An introduction to speech an language delay
Contributor Dr C M Ni Bhrolchain Huntingdon
Why is speech and language delay important?
• Common at 3-year check • 20% parents are concerned
• 6% of children show delay
• Autism 6 per 1000 (I every 3-4 years in a practice of 10,000) • Some conditions co-exist • Some conditions are serious
What do you need to do?
• Decide if there is a problem
• Decide what the problems are
• Decide what should be done about them
Is there a problem?
• Assess parents’ expectations • Assess child’s speech
• Assess child’s – General development – Hearing – Behaviour
What could be the problem?
• High parental expectation • Immature speech e.g. ‘wed’ for ‘red’; ‘lellow’ for ‘yellow’ • Abnormal substitutions (Normal understanding, development and language) • Abnormal understanding (Delayed/abnormal language skills with/without developmental delay) • Abnormal communication skills (Abnormal social skills, delayed language with/without developmental delay)
Other possibilities to consider
• Mild/Moderate hearing loss • Developmental delay with speech at the same level as other skills • Social deprivation
• Behaviour difficulties
All these may co-exist
Assessing speech and language
• 9 – 18 months – Single words with meaning e.g. dada, there, gone
• 18 – 24 months – Two words e.g. dada there, gone bed
• 24 – 30 months – Three words with verb e.g. daddy kick ball
Assessing speech and language (cont)
• 30 – 36 months – Four words
A 3-year old should be able to speak clearly in sentences so that a stranger can understand them
Understanding language
• 12 – 18 months – ‘Show me the…’ • 24 – 30 months – ‘Put the …in the…’ – ‘Show me someone sweeping’
• 30 – 36 months – ‘Which one is for eating with?’ – ‘Show me the big one’
Understanding communication
• Does the child understand nonverbal gestures? • Does he/she point for interest? • Does he/she follow a point?
• Does he/she seek joint interest e.g. in books?
Social behaviour
• Is he/she different to other children? How? • How does he/she cope with being left?
• Does he/she play with toys? How?
• Does he/she play with other children?
Social behaviour
• Does he/she realise if parent is upset or angry?
• Does he/she try to comfort others? • Is there any favourite activity that he/she does again and again? If so, what? • Is there any ritual or habit that he/she must follow? What happens if it’s interrupted?
Hearing loss
• • • • History Understands gesture May watch face intently Often tries desperately to communicate • Serous otitis on examination in some
Formal test suitable for 3-year olds
• Performance test • McCormick Toy Test • Some will do audiogram
Simple assessment of developmental delay
• History and HVs Denver • Blocks – Building tower or bridge, colour matching, colour naming • Shapesorter (3-piece)
• Inset puzzles, name pictures
• Books – How to look at books, turn pages, name pictures, listen to stories
Social deprivation
• Parent/child interaction • Has this child seen toys before?
• Does parent play with him/her?
• Home visit may be helpful
Referral pathways
• Hearing • Deprivation • Immaturity • Delayed speech • Audiology • Nursery/portage • Reassurance and review • S<
• Communication) disorder ) • Devt delay )
• S< and community paediatrician