Eligibility for Birth to 3 Program

In young children, language skills change dramatically during the child’s first three years. It is important to recognize that it is often difficult to determine the reason for or extent of a communication disorder in young children, particularly less than 24 months of age with no other apparent developmental concerns. Some children, in absence of any other developmental problems, may eventually catch up to their peers and thus may seem to “outgrow” their communication delay. (New York State Department of Heath, Early Intervention Program, Clinical Practice Guideline, Quick Reference Guide, Communication Disorders, Assessment and Intervention for Young Children)

One area of current discussion among experts in the field is the extent to which formal speech/language therapy is necessary for young children age 18 to 36 months who have a language delay but no other developmental problems. To date, no clear predictors have been established to indicate long-term outcomes for late talkers. (Ellis Weismer, 2000, p. 161) An important consideration is that there is a certain degree of variation in the timing of language development in typically developing children in this age range. Some experts maintain that children with milder language delays may catch up with typically developing peers by 48 months of age, especially if efforts are made to facilitate language development, such as increasing social interactions and involvement in play groups. However, experts also suggest that beginning speech language therapy by 24 months is important for those children who have more severe delays and those who appear at increased risk for continued delays.

Several studies suggest that many children who have an expressive language delay at 24 months (but have some words and no other apparent developmental problems) will gradually catch up to a functional language level that is more typical of their peers. (Fischel, et al., 1989; Paul, 1991; Paul and Alforde, 1993; Rescorla and Schwarz, 1990; Thal, et al., 1994) One of these studies (Rescorla and Schwartz, 1990) found that children at age 24 months who had a vocabulary of fewer than 30 words continued to have problems in the future. In contrast, in the group of children with milder delays (such as a 30-50 word vocabulary, or over 30 words but no word combinations), some continued to have problems, but a large percentage also caught up with typically developing peers at 4 to 5 years of age. While no single known factor can reliably predict later language status even for well-defined groups of children and certainly not for a individual child, (Thal & Thatich, 1996), Olswang, et al. (1998) identified several factors noted in these studies that appeared to predict which children with language delays at 18 to 24 months would still have delays at 36 to 48 months old. These predictors of future language delay are listed in the table below. Based on this evidence, Olswang (1998) has suggested using these predictors to determine which language-delayed 24 month olds are likely to attain normal language development on their own, and which children are likely to have ongoing language problems and would benefit from speech/ language intervention. The Birth to 3 Program has incorporated many of these considerations into the chart on page 21.