Communication disorders in young children

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Communication disorders in young children
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What is communication ?
Exchange of information with others
understand
produce
messages
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Forms of communication

• Nonlinguistic (gestures, bodyposture, facial
  expression, eye contact, head and body
  movement)
• Verbal words (speaking, writing, sign
  language)
• Paralinguistic (tone of voice, emphasis of words)

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Communication development

• Signals joint attention, gestural communication,
  turn-taking
• Language comprehension
• Language production

The ability to understand develops before the
ability to speak
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Communication

• Communication varies with the childs age and
  developmental status

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Speech milestones

• 1 to 6 months
• 6 to 9 months
• 10 to 11 months
• 12 months
• 13 to 15 months
• 16 to 18 months
• 19 to 21 months
• 22 to 24 months

• Coos in response to voice
• Babbling
• says "mama/dada, no meaning
• Says "mama/dada" with meaning
• Four to seven words jargon
• 10 words, some echolalia, jargon
• Vocabulary of 20 words
• Two-word phrases, vocabularygt50

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Speech milestones

• 400 words, two- to three-word phrases, use of
  pronouns
• Plurals and past tense, knows age and sex, 3-5
  words per sentence
• 3-6 words per sentence, asks questions, tells
  stories
• 6-8 words per sentence, names four colors, counts
  10 pennies correctly

• 2 to 2 1/2 years
• 2 1/2 to 3 years
• 3 to 4 years
• 4 to 5 years

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Signs of concern

• Not babbling by 12 to 15 months
• Not comprehending simple commands by the age of
  18 months
• Not talking by 2 years
• Not making sentences by 3 years
• Difficulty telling a simple story by 4-5 years

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Speech delay

• Speech delay is defined as the failure to acquire
  words by 18-24 months of age or phrases by 3
  years of age

Delayed acquisition of speech is not always due
to late maturation in children !
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The impact of communication disorder

• The communication has a long-term impact on
• learning (reading)
• social interaction

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Communication

• Language - rule-based system of symbolic
  communication involving a set of small units
• Speech - oral production articulation of words

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Language
Speech

• Form phonology morphology syntax
• Content semantics
• Function pragmatic

• Articulation
• Fluency
• Voice

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Language disorders
Speech disorders

• Improper use of words and their meanings
• Inability to express ideas
• Inappropriate grammatical patterns
• Reduced vocabulary
• Inability to follow directions

• Dysfluency
• Articulation or phonological disorders
• Difficulties with the pitch, volume or quality of
  the voice

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Major types of communication disorders

• Language disorders (60)
• general language delay (MR, autism, DD)
• specific language impairment (expressive,
  receptive expressive)
• Speech disorders (40)
• Hearing disorders

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Epidemiology of communication disorders

• The most common developmental problem in young
  children (25-50)
• The disorder is 3-4 times more common in boys
  than in girls

Early identification and early intervention are
important
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Language variations

• Familiar setting during examination !
• Cultural background
• Bilingualism
• Maturation delay - Late talkers

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Bilingualism

• A temporary delay in the onset of both languages
• Comprehension of the two languages is normal
• The child usually becomes proficient in both
  languages before 5 years

Children cannot have a communication disorder in
one language alone
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Causes of language disorders

• Hearing loss
• Mental retardation
• Autism /PDD
• Acquired brain damage (left hemisphere)

• Seizures
• CP
• Elective mutism
• Psychosocial deprivation

Specific language impairment

• Expressive language disorder
• Receptive aphasia

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Hearing Loss

• The most frequently overlooked disorder affecting
  speech development
• Common causes recurring middle ear infections,
  congenital malformations, meningitis, trauma,
  genetic disorders
• Diagnosis - behavioral or physiologic audiometry

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Hearing Loss

• Suspect hearing loss when a child does not seem
  to understand is inattentive looks intently at
  others who are speaking or better recognizes
  sounds with more lip movement, such as the letter
  W.

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Developmental Delay

• Speech delay caused by late maturation can be
  mild, moderate, severe, or very severe, depending
  on the level of impairment of word sounds, spoken
  language, and language comprehension.

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Mental Retardation

• Over half of all mentally retarded children are
  speech delayed
• Speech development is relatively more delayed in
  MR children than are other fields of development

Generalized delay suggestsmental retardation as
the causeof a child's speech delay
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Mental retardation

• Don't overlook common coexisting contributors
  such as deafness, dysarthria, or sensory
  deprivation
• Global language delay, delayed auditory
  comprehension and delayed use of gestures

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Pervasive Developmental DisordersDSM-IV

• Autistic disorder
• PDD-NOS (Pervasive developmental disorder-not
  otherwise specified)
• Aspergers disorder
• Retts syndrome
• Childhood disintegrative disorder (Hellers
  syndrome)

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Autism

• Onset before 36 months (18-30 mo.)
• Prevalence 1-21000
• Autism is more common in boys (3-41)
• Recurrence risk in families 3-8
• Biologic cause in 10-30 genetic syndromes,
  congenital infections, HIE, neurocutaneus,
  metabolic, epileptic

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Autism

• Onset occurs before 36 months
• Autistic children fail to make eye contact, smile
  socially, respond to being hugged or use gestures
  to communicate
• Ritualistic and compulsive behaviors, including
  stereotyped repetitive motor activity
• Autism is three to four times more common in boys
  than in girls

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Autism-clinical

• Impairment in social interaction
• Impairment in language communication
• Restricted, repetitive stereotyped pattern of
  behavior, interest activities

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Autism language

• About half of autistic children don't develop
  useful speech by age 5 and have a poor prognosis
• Speech abnormalities echolalia, perseveration,
  pronoun confusion, abnormalities of prosody,
  semantic pragmatic disorder

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Cerebral Palsy

• Delay in speech is common in CP
• Speech delay occurs most often in athetoid type
  of CP
• Factors that may account for the speech delay
  hearing loss, spasticity or incoordination of the
  muscles of the tongue, coexisting MR or a defect
  in the cerebral cortex

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Left Cerebral Lesion

• If acquired before 6 years, left-brain lesions
  shift the language center to the right hemisphere
  
• May cause speech delay and "pathologic"
  left-handedness (too early or without a family
  history of left-handedness)
• Aphasia, the loss of previously acquired speech,
  is almost always traced to a left cerebral lesion

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Seizures

• When these begin in the first decade, they can
  cause delayed speech or aphasia and can result
  in verbal auditory agnosia (word deafness)

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Elective mutism

• These children are negativistic, shy, timid and
  withdrawn
• Symptoms of poor adjustment, such as poor peer
  relationships or overdependence on their parents
• Anxiety, attention seeking, or embarrassment
  about a speech deficit
• Usually family psychopathology
• Can persist for months or years

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Psychosocial Factors

• Speech development can be slower in
• twins
• younger siblings
• children in lower socioeconomic classes
• children of deaf-mute parents
• children exposed to more than one language.

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Language regression

• Autistic regression
• Landau Kleffner - Aquired epileptic aphasia
• ESES - Electrical status epilepticus in sleep
• Disintegrative disorder

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Specific language impairment Developmental
language disorders (DLD)

• 5-10 of preschooler
• Difficulties in language acquisition (without
  hearing impairment, low intelligence and
  neurological damage)
• Diagnosis by exclusion
• Risk for reading/academic difficulty social
  failure

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Developmental language disorders (DLD) - major
types

• Phonology-syntactic
• Mixed receptive-expressive (verbal auditory
  agnosia)
• Expressive only (verbal dyspraxia)
• Higher order processing (semantic-pragmatic)
• Autistic spectrum

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Receptive Aphasia-word deafness

• A deficit in comprehension of spoken language
  with normal responses to nonverbal auditory
  stimuli
• The speech is delayed, sparse, agrammatic and
  indistinct in articulation
• Most children with gradually acquire a language
  of their own, understood only by those who are
  familiar with them

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Prognosis

• Expressive delay alone resolve spontaneously in
  the pre-school period
• A poorer prognosis for children with
  expressive/receptive delays
• It is not possible to predict at the time of
  identification, which of the children with
  expressive delay are likely to have persistent
  problems

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Diagnostic evaluation
All children with speech delay should be referred
for audiometry

• Audiometry with special earphones
• Tympanometry
• An auditory brain-stem response
• Imaging modalities are not indicated
• Prolonged sleep EEG is indicated in language
  regression (subclinical epileptiform EEG)

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Diagnostic evaluation

• Additional tests should be ordered only when they
  are indicated
• A karyotype for chromosomal abnormalities and a
  DNA test in children who have the phenotypic
  appearance of fragile X synd.
• An EEG should be considered in children with
  seizures or with significant receptive language
  disabilities or language regression (subclinical
  seizure activities)

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Developmental language disorders -etiology

• Genetic !
• Twin studies (96 concordance in MZ, 69 in DZ)
• Linkage to chromosome 7q31
• FOXP2 gene (Nature 4134 oct,2001)

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