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    The "late talker"—when silence isn't golden

    Not all children with delayed speech are "little Einsteins" or garden variety "late bloomers." Some have a speech-language disorder that will persist unless warning signs are recognized and intervention comes early. Includes a Guide for Parents.

    Key Points
    It's been a busy day at the office, and you're finishing up your last appointment—a 21-month-old with bilateral otitis media and fever. As you're writing a prescription, the mother remarks, "Should I be concerned, Doctor? Joey hasn't said any words yet. We believe he hears, because he goes running to the door as it opens when my husband comes in, and he becomes alert when I approach his room." You ask whether Joey responds to his name and is able to follow simple directions. "Yes," the mother answers, "but is it normal for a child to be so quiet? Joey did not babble much as a baby and has never said mama or dada. He just points and says 'uh-uh' or takes me by the hand trying to show what he wants. Lately, he's become so frustrated when he can't make himself understood that he throws himself on the floor in a rage." She goes on to tell you that her husband is unconcerned because he heard that boys often speak late, and that the grandparents have told her that Joey just needs time. "They say Uncle Jerry didn't speak until he was 3, and now he's an accountant, and Aunt Mary spoke late and now she doesn't shut up!"

    What advice do you give this mother? Joey seems to be developing normally in every other way—he's had a few ear infections before this one, all of which resolved without a prolonged period of effusion. But his delay in talking does warrant further assessment, and you decide to send him for a hearing test after his infection clears. Meanwhile, you tell the mother not to worry—boys often speak later than girls, and there seems to be a history of late talkers in this family. You let her know that if results of the hearing test are normal, you will follow up at the 2-year well visit.

    The "late talker"—a glossary
    Joey thus joins the ranks of "late talkers," a term used to describe children 18 to 20 months old who have fewer than 10 words, or those 21 to 30 months old who have fewer than 50 words and no two-word combinations. Typically, these children have no other problems. (For a glossary of terms pertaining to late talkers, see the box .)

    Along with the newsworthy rise in the number of children in whom autism has been diagnosed are reports of an approximate 30-fold increase in the number of children with speech or language impairments since 1989, according to a 2001 US Department of Education (DOE) report.1 Those statistics show 7,801 cases of speech or language impairment among children born in 1983 (who turned 6 in 1989). Among children born in 1994, that number jumped to 211,984.1 This rise does not appear to be attributable to increased awareness alone, as there has been no comparable rise in other developmental disabilities (e.g., autism, four-fold increase; mental retardation, two-fold increase). The etiology of speech and language impairments is not completely clear, but a multifactorial etiology has been entertained (environmental factors; genetics; prematurity, i.e., increased number of low birth weight infants).


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