Language is a communication system whereby information is transmitted through linguistic signs. The encoding and decoding of meanings allow the individual to express and communicate their thoughts and interaction with individuals in family and social settings ¹. Oral language learning happens in the early stages of life, reaching about 70% of adult language before five years of age. In the development of language, cognitive, affective and linguistic development processes participate, which is why it is considered a determining factor in the educational and social development of children ^2-5. Although there are deleterious signs and symptoms for the diagnosis of oral language disorders, these go unnoticed by parents, educational institutions and growth and development programs, and is generally diagnosed occasionally by specialists and in advanced stages, when the minor presents socialization difficulties throughout the life cycle ⁶.

On the other hand, the coexistence between behavior problems and language disorders tends to increase as the minor grows up without diagnosis and without intervention, which implies a greater risk of mental health disorders, increasing violent behaviors and tendency to juvenile delinquency, delay and difficulties in the acquisition of literacy skills and school dropout, compared to children with normal oral language development ^7,8. The World Health Organization (WHO) recommends monitoring in the early stages of childhood, in order to diagnose and treat any language impairment in order to correct them promptly, especially in the population with social vulnerability such as poverty, violence intrafamily and forced displacement ^9,10.

The social and political characteristics of the department of Cauca make it a region with high rates of social exclusion, and forced displacement from the rural area to the capital, exposing minors to adverse environments for their integral development ¹¹. Faced with these social vulnerabilities, the Colombian Institute of Family Welfare (ICBF) seeks to restore the rights of minors through the integration of this population into community homes, with the aim of providing social and educational support to children. However, children's homes do not have a protocol for the assessment of oral language development in this population.

In the capital of the department of Cauca (Popayán), a prevalence of 78.1% was found for alterations in expressive language and 41.7% in comprehensive language in children between 4 and 5 years of age; population from the State Social Enterprise (SSE) ¹². Similarly, according to the frequency of the Individual Service Provision Registry (ISPR), the specific developmental disorder of speech and language is the first cause of attention in the practice of Speech Therapy ¹³; However, the frequency and determining factors of oral language alterations in the most vulnerable child population, such as children institutionalized in community homes (CH) of the ICBF of the city of Popayán ¹⁴, are not known. The objective of this research was therefore to determine the prevalence of, and social determinants related to, oral language disorders in institutionalized children in Community Homes of the ICBF of the city of Popayán, Cauca during 2018.

261 children between the ages of 3 and 5 years were evaluated, in the period between May and November 2018. It was found that the median age was 52 months (IR: 44-58 months). 54.7% of the children were male, 55.2% of the children entered kindergarten in the range of 24 to 35 months and 20.3% of the minors were part of a family who was a victim of the armed conflict. The other sociodemographic characteristics are described in detail in 1.

Table 1

Characteristic	N= 261	%
Age (months)	52*	44-58*
Gender
Male	143	54.8
Female	118	45.2
Ethnicity
Other	233	89.3
Indigenous	27	10.3
Mixed	1	0.4
Born in
Cauca	228	87.4
Huila	9	3.5
Nariño	8	3.1
Valle	7	2.7
Cundinamarca	5	1.9
Antioquia	1	0.4
Ecuador	1	0.4
Quindío	1	0.4
Venezuela	1	0.4
Age they started nursery (months)
<12	2	0.8
12-23	38	14.6
24-35	144	55.2
≥ 36	77	29.5
Socioeconomic status
1	144	55.2
2	96	36.8
3	21	8.0
Father’s occupation
Works	208	79.7
Unemployed	6	2.3
Not registered	47	18.0
Father’s schooling
Primary	52	19.9
High school	132	50.6
Technical	19	7.3
Undergraduate	10	3.8
Not registered	48	18.4
Mother’s occupation
Works	127		44.4
Studies	18		6.9
Unemployed	116		48.7
Mother’s schooling
Primary	55		21.1
High school	167		64.0
Technical	29		11.1
Undergraduate	10		3.8
Who accompanies the child
Grandmother	55		21.1
Mother	181		69.4
Father, Mother	14		5.4
Aunt	6		2.3
Other	5		1.9
Parenting guidelines
Yes	167		64.0
No	94		36.0
Domestic violence
Yes	3		1.2
No	258		98.9
Type of family
Nuclear	130		49.8
Extended	84		32.2
Single parent	28		10.7
Mixed	19		7.3
Victim of the armed conflict
Yes	53		20.3
No	208		79.7
Displaced
Yes	51		19.5
No	210	80.4

*Median and inter-quartile ranges

Regarding language alterations, a prevalence of 46.4% was determined, with a mixed alteration of language and expressive language being the most prevalent (Table 2).

Table 2

Variable	n: 261	%
Alteration in oral language
Yes	121	46.4
No	140	53.6
Type of alteration of the language
None	140	53.6
Mixed	48	18.4
Expressive	40	15.3
Comprehensive	29	11.1
Articulation	4	1.5
Test TECAL
Normal	182	69.7
At risk	55	21.1
Deficient	24	9.2
TECAL - Vocubulary areas
Normal	193	74.0
At risk	43	16.5
Deficient	25	9.5
TECAL - Morphology
Normal	187	71.7
At risk	51	19.5
Deficient	23	8.8
TECAL - syntax
Normal	207	79.3
At risk	35	13.4
Deficient	19	7.3
Test TEPROSIF-R
Normal	160	61.3
At risk	30	11.5
Déficient	71	27.2

When analyzing the results according to the TECAL test, we found that the majority of children were at a normal level in all evaluations. When looking at the areas with the highest risk, it was determined that this was morphology, followed by vocabulary and syntax. At the deficient level, the area with the highest prevalence was vocabulary, followed by morphology and syntax. For the TEPROSIF-R test, most of the children were at the normal level, but 27.2% of the children showed alterations in the processes of phonological simplification (Table 2).

When exploring the possible sociodemographic variables that are associated with having or not having language alterations in the children who attend the CH of the ICBF, statistical significance was found in four variables: age of onset in the garden (OR: 2.94, 95% CI: 1.63 -5.34, p: 0.0001), father's occupation (OR: 0.42, 95% CI: 0.20-0.84, p: 0.008), family victim of the armed conflict (OR: 1.84, 95% CI: 0.96-3.58, p: 0.047) and displacement (OR: 1.86, 95% CI: 0.96-3.66, p: 0.046) (Table 3).

Table 3

Characteristic	Description	n	Children with alterations(n= 121)	Children without alterations(n= 140)	OR	CI (95%)	p
Age (years)	< 4	97	40	57	1.39	0.81-2.38	0.201
	≥ 4	164	81	83
gender	Masculine	143	70	73	0.79	0.47-1.33	0.350
	Feminine	118	51	67
Ethnicity	Indígenous	27	13	14	1.08	0.44-2.60	0.844
	Other	234	108	126
Born in	Other	33	18	15	1.45	0.65-3.26	0.313
	Cauca	228	103	125
Age they started nursery	<3	184	71	113	2.94	1.63-5.34	0.0001
	≥3	77	50	27
Teaching time (hours)	≤2	143	74	69	1.62	0.96-2.73	0.054
	>2	118	47	71
Socioeconomic status	1	144	69	75	1.57	0.93-2.65	0.070
	Otro	117	45	72
Father’s occupation	Does not work	53	16	37	0.42	0.20-0.84	0.008
	work	208	105	103
Father’s schooling	low level	101	46	55	0.94	0.55-1.61	0.833
	other	160	75	85
mothers occupation	does not work	116	48	68	0.69	0.41-1.17	0.148
	work	145	73	72
mothers schooling	low level	55	28	27	1.26	0.66-2.38	0.446
	Other	206	93	113
Child accompanied by	Other People	66	28	38	0.80	0.44-1.47	0.458
	Parents	195	93	102
Parenting guidelines	No	94	42	52	0.89	0.52-1.54	0.683
	yes	167	79	88
Domestic violence	yes	3	0	3	0	0-1.47	0.105
	No	258	121	137
Extended family	yes	84	35	49	1.32	0.75-2.31	0.294
	No	177	86	91
Nuclear family	yes	130	61	69	0.95	0.57-1.60	0.855
	No	131	60	71
Victim of armed conflict	yes	53	31	22	1.84	0.96-3.58	0.047
	No	208	90	118
Displaced	Si	51	30	21	1.86	0.96-3.66	0.046
	No	210	91	119

These results suggest that having entered the CH with less than three years of age protected the children from presenting oral language disorders. Regarding the occupation of the father, the prevalence of a language alteration in the children whose parents worked was 42%, in comparison with children who had non-working parents. On the other hand, the variables belonging to a family victim of the armed conflict or being displaced by violence tend to be risk factors for presenting oral language alterations. The multivariate analysis suggests that the variables that independently explain the language alterations in children who attend the CH of the ICBF are: father's occupation (ORa: 2.35, 95% CI: 1.23-4.49, p: 0.004) and being a victim of the armed conflict with (ORa: 1.86, 95% CI: 0.97-3.53 p: 0.013) (Table 4).

Table 4

Characteristic	Description	n	Cases*s	Controls**	OR	CI (95%)	p	ORa	C I (95%)	p
			(n=121)	(n=140)
Victim of the armed conflict	Yes	53	208	22	1.84	0.96-3.58	0.047	1.86	0.97-3.53	0.013
	No	31	90	118
Father’s occupation	Works	208	105	103	0.42	0.20-0.84	0.008	2.35	1.23-4.49	0.004
	Does not works	53	16	37

The prevalence of language alterations in children who attend CH in the city of Popayán was 46.3%. This is related to what was found in another study that evaluated the child population of low socioeconomic strata where 36% of preschool children presented difficulties Language (¹⁷). Likewise, 78.1% alterations were reported in expressive language and 41.7% in comprehensive language in the child population attending a SEE in the city of Popayán ¹². This is the first study to determine the prevalence of oral language disorders and explore the possible associated factors in children under 5 years of age attending CH of the ICBF, as demonstrated in various studies (Table 5).

Table 5

Study	Blumenfeld (18)	Velasco (19)	Salazar et al (11)	Cardona et al (20)	Muñoz et al (12)	Schonhaut et al (17)	Moreno (21)	chonhaut et al (22)
n	138	73	75	30	96	58	39	159
Characteristics
Design	Analytical observational crosssectional study	Empirical study	Exploratory study	Exploratory, descriptive, correlational study	Descriptive, crosssectional study	Analytical crosssectional study	Analytical observational study	Analytical observational study
Age	2 years	3 - 4 years	5 and 12 years	1 - 3 years	4 - 5 years	3 - 5 years	5-9 years	3-5 years
Mean age	-	-	-	23.7 months	59.3 months	years 11 months	-	4 years
Age of entry to kindergarten	without schooling	68.5% previously schooled	-	-	2.8 years	2 years	-	-
Mothers schooling	High school (43.0%)	-		14,4 years		11 years	low level
Displaced	-	-	si	-	-	-	-	-
Socioeconomic status	low	medium, medium high		high	low	low	low	low
Nuclear family	-	-	-	66.7%	75.0%	-	-	-
Domestic violence	-	-	-	-	-	-	Abuse and abandon	-
Emotional and physical
Used Test	Mac Arthur Bates Communication Skills Development Inventory	PLON R -	Human figure test	ENI, EAD, PLS-4	Reynell test, audiometry, otoacoustic emissions	eprosif, STSG, screening auditive, WPPSI	McCarthy scale MSCA, BLOC Puyuelo	TEPSI -
Language disturbances	11.6%	13.0%	si	-	78.1% expressive, 41.7% comprehensive	36.0%	100%	GE: 97% GC: 19%
Positive association	Behavioral problems and history of LD *	Socioeconomic status, previous schooling	-	-	-	Family history of LD * or learning	-	-
Positive association	-	-	-	Level of education, occupation and type of family	-			-

LD: language disturbance

The analysis by areas showed that, in general, the children presented alterations in all levels of oral language: vocabulary (9.5%), morphology (8.8%) and syntax (7.3%) this according to the TECAL test, however, it was found great variability in phonological simplification processes (27.2%). In this regard, a study with a population belonging to a low socioeconomic level found a concurrent compromise of receptive vocabulary in participants with delayed language development ¹⁸. In different studies, it has been found that men are more likely to present oral language disorders ²³, and we identified greater alterations in children (54.8%). No statistically significant differences were found, however, to suggest that gender is a determining factor for oral language disorders in children who attended this CH.

Regarding the sociodemographic characteristics, it was identified that the evaluated children belonged to a low socioeconomic stratum, as Muñoz described in their study in which 9 out of 10 households belonged to the Class 1 socioeconomic class. Schonhaut also obtained data on the family income of 134 families, with 72% having level 1 income and 19% having level 2 income, with 91% of the studied population concentrated in the lowest income ranges. This also affirms on the relationship between poverty and development problems, identifying associated factors in preschool children of low socioeconomic status in the metropolitan region of Chile. In the same way, Blumenfeld identified, in a health center in Buenos Aires, that 89% of the minors belonged to households with criminal activity and a “poverty” level of income, according to official data ^12,17,18,21. The socioeconomic aspect is a possible variable that intervenes in the development of language difficulties, which are closely related to problems of social exclusion ²⁴. Social determinants define intellectual development ²⁵, while the environmental context in which the child grows up limits the development of communication and oral language ²⁶.

Regarding schooling, it was found that 70.5% of the children entered kindergarten before the age of 3. Similar results were found in studies which identified that most of the children had been in school before the age of 3 ¹². This is an important factor in childhood development, directly related to the physical, cognitive and psychosocial dimensions, which are reflected in the ways in which they relate to others and to the environment that surrounds them. These relationships are necessarily traversed by language as an essential means of communication for children and with the possibilities of interaction offered by socialization agents ¹⁹.

On the other hand, in the present study the variable of parental education was not statistically associated with oral language alterations in this sample of children, coinciding with a study in which this association was not established either, but where it was concluded that as the mother's years of schooling increased, the child's range of language comprehension increased ²⁰. Regarding the type of family, 49.8% of the children evaluated are part of nuclear relatives, similar data refer to Cardona ²⁰ and Muñoz ¹², where 66.7% and 75% of the children belong to the same type of In this regard, this type of family is typical of low socioeconomic strata, where parental authority prevails and women dedicate themselves to housework ²⁷.

It was also determined that 19.5% of the children of these ICBF community homes are in a situation of displacement. These children have difficulties in adapting to new environments, which is represented in shyness or aggressiveness during social integration. This impacts and limits the development of the pragmatics of the language that allows the child to relate and integrate into the environment ¹¹. The only variables that show an association with oral language disorders in children from community homes of the ICBF are the occupation of the father and belonging to a family victim of the armed conflict. The father's occupation indicates that the family has higher economic income, which translates into a better quality of life. In addition, 69.3% of the children evaluated are in the care of the mother, which means that if the father is in charge of earning the household income, then the mother can dedicate most of her time to raising their children (Table 1). On the other hand, although there are no other studies that relate being a victim of the armed conflict with oral language disorders, one study suggests that abuse in childhood affects language development in children and that language difficulties occur according to the type of abuse inflicted on the minor. This research suggests that children's language difficulties may be a consequence of the sociocultural and affective deprivation situation they suffer as result of displacement due to the armed conflict ²¹.

Language development is influenced by different environmental factors, which can influence language development positively or negatively depending on the context. Children from ICBF community homes presented particular factors that make them vulnerable, including low socioeconomic level, unemployed mothers, single-parent families where the mother is the head of the household, and families in a situation of displacement, as evidenced in Table 3, where the sociodemographic characteristics of the children are described.

The high prevalence of oral language disorders in children from ICBF community homes shows the need to implement stimulation and monitoring strategies for adequate development. Despite the fact that different social variables were taken into account in the study, the only ones that suggest any relationship with oral language alterations in these children were the occupation of the father and being a victim of the armed conflict.

The community homes of the ICBF need to have a professional in speech therapy to be able to develop a monitoring program evaluating the language of children when they enter the CH and monitoring children with language difficulties. Additionally, workshops should be offered aimed at community mothers, which provide them with the necessary tools to identify the first warning signs of oral language disorders and activities focused on linguistic stimulation, following the guidelines of the normal language acquisition process. Parents and caregivers should also be included in the early stimulation of children's language skills, since they are the main actors in the formation of identity and the development of children's skills, knowledge and behaviors ²⁸.

Analytical studies should be carried out in this population to identify risk factors and protective factors, taking into account the social variables that can be modifiable and which can, therefore, favor the integral development of the minor. Professionals should be tasked with evaluating the cost-effectiveness of this. A scale needs to be standardized and validated that evaluates the language of children in Colombia, generating a direct impact on the statistics of the institutions, and for children who present language alterations at the national level.