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Language and Speech Development

Objectives

Describe key stages in the development of language and speech Know when to refer for further evaluation of speech and language delays

Generate a differential for language and speech delay

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Definitions  Language – use of systematic. socially agreed upon signals to convey meaning Receptive language – ability to understand  Expressive language – ability to produce symbolic communication   Speech – series of vocal sounds used as form of language CONTINUITY CLINIC .

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Correcting Misconceptions about Speech and Language Delay  Which of the following are true and which are false? Boys tend to be delayed > 6 months compared to girls  Children from bilingual households are significantly delayed  Otitis Media causes language delay  Second.and third-borns let their older siblings speak for them  CONTINUITY CLINIC .

Correcting Misconceptions about Speech and Language Delay  ALL ARE FALSE!!!!!!!!! Boys tend to be delayed > 6 months compared to girls Boys tend to be only slightly delayed (1-2 months)  Children from bilingual households are significantly delayed Children MAY show mild delay and early mixing only!  Otitis media causes language delay Otitis media is associated with language delay  Second.and third-borns let their older siblings speak for them Children have strong motivation to speak when able  CONTINUITY CLINIC .

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80% have problems in the communication domain 15-20% of young children have a communication disorder  CONTINUITY CLINIC .Background  Speech and language delays are the leading developmental concerns in parents of children less than 5 years old  Of children eligible for Early Intervention.

Normal Milestones in the Development of Language and Speech .

da-da Uses jargon Says first words 15 months 18-24 months 24-36 months Points to body parts by name Understands sentences Answers questions Follows 2 step commands Understands much of what is said Learns words slowly Learns words quickly Uses 2 word phrases Phrases 50% intelligible 3 or more word sentences Asks ―what‖ questions Asks ―why‖ questions Phrases 75% intelligble Masters m. b.Age Birth 2-4 months 6 months 9 months 12 months Receptive Skills Turns to source of sound Shows preference for voices & interest in faces Expressive Skills Cries Coos Takes turns cooing Responds to name Understands verbal routines (wave bye-bye) Follows a verbal command Babbles Points Says ma-ma. n. w. d. h 100% intelligble and tells stories 36-48 months 48-60 months . y. p.

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Risk Factors for Delays  Family history .   CONTINUITY CLINIC . Otitis media with effusion .causing a fluctuating hearing loss during the period of speech development. Low socioeconomic status and educational level These families are more likely to have a child with a poor outcome.There's a higher risk of continued delay if one of a toddler's parents or siblings had longterm language and learning difficulties.

reliance on direct model and prompting immature play skills. with limited number of consonant sounds and. little pretend play interactions with adults more than peers few communicative gestures (the late bloomer who caught up with his peers within a year used significantly more gestures than the child who had persistent delay) impaired social skills or behavior problems small vocabulary for age. less diverse verb repertoires comprehension delay of six months or greater relative to chronologic age CONTINUITY CLINIC .Warning Signs for Delay         little sound play or babbling as an infant. vowel distortions as a toddler poor verbal imitation skills. possibly.

or gesturing by 12 months no single words by 16 months no two-word spontaneous phrases by 24 months any regression in language or social skills at any age CONTINUITY CLINIC .Absolute Indications for Referral     no babbling. pointing.

and no other developmental disability has specific language impairment (SLI)  AKA language-learning impairment.7.     Incidence of SLI in 5 year olds .Language Impairment  A child with a receptive or expressive language disorder. or developmental aphasia. developmental language disorder.6% (NIH) Children with SLI are usually late talkers and most—67% to 84%—are boys. most children with SLI have a limited vocabulary and speak in short phrases rather than sentences The cause of SLI is unknown. If a child has SLI. CONTINUITY CLINIC . but it appears to run in families. or both. developmental dysphasia. there is a 25% chance that another family member will be affected. At 3 or 4 years old.

omit sounds. Articulation . or distort sounds. CONTINUITY CLINIC . saying "baw" instead of "ball". They may use sound substitutions such as "wady" for "lady". and phonologic disorder). so that "snake" comes out "snek. apraxia." Concern arises when these errors continue beyond the time a child normally outgrows them." or "silly" comes out "shhilly. misarticulate sounds in the course of normal speech development. not just those with a speech disorder.Speech Disorders   Include disorders of articulation and phonology (dysarthria.individual speech sounds and how they are pronounced    All children.

CONTINUITY CLINIC . when given auditory and visual cues. are able to imitate correct sounds or words. such as "k" and "g. And children usually outgrow velar fronting by 3 years." with consonants produced at the front of the mouth: "t" and "d. the child is replacing consonants made with the tongue moving toward the back of the mouth."  Children with a phonologic disorder make sound substitutions consistently but.Speech Disorders  Phonologic development . For example. can you give me one?"). tan you div me one?" (for "Mommy. In such cases. they have normal oral muscle tone. Usually.the gradual process of acquiring adult speech  The majority of children pick up most phonologic rules by age 5. "Mommy. most children stop deleting the final consonant in words (as when a child says "cuh" instead of "cup") between ages 2 and 3. An example of velar fronting is.

 Children with dysarthria have difficulty in the actual production of speech sounds. they are more likely to distort consonant sounds. in which consonants are omitted.motor speech disorders that result from nervous system injury   There is a lack of strength and control of the muscles used for both speech and non-speech functions. labored. CONTINUITY CLINIC . Many children with cerebral palsy have a dysarthric speech pattern. This differs from apraxia.Speech Disorders  Dysarthria . such as smiling and chewing.  In particular. distorting vowels. nasal speech. slurring words. and often producing slow.

neurologic motor speech impairment that affects the planning. and become increasingly angry at their inability to communicate Sometimes the same word can come out four different ways.Speech Disorders  Verbal apraxia . and palate (no muscle weakness) These children may point. the more stymied they become and the harder they are to understand. cheeks." Often a history of limited babbling and vocal play CONTINUITY CLINIC . Instead of saying "elephant. The more these children try to talk. They may drop the final consonant in single syllable words: "Cat come home" becomes "Ca co hoe. executing." they may say "efelant. grunt. and sequencing of speech movements      Causes a breakdown in the neural transmission of messages to the muscles of the jaw. tongue." They may transpose sounds within a word. lips.

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Use of Screening Tools   AAP policy statement recommends that pediatricians conduct standardized developmental screening tests on all infants and children at their 9-. 18.or 30-month well-child visits Examples: Ages and Stages Questionnaire (ASQ). Denver II CONTINUITY CLINIC .and 24. Parents' Evaluations of Developmental Status (PEDS).

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including reading disabilities (dyslexia) . autism. delay Some of these children spend a prolonged time in the oral-motor stage of play  An elevated lead level can cause behaviors that resemble developmental delay. and emotional disturbance   Referral to Early Intervention or Developmental Pediatrician to help prevent later language-based learning disabilities.Evaluation and Management  Lead testing for those with dev.