Late Talkers: A Population-Based Study of Risk Factors and School Readiness Consequences

JSLHR
Research Article
Late Talkers: A Population-Based Study of Risk

Factors and School Readiness Consequences
Carol Scheffner Hammer,a Paul Morgan,b George Farkas,c
Marianne Hillemeier,b Dana Bitetti,d and Steve Maczugab
Purpose: This study was designed to (a) identify socioeconomic status, being a nonsingleton, older
sociodemographic, pregnancy and birth, family health, maternal age at birth, moderately low birth weight,
and parenting and child care risk factors for being a late lower quality parenting, receipt of day care for less
talker at 24 months of age; (b) determine whether late than 10 hr/week, and attention problems. Being a
talkers continue to have low vocabulary at 48 months; late talker increased children’s risk of having low
and (c) investigate whether being a late talker plays a vocabulary at 48 months and low school readiness
unique role in children’s school readiness at 60 months. at 60 months. Family socioeconomic status had the
Method: We analyzed data from the Early Childhood largest and most profound effect on children’s school
Longitudinal Study, a population-based sample of readiness.
9,600 children. Data were gathered when the children Conclusions: Limited vocabulary knowledge at 24 and
were 9, 24, 48, and 60 months old. 48 months is uniquely predictive of later school readiness.
Results: The risk of being a late talker at 24 months Young children with low vocabularies require additional
was significantly associated with being a boy, lower supports prior to school entry.
I
t is well established that children’s language abilities mathematical abilities (Jordan, Levine, & Huttenlocher,
are critical to their academic success. Studies have 1995; Pappas, Ginsburg, & Jiang, 2003; Purpura, Hume,
consistently shown that language supports children’s Sims, & Lonigan, 2011). Larger vocabularies have been
reading abilities in early and later grades (Catts, Fey, associated with number naming abilities, knowledge of
Tomblin, & Zhang, 2002; National Institute of Child measurement and shapes, and geometry and the ability to
Health and Human Development [NICHD] Early Child manipulate symbolic representations (Hornung, Schiltz,
Care Research Network, 2005; Scarborough, 2001; Storch Brunner, & Martin, 2014; Vukovic & Lesaux, 2013). In ad-
& Whitehurst, 2002). Children with stronger language abil- dition, language abilities have been found to promote chil-
ities, and in particular larger vocabularies, have better dren’s behavioral functioning. For example, children with
reading comprehension and decoding skills than children stronger language are better able to communicate with
with weaker language abilities (Braze, Tabor, Shankweiler, teachers and peers and to regulate their behavior and emo-
& Mencl, 2007; Schatschneider, Fletcher, Francis, Carlson, tions (Carson, Klee, Lee, Williams, & Perry, 1998; Cole,
& Foorman, 2004; Verhoeven & Van Leeuwe, 2008). Al- Armstrong, & Pemberton, 2010; Menting, Van Lier, &
though less well studied, investigations have also demon- Koot, 2010; Qi & Kaiser, 2004).
strated significant relations between language and children’s Because of the importance of language, efforts have
been made to identify children who may be at risk for learn-
ing difficulties early in life. Much attention has been given
a
Teachers College, Columbia University, University Park, NY to late talkers or children who have limited expressive vocab-
b
The Pennsylvania State University, University Park ularies at 2 years of age. Interest in this group of children
c
University of California, Irvine began 15 to 20 years ago with the seminal works of Thal
d
Temple University, Philadelphia, PA and Bates (Thal, 1991; Thal & Bates, 1988), Paul (1991,
Dana Bitetti is now at La Salle University, Philadelphia, PA. 1993), and Rescorla and colleagues (Rescorla & Merrin,
Correspondence to Carol Scheffner Hammer: 1998; Rescorla, Roberts, & Dahlsgaard, 1997). Since work
carol.hammer@tc.columbia.edu in this area began, researchers have attempted to identify
Editor: Sean Redmond factors that place children at risk for being late talkers and
Associate Editor: Carolyn Mervis have investigated late talkers’ long-term outcomes.
Received December 3, 2015
Revision received July 30, 2016
Accepted August 8, 2016 Disclosure: The authors have declared that no competing interests existed at the time
https://doi.org/10.1044/2016_JSLHR-L-15-0417 of publication.
Journal of Speech, Language, and Hearing Research • Vol. 60 • 607–626 • March 2017 • Copyright © 2017 American Speech-Language-Hearing Association 607
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Despite this work’s many contributions, it has been significant factor in three studies that included this variable
difficult to generalize their findings to the larger population in the analyses. Complementing this finding, TEDS found a
of U.S. children. This is because the majority of studies in- genetic component to late talking. TEDS and Generation R
volve clinical samples with relatively small numbers of par- also found a relationship between late talking and exter-
ticipants, limited diversity in terms of socioeconomic status nalizing problems. One or two studies tested the following
(SES), and unspecified racial or ethnic identities (Bavin & possible risk factors, which were not found to be signifi-
Bretherton, 2013). For example, Thal and Bates (Thal, 1991; cantly related to being a late talker at 18 to 24 months:
Thal & Bates, 1988) studied the development of 10 late maternal mental health, maternal behavioral risk factors
talkers and 10 language-matched peers (SES not provided). (e.g., cigarette smoking), quality of parenting, and attendance
Paul (Paul & Fountain, 1999; Paul & Shiffer, 1991) investi- in day care. The studies that followed children into their
gated 36 late talkers from primarily middle-SES homes. school years found that late talkers display later language
Rescorla and colleagues (Rescorla & Merrin, 1998; Rescorla, abilities at the lower end of the typical range, with a subset
Roberts, & Dahlsgaard, 1997) followed the language devel- of these children showing specific language impairment
opment of 34 late talkers and 21 typically developing children (SLI; Dale & Hayiou-Thomas, 2013; Rice et al., 2008).
of middle and upper-middle SES. Population-based studies Although these studies have made valuable contribu-
are needed to better understand the risk factors for being a tions, additional research is needed for several reasons. First,
late talker as well as whether and to what extent late taking most of these studies took place outside of the United States.
may interfere with children’s school readiness. This, of course, is not by itself a limitation; however, the
To date, several community-based and population- United States differs from European countries and Australia
based studies have been conducted. Two took place in in many ways, including its racial and ethnic diversity and
Australia: (a) the Randomly Ascertained Sample of Children its educational, medical, and political contexts that can af-
born in Australia’s Largest State (RASCL), a longitudinal fect children’s development. Thus, a study conducted on a
study of 2,224 children from birth through 8 years of age sample from the United States would broaden the field’s
(cf. Rice, Taylor, & Zubrick, 2008; Zubrick, Taylor, Rice, & understanding of the effect of being a late talker in a more
Slegers, 2007), and (b) the Early Language in Victoria Study, diverse context. Second, three of the studies—the RASCL,
a longitudinal study of 1,911 children from birth through Early Language in Victoria, and Denmark studies—focused
age 4 years, which also included children learning English on children’s later development of their language abilities
as a second language (cf. Reilly et al., 2006, 2010). Others but not academic achievement or school readiness. It is
were conducted in the Netherlands, Sweden, Demark, and important to understand whether being a late talker is a
England and Wales. The study conducted in the Netherlands factor that affects children’s school readiness and academic
was titled “Generation R,” which was a longitudinal study outcomes given that academic success is critical for children’s
of more than 3,700 children who were assessed at 18 months future well-being. Third, the Early Language in Victoria,
and during the preschool years (Henrichs et al., 2011, 2013). TEDS, and Denmark studies investigated a relatively limited
The Swedish study involved more than 1,500 children who set of characteristics when identifying risk factors for low
were recruited at birth (Westerlund & Lagerberg, 2008). vocabulary at 24 months. An increased understanding is
The study in Denmark was a cross-sectional study of chil- needed of the role that various demographic, neurodevelop-
dren at 2 and 3 years of age (Bleses & Vach, 2013; note mental, maternal, and environmental factors and parenting
that middle-SES families were overrepresented in this study). and child care experiences may have in placing children at
The Twins Early Development Study (TEDS), which was risk for being a late talker and the effect these may have
carried out in England and Wales, was a longitudinal study on children’s later development (Bavin & Bretherton, 2013;
of twins who were followed from birth through age 12 years Bleses & Vach, 2013). This study was designed to address
(cf. Dale, Harlaar, Hayiou-Thomas, & Plomin, 2010; Dale these needs. The study (a) involved a population-based sample
et al., 1998). In addition, data from the NICHD Early Child from the United States, (b) included a large number of poten-
Care Study, a birth cohort study conducted in the United tial risk factors associated with late talking and later school
States, have been used to investigate children’s vocabulary readiness skills that have been implicated in the literature,
delays at 3 years of age and beyond (La Paro, Justice, Skibbe, and (c) focused on the unique role of late talking in school
& Pianta, 2004). readiness by targeting children’s language, literacy, math,
In general, these studies identified potential risk fac- and socioemotional outcomes at 48 and 60 months of age.
tors for being a late talker, although the specific risk fac-
tors considered and the number of factors included in the
analyses varied across the studies. Being a boy and of low Risk Factors Affecting Development
SES were identified as risk factors for late talking in most A number of factors may place children at risk for
of the studies. Low birth weight was found to be a factor being a late talker at age 2 years and may affect children’s
in one of the three studies that considered it. Preterm birth vocabulary, reading, math, and behavioral abilities during
was identified in one of two studies that investigated this the preschool years. These include sociodemographic fac-
factor. Low maternal age was found to be factor in being tors, pregnancy and birth characteristics, family health and
a late talker in the Swedish study but not in the RASCL family history of learning problems, parenting and child
study. Also, family history of language difficulties was a care, and early behavioral functioning. Many of these factors
608 Journal of Speech, Language, and Hearing Research • Vol. 60 • 607–626 • March 2017

have been targeted in various studies, which typically have Children’s race/ethnicity is another factor that needs to
involved relatively small samples and/or have followed be considered, although the findings in this research area are
children for a relatively short time period. To our knowl- also inconsistent. In a study of late talkers, Poll and Miller
edge, no study has simultaneously examined all of these (2013) did not observe an effect of race on children’s lan-
factors in a single longitudinal investigation of late talkers. guage abilities, nor did Nelson, Welsh, Trup, and Greenberg
Investigating these factors simultaneously allows for more (2011) in their study of the prevalence of language delay in
accurate estimation of the risk uniquely attributable to any Head Start children. Likewise, Horwitz et al. (2003) reported
one factor, thereby helping to better establish whether the that non-White children had a relatively low risk for language
factor should be the target of early screening and interven- delay compared with White children. However, La Paro
tion efforts. et al. (2004) found that African American children with a
language impairment at age 3 years were 13 times more likely
Sociodemographic Factors than their White peers to continue to have a language impair-
One key sociodemographic factor is gender, which ment at 54 months of age. When maternal sensitivity and
has been identified as a risk factor for being a late talker warmth were taken into account, this effect disappeared.
as well as for reading disabilities in numerous studies. Boys A significant effect of race/ethnicity on children’s reading
appear to be at greater risk than girls for low vocabulary and math abilities has been observed. For example, data from
early in life (Bavin & Bretherton, 2013; Dale & Hayiou- NCES show that African American and Hispanic children
Thomas, 2013; Zubrick et al., 2007). For example, in their are more likely to score lower than White children in reading
population-based study, Zubrick et al. (2007) found that and math as they progress through school. However, larger
boys were nearly three times more likely to be a late talker percentages of African American and Hispanic children come
than girls; however, Reilly et al. (2007) did not find an from families of low SES compared with White children.
effect of gender on late talking status at 24 months of age. Thus, race and SES may be confounded in these findings.
Other studies have found boys to be at higher risk for
low language during the preschool years (cf. Harrison & Pregnancy and Birth Characteristics
McLeod, 2010; Maatta, Laakso, & Tolvanen, 2012). Addi- Pregnancy and birth characteristics that may affect
tional studies have shown that girls have stronger reading children’s abilities include maternal age, low birth weight,
abilities than boys. For example, data from the Early Child- being a twin, medical and behavioral risks during preg-
hood Longitudinal Study–Kindergarten Cohort showed nancy, and complications during delivery. For example,
that girls entered kindergarten with stronger literacy skills older maternal age at children’s birth has been related to
(Ready, LoGerfo, Burkham, & Lee, 2005). In addition, SLI (Delgado, Vagi, & Scott, 2007) but not to late talker
gender has been found to be a predictor of reading achieve- status (Reilly et al., 2007; Zubrick et al., 2007). Low birth
ment in early grades (Campisi, Serbin, Stack, Schwartzman, weight has been associated with being a late talker (Rescorla,
& Ledingham, 2009). Less is known about the role of gen- 2013), lower cognitive functioning (Hack, Taylor, & Klein,
der in early math or behavioral abilities. 1995), poorer academic abilities at school entry (Lynch, 2011),
SES and related factors have also been implicated and impairments in self-regulation (Klebanov, Brooks-Gunn,
as risk factors in the Early Language in Victoria and & McCormick, 2001). Being a twin places children at greater
TEDS studies of late talkers and in studies of children’s risk for being a late talker (Reilly et al., 2007) and having
academic abilities (Bavin & Bretherton, 2013; Dale & lower language abilities (Bishop, Price, Dale, & Plomin,
Hayiou-Thomas, 2013; Fernald, Marchman, & Weisleder, 2003; Rutter, Thorpe, Greenwood, Northstone, & Golding,
2013). It must be noted, however, that economic disadvan- 2003); the risk is higher for monozygotic twins (as op-
tage was not found to be a factor in the RASCL study posed to dizygotic twins; Rice, Zubrick, Taylor, Gayan, &
(Zubrick et al., 2007) or the Early Language in Victoria Bontempo, 2014).
Study (Reilly et al., 2007). Zubrick et al. (2007) argued The evidence on the role of medical and behavioral
that neurobiological and genetic factors operate across risks in children’s language and academic outcomes is mixed.
families of varying sociodemographic characteristics. Others Some studies have found that maternal medical risks and
studies that have found that genetic factors play a role as- behavioral risks affect children’s language development and
sert that the shared environment of parents and children academic abilities (Anthopolos, Edwards, & Miranda, 2013;
can also influence language development (Dale, Tosto, Cho, Frijters, Zhang, Miller, & Gruen, 2013; Delgado, Vagi,
Hayiou-Thomas, & Plomin, 2015). & Scott, 2005; Goldschmidt, Richardson, Cornelius, & Day,
Nonetheless, research has consistently shown that 2004; Mensah & Kiernan, 2011). However, the effect of these
children from low-SES homes leave preschool with vocabu- risks may be accounted for by SES status (Batsrta, Hadders-
lary, reading, and math abilities that are below those of Algra, & Neeleman, 2003; Ellingson, Goodnight, Van Hulle,
their peers from middle-SES homes (Aikens, Kopack Klein, Waldman, & D’Onofrio, 2014; Gilman, Gardener, & Buka,
Tarullo, & West, 2013; Jordan & Levine, 2009). Likewise, 2008).
the National Center for Education Statistics (NCES) has
documented that children of low SES score lower than Family Health and History
children of middle SES on reading and math assessments Characteristics of the family, such as maternal physical
throughout their educational careers (NCES, 2014). and mental health and family history of mental and learning
Hammer et al.: Late Talkers’ School Readiness 609

difficulties, may also affect children’s development. In & Kisker, 2013; Crosnoe et al., 2010). The benefits of
regard to maternal physical health, one study found that quality parenting and child care were observed in children’s
mothers’ general health affected children’s language, literacy, reading and math scores in first, third, and fifth grades.
and math abilities at 3 years of age (Mensah & Kiernan,
2011). Findings on maternal mental health (i.e., maternal Early Behavioral Functioning of Children
depression and isolation) have yielded inconsistent results, Children’s early behavioral functioning may also have
although few studies have investigated this relationship. For an effect on early language and later academic outcomes,
example, maternal depression has not been implicated as a although the findings thus far have been mixed. For exam-
factor in late talking (Bavin & Bretherton, 2013; Zubrick ple, Henrichs et al. (2011) found that children with expres-
et al., 2007); however, investigations of children’s language sive vocabulary delay at 18 months were significantly more
development during the toddler and preschool years have likely to be rated by their mothers as having either external-
shown that children of depressed mothers have slower izing or internalizing problems; however, the authors noted
language growth than children of nondepressed mothers that the effect sizes were small and concluded that the rela-
(Brennan et al., 2000; Horwitz et al., 2003; Murray, 1992; tionship between early vocabulary and behavioral problems
NICHD Early Child Care Research Network, 1999; Pan, may not be causal. Likewise, Horwitz et al. (2003) observed
Rowe, Singer, & Snow, 2005). Also, the effects of maternal that when children’s social competence was accounted for,
depression have been observed on children’s cognitive devel- the relationship between language delay and behavioral
opment, literacy abilities, and behavioral functioning (Baker problems no longer existed.
& Iruka, 2013; Elgar, McGrath, Waschbusch, Stewart, & Studies of children’s later language, literacy, and math
Curtis, 2004; Harrison & McLeod, 2010; Hay et al., 2001; abilities have found positive associations between children’s
Herwig, Wirtz, & Bengel, 2004; La Paro et al., 2004). development and their behavioral functioning, however.
Having a family member with a learning disability Examples of this include studies of growth in children’s ap-
or special needs is a possible risk factor. Having a family proaches to learning (i.e., inhibitory control, attention, and
member with delayed language has been associated with working memory) and in children’s vocabulary, reading,
language delays in children in several studies (Bavin & and math (Dobbs, Doctoroff, Fisher, & Arnold, 2006; Li-
Bretherton, 2013; Flax, Realpe-Bonilla, Roesler, Choudhury, Grining, Votruba-Drzal, Maldonado-Carreño, & Haas, 2010;
& Benasich, 2008; Dale et al., 2010, 2015; Spinath, Price, McClelland et al., 2007; von Suchodoletz & Gunzenhauser,
Dale, & Plomin, 2004; Ukoumunne et al., 2012; Zubrick 2013). There is some evidence to suggest that internalizing
et al., 2007). problems are associated with lower vocabulary in boys
at age 3 years (Henrichs et al., 2013). In addition, the co-
Parenting and Child Care occurrence of attention-deficit/hyperactivity disorder (ADHD)
Parenting and attendance in child care may also affect and SLI is estimated to between 30% and 50% (Redmond,
children’s development. Parenting quality has been shown 2016). However, the relation among attention difficulties,
to mediate the effects of SES on development (Conger & language abilities, and reading is unclear. Tomblin, Zhang,
Donnellan, 2007; Guo & Harris, 2000; Yeung, Linver, & Buckwalter, and Catts (2000) found that reading disabilities
Brooks-Gunn, 2002). Children of parents who are warm were a mediator between language impairment and ADHD,
and nurturing, provide cognitively stimulating environ- whereas McGinty and Justice (2009) found that reading
ments, and establish routines for their children have higher disabilities served as a moderator. Redmond, Hogan, Ash,
cognitive, academic, and behavioral functioning (Crosnoe, and Guarino (2014) did not observe either a mediating or
Leventhal, Wirth, Pierce, & Pianta, 2010; Iruka, LaForett, moderating role but instead found that language impair-
& Odom, 2012). However, Zubrick et al. (2007) did not find ment and ADHD were distinct risk factors for reading
a relationship between parenting quality and late talking. disabilities. Redmond (2016) concluded that differences in
Overall, studies investigating the effect of child care the compositions of the samples, the scales used to measure
on development have identified a positive association of ADHD, and the ages of the participants made it difficult
child care attendance and children’s language, literacy, and to reconcile the discrepant findings.
math outcomes in early childhood and beyond. For exam- Additional evidence shows that externalizing problems
ple, Vallotton et al. (2012) found that participation in Early are related to lower language, reading, and math problems
Head Start programs promoted boys’ and girls’ vocabulary in early grades (Bulotsky-Shearer & Fantuzzo, 2011; Bulotsky-
development and appeared to buffer the effects of parent- Shearer, Fernandez, Dominguez, & Rouse, 2011; Carpenter &
ing stress on language development. Other studies have Drabick, 2011; Harrison & McLeod, 2010; Oliver, Dale, &
also shown that quantity and quality child care improves Plomin, 2004). However, Oliver et al. (2004) concluded that
children cognitive, language, and academic outcomes (Hall early language abilities were a stronger predictor of later
et al., 2009; Melhuish, Belsky, & Leyland, 2008; NICHD language difficulties than were behavioral problems.
Early Child Care Research Network, 2000, 2002, 2003;
Vandell, Belsky, Burchinal, Steinberg, & Vandergrift, 2010).
This benefit is particularly strong for children of low-SES Purpose of the Study
homes, particularly when the level of cognitive stimulation In this study, we sought to identify the risks for being
is consistent between home and child care (Chazan-Cohen a late talker (defined as having a low expressive vocabulary

at 24 months) and to determine whether being a late talker rounded to the nearest 50 per ECLS-B confidentiality require-
had a negative effect on children’s school readiness. We ments.) For the 48-month analyses, children with missing data
used data from the Early Childhood Longitudinal Study, on the outcome of interest—receptive vocabulary—were ex-
Birth Cohort (ECLS-B), a large nationally representative cluded, yielding a sample size of 5,450. At 60 months, the
sample, to address gaps in the existing literature. The use analyses included 4,200 children with data on the reading and
of this large national database permitted us to examine the math assessments. The final set of analyses included 3,000
unique role of a large number of possible factors in late children with kindergarten teacher reports of approaches
talking and children’s later school readiness and to do so to learning and externalizing and internalizing behaviors at
with data permitting generalizations to the general popula- 60 months. Missing data on independent variables in each
tion. Three questions were addressed: of the multivariate analyses were imputed using multiple
imputation procedures in SAS Version 9.3 (SAS Institute,
1. What are the risk factors for being a late talker at
Cary, NC).
24 months of age?
2. Do late talkers continue to have low vocabulary at
48 months of age? Procedure
3. Does being a late talker at 24 months of age play a ECLS-B staff conducted in-person assessments of
unique role in children’s school readiness, as defined children’s cognitive and behavioral functioning when the
by reading, math, and behavioral functioning at children were 9, 24, and 48 months of age. Interviews with
60 months of age? the children’s mothers were also conducted at these time
points. Children’s behavior was rated at 60 months of age
by their kindergarten teachers.
Method It is well known that, on average, girls’ vocabulary
and reading performance develops more rapidly than that
Data and Analytic Sample of boys. It is also known that girls tend to exhibit fewer
Data for this study came from the ECLS-B con- behavior problems than boys. As a result, it is common to
ducted by NCES. The ECLS-B began in 2001 with a use gender-specific norms when deciding whether a child
population-representative cohort of infants selected from has either a vocabulary or a behavior problem. In order
U.S. birth certificate files. The cohort included oversamples to test the robustness of our findings to the use of gender-
of Asian and Pacific Islanders, Native Americans and Alaska specific norms, we have reported all our analyses in two
Natives, infants born at moderately low (1,500–2,500 g) forms. In one of these, late talkers at 24 months, low
and very low (< 1,500 g) birth weight, and multiple births. vocabulary at 48 months, low reading performance at
More information about the ECLS-B is available at http:// 60 months, and behavior problems at 24 and/or 60 months
nces.ed.gov/ECLS/birth. Sampling weights provided in were defined (separately for boys and girls) as the members
the data set permit population-based estimates. of each group falling into the lowest performing 10% of
This study focuses on children who were either late the students. We refer to these as gender-specific norms (cut-
talkers or not and who had otherwise typical development offs). As an alternative, for each of these variables, we used
at 24 months of age. We classified children as being late the lowest performing 10% of the full sample (boys and
talkers if their expressive vocabulary scores fell within the girls combined) as the cutoff. We refer to these as overall
lowest 10% of the sample score distribution as measured sample norms (cutoffs). Our principal substantive findings
by the MacArthur Communicative Development Inventory were unaffected by which definitions were used in the
(M-CDI; Fenson et al., 1993). This classification is consis- analyses.
tent with previous studies of late talkers (Dale et al., 2010;
Dollaghan, 2013; Fenson et al., 1994; Weismer, 2006).
Children with missing M-CDI data were excluded Independent Variables
from the sample, as were those who were younger than Sociodemographic Characteristics
22 months or older than 26 months at the time of assess- Data were analyzed from maternal interviews and
ment. Because we were interested in examining outcomes birth certificate files regarding race/ethnicity (non-Hispanic
of children who were otherwise typically developing, those White, non-Hispanic African American, Hispanic, other
with very low birth weight or congenital anomalies were race/ethnicity), child age, gender, maternal marital status,
omitted from the sample. Also, children were omitted if and SES at the 24-month assessment. An SES index was
their parents answered that a language other than English calculated by ECLS-B staff using a composite of father’s
was the primary language in the home when responding to and mother’s education, father’s and mother’s occupation,
the question “What is the primary language spoken in your and household income. In cases in which only one parent
home?” This is due to potential differences between the was in the household, the SES index was computed using
English language development of monolingual and bilin- the information that was available on that parent. For
gual children. this study, the SES index scores were divided into quintiles
After these exclusions, the analytic sample at 24 months and represented in multivariate analyses as a set of four
included 6,050 children. (Note that all sample sizes are dummy variables.

Pregnancy and Birth Characteristics children such as reading to the child, telling stories, singing,
Children were characterized as nonsingletons if they and going on outings; the presence of toys, records, books,
were the product of a twin or higher order pregnancy. and audiotapes in the home; and safety and supportiveness
Maternal age at the child’s birth was classified as < 18, 18 of the home environment. A total count of the Home Ob-
to 35, or > 35 years of age. Birth weight between 1,500 servation for Measurement of the Environment items was
and 2,500 g was identified with a dichotomous variable for computed. The second measure of parenting was based on
moderately low birth weight. videotaped interactions during the Two Bags Task, a sim-
Complications of labor were taken into account with plified version of the Three Bags Task that has been used
a count variable that included abruptio placenta, anesthetic in previous research, including the Early Head Start Re-
complications, dysfunctional labor, breech or malpresenta- search and Evaluation Project and the NICHD Study of
tion, cephalopelvic disproportion, cord prolapse, fetal dis- Early Child Care (Nord, Edwards, Andreassen, Green, &
tress, excessive bleeding, fever > 100 °F, moderate or heavy Wallner-Allen, 2006). Parents were asked to play with their
meconium, precipitous labor (< 3 hr), prolonged labor children for 10 min using a children’s picture book and a
(> 24 hr), placenta previa, or seizures during labor. The set of toy dishes. A parenting support variable was created
total number possible was 14. We also included a count of by ECLS-B staff that consisted of the mean score for three
obstetrical procedures (range: 0–5), including induction of aspects of parent–child interaction: parental sensitivity,
labor, stimulation of labor, tocolysis, amniocentesis, and stimulation of child cognitive development, and parental
cesarean section. positive regard (e.g., warmth, responsiveness). Each of these
A count of medical risk factors in pregnancy included parenting characteristics was scored from 1 (very low) to 7
incompetent cervix, acute or chronic lung disease, chronic (very high).
hypertension, pregnancy-induced hypertension, eclampsia,
diabetes, hemoglobinopathy, cardiac disease, anemia, renal Center-Based Child Care
disease, genital herpes, oligohydramnios, uterine bleeding, At the 24-month assessment, mothers were asked
Rh sensitization, previous birth weighing 4,000+ g, or pre- how many hours per week their children spent in center-
vious preterm birth (range: 0–16). Behavioral risk factors based child care. At the 48-month assessment, mothers in-
during pregnancy, including alcohol and/or tobacco, use dicated how many hours per week their children spent in
were summed to form a scale ranging from 0 to 2. center-based child care and in Head Start. A dichotomous
variable was created to indicate children who spent more
Family Health and Well-Being than 10 hr/week in these settings.
Interviews with mothers elicited information about
the well-being of family members. In our analyses, we in- Behavioral Problems
clude dichotomous variables to indicate the presence of the Data collectors rated the children’s behavior using
following conditions among a parent or other family mem- the Behavior Rating Scale (BRS) Research Edition during
ber: mental illness; learning disability; or special need, de- the 24-month assessment. The BRS Research Edition,
lay, or disability. During the 24-month interview, mothers which was adapted from the BRS (Bayley, 1993), contains
indicated if they had medical conditions including asthma, 11 items from the full BRS. These items included coopera-
allergies, and diabetes. They also completed a modified ver- tion with the data collector, attention to the task, interest
sion of the Center for Epidemiologic Studies–Depression in the materials, persistence, and frustration with the tasks
Scale at the 24-month assessment. This scale consisted of presented (Nord et al., 2006). Data collectors rated chil-
12 items related to depression; each item was rated on a dren’s behavior on a 5-point scale. Specific items were
4-point scale. Scores were dichotomized such that mothers reverse coded to be consistent with other “appropriate”
with a score of > 24 were identified as having high levels behaviors.
of depression. Mothers also answered five questions related We used eight items from the BRS Research Edition
to social isolation at the 24-month assessment. The first to measure behavioral functioning. Self-regulation was mea-
three questions asked whom the respondents would ask for sured by four items (e.g., attention to tasks, persistence).
help in certain situations, and the others asked whether Externalizing and internalizing behaviors were measured
they attended religious services and whether they were emo- by two items, respectively: frustration and cooperation, and
tionally close to their own mothers. A response of no one fearlessness and social engagement. Crombach’s α for the
to any of the first three questions and a response of no to behavioral variables were .90, .64, and .72. Both gender-
either or both of the last two questions were considered to specific and sample-wide 10% cutoffs were used to infer that
indicate maternal isolation. a student experienced one of the problems.
Parenting
Parenting quality was indexed by the average of scores Outcome Variables
on two parenting assessments administered at 24 months. Late Talker at 24 Months
The first was a modified version of the Home Observation Children’s vocabulary was assessed during interviews
for Measurement of the Environment (Caldwell & Bradley, with the children’s mothers at 24 months of age using a
1984). This assessment measured activities done with modified version of the M-CDI that was developed by

Dale and Marchman for use in the ECLS-B. Mothers rated the frequency of each behavior on a 5-point scale
were asked whether their children could say each of from 1 (never) to 5 (very often). On the basis of the 22 be-
50 words and phrases commonly known and spoken at haviors from these assessments, we conducted an explor-
24 months, such as mommy, meow, thank you, and all gone. atory factor analysis using a promax rotation, retaining a
The numbers of words reported were summed to create a four-factor solution after examining several potential factor
total word score. The M-CDI vocabulary assessment has solutions and considering a priori criteria (Tabachnick &
high internal consistency (α = .96), and this assessment has Fidell, 2007). Items that reduced internal consistency and
been found to classify children into language status groups had factor loadings of .60 or lower were removed. We iden-
with 97% accuracy (Skarakis-Doyle, Campbell, & Dempsey, tified items in three of the four factors as relevant to the
2009). In this study, using the total sample, children whose present study. The first scale described approaches to learn-
scores were in the lowest 10% of the sample score distribu- ing (α = .91), which included five items: shows eagerness
tion (i.e., ≤13 words) were considered to be late talkers. We to learn, pays attention well, works/plays independently,
used both gender-specific and overall-sample 10% cutoffs keeps working until finished, and has difficulty concentrat-
in the analyses. For boys the 10% cutoff was 10 words, and ing. The second scale captured externalizing behavior
for girls the cutoff was 17 words. The overall-sample cutoff problems (α = .87), including disrupts others, has temper
was 13 words. tantrums, is physically aggressive, and annoys other chil-
dren. The third scale identified internalizing behavior prob-
Vocabulary at 48 Months lems (α = .64), which included seems unhappy, worries
Children’s vocabulary at 48 months was assessed about things, and acts shy. Items in each of these scales
with a modified version of the Peabody Picture Vocabulary were summed to obtain scale scores.
Test (PPVT; Dunn & Dunn, 1997). The PPVT is widely Children scoring in the bottom 10% of the distribu-
used and has high reliability values (i.e., .92–.93). Consistent tion for approaches to learning were identified as having
with prior studies (e.g., Webster, Majnemer, Platt, & Shevell, approaches to learning problems. Those scoring in the top
2004), we identified children scoring in the bottom 10% of 10% of the distributions for externalizing and internalizing
the overall PPVT score distribution at 48 months as having behaviors were considered to exhibit externalizing and in-
low vocabulary. As with the late talker variable, we also ternalizing behavior problems, respectively. As with other
found separate 10% cutoffs for each gender and coded variables, these cutoffs were computed both for the total
the low vocabulary at 48 months separately depending sample and for each gender separately, and both sets of
on the child’s gender. Both sets of analyses are reported analyses were reported.
in the tables.
Reading and Mathematics Scores at 60 Months Analyses

At 60 months, children were given (a) a reading test Descriptive statistics for study variables, including
consisting of 74 items assessing basic skills (i.e., letter percentage or mean and standard deviation, were calcu-
recognition, letter sounds, early reading, phonological lated using sampling weights provided in the ECLS-B data
awareness, print conventions, and word matching), reading set. Using multiple logistic regression, a set of three models
comprehension, and vocabulary and (b) a mathematics test was estimated to identify the odds of being a late talker
with 42 items assessing number sense, counting, operations, at 24 months. Model 1 estimated the extent to which socio-
geometry, patterns, and measurement. For each of these demographic characteristics, including race/ethnicity, age,
assessments, all children were given the same 24-question gender, and SES, functioned as predictors. Model 2 added
core test, and additional items were chosen for administra- additional variables related to nonsingleton birth, maternal
tion depending on whether they scored in the low, middle, age, and marital status. Model 3 added pregnancy, labor,
or high range on the core items. The reading and mathe- and birth-related characteristics; family health, parenting,
matics tests display high reliability, with theta reliability and child care variables; and child behavioral variables to
coefficients of .92 (Najarian, Snow, Lennon, Kinsey, & the regression model. All analyses were run twice—once with
Mulligan, 2010). In our analyses, we identified children gender-specific cutoffs for late talker and low 48-month
scoring in the bottom 10% of the distribution, both for the vocabulary and once with a single sample-wide 10% cutoff
sample as a whole and for each gender separately, as dis- for these variables. We also added a Gender × Child Age
playing low reading and mathematics achievement. interaction to allow for gender-specific rates of vocabulary
growth. In addition, interactions between child gender
Approaches to Learning, Externalizing, and Internalizing (male) and age, gender and SES, gender and nonsingleton,
Problems at 60 Months and SES and child care were investigated; however, because
Twenty-two behavioral assessment items were derived none of these were significant, they are not included in the
from several sources that included the Preschool Learning final results.
and Behavior Scales–Second Edition (Merrell, 2002); the Following this, sets of multivariate logistic regression
Social Skills Rating System (Gresham & Elliot, 1990); and models were estimated to predict the odds of having low
learning behavior items used in the Early Childhood Longi- receptive vocabulary at 48 months, low reading score at
tudinal Study, Kindergarten Class of 1998–1999. Teachers 60 months, low math score at 60 months, and behavioral

Table 1. Description of analysis population (N = 6,050).
problems at 60 months (i.e., problems with approaches to
learning, externalizing problems, and internalizing prob-
Variable M (SD) %
lems). These regressions were similar to those above. How-
ever, the regressions for low reading and low math scores White 65.1
at 60 months included low vocabulary at 48 months (de- African American 15.8
fined both with an overall sample and gender-specific cut- Hispanic 12.7
off as the lowest 10% of the children) and tested for an Other race 6.3
Child age 24.2 (0.7)
interaction between late talking at 24 months and low vo- Male 51.0
cabulary at 48 months in Model 1. We also tested for the Lowest SES quintile 14.4
following interactions: gender and age, gender and SES, Second-lowest SES quintile 18.4
gender and nonsingleton, and SES and child care in the Middle SES quintile 21.4
Second-highest SES quintile 23.1
regressions predicting 24-month late talker and 48-month Highest SES quintile 22.7
low vocabulary; however, none were significant. Our logis- Nonsingleton 3.2
tic regressions also included pseudo multiple correlation Mother’s age > 35 years at child’s birth 14.4
squared measures appropriate for binary outcomes. Because Mother’s age ≤ 18 years at child’s birth 7.0
Mother not married, 24 months 31.3
these are not directly comparable to multiple correlation Moderately low birth weight 6.5
squared measures when the dependent variable is continu- Labor complications 29.2
ous, such as those in the articles by Henrichs et al. (2011, Obstetric procedures 49.8
2013), we were not able to compare the variance explained Medical risk factors in pregnancy 16.1
Behavioral risk factors in pregnancy 13.1
in our regressions with the multiple correlation squared Family member with mental illness 12.5
reported in those articles. Family member with learning disability 18.0
Maternal health problems, 9 months 6.9
Household has person with special needs 8.3
Results Mother depressed, 9 months 9.6
Mother isolated, 9 months 29.4
Table 1 shows descriptive statistics for the overall Parenting score, 24 months 7.5 (1.1)
analysis sample with complete data, including the children’s Child in child care center > 10 hr/week, 24 months 15.7
parent-reported word score at 24 months (n = 6,050). The Approaches to learning problems, 24 months 9.1
Internalizing problems, 24 months 12.5
table also shows the mean 48-month receptive vocabulary Externalizing problems, 24 months 8.2
score for children with nonmissing scores (n = 5,450), the Child in child care center > 10 hr/wk, 48 monthsa 55.0
mean 60-month reading and math scores for those with Child in Head Start > 10 hr/week, 48 monthsa 17.0
nonmissing scores (n = 4,200), and the mean 60-month Word score, 24 months 29.3 (11.7)
Receptive vocabulary score, 48 monthsa 8.8 (1.9)
approaches to learning, internalizing, and externalizing Reading score, 60 monthsb 39.0 (14.4)
scores with nonmissing scores (n = 3,000). Math score, 60 monthsb 40.8 (10.3)
Approaches to learning scale score, 60 monthsb 18.6 (2.5)
Internalizing scale score, 60 monthsc 7.1 (3.2)
Risk and Protective Factors Related to Being a Externalizing scale score, 60 monthsc 6.3 (2.2)
Late Talker
Note. All sample sizes are rounded to the nearest 50 per Early
Table 2 reports odds ratio coefficients from the logis- Childhood Longitudinal Study, Birth Cohort confidentiality
tic regressions, sequentially adding predictors of a child’s requirements. Weighted. SES = socioeconomic status.
a
chance of being a late talker. The first three of these use n = 5,450. bn = 4,200. cn = 3,000.
gender-specific norms; the second three use an overall
sample-wide cutoff. Note that significant odds ratios that
are greater than 1.0 indicate increased odds of being a late
talker, whereas ratios that are less than 1.0 indicate reduced twin), and having an older mother both increased the odds
odds of this outcome. of being a late talker. Adding these variables as controls
Model 1 used basic sociodemographics—race/ethnicity, did not change the child age and family SES effects.
the child’s age in months, gender, and SES quintiles—as Model 3 added gestational and birth, family, parent-
predictors. Beginning with Model 1 of the gender-specific ing, child care, and child behavioral variables to the equa-
cutoffs, the results showed that older children are less likely tion. These additional predictors explained much of the
than younger children to be late talkers at 24 months of age SES effect on being a late talker. (Note that the statistical
(an odds ratio of 0.74:1 for a 1 SD increase in the child’s age significance of this mediation was confirmed with a Sobel
at testing). There was also a strong and monotonically de- test.) Significant effects among these predictors in increas-
clining relationship of SES quintiles with being a late talker. ing the odds of being a late talker included the effect of
Children in families in the lowest quintile had an odds ratio moderately low birth weight and child approaches to learn-
of being a late talker that was almost double (1.93:1) that ing and internalizing problems. Higher quality parenting
of children from families in the highest quintile. Model 2 and the child attending day care for more than 10 hr/week
added additional sociodemographic variables to the predic- decreased the odds of being a late talker. The child behav-
tion equation. Being a nonsingleton birth (i.e., having a ior problems were measured at the same time (24 months)

Table 2. Odds ratios of being a late talker at 24 months (N = 6,050a).
Gender-specific 10% cutoffs Overall 10% cutoffs

Variable Model 1 Model 2 Model 3 Model 1 Model 2 Model 3
African American 0.82 0.85 0.68* 0.79 0.83 0.63*

Hispanic 0.83 0.87 0.75 0.96 1.01 0.85
Other race 1.40* 1.44* 1.25 1.54* 1.58* 1.30
Child age 0.74*** 0.74*** 0.73*** 0.84 0.84 0.82*
Male 0.88 0.88 0.81 3.02*** 3.03*** 2.70***
Lowest SES quintile 1.93** 2.33*** 1.32 1.85* 2.27*** 1.21
Second-lowest SES quintile 1.82*** 2.10*** 1.44 1.69** 1.97*** 1.33
Middle SES quintile 1.54* 1.69** 1.38 1.47 1.61* 1.27
Second-highest SES quintile 1.38 1.45* 1.31 1.24 1.31 1.17
Male × child age, 24 months 0.98 0.97 1.02 0.88 0.88 0.92
Nonsingleton 1.62*** 1.14 1.74*** 1.48*
Mother’s age > 35 years at child’s birth 1.37* 1.38* 1.30 1.36
Mother’s age ≤ 18 years at child’s birth 0.71 0.66 0.73 0.69
Mother not married, 24 months 0.93 0.87 0.87 0.93
Labor complications 1.10 1.12
Obstetric procedures 0.92 0.94
Medical risk factors in pregnancy 0.97 1.04
Behavioral risk factors in pregnancy 0.78 0.69*
Moderately low birth weight 1.72*** 1.32
Family member with mental illness 1.04 1.02
Family member with learning disability 1.04 1.32
Household has person with special needs 1.35 0.96
Maternal health problems, 9 months 1.39 1.51
Mother depressed, 9 months 1.13 1.25
Mother isolated, 9 months 1.13 1.27
Parenting score, 24 months 0.69*** 0.65***
Child in child care center > 10 hr/week, 24 months 0.59** 0.66*
Approaches to learning problems, 24 months 2.40*** 2.71***
Internalizing problems, 24 months 1.35* 1.25
Externalizing problems, 24 months 1.12 1.19
Max-rescaled R2 0.02 0.04 0.12 0.06 0.07 0.15
Tjur’s R2 0.01 0.02 0.07 0.03 0.04 0.09
Note. Child age and parenting score are standardized with a mean of 0 and an SD of 1. SES = socioeconomic status.
a
Sample size is rounded to the nearest 50 per Early Childhood Longitudinal Study, Birth Cohort confidentiality requirements.
*p < .05. **p < .01. ***p < .001. Weighted regressions.
as late talker, so the direction of causality cannot be deter- late talkers were found to have a low receptive vocabulary
mined. However, it is still useful to see that these variables 2 years later. Eighty-three percent of the sample did not
were significantly related even with many other variables have vocabulary difficulties at 24 or 48 months; however,
controlled. 8% of these children had a vocabulary problem at 48 months.
The final three columns of Table 2 show the results Of those who were late talkers at 24 months, one fourth
using a sample-wide (rather than gender-specific) cutoff continued to have a vocabulary problem at 48 months. This
for defining being a late talker at 24 months. As expected, accounted for 2.6% of the total sample.
using a sample-wide cutoff showed boys as being much
more likely than girls (an odds ratio of about 3 to 1) to be
late talkers. The other findings using the gender-specific Role of Being a Late Talker at 24 Months on
cutoffs were generally robust to the use of a single sample- Vocabulary at 48 Months
wide cutoff. Once again, we found strong SES effects Table 3 shows the results of the logistic regressions
that were largely mediated by control variables such as predicting low vocabulary at 48 months. The first three
parenting quality, child care, and the child’s approaches to models used gender-specific cutoffs for 24-month late talker,
learning (attention). 48-month low vocabulary, and 24-month child behavior
problems, whereas the final three models used sample-wide
cutoffs. Model 1 included the following as predictors: being
Persistence of Vocabulary Problems at 48 Months a late talker, race/ethnicity, the child’s age at assessment,
Using sample-wide cutoffs, we also investigated the gender, a Gender × Age interaction, and the SES quintiles.
extent to which late talkers continued to have vocabulary Being a late talker at 24 months was a strong predictor of
problems and the extent to which children who were not low vocabulary at 48 months, increasing the odds of this

Table 3. Odds ratios of low vocabulary at 48 months (n = 5,450a).

Late talker, 24 months 4.27*** 4.26*** 3.47*** 3.71*** 3.72*** 2.92***

African American 1.14 1.11 0.90 1.19 1.17 0.90
Hispanic 1.67** 1.66** 1.40 1.78*** 1.76*** 1.44*
Other race 1.02 1.02 0.87 1.07 1.08 0.92
Child age, 24 months 0.92 0.92 0.90 0.85 0.85 0.83*
Male 1.03 1.02 0.96 1.44* 1.44* 1.36*
Lowest SES quintile 5.02*** 5.16*** 3.11*** 4.73*** 4.88*** 3.14***
Second-lowest SES quintile 2.99*** 3.08*** 2.11** 2.78*** 2.88*** 2.10**
Middle SES quintile, 24 months 1.85** 1.91** 1.46 1.79** 1.88** 1.49
Second-highest SES quintile 1.48 1.52 1.37 1.37 1.41 1.27
Nonsingleton 0.94 0.85 0.84 0.68**
Mother’s age > 35 years at child’s birth 1.37 1.43 1.43 1.48*
Behavioral risk factors in pregnancy 0.87 0.76
Moderately low birth weight 1.19 1.47*
Family member with learning disability 0.88 0.87
Parenting score, 24 months 0.74*** 0.74***
Child in child care center (not Head Start) > 10 hr/week, 48 months 0.44*** 0.46***
Child in Head Start > 10 hr/week, 48 months 0.51*** 0.52***
Approaches to learning problems, 24 months 1.91*** 2.03***
Internalizing problems, 24 months 1.23 1.55*
Max-rescaled R2 0.12 0.13 0.19 0.11 0.12 0.18
Tjur’s R2 0.07 0.07 0.12 0.07 0.07 0.12
Note. Child age and parenting scores are standardized with a mean of 0 and an SD of 1. SES = socioeconomic status.
a
outcome by a factor of 4.3 in Model 1. Being Hispanic behavior problems at 60 months. These models included be-
(1.67:1) and low or middle SES compared with high SES ing a late talker at 24 months, low vocabulary at 48 months,
also significantly increased these odds (i.e., the lower three the interaction between these variables as predictors, and
quintiles had odds ratios of 5.02:1, 2.99:1, and 1.85:1). behavioral functioning at 24 months and were estimated
Additional demographics were included in Model 2, using both gender-specific and sample-wide cutoffs for late
but none were significant. Model 3 added gestational and talker and low vocabulary.
birth conditions, family, child care, and child behavior
problems. Significant predictors were parenting, child care, Low Reading Performance
and approaches to learning problems, and these partially Table 4 displays the results for low reading perfor-
explained the SES effects. The final three models used sam- mance at 60 months. As before, similar patterns were ob-
ple-wide rather than gender-specific cutoffs. These results served for both gender-specific and sample-wide cutoffs for
showed the same patterns as were found with gender- late talker and 48-month vocabulary. It is not surprising
specific cutoffs. In particular, the very strong effect of SES that low vocabulary at 48 months strongly increased the
on low vocabulary continued to be observed. odds of low reading performance at 60 months. However,
even with this variable controlled, being a late talker also
increased the odds of low reading at 60 months. This was
Role of Being a Late Talker at 24 Months on
significant at the .05 level using the overall cutoffs and at
School Readiness the .10 level using gender-specific cutoffs. In addition, even
Tables 4–7 present the results of logistic regressions with these controls, low SES had exceptionally powerful
predicting low reading and math performance and high effects on low reading, with odds ratios of low vocabulary

Table 4. Odds ratios of low reading performance at 60 months (n = 4,200a).

Late talker, 24 months 1.61 1.61 1.62 1.78* 1.74* 1.72*

Low receptive vocabulary, 48 months 4.03*** 3.99*** 3.26*** 4.59*** 4.49*** 3.65***
Late talker, 24 months × low vocabulary, 48 months 0.50 0.51 0.61 0.52 0.54 0.65
African American 1.01 1.02 1.04 1.05 1.11 1.17
Hispanic 1.14 1.13 1.03 0.99 0.99 0.90
Other race 1.56 1.57 1.53 1.68 1.72 1.75
Child age 0.63*** 0.63*** 0.61*** 0.56*** 0.56*** 0.55***
Male 1.09 1.09 1.05 1.53*** 1.53** 1.51**
Second-lowest SES quintile 4.28*** 4.38*** 3.02** 4.37*** 4.67*** 3.08**
Middle SES quintile 3.16*** 3.23*** 2.65** 3.02*** 3.21*** 2.61**
Male × child age, 24 months 1.20 1.20 1.25 1.41* 1.41* 1.44*
Nonsingleton 1.40* 1.50* 1.43* 1.59*
Mother’s age > 35 years at child’s birth 1.14 1.25 1.30 1.43
Moderately low birth weight 0.95 0.84
Family member with learning disability 1.61** 1.78***
Parenting score, 24 months 0.95 0.92
Approaches to learning problems, 24 months 1.52 1.06
Internalizing problems, 24 months 1 00 1.18
Max-rescaled R2 0.18 0.18 0.21 0.20 0.20 0.23
Tjur’s R2 0.13 0.13 0.15 0.14 0.15 0.17
a
in the range of 7:1 when comparing the lowest and highest lowest SES quintile and almost 8 to 1 for the second-lowest
SES quintiles. Other noteworthy findings included the posi- quintile. In Model 3, quality parenting and 48-month
tive effect on low reading of having a family member with center-based child care or Head Start for more than 10 hr/
a learning disability as well as the strong effects of child week resulted in decreased odds of low math performance.
care more than 10 hr/week in decreasing the odds of low Having a family member with learning disabilities increased
reading at kindergarten entry. the odds by 1.65:1. These variables also partially accounted
for the negative effect of low SES on the outcomes. The re-
Low Math Performance sults using sample-wide cutoffs showed very similar patterns.
Table 5 includes the calculations for low math perfor-
mance at 60 months; results generally are similar to those Problem Behavior
for low reading. The effect of being a late talker (2.20:1) Table 6 shows calculations for the odds of teacher-
was significantly and positively related to low math scores, reported behavior problems—approaches to learning and
as was low receptive vocabulary (3.51:1). The interaction externalizing and internalizing problems—at 60 months.
between these variables was not significant. African Model 2 for approaches to learning problems showed that,
American children were at increased odds for low math even after extensive controls, being a late talker signifi-
scores (1.52:1). cantly increased a child’s odds (2.19:1) for difficulties in
The effect of the lowest SES quintile was even larger this area. In addition, in Model 1, low SES increased a
than for low reading, with odds of almost 15 to 1 for the child’s odds of having approaches to learning problems,

Table 5. Odds ratios of low math performance at 60 months (n = 4,200a).

Late talker, 24 months 2.20** 2.17* 1.94* 2.06* 2.01* 1.80

Low receptive vocabulary, 48 months 3.51*** 3.59*** 2.62*** 3.39*** 4.48*** 3.42***
African American 1.52* 1.53* 1.49 1.66* 1.75** 1.67*
Hispanic 0.91 0.94 0.79 1.03 1.07 0.92
Other race 1.12 1.12 0.94 1.31 1.33 1.18
Child age 0.62*** 0.62*** 0.60*** 0.62*** 0.62*** 0.60***
Male 1.11 1.12 1.03 1.32 1.33 1.20
Second-lowest SES quintile 7.74*** 8.18*** 5.15*** 6.90*** 7.18*** 5.05***
Middle SES quintile 6.14*** 6.34*** 4.87*** 4.91*** 4.94*** 4.08***
Second-highest SES quintile 2.96** 3.03** 2.66* 2.36* 2.37* 2.14
Nonsingleton 1.33 1.33 1.39 1.40
Mother’s age > 35 years at child’s birth 1.13 1.18 0.84 0.86
Moderately low birth weight 1.05 1.09
Family member with mental illness 0.66 0.62*
Family member with learning disability 1.65* 1.80**
Parenting score, 24 months 0.80* 0.76*
Approaches to learning problems, 24 months 1.60 1.47
Internalizing problems, 24 months 0.96 0.91
Max-rescaled R2 0.25 0.25 0.29 0.25 0.26 0.29
Tjur’s R2 0.16 0.16 0.20 0.17 0.17 0.20
a
but this was largely explained by the control variables in Discussion

Model 2. Higher quality parenting decreased the odds of Our study had three purposes. First, we attempted
approaches to learning problems at 60 months, and a child to identify risk factors for being a late talker at 24 months.
in Head Start for more than 10 hr/week increased the odds Second, we investigated whether late talkers continue to
of approaches to learning problems at 60 months. have low vocabulary at 48 months. Third, we examined
Even after extensive controls, the odds of having in- whether being a late talker and/or having low 48-month
ternalizing problems were increased by low vocabulary at vocabulary plays a unique role in children’s school readi-
48 months (2.86:1). Being a late talker did not significantly ness. We designed the study to extend the current knowl-
affect these odds, although it exerted an indirect effect via edge base by analyzing a population-based sample from
its effect on 48-month vocabulary. Both late talker and the United States and by focusing on a large number of
low 48-month vocabulary significantly increased the odds variables that have been implicated as risk factors in prior
of externalizing problems at 60 months. Low SES also studies, including sociodemographics, pregnancy and birth
increased the odds of externalizing problems—an effect characteristics, family health and well-being, parenting
largely explained by the control variables in Model 2. These and child care, and early behavioral functioning. Use of
findings were generally replicated using sample-wide cutoffs a nationally representative sample and the inclusion of nu-
in Table 7, although the late talker and 48-month vocabu- merous potential risk factors permit us to clarify the rela-
lary lost significance there for externalizing problems. tionship between these factors and late talker status and

Table 6. Odds ratios of teacher-reported behavior problems at 60 months (n = 3,000a) using gender-specific cutoffs.
Approaches to Internalizing Externalizing

learning problems problems problems
Late talker, 24 months 2.51** 2.19** 1.51 1.40 1.72* 1.78*

Low receptive vocabulary, 48 months 1.45 1.46 2.98*** 2.86*** 1.89* 2.05**
African American 1.25 0.88 0.59 0.57 1.62* 1.35
Hispanic 1.38 1.30 0.91 0.80 0.84 0.83
Other race 1.23 0.98 0.51 0.49 1.36 1.12
Child age 1.06 1.03 1.26 1.25 1.02 1.05
Male 0.96 0.91 1.10 1.09 1.06 1.05
Lowest SES quintile 3.67*** 1.62 1.51 1.41 2.91*** 1.59
Second-lowest SES quintile 3.10** 1.78 1.11 1.00 1.96* 1.31
Middle SES quintile 2.84** 1.95 1.49 1.41 1.81* 1.34
Nonsingleton 0.88 1.21 0.83
Mother’s age > 35 years at child’s birth 0.70 0.67 0.63
Mother’s age ≤ 18 years at child’s birth 0.60 1.07 0.86
Mother not married, 24 months 1.21 0.77 1.66*
Labor complications 1.10 1.33 1.25
Obstetric procedures 0.94 0.65 0.96
Medical risk factors in pregnancy 1.43 1.73* 1.59*
Behavioral risk factors in pregnancy 1.58 0.85 1.36
Moderately low birth weight 1.30 0.77 0.99
Family member with mental illness 1.28 1.16 1.18
Family member with learning disability 1.11 0.78 1.32
Household has person with special needs 1.18 0.88 1.42
Maternal health problems, 9 months 1.27 1.64 0.98
Mother depressed, 9 months 0.94 0.43 0.96
Mother isolated, 9 months 1.06 0.90 0.96
Parenting score, 24 months 0.64*** 0.86 0.90
Child in child care center (not Head Start) > 10 hr/week, 48 months 1.37 0.64 1.34
Child in Head Start > 10 hr/week, 48 months 1.67* 0.89 1.19
Approaches to learning problems, 24 months 1.37 0.78 1.12
Internalizing problems, 24 months 0.75 1.72 0.39**
Externalizing problems, 24 months 1.30 0.92 1.71
Max-rescaled R2 0.07 0.11 0.03 0.05 0.07 0.10
Tjur’s R2 0.03 0.06 0.02 0.03 0.04 0.06
a
enable us to control for possible confounding factors to population-based investigations that addressed this issue
determine whether late talking has a unique effect on chil- (Bleses & Vach, 2013; Dale et al., 2010; Reilly et al., 2007;
dren’s school readiness in the U.S. population as a whole. Westerlund & Lagerberg, 2008) as well as other studies of
early language development (e.g., Harrison & McLeod,
2010; Maatta et al., 2012).
Risk Factors for Being a Late Talker Also, difficulties with approaches to learning at
We found that a number of sociodemographic, birth, 24 months (i.e., having difficulties paying attention, work-
and family variables were significantly related to being a ing independently, concentrating, and completing tasks)
late talker at 24 months of age. As expected, boys were sig- were associated with late talker status. This result is consis-
nificantly more likely than girls to be a late talker. Remov- tent with that of Henrichs et al. (2013). Because ratings of
ing this effect by using gender-specific norms, we found children’s behavior and the M-CDI were both completed
that low SES strongly increased the odds of being a late when the children were 24 months of age, the direction of
talker—an effect largely explained by low birth weight, the the relationship is unclear. It could be that having prob-
quality of parenting, time in day care, and the child’s ap- lems with approaches to learning is a risk factor for being
proaches to learning (attention) problems. The finding that a late talker, or it could be that this difficulty is the result
boys are at greater risk than girls of being a late talker and of low language abilities at an early age. Whichever the di-
in early language development is consistent with several rection of causality, and other things being equal, problems

Table 7. Odds ratios of teacher-reported behavior problems at 60 months (n = 3,000a) using overall cutoffs.
Approaches to Internalizing Externalizing

learning problems problems problems
Late talker, 24 months 2.27** 2.10** 1.06 1.01 1.52 1.56

Low receptive vocabulary, 48 months 1.84* 1.83* 3.64*** 3.62*** 1.32 1.39
African American 1.25 0.96 0.57 0.56 1.78** 1.41
Hispanic 1.13 1.05 0.85 0.76 1.10 1.10
Other race 1.24 1.04 0.52 0.49 1.88* 1.49
Child age 1.06 1.03 1.24 1.24 1.22 1.24
Male 1.91*** 1.86*** 1.01 1.02 4.33*** 4.18***
Lowest SES quintile 4.53*** 2.46* 1.55 1.48 2.95*** 1.53
Second-lowest SES quintile 3.97*** 2.71** 1.15 1.04 1.94* 1.21
Middle SES quintile 2.79** 2.09* 1.50 1.43 1.45 1.01
Second-highest SES quintile 1.93* 1.65 1.11 1.14 1.32 1.14
Nonsingleton 0.74 1.25 1.07
Mother’s age > 35 years at child’s birth 0.56* 0.67 0.69
Mother’s age ≤ 18 years at child’s birth 0.87 1.07 1.05
Mother not married, 24 months 1.22 0.73 1.78
Labor complications 1.10 1.34 1.03
Obstetric procedures 1.05 0.64* 0.95
Medical risk factors in pregnancy 1.38 1.73* 2.08**
Behavioral risk factors in pregnancy 1.24 0.90 1.87*
Moderately low birth weight 1.23 0.77 0.73
Family member with mental illness 1.24 1.11 1.15
Family member with learning disability 1.32 0.76 1.10
Household has person with special needs 0.90 0.88 0.97
Maternal health problems, 9 months 1.10 1.67 0.64
Mother depressed, 9 months 1.18 0.44 1.02
Mother isolated, 9 months 0.97 0.92 1.00
Parenting score, 24 months 0.73*** 0.86 0.83
Child in child care center (not Head Start) > 10 hr/week, 48 months 1.31 0.66 1.72**
Child in Head Start > 10 hr/week, 48 months 1.45 0.90 1.36
Approaches to learning problems, 24 months 1.25 0.68 1.63
Internalizing problems, 24 months 0.79 1.67 0.37**
Externalizing problems, 24 months 1.20 1.06 1.51
Max-rescaled R2 0.11 0.14 0.03 0.05 0.12 0.16
Tjur’s R2 0.07 0.09 0.02 0.03 0.06 0.09
a
with approaches to learning are positively associated with shared environment of parents and children influences
being a late talker. As noted earlier, co-occurrence of atten- children’s language development (Dale et al., 2015). Warm
tional difficulties and SLI have been observed, but the na- and nurturing parents create stimulating environments and
ture of the relationship remains unclear (Redmond, 2016). provide supports by establishing routines. This, in turn, re-
Of note is that the strong relation between SES and sults in higher cognitive and language abilities (cf. Conger &
being a late talker was fully explained by the mediating Donnellan, 2007; Guo & Harris, 2000; Yeung et al., 2002).
variables. The effect of SES on late talking was inconsis- Also, these results are supported by past studies that have
tent in the four prior population-based studies that were shown that center-based child care promotes children’s out-
reviewed. Our study helps clarify the relationship because comes in many areas and that child care appears to minimize
the investigation targeted a large number of possible ex- the effects of stress experienced by low-income parents (Hall
planatory variables in the statistical analyses. We found et al., 2009; NICHD Early Child Care Research Network,
that the effects of SES were accounted for by a number of 2000, 2002, 2003; Melhuish et al., 2008; Vallotton et al.,
variables, including quality parenting and children’s atten- 2012; Vandell et al., 2010). However, attendance in child
dance in a day care center. These findings are consistent care has also been found to increase children’s risk for be-
with a large number of studies that have found that quality havior problems (NICHD Early Child Care Research Net-
parenting supports children’s development and that the work, 2003).

Vocabulary Status at 48 Months quintile. Even children in the middle-SES and second highest
quintiles were at increased risk for these outcomes. These
We also investigated whether children who were
important findings demonstrate that the effects of SES are
late talkers at 24 months continue to have low vocabulary
profound and increasing as children age from birth to school
scores at 48 months. We found that one fourth of later
entry (Hillemeier, Farkas, Morgan, Martin, & Maczuga,
talkers continued to have low vocabulary scores (defined
2009; Rescorla, 2013).
as the lowest 10%) during preschool. This is consistent with
previous studies that have shown that not all late talkers
continue to have low language abilities (Dale & Hayiou- Limitations
Thomas, 2013; Rescorla, 2009; Rice et al., 2008). How-
There are at least three limitations to this study. The
ever, we also found that even after entering a large number
first is that direct observations of the children’s vocabulary
of controls, being a late talker at 24 months of age had a
at 24 months were not made. Instead, an abbreviated
significant effect on later vocabulary. Late talkers were
version of the M-CDI, a parent report measure, was used.
three times more likely to have low vocabulary scores at
However, the M-CDI and its short form have been used
48 months. It should be pointed out, however, that SES
extensively in research and clinically (cf. Bleses & Vach,
had the largest effect on children’s vocabulary scores even
2013; Moyle, Ellis Weismer, Lindstrom, & Evans, 2007;
after controlling for a large number of variables, including
Thal, Miller, Carlson, & Vega, 2005). Through its usage,
parenting quality and center-based child care and/or Head
parents have been found to be reliable reporters of young
Start services. As suggested by Rescorla and Dale (2013),
children’s vocabulary. Further, any measurement error in
SES may not show a direct effect on late talking once
our vocabulary measure simply indicates that our results
other variables are controlled, but its association with the
are conservative; a more reliable measure would have pro-
child’s language performance increases as children progress
duced even larger associations. Second, children’s receptive
through the preschool years and enter kindergarten.
and expressive vocabularies were not both measured at
each of the data collection waves. However, strong correla-
tions between children’s receptive and expressive vocabu-
Role of Late Talking in School Readiness
laries have been reported in the literature. For example,
at 60 Months Sideridis and Simos (2010) found a significant correlation
Our study also investigated whether late talking played of .66 between receptive and expressive vocabularies. In
a unique role in children’s school readiness at 60 months addition, Tomblin and Zhang (2006) did not find evidence
of age, a question that has received relatively little atten- for a receptive–expressive dichotomy and argued that sepa-
tion. We found that late talking increased the odds of low rate measures of these variables are not warranted. Third,
reading scores, low math scores, and both approaches to in light of the large size of the sample, the ECLS-B did
learning and externalizing behavior problems. Overall, these not conduct specific observations of parent–child and care-
findings show that being a late talker places children at risk giver–child interactions in homes and child care centers.
for reduced school readiness and are supported by existing Thus, we are unable to discuss the quantity and quality of
research that has demonstrated the important relationships language that the children experienced in these two set-
between children’s language abilities and their reading, tings. Such studies are desirable because they would help
math, and behavioral functioning (e.g., Braze et al., 2007; us better understand the language development of children
Cole et al., 2010; Purpura et al., 2011; Redmond, 2016; from a wide variety of backgrounds and cultures.
Verhoeven & Van Leeuwe, 2008).
It should be noted that low vocabulary at 48 months
played a larger role in children’s school readiness than late Implications
talker status. Having a low vocabulary prior to school This study has several key implications. First, the
entry, independent of late talker status at 24 months, more study demonstrates the high value of using publically avail-
than tripled the odds of low reading in kindergarten and able population-based data sets to address key questions.
math scores in kindergarten. This finding illustrates the Such data sets permit researchers to investigate questions
critical importance of vocabulary in school readiness. In that they could never answer on their own. This is because
particular, being a late talker at 24 months is itself a strong individual researchers and single research groups do not
predictor of low vocabulary at 48 months. have access to resources that allow them to recruit a large
However, the most significant finding is the very large representative sample and gather data on a large number of
effect that SES had on children’s school readiness, even independent and dependent variables (Justice, Breit-Smith,
after controlling for a large number of variables. Children & Rogers, 2010). Examples of existing data sets include
from families in the lowest SES quintile were about seven but are not limited to the ECLS-B (which was used in this
times more likely to have low reading scores, nearly 15 times study), the Early Children Longitudinal Study–Kindergarten
more likely to have low math scores, almost four times Cohort, the NICHD Study of Early Child Care/NICHD
more likely to have difficulties with approaches to learn- Study of Early Child Care and Youth Development, Head
ing, and almost three times more likely to have externaliz- Start Family and Child Experiences Study, and the National
ing problems compared with children in the highest SES Household Education Survey. In addition, a number of

data sets are available from the National Center for Educa- the amount of talk that children hear in order foster vocabu-
tion Statistics (http://nces.ed.gov/pubsearch/licenses.asp). lary and language growth. This program and others like it
Through these data sets, which are underutilized in the are excellent examples of public health programs in which
field of speech-language pathology, researchers can answer speech-language pathologists should be involved from crea-
pressing questions and obtain findings that are generaliz- tion through implementation and evaluation.
able to the population level. Likewise, efforts are occurring throughout the coun-
Second, our investigation demonstrates the critical try to increase the number of Early Head Start programs,
importance of children’s vocabulary abilities at both 24 which work closely with parents, and to offer universal pre-
and 48 months of age for their later development. Thus, school. The Every Student Succeed Act, passed in Decem-
it is essential that children with low vocabulary levels at ber 2015, has expanded the previous national education law
any point in their development be provided with interven- by calling for the provision of high-quality preschool across
tions that promote vocabulary learning. It is well docu- the nation. Given the critical importance of early vocabu-
mented that children with strong vocabularies are able to lary and language, it is imperative that speech-language
take advantage of their vocabulary knowledge to acquire pathologists be involved at the policy level. No other pro-
new words and that the gap between children with weak fession has the expertise and training in language develop-
and strong vocabularies widens over time. Also, children ment and language facilitation strategies that speech-language
with strong vocabularies can use them to decode and com- pathologists do. Speech-language pathologists have much
prehend written texts, which is crucial for the development to offer in addition to the remediation of existing language
of reading skills (Braze et al., 2007; NICHD Early Child disorders and must assume a more active role in the pre-
Care Research Network, 2005). Vocabulary support pro- vention of language delays and disorders and in shaping
vided early in life would greatly enhance children’s later public health and educational policies and programming at
vocabulary development as well as their school readiness. the local, state, and federal levels.
Third, our study identified three potentially mallea-
ble factors that are related to being a late talker: parenting
quality, child care, and approaches to learning. Regardless Acknowledgments
of SES, it appears that there are parents who could use
This study was supported by Institute of Education Sciences
additional supports during their children’s early years in
Grant R324A120046. Infrastructure support was also provided
order to foster their children’s development. Thus, efforts through the Pennsylvania State University Population Research
should be made to help parents engage in high-quality in- Institute, which is funded by Eunice Kennedy Shriver National
teractions with their children in order to foster language Institute of Child Health and Human Development Grant R24-
development and create homes with more cognitively stim- HD041025. The authors thank Philip Dale, J. Bruce Tomblin,
ulating environments. Of course, it is essential that these and Elizabeth Crais for their valuable input on the study and article.
supports be culturally sensitive. In addition, it appears that
attendance in child care for 10 hr or more/week enhances
children’s vocabulary. Therefore, providing high-quality References
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JSLHR

Late Talkers: A Population-Based Study of Risk

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Hammer et al.: Late Talkers’ School Readiness 609

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Hammer et al.: Late Talkers’ School Readiness 611

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Reading and Mathematics Scores at 60 Months Analyses

Hammer et al.: Late Talkers’ School Readiness 613

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Gender-specific 10% cutoffs Overall 10% cutoffs

African American 0.82 0.85 0.68* 0.79 0.83 0.63*

Hammer et al.: Late Talkers’ School Readiness 615

Gender-specific 10% cutoffs Overall 10% cutoffs

Late talker, 24 months 4.27*** 4.26*** 3.47*** 3.71*** 3.72*** 2.92***

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Gender-specific 10% cutoffs Overall 10% cutoffs

Late talker, 24 months 1.61 1.61 1.62 1.78* 1.74* 1.72*

Hammer et al.: Late Talkers’ School Readiness 617

Gender-specific 10% cutoffs Overall 10% cutoffs

Late talker, 24 months 2.20** 2.17* 1.94* 2.06* 2.01* 1.80

but this was largely explained by the control variables in Discussion

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Approaches to Internalizing Externalizing

Late talker, 24 months 2.51** 2.19** 1.51 1.40 1.72* 1.78*

Hammer et al.: Late Talkers’ School Readiness 619

Approaches to Internalizing Externalizing

Late talker, 24 months 2.27** 2.10** 1.06 1.01 1.52 1.56

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Hammer et al.: Late Talkers’ School Readiness 621

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Hammer et al.: Late Talkers’ School Readiness 623

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Hammer et al.: Late Talkers’ School Readiness 625

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Late talker, 24 months 4.27* 4.26* 3.47* 3.71* 3.72* 2.92*

Late talker, 24 months 2.51 2.19 1.51 1.40 1.72* 1.78*

Late talker, 24 months 2.27 2.10 1.06 1.01 1.52 1.56