Learning from success stories: a qualitative investigation of factors influencing families of late talkers to pursue communication evaluations before age three

Federal Grant Award Summary

The Trustees of Columbia University in the City of New York received a $461,995 Project Grant from the National Institutes of Health Office of the Director under the Trans-NIH Research Support program (CFDA 93.310), awarded August 1, 2025, with a completion date of July 31, 2027. This qualitative research study investigates the factors that influence families of late talkers—children with late language emergence (LLE)—to pursue communication evaluations before age three. The research specifically addresses a critical gap in understanding "access outliers," which are families who successfully obtain early evaluations despite barriers such as limited English proficiency, by employing evidence-informed decision-making (EIDM) theory and decision-sampling methodology grounded in implementation science.

The project will generate qualitative research data and findings on the roles that pediatricians, early childhood education providers, family members, and community supporters play in facilitating early communication evaluations for Spanish-speaking and other underserved populations. The study will produce evidence-based insights that inform strategies to increase timely access to communication evaluations and improve outcomes for the approximately 20% of late-talking children who develop persistent developmental language disorders. The research directly supports the NIH's mission to advance biomedical and behavioral science while addressing health disparities in early childhood communication assessment and intervention.

Abstract

Communication delays are prevalent in young children. The most common communication delay is late LAN- guage emergence (LLE) or "late talking." outcomes for late talking children are highly variable. Some late talk- ERS "catch up" to their peers, while about 20% have lifelong language impairments that persist over time (i.e., developmental language disorder). Given the variability in outcomes, many late talkers do not receive commu- nication evaluations in a timely manner - a problem that is exacerbated for spanish-speaking families with LIM- ited english proficiency (LEP). There is little research on "access outliers", that is, families who raise concerns about their children's communication delays and then successfully pursue evaluations in their children's first three years of life. Similarly, there is limited information about how professionals (e.g., pediatricians, early childhood and education providers) or other supporters (e.g., members of the family, community) helped fami- lies obtain these early communication evaluations, but this information is imperative for understanding how to effectively support more families. Qualitative approaches in implementation science may be leveraged to UN- derstand the decisions of access outliers. The evidence-informed decision-making (EIDM) theory suggests that complex decisions are based on research evidence, values/preferences, and expert judgement. The decision- sampling framework is a qualitative method in which participants report on their decisions, and then answer a series of questions that are grounded in the EIDM theory. The goal of this study to understand the factors that influence families to pursue communication evaluations early (