“It Can Start by Being a Late Talker”: the Prevalence, Availability of Speech

Discipline of Speech Pathology

Faculty of Health Sciences

ABN 15 211 513 464 Ms Rosemary Hodges, Dr. Natalie Munro The University of Sydney and Dr Elise Baker NSW 2006 AUSTRALIA

Submission to the Senate Community Affairs Reference Committee, 2014.

“An inquiry into the prevalence of different types of speech, language and communication disorders and speech pathology services in Australia”

“It can start by being a late talker”: The prevalence, availability of speech pathology services and outcomes for children who have speech and language communication disorders.

For every parent, hearing their child start to talk is a milestone that is eagerly anticipated. Mums and dads excitedly record their child’s first words in baby books and on smart phones. While for most, these precious first words occur around a child’s first birthday, some parents are left waiting and wondering why their child just isn’t talking. In this submission we comment on the prevalence, availability of speech pathology services and outcomes of children who are late to talk and then diagnosed with speech/language impairment.

Prevalence:

For some children, learning to talk does not come easily. By 2-years-old, these children are often termed “late talkers”. Late talkers are toddlers who use less than 50 words and few word combinations in the absence of other developmental delays (e.g. cognitive, physical) (Rescorla, 1989). A recent Australian study suggests that these children represent around 19% of 2-year-olds (Reilly et al., 2007).

Both research (e.g., Horwitz et al., 2003) and our personal experiences with families indicate that late talking is of significant concern for parents. Some late talking toddlers use few words and continue to rely on gestures to communicate. Others try to talk in

words but are difficult to understand, because they use a small number of speech sounds in words. Parents’ of late talking toddler become understandably anxious and worried about their children’s future---socially, emotionally and academically. The situation is further complicated by well-meaning friends and neighbours re-assuring anxious parents that children late to talk will “catch up” or “talk when he/she is ready”. While some late talkers do eventually catch up, research on the long term outcomes for children who are late to talk has suggested that between 20 – 70% of these children will go on to have a specific language impairment (e.g., Leonard, 1998; Paul, 1993). The situation is further complicated by research reporting that late talkers who appear to resolve and ‘catch up’ can still find language and literacy tasks more difficult throughout childhood compared to children with typically developing language at 2-years-old (Rescorla, 2009). Thus, late talking is likely to be the first sign of a communication impairment.

Availability of services:

At the Kids Talk Lab at the University of Sydney, we have conducted several research projects examining the speech and language skills of young Australian children. As a result we have come into contact with many families who have toddlers or preschoolers with speech and language impairment. Through the course of our contact with families, we often hear about parents’ struggles to find and access appropriate and targeted early intervention services for their children.

Australian research examining the availability of early intervention speech pathology services for children reflects the conversations we have with parents. For example, Ruggero et al. (2012) examined waiting list times for paediatric clients and found that the most common waiting list time to receive an initial assessment was 2-6 months, however a quarter of children waited over 6 months for such a service. Children accessing community health services were more likely to wait for a longer period of time compared to those accessing private services.

Anecdotal evidence from the authors’ own experiences working with parents from metropolitan Sydney suggests that waiting times may be quite short for private services, but considerably longer for community health services. Some parents simply cannot afford private services and therefore may remain on community health waiting lists, while living with the day-to-day frustrations of trying to communicate with their toddlers. While the families of children with Autism Spectrum Disorders or other disabilities are now provided with funding packages from the Australian government (e.g., FaHCSIA, Better Start packages) children displaying a delay in speech and/or language only, are provided with no such support.

Outcomes for children with late talking/speech and language impairment:

Children who start talking late are at risk of on-going language impairment (e.g. Rescorla, 2002; Rice et al., 2008). A large Australian study has shown that children that have language impairments early in childhood can perform more poorly at school, not only in language and literacy but also mathematical thinking and in their approaches to learning (Harrison et al, 2009).

Long term follow-up of young children with language impairment into adolescence and adulthood suggests other adverse consequences of language impairment including behavioural and psychiatric difficulties (e.g., Beitchman et al., 1996).

The situation for children from socially disadvantaged communities is worse. UK research reports that 50% of children from socially disadvantaged backgrounds commence school with significant speech and language communication difficulties (Locke et al., 2002). Vocabulary levels can be nearly one year lower - a major concern because vocabulary at school-age entry is a strong predictor of academic and vocational outcome. Good spoken language skills underpin reading and writing skills.

Effective therapies exist:

Children who are late to talk, can be helped. With effective and adequate therapy, families can be equipped to help their children communicate (e.g., Girolametto et al., 1996; 1997). This help has the potential to avoid or at least minimize long term academic, social-emotional and behavioural consequences.

Speech, language and communication initiatives in the UK since their national review (Bercow, 2008) have demonstrated positive results in developing “integrated health and education promotion and prevention with under 5s in disadvantaged areas” and approaches that build parent’s and teacher’s capacities to improve communication skills in the home and school (see http://www.thecommunicationtrust.org.uk/commissioners/reports.aspx) and the Better Communication 2012 report (see references).

Recommendations:

• Readily accessible speech pathology assessment and intervention services for families with young children, across all Australian States and Territories.

• Fund nation-wide strategies to promote the importance of talking and listening in early childhood. As John Bercow identified: “there is a grossly inadequate recognition across society of the importance of communication development” (Bercow report, 2008).

• Fund free quality preschool programs for children the year before school entry in addition to nation-wide training programs for childcare workers and teachers in supporting their capacity to facilitate children’s communication and pre-literacy skills.

Yours Sincerely,

Rosemary Hodges (B.App.Sc, Hons) PhD Candidate, The University of Sydney; Dr. Natalie Munro (B.App.Sc. Hons), PhD; Dr. Elise Baker (B.App.Sc, Hons) PhD.

Reference List

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Gascoigne MT (ed). (2012) Better communication – shaping speech, language and communication services for children and young people. London: RCSLT. Retrieved from https://www.thecommunicationtrust.org.uk/commissioners/reports.aspx 20th February 2014. Girolametto, L., Pearce, P. S., & Weitzman, E. (1996). Interactive focused stimulation for toddlers with expressive vocabulary delays. Journal of speech and hearing research, 39(6), 1274-1283.

Girolametto, L., Pearce, P. S., & Weitzman, E. (1997). Effects of lexical intervention on the phonology of late talkers. Journal of speech, language, and hearing research: JSLHR, 40(2), 338-348.

Harrison, L.J., McLeod, S., Berthelsen, D. & Walker, S. (2009). Literacy, numeracy, and learning in school-aged children identified as having speech and language impairment in early childhood, International Journal of Speech-Language Pathology, 11, 392-403.

Horwitz, S., Irwin, J., Briggs-Gowan, M., Heenan, J., Mendoza, J., & Carter, A. (2003). Language Delay in a Community Cohort of Young Children. Journal of American Academy of Child and Adolescent Psychiatry, 42(8), 932-940.

Leonard, L. (1998). Children with specific language impairment. Cambridge, MA: MIT Press.

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Reilly, S., Wake, M., Bavin, E. L., Prior, M., Williams, J., Bretherton, L., et al. (2007). Predicting language at 2 years of age: a prospective community study. Pediatrics, 120(6), e1441-1449.

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Rice, M., Taylor, C., & Zubrick, S. (2008). Language outcomes of 7-year-old children with or without a history of late language emergence at 24 months. Journal of Speech, Language & Hearing Research, 51, 394-407.

Ruggero, L., McCabe, P., Ballard, K.J. & Munro, N. (2012). Paediatric speech-language pathology service delivery: An exploratory survey of Australian parents, International Journal of Speech-Language Pathology, 14, 338-350.