Editing Language delay (section)

==Causes==
Language delays are the most frequent [[Global developmental delay|developmental delays]], and can occur for many reasons. A delay can be due to being a "[[late bloomer]]", "[[late talker]]", or a more serious problem. Such delays can occur in conjunction with a lack of mirroring of [[facial response]]s, unresponsiveness or unawareness of certain [[noise]]s, a lack of interest in playing with other children or toys, or no pain response to stimuli.<ref>{{cite web|url=http://www.toplanguageguide.com/language-acquisition.php|title=Language Learning Styles|date=August 2013|publisher=TLG|url-status=dead|archive-url=https://web.archive.org/web/20130823095038/http://www.toplanguageguide.com/language-acquisition.php|archive-date=23 August 2013|access-date=22 August 2013}}</ref><ref>{{cite web|url=http://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/Autism_Resource_Center/FAQ.aspx|title=Frequently Asked Questions|publisher=American Academy of Children & Adolescent Psychiatry|access-date=22 August 2013}}</ref>

===Socio-economic factors===
'''Socio-economic status'''

Children from families of low educational level are more likely to have delays and difficulties in [[expressive language]].<ref name=":26">{{cite journal | vauthors = Horwitz SM, Irwin JR, Briggs-Gowan MJ, Bosson Heenan JM, Mendoza J, Carter AS | title = Language delay in a community cohort of young children | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 42 | issue = 8 | pages = 932–40 | date = August 2003 | pmid = 12874495 | doi = 10.1097/01.CHI.0000046889.27264.5E }}</ref> While language development is not directly affected by the socioeconomic level of a family, the conditions that are associated with the socioeconomic level affects the process of language development to a certain extent.<ref name=":26" /> A child's early vocabulary development can be influenced by socioeconomic status via maternal speech, which varies according to the socioeconomic status of the family.<ref name=":51">{{cite journal | vauthors = Hoff E | title = The specificity of environmental influence: socioeconomic status affects early vocabulary development via maternal speech | journal = Child Development | volume = 74 | issue = 5 | pages = 1368–78 | date = September 2003 | pmid = 14552403 | doi = 10.1111/1467-8624.00612 }}</ref> Mothers with higher education levels are more likely to use rich vocabulary and speak in longer utterances when interacting with their children, which helps them develop their productive vocabulary more than children from a lower socioeconomic status.<ref>{{cite journal | vauthors = Dollaghan CA, Campbell TF, Paradise JL, Feldman HM, Janosky JE, Pitcairn DN, Kurs-Lasky M | title = Maternal education and measures of early speech and language | journal = Journal of Speech, Language, and Hearing Research | volume = 42 | issue = 6 | pages = 1432–43 | date = December 1999 | pmid = 10599625 | doi = 10.1044/jslhr.4206.1432 }}</ref>

[[Poverty]] is also a high risk factor for language delay as it results in a lack of access to appropriate therapies and services.<ref name=":3">{{cite journal | vauthors = Brown CM, Beck AF, Steuerwald W, Alexander E, Samaan ZM, Kahn RS, Mansour M | title = Narrowing Care Gaps for Early Language Delay: A Quality Improvement Study | journal = Clinical Pediatrics | volume = 55 | issue = 2 | pages = 137–44 | date = February 2016 | pmid = 25994319 | pmc = 4788473 | doi = 10.1177/0009922815587090 }}</ref> The likelihood of those requiring early intervention for language delays actually receiving help is extremely low compared to those that don't actually need it.<ref name=":3" />

===Natural/medical factors===
'''Hearing loss'''

The process of children acquiring language skills involves hearing sounds and words from their caregivers and surroundings. Hearing loss causes that lack of these sound inputs, causing these children to have difficulties learning to use and understand language, which will eventually lead to delayed speech and language skills.<ref>{{cite web|url=https://www.asha.org/public/hearing/effects-of-hearing-loss-on-development/|title=Effects of Hearing Loss on Development|website=asha.org|access-date=31 March 2021}}</ref>  For example, they may struggle with putting sentences together, understanding speech from other people or using the correct grammar,<ref>{{cite web|url=https://www.cincinnatichildrens.org/health/h/hearing-communication#:~:text=Hearing%20loss%20can%20affect%20a,understanding%20and%20talking%20very%20difficult|title=Hearing Loss: How it affects Communication|website=cincinnatichildrens.org|access-date=31 March 2021}}</ref> which are some language skills that typically developing children possess.

'''Autism'''

There is strong evidence that [[autism]] is commonly associated with language delay.<ref name="pmid166085442">{{cite journal|vauthors=Miniscalco C, Nygren G, Hagberg B, Kadesjö B, Gillberg C|title=Neuropsychiatric and neurodevelopmental outcome of children at age 6 and 7 years who screened positive for language problems at 30 months|journal=Developmental Medicine and Child Neurology|volume=48|issue=5|pages=361–6|date=May 2006|pmid=16608544|doi=10.1017/S0012162206000788|s2cid=23692745|hdl=2077/851|doi-access=free |hdl-access=free}}</ref><ref name="pmid197130732">{{cite journal|vauthors=Hagberg BS, Miniscalco C, Gillberg C|title=Clinic attenders with autism or attention-deficit/hyperactivity disorder: cognitive profile at school age and its relationship to preschool indicators of language delay|journal=Research in Developmental Disabilities|volume=31|issue=1|pages=1–8|year=2010|pmid=19713073|doi=10.1016/j.ridd.2009.07.012 }}</ref>  Children with autism may have difficulties in developing language skills and understanding what is being said to them. They may also have troubles communicating non-verbally by using hand gestures, eye contact and facial expressions.<ref name=":27" /> The extent of their language usage is heavily influenced by their intellectual and social developments. The range of their skills can be very different and on opposite ends of a spectrum. Many children with autism develop some speech and language skills, but not like typically developing children, and with uneven progress.<ref name=":27">{{cite web|url=https://www.nidcd.nih.gov/health/autism-spectrum-disorder-communication-problems-children|title=Autism Spectrum Disorder: Communication Problems in Children|website=nidcd.nih.gov|date=13 April 2020 |access-date=31 March 2021}}</ref>

[[Asperger syndrome]], which is classified under the broad umbrella term of autistic spectrum disorder, however, is not associated with language delay.<ref name="DSM-IV-TR-299.002">{{cite book|title=Diagnostic and statistical manual of mental disorders: DSM-IV|author=American Psychiatric Association|publisher=American Psychiatric Association|year=2000|isbn=0-89042-025-4|edition=4|location=Washington, DC|chapter=Diagnostic criteria for 299.00 Autistic Disorder|oclc=768475353|chapter-url=http://cdc.gov/ncbddd/autism/hcp-dsm.html}}</ref> Children diagnosed with Asperger syndrome have decent language skills but use language in different ways from others. They may not be able to understand the use of language devices, such as irony and humor, or conversation reciprocity between involved parties.<ref>{{cite web|url=https://www.autism-society.org/what-is/aspergers-syndrome/|title=Asperger's Syndrome|website=autism-society.org|access-date=31 March 2021}}</ref>

'''Heritability'''

[[Gene]]s have a very big influence in the presence of language impairments.<ref>{{cite journal|vauthors=Bishop DV, North T, Donlan C|title=Genetic basis of specific language impairment: evidence from a twin study|journal=Developmental Medicine and Child Neurology|volume=37|issue=1|pages=56–71|date=January 1995|pmid=7828787|doi=10.1111/j.1469-8749.1995.tb11932.x|s2cid=21594745 }}</ref> Neurobiological and genetic mechanisms have a strong influence on late language emergence. A child with a family history of language impairments is more likely to have delayed language emergence and persistent language impairments.<ref>{{cite journal|vauthors=Lyytinen P, Poikkeus AM, Laakso ML, Eklund K, Lyytinen H|title=Language development and symbolic play in children with and without familial risk for dyslexia|journal=Journal of Speech, Language, and Hearing Research|volume=44|issue=4|pages=873–85|date=August 2001|pmid=11521780|doi=10.1044/1092-4388(2001/070) }}</ref> They are also 2 times more likely to be late talkers as compared to those with no such family history.<ref>{{cite journal|vauthors=Zubrick SR, Taylor CL, Rice ML, Slegers DW|title=Late language emergence at 24 months: an epidemiological study of prevalence, predictors, and covariates|journal=Journal of Speech, Language, and Hearing Research|volume=50|issue=6|pages=1562–92|date=December 2007|pmid=18055773|pmc=3521638|doi=10.1044/1092-4388(2007/106) }}</ref>

[[genetic disorder|Genetic abnormalities]] may also be a cause of language delays. In 2005, researchers found a connection between expressive language delay and a genetic abnormality: a duplicate set of the same genes that are missing in individuals with [[Williams-Beuren syndrome]]. Also so called [[XYY syndrome]] can often cause speech delay.<ref>{{Cite web|url=https://medlineplus.gov/genetics/condition/47xyy-syndrome/|title=47,XYY syndrome: MedlinePlus Genetics|website=medlineplus.gov}}</ref>

'''Twins'''

Being a twin increases the chance of speech and language delays. Reasons for this are thought to include less one-on-one time with parents, the premature birth of twins, and the companionship of their twin sibling reducing their motivation to talk to others.<ref>{{Cite news|url=https://twinpickle.com/2017/11/07/do-twins-talk-to-each-other/|title=Do Twins Talk to Each Other in a Secret Language?|date=2017-11-07|work=Twin Pickle|access-date=2018-03-06|language=en}}</ref>{{more citations needed|date=July 2022}} A [[twin study]] has also shown that [[Genetics|genetic]] factors have an important role in language delay. [[Monozygotic twin]] pairs (identical twins) recorded a higher consistency than [[dizygotic twin]] (fraternal twins) pairs, revealing monozygotic twins experiencing early vocabulary delay is attributed to genetic etiology.<ref name=":28">{{cite journal|vauthors=Bishop DV, Price TS, Dale PS, Plomin R|title=Outcomes of early language delay: II. Etiology of transient and persistent language difficulties|language=en|journal=Journal of Speech, Language, and Hearing Research|volume=46|issue=3|pages=561–75|date=June 2003|pmid=14696986|doi=10.1044/1092-4388(2003/045) }}</ref> The environmental factors that influences both twins also play a big role in causing early language delay, but only when it is transient.<ref name=":28" />

'''Gender'''

Research has shown that boys are at greater risk for delayed language development than girls.<ref name=":29">{{cite web|url=https://www.sciencedaily.com/releases/2014/02/140217085246.htm|title=Gender, genes play an important role in delayed language development|website=sciencedaily|access-date=31 March 2021}}</ref> Almost all developmental disorders that affect communication, speech and language skills are more common in males than in females.<ref>{{cite journal|vauthors=Adani S, Cepanec M|title=Sex differences in early communication development: behavioral and neurobiological indicators of more vulnerable communication system development in boys|journal=Croatian Medical Journal|volume=60|issue=2|pages=141–149|date=April 2019|pmid=31044585|pmc=6509633|doi=10.3325/cmj.2019.60.141 }}</ref> British scientists have found that the male sex hormone ([[testosterone]]) levels were related to the development of both autism and language disorders, which explains why boys are at a greater risk of developmental disorders biologically.<ref name=":29" />

'''Perinatal conditions'''

There is a high prevalence of early language delay among toddlers with [[palsy|neonatal brachial plexus palsy]].<ref name=":31">{{cite journal|vauthors=Chang KW, Yang LJ, Driver L, Nelson VS|title=High prevalence of early language delay exists among toddlers with neonatal brachial plexus palsy|journal=Pediatric Neurology|volume=51|issue=3|pages=384–9|date=September 2014|pmid=25160543|pmc=4792271|doi=10.1016/j.pediatrneurol.2014.04.021 }}</ref> Hand usage and gestures are part of the [[motor system]] and have been proven correlate to comprehension and production aspects in language development. An interruption in the hand/arm usage caused by this condition during stages of language development could possibly cause these children to experience language delays.<ref name=":31" />

Stress during pregnancy is associated with language delay.<ref name="pmid173553982">{{cite journal|vauthors=Talge NM, Neal C, Glover V|title=Antenatal maternal stress and long-term effects on child neurodevelopment: how and why?|journal=Journal of Child Psychology and Psychiatry, and Allied Disciplines|volume=48|issue=3–4|pages=245–61|year=2007|pmid=17355398|doi=10.1111/j.1469-7610.2006.01714.x |pmc=11016282}}</ref> High levels of prenatal stress can result in poorer general intellectual and language outcomes.<ref>{{cite journal|vauthors=Laplante DP, Barr RG, Brunet A, Galbaud du Fort G, Meaney ML, Saucier JF, Zelazo PR, King S|display-authors=6|title=Stress during pregnancy affects general intellectual and language functioning in human toddlers|journal=Pediatric Research|volume=56|issue=3|pages=400–10|date=September 2004|pmid=15240860|doi=10.1203/01.PDR.0000136281.34035.44|s2cid=13333204|doi-access=free }}</ref> Chemical exposure during pregnancy may also be a factor that causes language delays.<ref>{{cite journal|vauthors=Repouskou A, Papadopoulou AK, Panagiotidou E, Trichas P, Lindh C, Bergman Å, Gennings C, Bornehag CG, Rüegg J, Kitraki E, Stamatakis A|display-authors=6|title=Long term transcriptional and behavioral effects in mice developmentally exposed to a mixture of endocrine disruptors associated with delayed human neurodevelopment|journal=Scientific Reports|volume=10|issue=1|pages=9367|date=June 2020|pmid=32518293|pmc=7283331|doi=10.1038/s41598-020-66379-x|doi-access=free|bibcode=2020NatSR..10.9367R }}</ref>

===Environmental factors===
'''Interactive communication and parental inputs'''

[[Psychosocial deprivation]] can cause language delays in children. An example of this is when a child does not spend enough time communicating with adults through ways such as babbling and joint attention. Research on early brain development shows that babies and toddlers have a critical need for direct interactions with parents and other significant care givers for healthy brain growth and the development of appropriate social, emotional, and cognitive skills.<ref name="American Academy of Pediatrics2">{{cite journal | author = Committee on Public Education | title = Media education. American Academy of Pediatrics. | journal = Pediatrics | volume = 104 | issue = 2 Pt 1 | pages = 341–3 | date = August 1999 | pmid = 10429023 | doi = 10.1542/peds.104.2.341 | doi-access =  }}</ref>

A study examining the role of interactive communication between parents and children has shown that parents' language towards toddlers with language delay differ from parents' language towards typically developing toddlers in terms of the quality of interaction.<ref name=":42">{{cite journal| vauthors = Vigil DC, Hodges J, Klee T |date=June 2005|title=Quantity and quality of parental language input to late-talking toddlers during play|journal=Child Language Teaching and Therapy|language=en|volume=21|issue=2|pages=107–122|doi=10.1191/0265659005ct284oa|s2cid=145190021|issn=0265-6590}}</ref> While late talkers and children with typical language development both receive similar quantitative parental input in terms of the number of utterances and words, parents of late talkers are found to respond less often to their children than parents of children with typical language development.<ref name=":42" /> Parents of late talkers tend to change or introduce topics more often than other parents in order to engage their children in more talk rather than responding to their child's speech. They also seem to not provide an environment that is suitable for child engagement, nor do they establish routines that serve as a platform for communicative acts with their children. This, together with the fact that they respond less often to their children, shows that parents of late talkers do not follow their child's lead.<ref name=":42" /> Instead, these parents are more likely to adapt to the child's communication, which results in an "idiosyncratic feedback cycle" that worsens the child's language difficulties rather than help with their language acquisition.<ref>{{cite book|title=Reassessing parent-focused language intervention programs| vauthors = Tannock R, Girolametto L |publisher=Paul H. Brookes Publishing|year=1992|pages=49–79}}</ref>

'''Birth order'''

First-born children grow up in an environment that provides more possibilities of communicative interaction with adults, which differs from what is experienced by their younger siblings.<ref name=":51" /> Younger siblings are likely to have less one-on-one time with their parents or guardians. Older siblings also tend to talk for their younger siblings, giving them less opportunities to grow their language skills.<ref>{{cite book|title=Language Development from Theory to Practice| vauthors = Turnbull K, Justice L |date=2017|publisher=Pearson|edition=Third}}</ref>

'''Television viewing'''

Excessive television viewing is associated with delayed language development. Children who watched television alone were 8.47 times more likely to have language delay when compared to children who interacted with their caregivers during television viewing.<ref name="Chonchaiya 20082">{{cite journal | vauthors = Chonchaiya W, Pruksananonda C | title = Television viewing associates with delayed language development | journal = Acta Paediatrica | volume = 97 | issue = 7 | pages = 977–82 | date = July 2008 | pmid = 18460044 | doi = 10.1111/j.1651-2227.2008.00831.x | s2cid = 10635877 | doi-access = free }}</ref> Some educational television shows, such as Blue's Clues, have been found to enhance a child's language development.<ref name="Children, wired – for better and fo">{{cite journal | vauthors = Bavelier D, Green CS, Dye MW | title = Children, wired: for better and for worse | journal = Neuron | volume = 67 | issue = 5 | pages = 692–701 | date = September 2010 | pmid = 20826302 | pmc = 3170902 | doi = 10.1016/j.neuron.2010.08.035 }}</ref> But, as recommended by the [[American Academy of Pediatrics]], children under the age of 2 should watch no television at all, and after age 2 watch no more than one to two hours of quality programming a day. Therefore, exposing such young children to television programs should be discouraged, especially television shows with no educational value.<ref name="Children, wired – for better and fo"/> Parents should engage children in more conversational activities to avoid television-related delays to their children language development, which could impair their intellectual performance. However, in a study conducted by Dr. Birken of the Hospital for Sick Children, it was found that watching television while interacting with a parent of caregiver is actually beneficial for children who are bilingual. The study spanned four years, from 2011 to 2015, and was based on parent report and clinician observation. Over the four years it was found that if a bilingual child had interaction with an adult while watching television they did not experience language delay and it in fact helped them develop English, their second language.<ref>{{cite web|url=https://www.pbs.org/newshour/health/toddlers-screen-time-linked-slower-speech-development-study-finds|title=Toddler's Screen Time Linked to Slower Speech Development| vauthors = Akpan N |website=PBS|access-date=1 December 2018|date=2017-05-04}}</ref>