LWW/IYC IYC200089 February 23, 2012 1:31

Infants & Young Children

Vol. 25, No. 2, pp. 158–171
Copyright C 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Factors Associated With

Expressive and Receptive
Language in French-Speaking
Toddlers Clinically Diagnosed
With Language Delay
Audette Sylvestre, PhD; Chantal Desmarais, PhD;
François Meyer, PhD; Isabelle Bairati, PhD;
Nancie Rouleau, PhD; Chantal Mérette, PhD
The purpose of this exploratory study was to examine child and environmental factors known to
be associated to language development and how they relate to results in expressive vocabulary,
expressive language, and receptive language in language-delayed toddlers. The cross-sectional
data on 96 French-speaking children aged 18–36 months were gathered at the point of entry
into a longitudinal study of 2-year-old children displaying language delay. Measures of language,
child development, and child and environmental factors were administered. When several factors
individually associated with language development were considered concurrently, cognitive devel-
opment was consistently associated with the outcomes. Other child factors, such as male gender
and age, were also retained in the regression model explaining expressive vocabulary, whereas
only age was added in the model explaining expressive language. Two environmental factors
were involved in receptive language; that is, parental education and parental stress accounted for
8% of the variance. Factors linked to development varied across language modalities such that
parental education and parental stress were related to comprehension but not to production. The
findings suggest a strong biological trajectory for expressive language development and vocabu-
lary production, which are not affected by environmental factors. Key words: environmental
factors, expressive language, French language, language delay, receptive language, toddlers,
vocabulary

Author Affiliations: Département de réadaptation,
Programme de maı̂trise en orthophonie, Université
Laval, Centre Interdisciplinaire de Recherche en
Réadaptation et Intégration Sociale, Québec, Canada
(Drs Sylvestre and Desmarais); Département de
médecine sociale et préventive, Université Laval,
Centre de Recherche L’Hôtel-Dieu-de-Québec, Québec,
Canada (Dr Meyer); Département de chirurgie,
Université Laval and Direction de Santé publique de
la Capitale-Nationale, Québec, Canada (Dr Bairati);
École de psychologie (Dr Rouleau) and Département
de psychiatrie (Dr Merette), Université Laval, Centre
de Recherche Université Laval—Robert Giffard,
Québec, Canada.
This study was supported by Grant 6472 from the Fonds
de la recherche en santé du Québec (Quebec Fund for
Health Research).
The authors thank Lyne Champoux, Karine Messier,
Hélène Crépeau, Olga Gordynska, Isabel Moreau, and
numerous research assistants as well as statistics con-
sultants for their assistance. They also thank the SLPs
who collaborated in the recruitment of participants
and the children and parents who generously gave of
their time to participate in this study.
The authors have disclosed that they have no signif-
icant relationships with, or financial interest in, any
commercial companies pertaining to this article.
Correspondence: Audette Sylvestre, PhD, Département
de réadaptation, Programme de maı̂trise en ortho-
phonie, Pavillon Ferdinand-Vandry, Université Laval,
1050, avenue de la Médecine, Québec, QC, Canada G1V
0A6 (audette.sylvestre@rea.ulaval.ca).
DOI: 10.1097/IYC.0b013e31823dca22

158

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LWW/IYC IYC200089 February 23, 2012 1:31
Factors Associated With Language Delay
L ANGUAGE DELAY (LD) represents the
most prevalent developmental problem
among young children (Law, 1992). Various
studies have established that 10%–19% of in-
fants younger than 3 years are affected by
LD without any identified underlying explana-
tory cause (Dale, Price, Bishop, & Plomin,
2003; Horwitz et al., 2003; Klee et al., 1998;
Reilly et al., 2007; Rescorla, 1989; Zubrick,
Taylor, Rice, & Slegers, 2007). Having early
LD places a child at risk to experience be-
havioral and psychosocial adjustment prob-
lems at preschool age, as well as later learning
difficulties (Carson, Klee, Perry, Donaghy, &
Muskina, 1997; Justice, Invernizzi, & Meier,
2002; Vigil, Hodges, & Klee, 2005). Language
development depends on complex interac-
tions between neurobiological and environ-
mental stimuli (Elman et al., 1996; Garbarino
& Ganzel, 2000; Shonkoff & Marshall, 2000).
Therefore, to better define the targets of pre-
vention and early intervention programs for
children affected by LD, one must identify the
factors linked to this condition.
Several studies have been carried out to in-
ventory factors linked to early language de-
velopment, and those results are summarized
in various systematic reviews (Desmarais,
Sylvestre, Meyer, Bairati, & Rouleau, 2008;
Nelson, Nygren, Walker, & Panoscha, 2006;
Prathanee et al., 2009; Prathanee, Thinkham-
rop, & Dechongkit, 2007). Results reveal the
diversity of factors associated with negative
outcomes in language development, such as
male gender, prematurity, low birth weight,
family history of language or learning disabili-
ties, single parenthood, small family size, late
birth order, young age of mother (<18 years)
at birth of child, mother with severe depres-
sion, high parental stress, low parental educa-
tion, and low socioeconomic status. A close
association between language and cognition
has also been reported in explanatory models
of language development (Bates, Tomasello,
& Slobin, 2005; Hirsch-Pasek, Golinkoff,
Hennon, & Maguire, 2004).
In studies examining risk factors of early
LD, the outcome was almost exclusively ex-
pressive vocabulary, that is, to say the num-
ber of words the child uses (Desmarais et al.,
Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
159
2008). Few researchers have addressed the
study of factors likely to be related to language
expression in a broad sense, even if expres-
sive language integrates a number of linguis-
tic dimensions other than vocabulary itself,
including grammar and pragmatic skills. This
is also true for factors linked to language com-
prehension, despite the fact that a number
of children younger than 3 years with lexical
delays often exhibit more global language dif-
ficulties (Bishop, Price, Dale, & Plomin, 2003;
Desmarais, Sylvestre, Meyer, Bairati, &
Rouleau, 2010). Receptive language difficul-
ties, such as the inability to understand ques-
tions or instructions, are much less under-
stood because children with this problem are
frequently excluded from the studies (Hadley
& Holt, 2006; Rescorla & Merrin, 1998).
Within this context, the purpose of this
research was to examine the associations
between potential child and environmental
factors and early LD in terms of how they ex-
plain the developmental outcomes of 3 differ-
ent linguistic dimensions, that is, expressive
vocabulary, expressive language, and recep-
tive language, among French-speaking Que-
bec children who were clinically diagnosed
with LD between the ages of 18 months and
36 months.
METHODS
This study was conducted by using en-
try data of a longitudinal study, including
2-year-old white French-speaking Quebec
children with LD. Children were recruited be-
tween February 2005 and January 2007 via 10
speech–language pathologists (SLPs) working
in health units of the Quebec City region in
Canada. To participate in the study, children
had to be between 18 months and 36 months
old and diagnosed with LD based on the clini-
cal evaluation performed by the SLPs. To carry
out the evaluation, the SLP met the parent and
child for one session during which a parent-
child play interaction was observed and the
child’s utterances were recorded. The clini-
cian then interviewed the parent to complete
the data collection necessary to confirm the
presence of LD. Children were not eligible if
LWW/IYC IYC200089 February 23, 2012 1:31
160 INFANTS & YOUNG CHILDREN/APRIL–JUNE 2012
their LD was associated with a known underly-
ing cause. This research was approved by the
Laval University research ethics committee.
Subjects
For the purpose of the current study, six
participants were excluded from the entire
cohort of 102 children since they spoke not
only French but also a second language at an
advanced level, relative to their age. A total
of 96 children (69 boys and 27 girls) whose
average ages were 29.4 months (SD = 4.4)
participated in the study.
Materials and procedures
Data collection was carried out by two
trained research assistants during a 2-hr in-
home visit, 2–3 weeks after the SLP assess-
ment. One research assistant verified that
the parent had properly filled out the previ-
ously mailed French–Canadian version of the
MacArthur Bates Communicative Develop-
ment Inventories (MBCDI; Fenson et al., 1993;
Trudeau, Frank, & Poulin-Dubois, 1999) used
to evaluate the child’s expressive vocabulary.
Additional information was collected through
structured questionnaires administered face-
to-face with the index parent (typically
the child’s mother). Those questionnaires al-
lowed for the gathering of information con-
cerning the expressive and receptive lan-
guage development of the child, as well as
the factors under investigation. Meanwhile,
the child’s cognitive development was evalu-
ated by the second research assistant.
Structured questionnaires, already used in
a large health survey and other cohort studies
conducted in the province of Quebec, were
administered during the home visit.
Language assessment
The three dependent variables measured
were expressive vocabulary, expressive lan-
guage, and receptive language. Vocabulary
was evaluated by using the long form of the
16- to 30-month French–Canadian version of
the MBCDI (Trudeau et al., 1999). It com-
prises a list of 664 words grouped in 21 cat-
egories among which the parent identifies
Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
those that the child uses. The total number of
words instead of the percentile rank was se-
lected for the analyses because some children
in the sample were older than 30 months.
Expressive and receptive languages were
evaluated by using the parental French–
Canadian version of the Rossetti Infant Tod-
dler Language Scale (ITLS; Rossetti, 1990;
Sylvestre & St-Cyr Tribble, 2001). It is a
criterion-referenced tool where each scale is
divided into twelve 3-month intervals. It is
used to compare a child’s performance to gen-
eral developmental standards and does not
provide a standardized score. For the pur-
pose of the study herein, a score was derived
by using a statistical saturation procedure, by
way of establishing the percentage of correct
responses related to four age intervals per
scale, that is, the interval corresponding to
the child’s age as well as to the three preced-
ing intervals (Desmarais et al., 2010).
Selected factors
A structured questionnaire was adminis-
tered to evaluate the sociodemographic sta-
tus (e.g., age, education, income, and family
composition); perinatal history (e.g., number
of weeks of gestation, baby’s weight at birth,
and maternal postnatal depression); and his-
tory of language, hearing, or learning prob-
lems in the family.
The Parenting Stress Index—Short Form
(Abidin, 1990) was designed to evaluate the
level of stress experienced by an adult in
his/her role as a parent. It consists of 36 items,
which the parent answers by using a 5-point
Likert scale. A high score reveals a high level of
stress. The French–Canadian translation of the
original tool was validated by its authors, yield-
ing coefficients of internal coherence rang-
ing from 0.46 to 0.82 (Bigras, LaFrenière, &
Abidin, 1995).
The language stimulation style adopted
by the parent was measured by using the
Communication Stimulation Questionnaire
(Sylvestre, St-Cyr Tribble, Payette, & Cronk,
1998). The tool includes seven scenarios for
each of the age groups. Scenarios such as
“Imagine that your child has finished his meal
LWW/IYC IYC200089 February 23, 2012 1:31
Factors Associated With Language Delay
and pushes his plate saying ‘no eat’; tell
me what you say and do” are presented to
the parent. The answers are transcribed and
then analyzed. Twenty-seven indicators help
to pinpoint the style used for each scenario.
Language stimulation style is determined by
adding the results of each scenario. This tool
assigns the parents’ styles to one of the two
categories, supportive or directive (Kloth,
Janssen, Kraaimaat, & Brutten, 1998). After
18 months of age, directive style is considered
to represent a child development risk factor
(Hampson & Nelson, 1993).
The French–Canadian version (Kovess &
Fournier, 1990) of the Composite Interna-
tional Diagnostic Interview Simplified (Robins
et al., 1988) was used to diagnose the pres-
ence of parental major depression during the
last 6 months from the respondent’s point of
view. Analysis provides a dichotomous score,
indicating the presence or absence of such
a depression. The comparison between the
diagnoses made by using Composite Inter-
national Diagnostic Interview Simplified with
those made by psychiatrists in both Quebec
and France yields a kappa of 0.47 for depres-
sive disorders (Fournier, Lesage, Phil, Toupin,
& Cyr, 1997).
Finally, the Mental Development Index
of the Bayley Scales of Infant and Toddler
Development–II (BSITD-II; Bayley, 1993) was
used to evaluate the child’s cognitive develop-
ment. This tool is designed for use with chil-
dren aged 1–42 months and is widely used
in research settings with late-talking children.
The Mental Development Index scale evalu-
ates memory, habituation, problem solving,
number concepts and generalization, classi-
fication, and language and social skills. The
distribution of the BSITD scores is age stan-
dardized (within 1-month interval) to a mean
of 100 and a standard deviation of 15. The
tool’s homogeneity is 0.88, whereas inter-
judge agreement yields a coefficient of 0.96
and a stability coefficient of 0.83. The mental
scale is highly correlated with the Weschler
Preschool and Primary Scale of Intelligence—
Revised (Weschler, 1989) with coefficients
of 0.73, confirming good concurrent validity
Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
161
for intellectual functioning. The administra-
tion was carried out in a standardized fashion
according to the instructions provided in the
test manual.
Data analysis
All analyses were performed using
SAS/STAT software, Version 9.2 of the SAS
System for Windows. Copyright 2002–2008
SAS Institute Inc. SAS and all other SAS
Institute Inc. product or service names are
registered trademarks or trademarks of SAS
Institute Inc., Cary, NC. We first estimated the
bivariate association between each of the 3
dependent variables (expressive vocabulary,
expressive language, and receptive language)
and the predictive factors by calculating a
Pearson correlation coefficient using the
CORR procedure of SAS or by performing
Student’s t testing for a categorical factor
using the TTEST procedure of SAS. Then,
for each of the three outcomes, all factors
associated with p ≤ .10 in the bivariate
analysis were considered as candidate factors
(CFs) in a multivariate linear regression
analysis that tests their independent and joint
contribution on language development using
the REG procedure of SAS. Because of the
exploratory nature of the study, the analyses
were conducted by using a stepwise selection
procedure, specifying .05 as the significance
level for entry and for staying in the model.
For each step of the stepwise analysis, we
manually calculated the degrees of freedom
(df) such that the number of df for the model
is given by the number of CFs considered in
the analysis (Thompson, 1995) rather than
the number of factors retained in the model,
as actually used in the “stepwise selection”
option of the REG procedure of SAS. The
number of df for the error is then n − 1 −
CF, where n is the number of subjects. This is
explained by the fact that, at each step of the
stepwise selection, the factors retained in the
model are not randomly selected but rather
chosen among all CFs not yet entered in
the model, taken into account those already
retained. Hence, through the entire selection
process, the number of df will be fixed to
LWW/IYC IYC200089 February 23, 2012 1:31
162 INFANTS & YOUNG CHILDREN/APRIL–JUNE 2012
the number of CFs. In addition, given that
any stepwise selection does not guarantee to
identify the best set of predictive variables,
we performed another method of selection
based on the coefficient of determination R2
(the RSQUARE option of the REG procedure
of SAS). Using the RSQUARE selection of SAS,
we selected the best subset of independent
variables that best predict an outcome by
maximizing the R2 , fixing the subset size to
the number of variables retained in the final
models of the previous stepwise selections.
In the case of expressive vocabulary, the
child’s age was forced into the model because
the measurement scale does not take age
into account, which is a main determinant
of language development. This procedure
allowed us to consider the influence of other
factors, beyond the role played by the child’s
age. The validation of each of the final models
was carried out by using a residual analysis
to verify the assumptions of homogeneity
of variance and normality. Noncollinearity
and assumptions of linear regression were
verified on all models. The partial coefficient
of determination (partial R2 values) was used
to measure, at each step, the gain in the
proportion of the total variance explained by
the model.
RESULTS
The various sociodemographic characteris-
tics and the distribution of the selected fac-
tors are shown in Table 1. The distribution
of the sociodemographic characteristics re-
vealed that families were mostly in the middle
and upper-middle socioeconomic status cate-
gories.
Scores of language development are shown
in Table 2. The MBCDI data are missing for
one participant. Some LD children obtained
low scores in one dimension of language,
for example, expressive language, and not
in another, for example, receptive language,
which explains the range of scores up to
100% for the ITLS. The distribution for all
three assessed dimensions is compatible with
the Gaussian variable distribution hypothesis
Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
(normality test), according to the results of
the descriptive flattening (kurtosis) and sym-
metry tests (skewness) (results not shown).
Bivariate analyses between each language
variable and selected factors are shown in
Table 3. A review of the table shows that fac-
tors relating to expressive vocabulary size at
p ≤.10 include being a boy (p = .01), child’s
age (p <.0001), birth weight (p = .009), and
cognitive development (p <.0001). In terms
of expressive language, being a boy (p = .03),
child’s age (p <.0001), and cognitive devel-
opment (p <.0001) are the factors related to
development. Factors related to receptive lan-
guage incorporate being a boy (p = .02), ed-
ucation of index parent (p = .05), cognitive
development (p <.0001), number of weeks
of pregnancy (p = .05), family size (p = .07),
and parental stress (p = .009). Hence, the
three language variables had four, three, and
six CFs, respectively, that were considered in
the following multivariate regressions.
The results from the stepwise selection pro-
cedure of the multivariate regression analysis
relating the CFs to expressive vocabulary are
shown in Table 4. The final model, obtained in
three steps, explains 48% of the total variance
and 12% aside from the child’s age. According
to this final model detailed in Table 5, boys
had fewer words in their expressive vocabu-
lary than girls and a higher level of cognitive
development was associated with better ex-
pressive vocabulary.
In the multivariate regression model pre-
dicting the expressive language, two factors
were retained, explaining 33% of the total
variance (Table 6). Table 7 shows that both
child cognitive development (p <.0001) and
age (p = .002) were highly significant. Given
the ITLS characteristics and the fact that age
entered the model, it seemed that being lo-
cated closer to the upper end of the bracket
for each 3-month interval was associated with
better skills in terms of language expression.
Analysis also revealed that better cognitive de-
velopment was associated with better expres-
sive language.
The results from the multivariate regres-
sion model created to account for all factors
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Factors Associated With Language Delay 163

Table 1. Participants’ Characteristics (N = 96)

Observed
Mean (SD) Range N (%)

Child’s age (mo) 29.4 (4.4) 18–36

Child’s gender (male) 69 (71.9)
Child’s cognitive developmenta 85.8 (12.7) 50–115
Number of weeks of pregnancy 39.0 (1.6) 33.4–41.6
Birth weight (g) 3391.3 (483.9) 2060–4180
Family history of language or learning problems 13 (13.5)
Family type (other than biparental) 8 (8.3)
Family size 1.9 (0.8) 1–4
Birth order 1.6 (0.7) 1–4
Age of mothers at child’s birth 29.6 (4.6) 18–39
Postpartum depression 7 (7.3)
Major depression in past 6 monthsb 4 (4.2)
Communication stimulation style (directive)c 77 (80.2)
Parental stress (36–180)d 72.6 (16.2) 43–118
Education of respondent parent (< high school) 35 (36.5)
Income (<$40 000) 22 (22.9)

a Mental Development Index of the Bayley Scales of Infant and Toddler Development—II (Bayley, 1993).
b Composite International Diagnostic Interview Simplified (Robins et al., 1988).
c Communication Stimulation Questionnaire (Sylvestre et al., 1998).
d Parenting Stress Index—Short Form (Abidin, 1990).

simultaneously related to receptive language development had better receptive language

are shown in Table 8. Parental level of ed-
ucation and parental stress added 8% to the
percentage of the variance already explained
by the cognitive development, that is, 4% and
4%, respectively. The final model explains
31% of the variance and was obtained in three
steps. According to the final model (Table 9),
for a given education level and parental
stress level, children with better cognitive
(p <.0001). Children with the same level of
cognitive development and whose index par-
ents had the same level of stress had weaker
scores on receptive ITLS when the parents
were less educated (p = .03). Also, after taking
cognitive development and education level
into account, children whose parents had
higher stress level had lower scores on the
receptive language scale (p = .005).

Table 2. Language Development Scores (N = 96)

Observed
Mean (SD) Range

Expressive vocabulary—total number of words—MBCDIa,b 163.3 (135.4) 5–552

(0–664)
Expressive language—ITLSc (0%–100%) 60.9 (24.7) 0–100
Receptive language—ITLSc (0%–100%) 78.4 (19.7) 6.2–100

aN = 95.
b MBCDI, MacArthur Bates Communicative Development Inventories (MBCDI; Fenson et al., 1993; Trudeau et al., 1999).
c ITLS, Infant Toddler Language Scale (Rossetti, 1990; Sylvestre & St-Cyr Tribble, 2001).

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
 Table 3. Bivariate Analysis Between Selected Factors and Language Variables (N = 96)
LWW/IYC

Expressive
164

vocabulary Number Expressive Receptive

of words (MBCDI) Language (ITLS) Language (ITLS)
Total Sample
IYC200089

N (%) Mean (SD) p Mean (SD) p Mean (SD) p

a
Child’s gender
Male 69 (71.9) 138.7 (114.1) .01 57.4 (24.6) .03 75.9 (21.2) .02
Female 27 (28.1) 228.6 (165.4) 69.7 (23.2) 84.6 (13.7)
Family history language or learning problemsa
Yes 13 (13.5) 159.5 (127.5) .91 56.2 (28.4) .46 74.1 (23.9) .40
No 83 (86.5) 163.9 (137.3) 61.6 (24.2) 79.0 (19.0)
February 23, 2012

Family typea
Other 8 (8.3) 228.2 (170.1) .16 71.8 (25.1) .19 76.4 (8.4) .56
Biparental 88 (91.7) 157.4 (131.3) 59.9 (25.1) 78.6 (20.4)
Postpartum depressiona
1:31

Yes 7 (7.3) 140.6 (183.1) .65 52.2 (34.5) .34 72.6 (31.4) .42
No 89 (92.7) 165.1 (132.1) 61.6 (23.9) 78.8 (18.7)
Maternal major depression in past 6 monthsa
Yes 4 (4.2) 102.7 (86.7) .36 49.3 (32.4) .34 64.1 (38.6) .14
No 92 (95.8) 166.0 (136.8) 61.4 (24.4) 79.0 (18.6)
Communication stimulation style of index parenta
Directive 77 (80.2) 154.4 (134.4) .20 61.2 (23.4) .81 75.3 (18.9) .44
INFANTS & YOUNG CHILDREN/APRIL–JUNE 2012

Facilitating 19 (19.8) 199.2 (136.7) 59.6 (30.2) 75.3 (23.0)

Education of index parenta
<High school 35 (36.5) 183.9 (144.4) .26 60.5 (28.5) .92 75.6 (20.9) .05
High school and more 61 (63.5) 151.3 (129.5) 61.1 (22.5) 80.0 (18.9)
Incomea
<$40,000 22 (22.9) 179.2 (136.8) .53 59.0 (26.7) .69 73.9 (21.2) .22
$40,000 and more 74 (77.1) 158.5 (135.5) 61.4 (24.3) 79.7 (19.2)
Mean (SD) r r r
Child’s age (mo)b 29.4 (4.4) 0.60 <.0001 0.38 <.0001 − 0.01 .90
Child’s cognitive developmentb 85.8 (12.7) 0.36 <.0001 0.51 <.0001 0.48 <.0001
Number of weeks of pregnancyb 39.0 (1.6) − 0.01 .89 0.01 .91 0.20 .05
Birth weight (g)b 3391.3 (483.9) − 0.27 .009 − 0.12 .23 0.04 .71
Family sizeb 1.9 (0.8) − 0.08 .44 0.05 .60 0.19 .07
Birth orderb 1.6 (0.7) − 0.16 .12 − 0.07 .50 0.16 .13
Age of mother at child’s birthb 29.6 (4.6) − 0.15 .15 − 0.06 .57 0.02 .82
Parental stressb 72.6 (16.2) − 0.09 .38 0.02 .81 − 0.27 .009

Note. ITLS = Infant Toddler Language Scale; MBCDI = MacArthur Bates Communicative Development Inventories.
a p value resulting from a Student t test.
b p value resulting from a Pearson correlation.

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
LWW/IYC IYC200089 February 23, 2012 1:31

Factors Associated With Language Delay 165

Table 4. Summary of Each Step of the Stepwise Procedure Based on Thompson (1995) for
Expressive Vocabulary (N = 95)

Corrected
Degree of
Candidate Freedom Sum of Squares
Factors Entered Partial
Step into the Model Model Error Model Error F p R2

1 Child’s age 4 90 614 439 1 108 065 12.5 <.0001 .36

2 Child’s age + 4 90 764 951 957 554 18.0 <.0001 .09
Child’s gender
3 Child’s age + 4 90 815 399 907 106 20.2 <.0001 .03
Child’s gender
+ Child’s
cognitive
development
Total .48

Note. For expressive vocabulary, there were four candidate factors: child’s gender; child’s age; child’s cognitive devel-
opment; and birth weight.

Table 5. Summary of Regression Analysis of Factors Related to Expressive Vocabulary

(N = 95)

95% Confidence
Nonstandardized Standardized Interval for β
Candidate Factors
Entered into the Coefficients Coefficients Lower Upper
Model β SE β β p Bound Bound

Child’s age (month) 16.97 2.40 .55 < .0001 12.20 21.74
Child’s gender (male) − 79.66 23.37 − .26 0.001 − 126.08 − 33.24
Child’s cognitive 1.89 0.84 .18 0.03 0.22 3.56
development

Table 6. Summary of Each Step of the Stepwise Procedure Based on Thompson (1995) for
Expressive Language (N = 96)

Candidate Factorsa Corrected df Sum of Squares

Entered into the
Step Model Model Error Model Error F p Partial R2

1 Child’s cognitive 3 92 15 019 43 035 10.7 <.0001 .26

development
2 Child’s cognitive 3 92 19 126 38 929 15.1 <.0001 .07
development +
Child’s age
Total .33

a For
expressive language, there were three candidate factors: child’s gender; child’s age; and child’s cognitive develop-
ment.

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LWW/IYC IYC200089 February 23, 2012 1:31

166 INFANTS & YOUNG CHILDREN/APRIL–JUNE 2012

Table 7. Summary of Regression Analysis of Factors Related to Expressive language (N = 96)

Nonstandardized Standardized 95% Confidence
Candidate Coefficients Coefficients Interval for β
Factors Entered
into the Model β SE β β p Lower Bound Upper Bound

Child’s cognitive .86 .17 .44 <.0001 0.52 1.20

development
Child’s age (mo) 1.54 .49 .27 .002 0.56 2.51

Table 8. Summary of Each Step of the Stepwise Procedure Based on Thompson (1995) for
Receptive Language (N = 96)

Candidate Factorsa Corrected df Sum of Squares

Entered into the
Step Model Model Error Model Error F p Partial R2

1 Child’s cognitive 6 89 8,540 28 284 4.5 .0005 .23

development
2 Child’s cognitive 6 89 10,154 26 670 5.7 <.0001 .04
development +
Parental stress
3 Child’s cognitive 6 89 11,545 25 279 6.8 <.0001 .04
development +
Parental stress +
Education of
index parent
Total .31

a For
receptive language, there were six candidate factors: child’s gender; education of index parent; child’s cognitive
development; number of week of pregnancy; family size; and parental stress.

Table 9. Summary of Regression Analysis of Factors Related to Receptive Language (N = 96)

Nonstandardized Standardized 95% Confidence
Candidate Factors Coefficients Coefficients Interval for β
Entered into the
Model β SE β β p Lower Bound Upper Bound

Child’s cognitive .71 0.13 .46 <.0001 0.45 0.98

development
Parental stress − .31 0.11 − .26 .005 − 0.53 − 0.10
Education of index − 8.16 3.63 − .20 .03 − 15.36 − 0.96
parent (<high
school)

When we performed, for each outcome, the as those produced by the stepwise approach
nonsequential analysis by selecting the best (results not shown). Hence, the final models
subset of CFs that best predicted the outcome, that we presented were robust to the method
we obtained exactly the same set of factors of selection.

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LWW/IYC IYC200089 February 23, 2012 1:31
Factors Associated With Language Delay
DISCUSSION
The purpose of this study was to exam-
ine potential factors that were related to ex-
pressive vocabulary, expressive language, and
receptive language among French-speaking
children from Quebec diagnosed with LD be-
tween the ages of 18 months and 36 months.
When several factors were considered con-
currently, cognitive development was consis-
tently associated with language development.
Other child factors such as male gender and
age were also retained in the regression model
explaining expressive vocabulary, whereas
only age was added to cognitive development
in the model explaining expressive language.
Two environmental factors were involved in
the development of receptive language, with
parental level of education and parental stress
accounting for a part of the variance. Taken
individually, many factors were not signifi-
cantly related to LD. The absence of links with
positive family history is particularly strik-
ing, considering the strength of association
highlighted in recent epidemiological studies
(Reilly et al., 2007; Zubrick et al., 2007).
Links that were expected between cogni-
tive development and each of the linguistic
dimensions investigated may at least in part be
explained by the fact that the mental scale of
the BSITD-II (Bayley, 1993) comprises many
items that test verbal abilities. Nevertheless,
these links are not surprising, considering the
well-known mutual and reciprocal influences
of these two spheres of development. Our re-
sults converge with the point of view that lan-
guage and cognitive development rest on a
unified developing system using a common
set of domain-general learning mechanisms
and representational resources (Bates et al.,
2005; Marchman & Thal, 2005).
With regard to the other factors measured
in this study, the lack of association between
language development and several factors is
not consistent with results of previous reports
from community samples (Reilly et al., 2006;
Reilly et al., 2007; Zubrick et al., 2007). These
studies suggest a strong biological trajectory
for expressive language development and vo-
Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
167
cabulary production, which is not affected by
environmental factors. It does not, however,
apply to receptive language in our sample.
Children with low receptive language abili-
ties come from environments characterized
by low parental education and high levels of
parental stress. Links between education and
language development have been highlighted
in many studies on expressive language (Hoff
& Tian, 2005; Rowe, 2008). It has indeed been
shown that less-educated parents talk less, use
a less-varied vocabulary, and provide more
commands than do more educated parents
(Hoff, 2003). It has also been shown that high
levels of parental stress predict low expres-
sive language in children aged 18–39 months
(Horwitz et al., 2003) and low scores in gen-
eral language development in severely ne-
glected children aged 2–36 months (Sylvestre
& Mérette, 2010). However, to the best of our
knowledge, our results are the first to show a
specific link between these factors and recep-
tive language.
An important issue raised by our findings
is the question as to why factors are differ-
ent across modalities, that is, why parental
education and parental stress are related to
comprehension and not to production. One
possible explanation is that, in order for re-
ceptive language to develop, the child needs
more contextual cues than for expressive lan-
guage. When children are confronted with a
less-familiar word or statement, for example,
they rely on various strategies to compensate
for their lack of understanding such as cues
presented within the communication context
(Clark, 2004). To understand a message, chil-
dren have to go beyond the meaning of words
and sentences and grasp speech in real time,
integrate social context language, decode the
intentions of the persons speaking, and form
a representation of their communication in-
tentions (Diesendruck, Markson, Akhtar, &
Reudor, 2004). The manner in which the con-
text supports language comprehension de-
velopment is compounded by an analysis of
nonlinguistic indications, such as adult ges-
tures and glances directed toward a named ob-
ject (Paul, 2000). It is plausible that elevated
LWW/IYC IYC200089 February 23, 2012 1:31
168 INFANTS & YOUNG CHILDREN/APRIL–JUNE 2012
parental stress may affect the child’s availabil-
ity and regularity of routines, thereby reduc-
ing the quality and quantity of opportunities
to put the language and all the stimulation
provided into context (Most, Fidler, Laforce-
Booth, & Kelly, 2006).
One must keep in mind that the results of
the present study rely on cross-sectional ob-
servations. Given the continuous and longitu-
dinal nature of language development, the ab-
sence of a relationship at a given time may not
preclude such a relationship at other points in
time. It is plausible, for instance, that children
younger than 3 years do not yet differ suffi-
ciently, in terms of language, to reveal ma-
jor influences but that, as they grow and as
their language becomes more complex, the
links with certain factors may become appar-
ent. As language becomes more complex, it
is also possible that children will be faced
with different types of language difficulties
(Justice, Bowles, Pence, Turnbull, & Skibbe,
2009). Furthermore, the role of different fac-
tors may be significant at certain stages of
development, whereas if a factor appeared
earlier or later in time, it might have no ef-
fect. The timing of the occurrence of the fac-
tor would then be crucial for development.
In addition, once the factor has occurred, its
impact on language may be direct or remain
latent for some time and have a delayed con-
sequence on language. Another possibility is
that the duration of exposure to certain fac-
tors may be responsible for their effects. For
example, a child may need to be exposed to
major parental depression for some time for
a related effect to become apparent. A dose–
response effect can also be considered in that
the impact of a given factor may become ap-
parent only when it manifests itself with a cer-
tain magnitude (e.g., economic deprivation).
Finally, there could be a cumulative effect of
factors; that is, being exposed to many fac-
tors simultaneously may have more impact
than the nature of the individual factors, as
proposed in the model of cumulative risk fac-
tors (Rutter, Pickles, Murray, & Eaves, 2001;
Sameroff, Seifer, Zax, & Barocas, 1987).
Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Turning to the caveats of the study, it is
clear that the cross-sectional design prevents
any inference of the direction of the causal
relationships among the phenomena studied.
Indeed, given that the environmental factors
identified deal with the child–parent relation-
ship, the causality links may be bidirectional.
Moreover, despite the relatively large size of
our sample when compared to the corpus of
studies of LD children younger than 3 years,
it is also conceivable that it lacked statistical
power to detect links between certain fac-
tors and language development. This being
said, there are also numerous strengths worth
mentioning in this study. The size and qual-
ity of the sample must be emphasized. Few
research studies of children younger than 3
years with LD have included so many partic-
ipants, all with a confirmed diagnosis of LD
by an SLP. Our sample probably consists of
children whose level of development is on a
continuum; that is, some children’s language
abilities are close to normal limits and others
have more severe problems, which are likely
to lead to a diagnosis of specific-language im-
pairment at a later time. This renders the re-
sults directly applicable to the clinical setting.
Also, the quantity and variety of factors mea-
sured allow simultaneous assessment of all
variables known to date to influence the lan-
guage development of young children. More-
over, it is the first study on children younger
than 3 years that has taken an interest in el-
ements of language development that go be-
yond expressive vocabulary, that is, expres-
sive language in a broad sense as well as
receptive language. Finally, the results have
made it possible to demonstrate that different
factors are linked to these different linguistic
dimensions.
CONCLUSION
This study has given rise to some sugges-
tions for clinical practice and future research
directions. On the clinical front, we note
that the risk for LD is not equivalent for all
children because some environmental factors
LWW/IYC IYC200089 February 23, 2012 1:31
Factors Associated With Language Delay
may have a negative impact on language devel-
opment. But, most of the early prevention and
intervention programs target the support and
improvement of the quality of parent–child
relationships and the quantity and quality
of language stimulation offered by parents
to the child (Baxendale & Haskett, 2003;
Warr-Leeper, 2001). Despite the fact that
these dimensions constitute determining fac-
tors in child language development, the re-
sults of the present study suggest that some
peripheral factors may influence these vari-
ables, namely education level and parental
stress.
Moreover, the fact that factors associated
with expressive vocabulary, with a measure
of global expressive language, and with a
measure of receptive language were different
points to the use of different clinical strate-
gies. This call for the adoption of selective
actions, the nature, and intensity should vary
according to the analysis of the situation of
the child (Epps & Jacob, 2000).
Finally, given the impact of an LD on sub-
sequent child development, it is critical to act
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