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My Child Doesnt Talk

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What is the most common complaint among children who are referred for ... auditory processing disorder, Landau-Kleffner Syndrome, selective mutism, etc. ... – PowerPoint PPT presentation

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Title: My Child Doesnt Talk


1
My Child Doesnt Talk!
  • Mark Cohen, M.D., F.A.A.P.
  • Developmental Pediatrician
  • Exceptional Family Member Program
  • Tripler Army Medical Center
  • Honolulu, Hawaii

2
Question
  • What is the most common complaint among children
    who are referred for developmental pediatrics
    evaluation?

3
Hint
4
Answer
  • Hes not talking.

5
First word (not mama or dada)
  • 50 by 12 months
  • 90 by 15 months
  • If a child is not saying any words at the 15
    month visit
  • DONT WAIT -- EVALUATE!

6
QUIZ
  • Which of the following would be a good
    explanation of why a child is not talking by 15
    months of age?
  • (Im not going to tell you how many of the
    choices are correct)

7
He doesnt talk because
  • Hes a boy
  • His siblings all talk for him
  • He gets everything he needs
  • We speak two languages at home
  • Hes lazy
  • His father didnt talk until he was 3

8
He doesnt talk because
  • Hes a boy
  • His siblings all talk for him
  • He gets everything he needs
  • We speak two languages at home
  • Hes lazy
  • His father didnt talk until he was 3

9
He doesnt talk because
  • Hes a boy
  • His siblings all talk for him
  • He gets everything he needs
  • We speak two languages at home
  • Hes lazy
  • His father didnt talk until he was 3

10
He doesnt talk because
  • Hes a boy
  • His siblings all talk for him
  • He gets everything he needs
  • We speak two languages at home
  • Hes lazy
  • His father didnt talk until he was 3

11
He doesnt talk because
  • Hes a boy
  • His siblings all talk for him
  • He gets everything he needs
  • We speak two languages at home
  • Hes lazy
  • His father didnt talk until he was 3

12
He doesnt talk because
  • Hes a boy
  • His siblings all talk for him
  • He gets everything he needs
  • We speak two languages at home
  • Hes lazy
  • His father didnt talk until he was 3

13
He doesnt talk because
  • Hes a boy
  • His siblings all talk for him
  • He gets everything he needs
  • We speak two languages at home
  • Hes lazy
  • His father didnt talk until he was 3

14
So, what are the real reasons?
15
The Real Reasons
  • Generalized developmental delay

16
The Real Reasons
  • Generalized developmental delay
  • Hearing loss

17
The Real Reasons
  • Generalized developmental delay
  • Hearing loss
  • Speech and language disorders

18
The Real Reasons
  • Generalized developmental delay
  • Hearing loss
  • Speech and language disorders
  • Autism

19
The Real Reasons
  • Generalized developmental delay
  • Hearing loss
  • Speech and language disorders
  • Autism
  • Other less common conditions (deprivation/abuse,
    cerebral palsy, central auditory processing
    disorder, Landau-Kleffner Syndrome, selective
    mutism, etc.)

20
Developmental Delay
  • Due to an abnormality of brain function
  • NOT due to laziness, stubbornness, or poor
    parenting
  • Terminology
  • Developmental delay up to about age 4
  • Mental retardation for older children

21
Developmental Delay
  • Delay in multiple domains
  • Language
  • Expressive
  • Receptive
  • Motor
  • Gross
  • Fine
  • Cognitive/Adaptive (Thinking)
  • Personal/Social

22
Developmental Delay
  • Multiple causes
  • Chromosomal (Trisomy 21, Fragile X)
  • Genetic, non-chromosomal syndromes
  • Intrauterine toxin (Fetal alcohol syndrome)
  • Metabolic (hypothyroidism)
  • Infection (intrauterine or postnatal)
  • Etc., etc., etc.
  • WRDK

23
  • CAUTION
  • Devel appears WNL

24
  • CAUTION
  • Many children with significant delay are
    missed by medical professionals because they
    look good

25
Take-home Lesson 1
  • If a child is not talking, you MUST consider
    developmental delay as a possible cause.

26
Hearing Loss
27
Hearing Loss
  • Infant screening has been a BIG help
  • Family history
  • Hearing loss
  • Kidney disease
  • History of meningitis or frequent otitis
  • Ask the parents if theyre concerned
  • Forget the hand clap!

28
Hearing Loss
  • Infant screening is not 100 reliable
  • Hearing loss can be acquired postnatally
  • Children with significant hearing loss can
    respond to visual cues, vibration, etc.
  • So.

29
Take-home Lesson 2
  • Any child who is not talking needs a HEARING
    TEST!
  • Refer to an audiologist with pediatric expertise
  • For younger children, may need ABR (Auditory
    Brainstem Response)

30
Speech and Language Disorders
31
Quick Review Language vs. Speech
  • Receptive language (brain)
  • Expressive language (brain)
  • Speech (brain muscles oral structures)
  • May have a problem with any or all of these

32
Developmental Language Disorder
  • Expressive, receptive, or mixed
  • Mixed delays are often associated with delayed
    cognitive development
  • Motor skills and nonverbal cognitive skills may
    not be as severely delayed

33
Expressive Language Delay
  • Isolated delay
  • Key receptive language is OK
  • No delays in other areas
  • May be familial
  • Most will develop normal speech (with speech
    therapy)

34
Developmental Phonological Disorder
  • Distortions, omissions, substitutions of phonemes
    producing speech that is difficult to understand
  • A language problem, not a motor problem
  • Vowel sounds are usually OK
  • Responds to speech/language therapy
  • May have later reading problems (dyslexia)

35
Developmental Apraxia of Speech
  • Developmental Verbal Dyspraxia
  • Apraxia of Speech
  • Developmental Articulatory Dyspraxia
  • Apraxia
  • Dyspraxia

36
Developmental Apraxia of Speech
  • Primarily a speech problem
  • (Some think its also a language problem)
  • Impairment in the brains ability to plan and
    control motor patterns
  • No weakness of muscles
  • Apraxia may affect fine and gross motor skills as
    well as speech

37
Signs of DAS
  • Does not coo or babble as an infant
  • Late to talk, and words are missing sounds
  • Speech is slow, irregular, and there are
    inconsistent errors
  • Errors in both vowels and consonants

38
Autistic Spectrum Disorders
39
Autistic Spectrum Disorders
  • Pervasive developmental disorders
  • Autistic disorder
  • Aspergers disorder
  • Retts disorder
  • Childhood disintegrative disorder
  • Pervasive developmental disorder, not otherwise
    specified (PDD-NOS)

40
Autistic Disorder
  • Impairment in social interaction
  • Impairment in communication
  • Restricted, repetitive, and stereotypic patterns
    of behavior, interests or activities
  • Impairment in social interaction, social
    communication, or imaginative play

41
PDD-NOS
  • Child appears to be in the autistic spectrum but
    doesnt fit full criteria for autistic disorder
  • More common in younger children
  • Treatment approach same as autism
  • Long-term prognosis uncertain

42
MYTHS About Autism
  • Parents cause autism
  • MMR vaccine causes autism
  • All autistic children are severely retarded, or
    savants like Rain Man
  • Autistic children never make eye contact or
    express affection
  • Autism is permanent and incurable

43
More MYTHS About Autism
  • All autistic children
  • line up their toys
  • spin around
  • flap their hands
  • walk on their toes
  • turn light switches on and off

44
FACTS About Autism
  • Autism represents a spectrum, from mild to severe
  • Autism is a brain disorder, probably due to
    genetics and other factors
  • An autistic child can make eye contact and be
    affectionate

45
More FACTS About Autism
  • Not all autistic behaviors are due to autism
  • Not all autistic children demonstrate autistic
    behaviors

46
Early Intervention for ASD
  • Speech/language therapy
  • Social skills training
  • Behavioral intervention
  • Medication, in selected circumstances

47
Red Flags for Autism
  • Not talking, or loss of previously acquired
    language
  • Does not respond when name is called
  • Does not point for wants or to show
  • Limited emotional reciprocity
  • Does not respond to facial expressions
  • No or minimal imaginative play

48
Screening Tool M-CHAT
  • Modified Checklist for Autism in Toddlers
  • 18 months to 2 years
  • Verbally administered questionnaire

49
M-CHAT Key Questions
  • Does the child
  • Take an interest in other children?
  • Use index finger to point, to indicate interest
    in something?
  • Bring objects to show parent?
  • Imitate parents facial expression?
  • Respond to name when called?
  • Look at something when parent points?

50
Take-home lesson 3
  • Be aware of the possibility of autism in a child
    with delayed speech.
  • Not turning when name is called
  • No pointing
  • No imaginative or pretend play
  • DONT WAIT REFER!
  • under 3 years, H-KISS (0-3 Program)
  • over 3 years, Dept. of Education

51
Why is early diagnosis of autism so important?
  • With early intervention (before age 3)
  • Many children with ASD can have significant
    improvement in communication and social skills

52
Detecting Problems Early
  • Developmental screening
  • Denver II (formerly DDST)
  • PDQ (Prescreening Developmental Questionnaire)
  • PEDS (Parents Evaluation of Developmental
    Status)
  • ASQ (Ages and Stages Questionnaire)

53
Detecting Problems Early
  • Language screening
  • ELM (Early Language Milestone Scale)
  • CLAMS (Clinical Linguistic Auditory Milestone
    Scale)

54
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55
Helpful Resources
  • American Speech/Language Hearing Association
    www.asha.org
  • Autism Society of America www.autism-society.org
  • NIDCD (National Institute on Deafness and
    Communication Disorders) http//www.nidcd.nih.gov/
    health/voice/speechandlanguage.asp

56
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