II. Definitions
- Speech
- Verbal production of language
- Language
- Processing of communication
- Receptive Language
- Language comprehension
- Expressive Language
- Conveyance of ideas via speech, writing or visual expressive forms (e.g. drawing)
III. Epidemiology
-
Prevalence of speech or language disorders
- One in 8 children ages 2-5 years old in the U.S.
IV. Diagnosis
V. Risk Factors
- Male gender
- Chronic Hearing Deficit
- Birth weight <2500 g
- Social Determinants of Health
- Harrison (2010) J Speech Lang Hear Res 53(2): 508-29 [PubMed]
VI. Findings
- See Language Milestone
- See Language Milestone Red Flags
- See Developmental Red Flags
- See Speech Exam
- See Congenital Anomaly
- Language and Speech Delay impact the speed of skill attainment
- However, children with speech and Language Delay typically have the capacity to acquire the skills at a slower rate
- Managing speech and language deficits allows for decreased barriers to learning and the associated social and academic impact
VII. Evaluation: Screening
- See Language Milestone
- See Language Milestone Red Flags
- See Developmental Red Flags
- Ages and Stages Questionnaire
- Survey of Wellbeing of Young Children
- Communication Development Inventories
- Language Development Survey
VIII. Causes: Primary Language Disorders
- Developmental Speech and Language Delay
- Delayed speech despite normal comprehension, intelligence, Hearing, socialization, articulation
- Most common of the primary language disorders
- Expect normal speech by school age with parent and therapist intervention
- Expressive Language Disorder
- Presents in similar fashion to Developmental Speech and Language Delay
- Active intervention is critical as this does not correct spontaneously
- Childhood onset fluency disorders
- Stuttering
- Cluttering (fast or irregular speech resulting in dysfluency)
- Social communications disorder
- Social verbal and gestural disorder (e.g. eye contact, facial expressions, body language)
- Interventions to promote social interaction, role-play
- Receptive Language Disorder
- Delayed speech characterized as sparse, agrammatic, and with poor articulation
- Example: Does not respond to "point to the picture of the girl?" or "where is the dog?"
- Response to intervention is less than for other primary language disorders and longterm speech development is abnormal
- Reduced vocabulary
- Limits communication (both reception and expression)
- Best outcomes if identified age <4 years and intervention to improve language use and comprehension
IX. Causes: Secondary Language Disorders
-
Autism
- Associated with Echolalia, pronoun reversal, language regression and impaired communication
-
Cerebral Palsy
- Associated with Incoordination of Tongue, Hearing Loss, cognitive delay
- Childhood Apraxia of Speech
- Difficulty creating sound in the correct order (speech is difficult to understand)
-
Dysarthria
- Severity ranges from slurred articulation to completely incomprehensible speech
-
Hearing Loss
- Before spoken language established (esp. at birth or first few months of life)
- Distorted speech sounds
- Significant impact on language development
- After spoken language established
- Gradual decline in articulation, and lack of progress in expanding vocabulary
- Evaluate for underlying cause
- Establish alternative communication modalities (e.g. sign language)
- May respond to Hearing Aids, Cochlear Implants
- Before spoken language established (esp. at birth or first few months of life)
- Cognitive Disorder or Global Developmental Delay
- See Developmental Milestones
- Overall Developmental Delay
- Intellectual Development Disorder
- Intellectual Function deficit with associated deficits in social judgment, behavior, communication
- Disorders include Down Syndrome, Fragile X Syndrome, Williams Syndrome, Rett Syndrome
- Selective Mutism
- Refusal to speak in certain social situations
- Craniofacial Disorders
- Cleft Lip and Cleft Palate
- Dental malocclusion
- Macroglossia
- 22q11.2 Deletion Syndrome
- Functional disorders
- Vocal Cord Dysfunction
- Myofunctional disorder
- Tongue thrust at rest or with Swallowing
X. Resources
- Books for parents
- Schwartz (2003) New Language of Toys
- Hamaguchi (2010) Childhood Speech, Language, and Listening Problems
- Web
- American Speech-Language Hearing Association
XI. Management: Referral
- Indications
- See Language Milestone Red Flags
- Speech or Language Milestone regression
- Delayed vocabulary (<50 words at age 24 months)
- Incomprehensible speech at 24 months
- Consultants
- Early intervention programs (see resources, CDC "act early" program below)
- Self-referral and government supported for under age 3 years in U.S.
- Speech and language pathologist
- Early intervention program
- Audiologist
- Public school (as of age 3 years old)
- Early intervention programs (see resources, CDC "act early" program below)
XII. Prognosis
- Early diagnosis and treatment prior to school age results in best outcomes
- Speech and language disorders starting in preschool that extend into elementary school have worse prognosis
- Associated with other learning disabilities (in contrast with better outcomes with early intervention)
- Associated with longterm reading difficulty, lower skilled employment and higher unemployment rates
- Associated with longterm behavioral and psychosocial impacts
- Snowling (2006) J Child Psychol Psychiatry 47(8): 759-65 [PubMed]
XIII. Prevention
- Universal Hearing screening
- See Pediatric Auditory Screening for schedule
- Early exposure to language (first 6 months of life) has a significant impact on a child's mastery of language
- Parents and Caregivers should start early in their communication with children, engaging them in social interaction
- Frequent communication with simple sentences and clear word pronunciation
- Incorporate language in everyday tasks, steadily broadening vocabulary
- Encourage less Screen Time in favor of activities that build communication skills
- Reading and writing
- Social interaction
XIV. Resources
- Early intervention programs (CDC "act early" program)