An introduction to speech an language delay

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An introduction to speech an language delay

• Contributor
• Dr C M Ni Bhrolchain
• Huntingdon

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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

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What do you need to do?

• Decide if there is a problem
• Decide what the problems are
• Decide what should be done about them

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Is there a problem?

• Assess parents expectations
• Assess childs speech
• Assess childs
• General development
• Hearing
• Behaviour

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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)

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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

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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

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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

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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

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Understanding communication

• Does the child understand non-verbal gestures?
• Does he/she point for interest?
• Does he/she follow a point?
• Does he/she seek joint interest e.g. in books?

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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?

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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 its interrupted?

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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

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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

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Social deprivation

• Parent/child interaction
• Has this child seen toys before?
• Does parent play with him/her?
• Home visit may be helpful

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Referral pathways

• Hearing
• Deprivation
• Immaturity
• Delayed speech
• Communication) disorder )
• Devt delay )

• Audiology
• Nursery/portage
• Reassurance and review
• SLT
• SLT and community paediatrician