Wednesday, August 2, 2017

Speech and Language Delay in Children

Department of Pediatric Dentistry
Lutheran Medical Center
           
Resident’s Name: Albert Yamoah, DDS                                                                                                 Date: 08/02/2017
Article Title: Speech and Language Delay in Children
Author(s): Maura R McLaughlin, MD – University of Virginia School of Medicine
Journal: American Family Physician
Date: 2011
Major TopicEvaluation of speech and language delay in children
Type of Article: Literature Review
Main Purpose: Information for the practitioner regarding speech and language delays in children
Definition:
Speech – verbal production of language. 
Language – conceptual processing of communication, includes receptive language (understanding) and expressive language (the ability of convey information, feelings, thoughts, and ideas)
- The reported prevalence of language delay in children 2-7 years of age: 2.3 to 19%
- Most consistently reported risk factors: Family history, male sex, prematurity, and low birth weight.
- Less consistently reported risk factors: Levels of parental education, childhood illness, late birth order and larger family size.

Normal Development:
- “Rule of Fours”: If the child’s age in years divided by four, the quotient is approximately equal to the amount of speech that should be understandable.  2 y/o: 50% understandable speech.

Bilingual language learning:
- Mixing of the two languages is normal and usually by 5 y/o the child is proficient in both.

Atypical Development: 
- Primary speech and language development: no other etiology can be found (developmental)
- Secondary speech and language problems: attributable to another condition (Autism, CP, Dysarthria)

Indications for referral: 
- When speech and language delay is suspected referral to speech-language pathologist or local early intervention program is recommended.  
- Children without health insurances can access therapy though the Disabilities Education Act and through the public school system.

Therapies:
- For primary expressive language disorder success rate is high for speech therapy.  For children with receptive language disorder the effect is much smaller.  Parents can effectively administer speech-language therapy but first must received training from a speech pathologist. Therapy longer than 8 weeks is most effective.
- Important to talk with parents about diagnosis, letting them know that there are professionals that can help and that most children show a positive response to intervention.  Follow-up visits physicians should focus on the positive changes rather than comparing to age-based norms. Support for parents should include making recommendations on books to read and providing information about other organizations that might have helpful suggestions as well.
- When speech and language delay is suspected, the primary care physician should discuss this concern with the parents and recommend referral to a speech-language pathologist and an audiologist. There is good evidence that speech-language therapy is helpful, particularly for children with expressive language disorder.
Remarks:
Assessment of Article:  Level of Evidence: Level III



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