SPEECH & LANGUAGE DEVELOPMENT

NORMAL LANGUAGE DEVELOMENT

CASE STUDY:

Alexander is a 12 month old ex-27 weeker. He passed his newborn hearing screen, as per parents. He is easily entertained and smiles and laughs freely. He has just started playing peekaboo when verbally cued. He enjoys using his hands and can crawl, cruise and stand unassisted. He babbles and sings to amuse himself. He claps whenever he hears music. He says 'Dada' to indicate daddy, but doesn't have a word for mommy yet. He says "baba" when he's hungry, indicating 'bottle'. He does not wave good bye and also does not readily respond to his name but he works to localize louder sounds. He has a big brother who is 3 and talks too much. Only English is spoken in the home. His parents are a little worried that he doesn't readily respond to his name. What is the next course of action?

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SPEECH DELAYS & DISORDERS

• Prevalence: 5% to 8% by the preschool years

DELAYS:

• No agreed upon definition
• Clinicians should consider data from multiple sources (hx, screening tools, judgment)
• Parental concern is sufficient reason for closer examination of the child's status.
• EI often defines 20-30% delay from chron. age to determine eligibility for services

"DISORDER"
The term “language disorder” refers to a deficit in the comprehension or production of language that causes clinically significant impairment in functioning relative to developmental norms and cultural expectations. A child who has a developmental language delay may or may not develop a speech-language disorder, depending on the severity of the delay and whether it causes significant impairment in functioning. The clinician may identify a child at risk or one who is presenting with delayed language development, but the speech-language clinician usually determines whether a delay is clinically significant or constitutes a disorder.

CORRELATION OF DELAYS WITH DISORDERS

• 13% to 18% of 1½- to 3-year-old children present with late talking or expressive delays.
• At 4 years, approximately 50% of late talkers still present with language difficulties.
• Current screening methods for who will go on to develop disorder are unreliable
• Risk: Low SES, family hx of language disorders, richness of language environment
• Reach Out & Read: Associated with higher expressive & receptive language skills.

DISORDERS: SPECIFIC LANGUAGE IMPAIRMENT

• Disorder of oral language acquisition in the absence of other identifiable cause.
• 1st rule out: environmental deprivation, deficits in nonverbal cognitive ability, hearing loss, autism
• By kindergarten age, an estimated 7% of children have SLI.
• Recent Study: Often have other, more subtle, deficits in nonlanguage areas of functioning

DISORDERS: PHONOLOGIC DISORDER

• Inability to articulate sounds expected for age & developmental level
• 2-3% of school-aged children
• Errors of omission (nana=banana), commission (fum=thumb), or sequencing (pasgetthi)

DISORDERS: CHILDHOOD APRAXIA OF SPEECH

• CAS: Irregular & inconsistent speech patterns
• Thought to be CNS origin, likely genetic
• Prevalence: 0.1-1%
• Think of this in child with delayed babbling
• Most children improve with therapy

DISORDERS: STUTTERING

• Not to be confused with developmental dysfluency
• Onset is usually 4-5, always before age 10
• Involves avoidance of words which trigger stuttering
• Occurs in 1% of school-aged children. M>F, strong familial correlation
• Resolves with therapy targeting speech production and emotional issues

A note on developmental dysfluency: "I want... I want... I want some juice"... Not uncommon among 2 and 3 year olds, usually resolves by age 4 years. Clinicians should reassure parents of toddlers and preschoolers that this is a normal developmental pattern that typically resolves without treatment. Parents should be cautioned against interrupting, filling in, or offering prompts to the child (eg, “Slow down,” “Take your time” ) or placing children in situations in which they are pressured to speak.

DISORDERS: DYSARTHRIA

• Impaired function of muscles used for speech production
• CP, muscle disorders, brain injury.
• Speech therapy is indicated as well as augmented communication

DISORDERS: DYSLEXIA

• Deficit in ability to recognize words in print & spell at age appropriate level
• Despite adequate reading instruction, motivation, and no cognitive deficits
• ~8% of second graders have a reading disability. There is often a family history.
• Early detection is essential to avoid significant academic delay.

SPECIAL CONDITIONS

Hearing Loss:
Currently all states have universal routine newborn hearing screens. If there is an abnormality, amplification should be initiated within 1 month of diagnosis and cochlear implantation should be considered between 12 and 24 months.
More commonly, language delay can result from Otitis Media with Effusion. Hearing testing should be performed if effusions persist for 3 months or longer or at any time if delays or hearing impairment is suspected as newborn screening may not detect moderate hearing loss.

BILINGUAL SPEECH DEVELOPMENT

A bilingual child follows the same developmental schedule as a monolingual learner but incorporates elements from both languages. First words may emerge slightly later but still occur within the normal range. Some mixing of words or grammatical rules may occur until the languages are differentiated, often not until ages 3 or 4 years.
Bilingualism does NOT cause language delay. Evaluation of the bilingual child who has delayed speech-language milestones should use the same criteria as for monolingual children. When a child has weak primary language skills or recognized delay, the family should be encouraged to use the child's dominant language at home. Progress at differentiating languages is associated with clear environmental contexts (e.g. Language #1 at home, language #2 at school)

AUTISM
Most children who have autism spectrum disorder have some level of speech-language delay, and approximately 25% to 30% have a history of language regression, which occurs usually between 15 and 24 months of age. Developmental regression at any age is an automatic indication for referral.

GENETIC SYNDROMES

• Williams
• Turners
• Velocardiofacial
• Klinefelters
• Downs, Fragile X

MANAGEMENT

Formal screening instrument should be administered at the 9-, 18-, and 30-month visits or at 24 months if patients will not be seen at 30 months.

When a speech-language problem is suspected, the clinician should make simultaneous referrals for audiologic and speech-language evaluations

If the child is younger than age 3 years, a referral should be made to the local early intervention program; if 3 years or older, referral should be to the public school early childhood program. EI services are free and treatment can be started promptly when an abnormality is detected.

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NOTE:

• Do not disregard delays in pts who are 2nd & 3rd born

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HAPPY BIRTHDAY & GOOD BYE

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B,E,D,D

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E,A,B,D,A