SLP)?

The Hanen Centre, which is based in Canada, suggests that your child needs to see an SLT if

they’re 18 months old and not using at least 20 words, including different types of words, such as nouns or names of things (cup, biccie for biscuit), verbs or doing words (eat, go), prepositions or location words (up, down), adjectives or describing words (hot, mine), and social words (hi, bye). They need different types of words so that they can combine them into phrases like want biccie.

they’re 24-month-olds and they aren’t using at least 100 words and combining 2 words together. The word combinations need to be original. Phrases like Thank you. I want to, all gone, what’s that? are not genuine phrases. They’re chunks that are learned as one unit. Examples of real word combinations come from the child themselves, which they haven’t heard before. Things like: “kitty gone”, or “dirty dress”.

The research suggests that we can reliably identify language delay at 24 months. But you need to take into consideration how long waiting lists in your country are. It’s never too early to have the referral made to an SLT. We can assess children from a very young age. And it’s better to be referred and not need the referral than need it and be stuck on a waiting list. Please listen to your instinct and ignore comments like ‘Oh he’s too young to see an SLT’. That’s just not true! A recent multinational study involving 59 professionals from psychology, education, SLT, pediatrics, and child psychiatry says that healthcare professionals should rely on concerns expressed by the people who know the child well. And the outcomes for children where the diagnosis is made later are not as positive as when the problem is identified early. The research shows that younger children make greater progress in their language development with intervention. But, language disorders that are evident at age 5 tend to stay fairly stable throughout the school years.

Find out more about what we do here. Ideally, you want an SLT who has experience working with bilingual families. If that’s not possible, read this post before you go so you’ll be prepared.

Is it because we speak more than one language?

Definitely not! More people in the world speak two languages or more but most of the research tends to involve children who speak one language. Your child’s language development is affected by the amount and quality of input they get and the opportunities they have to use the language(s) they have. But speaking more than one language does not cause even a temporary delay in language development. What’s important is to describe what languages your child is exposed to, who they speak them with, and a rough idea of how much exposure to and use of each language is typical for your child. Please don’t compare the development of your child’s languages to that of other children. Each family is unique and comparisons are not helpful unless the language environment and experience are the same – and that’s unique to each child. And don’t compare them to monolingual children either. It’s not a legitimate comparison. Elizabeth Peña says bilingualism is like cake. If you make raspberry-apple cake, for example, both flavors are unique and together they enhance the flavor of the whole. The cake isn’t one or the other. It’s a unique combination.

What can you do to help? Here are 7 ideas to get you started:

#1 Get a referral to an SLT and preferably one who is experienced in working with multilingual families. Don’t accept advice to drop a home language. This suggestion is not supported by any research and is not best practice. Don’t feel under pressure to follow a one person one language (OPOL) approach either, as this isn’t the only or the most effective way to nurture multilingual development and it can feel somewhat unnatural. For more on what to expect from a speech and language therapy assessment, read this. In terms of intervention for young children, it’s generally done through the parents, showing you how to best encourage your child’s language development. And these parent-implemented interventions work. It’s worth getting in early as the benefits go beyond vocabulary to grammar, reading & writing, academic performance, and communication.

#2 Get your child’s hearing checked just to make sure it’s as it should be.

#3 If you’re worried that your child’s expressive language is not progressing, set aside 30 minutes a day where your sole focus is on interacting with them. In this 30-minute period, you want to observe them closely and see what they are interested in. What are they looking at? Playing with? Children’s language develops better when we give them the name for the thing they’re looking at or the action they’re doing than when we try to direct their attention to what we’re interested in. So it should sound something like: Oh, you’re walking to the sofa. Plop! You sat down! And not like this: Look, Jamie, here’s a book. Look at the book. This small action consistently taken will make a difference.

# 4 Keep a communication diary. Now don’t panic. It doesn’t have to be anything fancy, just somewhere you can write down how they communicate. So it can be that they use their whole body, they move away to say I don’t want that. Or they use a word with a gesture like shaking their head and saying “No”. You also want to look at what they’re communicating about. These are called communicative intentions and are really important because vocabulary is not enough. They need experience using the words they’ve got to communicate about what’s important to them. So, this includes things like: greeting you when you come home, indicating farewell or goodbye, requesting action like holding his hands up to communicate Pick me up, rejecting something, commenting. These can be done using words or gestures or whole-body movements. You want to see new words appearing over the course of a month.

# 5 Record the different types of words your child uses. So, what nouns, verbs, adjectives, prepositions, and so on. Diversity in your child’s vocabulary in terms of the different types of words is important. They need nouns and verbs in order to put two words together. Keep a record of the different types of words that your child is using in all of their languages – the names of things like animals, family members, pets, toys, favorite characters, etc. For tips on how to build your child’s noun vocabulary, read this. (It’s totally normal for children to have a word in one language and not in another).

There is research showing that children who use a range of different verbs develop better when it comes to grammar than children who use a more restricted range of verbs. You need to think about the verbs in all of your child’s languages. For more details about verbs and how to develop your child’s verb vocabulary, read this.

# 6 Gestures are really important for language development. Check out the excellent First Words Project website and especially the 16X16 series here.

#7 Look at books together. Look is the important word here. You don’t have to read the book to encourage an interest in books and boost language development. The idea is that you use the book as a conversation starter with your child. You can find 18 ways to make the most of books with your child here and 40 book ideas for reading together here.

If you’d like more tips about speech, language, and communication, be sure and sign up at www.talknua.com

References

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Bishop, DVM, Snowling, M., Thompson, P., Greenhalgh, T, & the CATALISE consortium. (2016) Phase 2 of CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development: terminology. Journal of Child Psychology & Psychiatry 58(10): 1068-1080.
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