No AccessJournal of Speech, Language, and Hearing ResearchResearch Article1 Apr 2010

Risk and Protective Factors Associated With Speech and Language Impairment in a Nationally Representative Sample of 4- to 5-Year-Old Children


    To determine risk and protective factors for speech and language impairment in early childhood.


    Data are presented for a nationally representative sample of 4,983 children participating in the Longitudinal Study of Australian Children (described in McLeod & Harrison, 2009). Thirty-one child, parent, family, and community factors previously reported as being predictors of speech and language impairment were tested as predictors of (a) parent-rated expressive speech/language concern and (b) receptive language concern, (c) use of speech-language pathology services, and (d) low receptive vocabulary.


    Bivariate logistic regression analyses confirmed 29 of the identified factors. However, when tested concurrently with other predictors in multivariate analyses, only 19 remained significant: 9 for 2–4 outcomes and 10 for 1 outcome. Consistent risk factors were being male, having ongoing hearing problems, and having a more reactive temperament. Protective factors were having a more persistent and sociable temperament and higher levels of maternal well-being. Results differed by outcome for having an older sibling, parents speaking a language other than English, and parental support for children’s learning at home.


    Identification of children requiring speech and language assessment requires consideration of the context of family life as well as biological and psychosocial factors intrinsic to the child.


    • Almost, D., & Rosenbaum, P. (1998). Effectiveness of speech intervention for phonological disorders: A randomized controlled trial.Developmental Medicine and Child Neurology, 40, 319–325.
    • Australian Bureau of Statistics. (2003). 2039.0 Information paper: Census of population and housing – Socio-economic indexes for areas (SEIFA). Canberra, Australia: Author.
    • Australian Institute of Family Studies. (2007). Growing up in Australia: The Longitudinal Study of Australian Children. Retrieved June 29, 2007 from
    • Barr, J., McLeod, S., & Daniel, G. (2008). Siblings of children with speech impairment: Cavalry on the hill.Language, Speech, and Hearing Services in Schools, 39, 21–32.
    • U. Bronfenbrenner (Ed.), 2005). Making human beings human. Bioecological perspectives on human development. Thousand Oaks, CA: Sage.
    • Brookhouser, P. E., Hixson, P. K., & Matkin, N. D. (1979). Early childhood language delay: The otolaryngologist’s perspective.Laryngoscope, 89, 1898–1913.
    • Caldwell, B. M., & Bradley, R. H. (1984). Home observation for measurement of the environment. Little Rock: University of Arkansas Press.
    • Campbell, T. F., Dollaghan, C. A., Rockette, H. E., Paradise, J. L., & Feldman, H. M. (2003). Risk factors for speech delay of unknown origin in 3-year-old children.Child Development, 74, 346–357.
    • Chevrie-Muller, C., Watier, L., Arabia, J., Arabia, C., & Dellatolas, G. (2005). Teachers' screening for language and behaviour difficulties in 2059 children aged 3,5 years.Revue d’Epidémiologie et de Santé Publique, 53, 645–657.
    • Choudhury, N., & Benasich, A. A. (2003). A family aggregation study: The influence of family history and other risk factors on language development.Journal of Speech, Language, and Hearing Research, 46, 261–272.
    • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
    • Coplan, J. G., Gleason, J. R., Ryan, R., Bourke, M. G., & Williams, M. L. (1982). Validation of an early language milestone scale in high-risk population.Pediatrics, 70, 677–683.
    • Desmarais, C., Sylvestre, A., Meyer, F., Bairati, I., & Rouleau, N. (2008). Systematic review of the literature on characteristics of late-talking toddlers.International Journal of Language and Communication Disorders, 43, 361–389.
    • Dollaghan, C. A., & Campbell, T. F. (2009). How well do poor language scores at ages 3 and 4 predict poor language scores at age 6?.International Journal of Speech-Language Pathology, 11, 358–365.
    • Felsenfeld, S., & Plomin, R. (1997). Epidemiological and offspring analyses of developmental speech disorders using data from the Colorado Adoption Project.Journal of Speech, Language, and Hearing Research, 40, 778–791.
    • Fox, A. V., Dodd, B., & Howard, D. (2002). Risk factors for speech disorders in children.International Journal of Language and Communication Disorders, 37, 117–132.
    • Furukawa, T. A., Kessler, R. C., Slade, T., & Andrews, G. (2003). The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being.Psychological Medicine, 33, 357–362.
    • Gibbard, D., Coglan, L., & MacDonald, J. (2004). Cost-effectiveness analysis of current practice and parent intervention for children under 3 years presenting with expressive language delay.International Journal of Language and Communication Disorders, 39, 229–244.
    • Glascoe, F. P. (2000). Parents' Evaluation of Developmental Status: Authorised Australian version. Parkville, Australia: Centre for Community Child Health.
    • Harrison, L. J., McLeod, S., Berthelsen, D., & Walker, S. (2009). Literacy, numeracy, and learning in school-aged children identified as having speech and language impairment in early childhood.International Journal of Speech-Language Pathology, 11, 392–403.
    • Harrison, L., & Ungerer, J. (2005). What can the Longitudinal Study of Australian Children tell us about infants' and 4 to 5-year-olds' experiences of early childhood education and care?.Family Matters, 72, 26–35.
    • Harrison, L. J., Ungerer, J. A., Smith, G. J., Zubrick, S. R., Wise, S., with Press, F., & Waniganayake, M., the LSAC Research Consortium (2009). Child care and early education in Australia. The Longitudinal Study of Australian Children.Social Policy Research Paper No. 40. Canberra, Australia: Australian Government Department of Families, Housing, Community Services and Indigenous Affairs.
    • Hauner, K. K. Y., Shriberg, L. D., Kwiatkowski, J., & Allen, C. T. (2005). A subtype of speech delay associated with developmental psychosocial involvement.Journal of Speech, Language, and Hearing Research, 48, 635–650.
    • Hwa-Froelich, D. A., & Westby, C. E. (2003). Frameworks of education: Perspectives of Southeast Asian parents and Head Start staff.Language, Speech, and Hearing Services in Schools, 34, 299–319.
    • Hosmer, D. W., & Lemeshow, S. (1989). Applied logistic regression. New York: Wiley.
    • Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., & Mroczek, D. K. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress.Psychological Medicine, 32, 959–976.
    • Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., & Gfroerer, J. C. (2003). Screening for serious mental illness in the general population.Archives of General Psychiatry, 60, 184–189.
    • King, T. M., Rosenberg, L. A., Fuddy, L., McFarlane, E., Sia, C., & Duggan, A. K. (2005). Prevalence and early identification of language delays among at-risk three year olds.Journal of Developmental and Behavioral Pediatrics, 26, 293.
    • Law, J., Boyle, J., Harris, F., Harkness, A., & Nye, C. (2000). Prevalence and natural history of primary speech and language delay: Findings from a systematic review of the literature.International Journal of Language and Communication Disorders, 35, 165–188.
    • Luinge, M. R., Post, W. J., Wit, H. P., & Goorhuis-Brouwer, S. M. (2006). The ordering of milestones in language development for children from 1 to 6 years of age.Journal of Speech, Language, and Hearing Research, 49, 923–940.
    • Lyytinen, H., Ahonen, T., Eklund, K., Guttorm, T. K., & Laakso, M.-L. (2001). Developmental pathways of children with and without familial risk for dyslexia during the first years of life.Developmental Neuropsychology, 20, 535–554.
    • McLeod, S., & Harrison, L. J. (2009). Epidemiology of speech and language impairment in a nationally representative sample of 4- to 5-year-old children.Journal of Speech, Language, and Hearing Research, 52, 1213–1229.
    • McLeod, S., & McKinnon, D. H. (2007). The prevalence of communication disorders compared with other learning needs in 14,500 primary and secondary school students.International Journal of Language and Communication Disorders, 42(S1)37–59.
    • National Institute of Child Health and Human Development Early Child Care Research Network (2004). Multiple pathways to early academic achievement.Harvard Educational Review, 74, 1–29.
    • Nelson, H. D., Nygren, P., Walker, M., & Panoscha, R. (2006). Screening for speech and language delay in preschool children: Systematic evidence review for the U.S. Preventive Services Task Force.Pediatrics, 117, e298–e319.
    • Peters, S. A., Grievink, E. H., van Bon, W. H., van den Bercken, J. H., & Schilder, A. G. (1997). The contribution of risk factors to the effect of early otitis media with effusion on later language, reading, and spelling.Developmental Medicine and Child Neurology, 39, 31–39.
    • Prior, M., Bavin, E. L., Cini, E., Reilly, S., & Bretherton, L. (2008). Influences on communicative development at 24 months of age: Child temperament, behaviour problems, and maternal factors.Infant Behavior and Development, 31, 270–279.
    • Reilly, S., Bavin, E. L., Bretherton, L., Conway, L., & Eadie, P. (2009). The Early Language in Victoria Study (ELVS): A prospective, longitudinal study of communication skills and expressive vocabulary development at 8, 12 and 24 months.International Journal of Speech-Language Pathology, 11, 344–357.
    • Reilly, S., Eadie, P., Bavin, E. L., Wake, M., & Prior, M. (2006). Growth of infant communication between 8 and 12 months: A population study.Journal of Paediatrics and Child Health, 42, 764–770.
    • Reilly, S., Wake, M., Bavin, E. L., Prior, M., & Williams, J. (2007). Predicting language at 2 years of age: A prospective community study.Pediatrics, 120, e1441–e1449.
    • Rothman, S. (2003, June). An Australian version of the Adapted PPVT–III for use in research. Unpublished manuscript, Australian Council for Educational Research
    • Roulstone, S., Miller, L. L., Wren, Y., & Peters, T. J. (2009). The natural history of speech impairment of 8-year-old children in the Avon Longitudinal Study of Parents and Children: Error rates at 2 and 5 years.International Journal of Speech-Language Pathology, 11, 381–391.
    • Rowe, M. L., & Goldin-Meadow, S. (2009, February13). Differences in early gesture explain SES disparities in child vocabulary size at school entry.Science, 323, 951–953.
    • Sanson, A., Hemphill, S. A., & Smart, D. (2004). Connections between temperament and social development: A review.Social Development, 13, 142–170.
    • Sanson, A., Nicholson, J., Ungerer, J., Zubrick, S., & Wilson, K. (2002). Introducing the Longitudinal Study of Australian Children (LSAC Discussion Paper No. 1). Melbourne: Australian Institute of Family Studies.
    • Sanson, A., Prior, M., Garino, E., Oberklaid, F., & Sewell, J. (1987). The structure of infant temperament: Factor analysis of the Revised Infant Temperament Questionnaire.Infant Behavior and Development, 10, 97–104.
    • Schwarz, I. E., & Nippold, M. A. (2002). The importance of early intervention.Advances in Speech-Language Pathology, 4, 69–73.
    • Shriberg, L. D., Friel-Patti, S., Flipsen, P. J., & Brown, R. L. (2000). Otitis media, fluctuant hearing loss, and speech-language outcomes: A preliminary structural equation model.Journal Speech, Language, and Hearing Research, 43, 100–120.
    • Singer, L. T., Siegel, A. C., Lewis, B., Hawkins, S., Yamashita, T., & Baley, J. (2001). Preschool language outcomes of children with history of bronchopulmonary dysplasia and very low birth weight.Journal of Developmental and Behavioral Pediatrics, 22, 19–26.
    • Stanton-Chapman, T. L., Chapman, D. A., Bainbridge, N. L., & Scott, K. G. (2002). Identification of early risk factors for language impairment.Research in Developmental Disabilities, 23, 390–405.
    • Tabachnick, B. G., & Fidell, L. (2001). Using multivariate statistics. Boston, MA: Allyn & Bacon.
    • Tallal, P., Ross, R., & Curtiss, S. (1989). Familial aggregation in specific language impairment.Journal of Speech and Hearing Disorders, 54, 167–173.
    • Tomblin, J. B., Hardy, J. C., & Hein, H. A. (1991). Predicting poor-communication status in preschool children using risk factors present at birth.Journal of Speech and Hearing Research, 34, 1096–1105.
    • Tomblin, J. B., Smith, E., & Zhang, X. (1997). Epidemiology of specific language impairment: Prenatal and perinatal risk factors.Journal of Communication Disorders, 30, 325–344.
    • U.S. Preventative Services Task Force (2006). Screening for speech and language delay in preschool children: Recommendation statement.American Family Physician, 73, 1605–1610.
    • Wake, M., Sanson, A., Berthelsen, D., Hardy, P., & Mission, S. (2008). How well are Australian infants and children aged 4 to 5 doing? Findings from the Longitudinal Study of Australian Children Wave 1 (Social Policy Research Paper No. 36). Canberra: Commonwealth of Australia.
    • Weindrich, D., Jennen-Steinmetz, C., Laucht, M., Esser, G., & Schmidt, M. H. (2000). Epidemiology and prognosis of specific disorders of language and scholastic skills.European Child and Adolescent Psychiatry, 9, 186–194.
    • Whitehurst, G. J., Arnold, D. S., Smith, M., Fischel, J. E., Lonigan, C. J., & Valdez-Menchaca, M. C. (1991). Family history in developmental expressive language delay.Journal of Speech and Hearing Research, 34, 1150–1157.
    • World Health Organization. (2007). International classification of functioning, disability and health—Version for children and youth: ICF-CY. Geneva, Switzerland: Author.
    • Yliherva, A., Olsen, P., Maki-Torkko, E., Koiranen, M., & Jarvelin, M. R. (2001). Linguistic and motor abilities of low-birthweight children as assessed by parents and teachers at 8 years of age.Acta Paediatrica, 90, 1440–1449.
    • Yoshinaga-Itano, C., Sedey, A. L., Coulter, D. K., & Mehl, A. L. (1998). Language of early- and later-identified children with hearing loss.Pediatrics, 102, 1161–1171.
    • Zubrick, S. R., Taylor, C. L., Rice, M. L., & Slegers, D. W. (2007). Late language emergence at 24 months: An epidemiological study of prevalence, predictors, and covariates.Journal of Speech, Language, and Hearing Research, 50, 1562–1592.

    Additional Resources