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Heterogeneous Trajectories of Delayed Communicative Development From 12 to 36 Months

Predictors and Consequences

Hentges, Rochelle F. PhD*,†; Madigan, Sheri PhD*,†; Plamondon, Andre PhD; Racine, Nicole PhD*,†; Collisson, Beverly PhD†,§; Tough, Suzanne PhD†,§,‖; Graham, Susan PhD*,†

Journal of Developmental & Behavioral Pediatrics: June 2019 - Volume 40 - Issue 5 - p 335–343
doi: 10.1097/DBP.0000000000000677
Original Article

Objective: The objective of the study was to identify distinct trajectories of delayed communicative development from 12 to 36 months and examine differences in risk factors and developmental outcomes for each trajectory.

Methods: Participants were 2192 children drawn from a prospective longitudinal pregnancy cohort in a large Canadian city. Maternal pregnancy medical records were used to determine perinatal risk factors. The Ages and Stages Questionnaire Communication subscale was administered at 12, 24, and 36 months. At 36 months, mothers reported on the child's health, cognitive, and behavioral development.

Results: Using growth mixture modeling, we identified 4 trajectories of communicative development. Most children (81.1%) were characterized by high and stable scores from 12 to 36 months. The remaining children fell into a low-increasing class (13.0%), a moderate-stable class (4.5%), and a low-decreasing class (1.4%). At 36 months, the low-increasing class had caught up to the high-stable group. However, by 36 months, the low-decreasing class fell under the recommended “referral” cutoff, and the moderate-stable class fell under the “monitoring” cutoff criteria. Children with continued communication problems at 36 months were more likely to have a congenital anomaly and lower family income than late-talking children who had caught up.

Conclusion: Repeated assessments of a brief screening tool were able to differentiate patterns of communicative development over time, each with unique risk factors and developmental outcomes. Results highlight the potential for risk factors and repeated screenings to help identify children most at risk for persistent communication delays and in need of early support services.

This article has supplementary material on the web site:

*Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Canada;

Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Canada;

Department des fondements et pratiques en éducation, Université Laval, Québec, Canada;

§Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Canada;

Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada.

Address for reprints: Sheri Madigan, PhD, Department of Psychology, University of Calgary, 2500 University Avenue, 2500 University Dr. N.W., Calgary, AB, T2N 1N4 Canada; e-mail:

Disclosure: The authors declare no conflict of interest.

All Our Families is funded through Alberta Innovates Interdisciplinary Team Grant 200700595, the Alberta Children's Hospital Foundation, and the Max Bell Foundation. Dr. Hentges is supported by a fellowship from the Talisman Energy Fund in Support of Healthy Living and Injury Prevention and the Alberta Children's Hospital Foundation.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received September , 2018

Accepted March , 2019

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