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Child with speech delay

A child is considered to have speech delay if the child’s speech development is significantly below the normal for the children in the same age.

SPEECH DEVELOPMENT

1-6 months

Coos

6-9 months

Babbling

10-11 months

Mama – Dada with meaning

12 months

3 words + mama/ dada

13-15 months

4-7 words

16- 18 months

Vocabulary of 10 words

19-21 months

Vocabulary of 20 words

22 -24 months

Vocabulary of >50 words

2 – 2 ½ years

Two word phrase

3 – 4 years

3-6 words in sentences, ask questions, tell stories, all speech understood by strangers

4-5 years

Six to eight words per sentence.

 

CAUSE OF SPEECH DELAY

  • Mental retardation
  • Hearing loss
  • Express language disorder
  • Autism
  • Elective mutism
  • Receptive aphasia
  • Cerebral palsy
  • Bilingualism
  • Maturation delay

INDICATION FOR REFERRAL

Any age having lack of interest to sound; lack of interest in interaction with people and lose of previous milestones.

  • 6 months – 9 months: poor sound localization
  • 12 months: No verbal / failure to use mama – dada
  • 15 – 18 months: No single words; poor understanding of language
  • 24 months: Vocabulary less than 50 words or not 2 words phrase
  • 48 months: Inability to participate in conversation

MENTAL RETARDATION

Kids with mental retardation have speech delay and auditory comprehension delay. The cause of 30 - 40% of children with mental retardation cannot be determined. Known cause of mental retardation includes genetic defect, intrauterine infection, maternal medication, hypoxia, kernicterus, hypothyroidism, meningitis, encephalitis and metabolic disorders.

HEARING LOSS (CONDUCTIVE OR SENSORINEURAL)

Conductive hearing loss

  • It is commonly caused by  OME (otitis media with effusion) or malformation of the middle ear structures or atresia of the external auditory canal. Sensorineural hearing loss may result from intracranial infection, hemorrhage, kernicterus, pendred syndrome, Waardenburg syndrome, usher syndrome, meningitis, hypoxia and toxic drugs.

MATURATION DELAY

In this condition, a delay occurs in the maturation of the central neurologic process, required to produce speech. It is more common in boys and there is a family history of speech delay. The prognosis is excellent; they have normal speech development by the age of school entry.

EXPRESSIVE APHASIA

These children have normal intelligence, normal hearing and skills and development. The primary defect is brain dysfunction that results in an inability to translate ideas into speech.

BILINGUALISM

Bilingual home environment may cause temporary delay in the onset of both languages.

AUTISM

Failure to make eye contact, repetitive motor activity and speech delay.

SELECTIVE MUTISM

The child does not speak because they do not want to. They speak just when they are alone or with their parents but they don’t speak at school, in public situation or with strangers.

RECEPTIVE APHASIA

The child responds normally to nonverbal auditory stimuli, but they have problems with comprehension of spoken language.

CEREBRAL PALSY

Child with cerebral palsy commonly has speech delay because of hearing loss incoordination or spastic of the muscle of the tongue, co-existing mental retardation. 

APPROACH TO THE CHILD WITH SPEECH DELAY

  1. Full history of language development milestones.
  2. Determine if the delay is expressive alone or receptive. Does the child follow commands?
  3. Complete development history including:
    • Gross motor
    • Fine motor
    • Social
    • Cognitive
  • The social development is critical:
    • Does the child point to objects?
    • Is the child interested in communication?
    • Does the child demonstrate reciprocity?
    • What is the nature of the child’s play?
  1. Have any milestones ever been lost?
  2. Result of audiology test
    • Does the child turn to sound or respond to his name
  1. Medical history focusing or factor that affect cognition (genetic disorders, prenatal exposure, prematurity, birth asphyxia, intracranial hemorrhage); hearing (meningitis, ototoxic medication, chronic otitis media) and motor development (neuromuscular disorders).
  2. Family history of speech delay, learning disabilities, hearing impairment, genetic disorders.

PHYSICAL EXAM

  • Observe the child during encounter, including interactions with parents, interaction with strangers and the child at play
  • Assessment of the growth and dysmorphic features
  • Skin exam for neurocutaneous disease
  • Full neurologic exam
  • External ear exam and tympanic membranes
  • Mouth and pharynx exam for malformation that may impact speech

INVESTIGATION -

  • Formal audiology assessment
  • Child with some expressive language ability may be referred for psychoeducational testing
  • Karyotype or specific genetic test maybe indicated for abnormal neurologic exam
  • MRI
  • Iron deficiency and lead poisoning contribute to development delay

The management of a child with speech delay demands health care team which includes physician, speech language pathologist, audiologist, occupational therapist, social workers. The physician should provide the team with information about the cause of speech delay and be responsible for any medical treatment.

A speech language pathologist plays an essential role of treatment plan.

  • Children with hearing loss, hearing aids, auditory training, lip reading, reconstruction of external canal, cochlear implantation may be necessary.
  • Psychotherapy and behavioral therapy is indicated for child with selective mutism or when the speech is delayed caused by behavioral problems, and for autistic children.
  • Most children with specific language impairment are at risk for future academic and behavioral disorder and requires regular long term follow-up.

 

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