Transcript Language and Speech Development

Language and Speech
Development
Objectives
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Describe key stages in the development of
language and speech
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Know when to refer for further evaluation of
speech and language delays
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Generate a differential for language and speech
delay
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Definitions
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Language – use of systematic, socially agreed
upon signals to convey meaning
Receptive language – ability to understand
 Expressive language – ability to produce symbolic
communication
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Speech – series of vocal sounds used as form of
language
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Correcting Misconceptions about
Speech and Language Delay
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Which of the following are true and which are
false?
Boys tend to be delayed > 6 months compared to
girls
 Children from bilingual households are significantly
delayed
 Otitis Media causes language delay
 Second- and third-borns let their older siblings speak
for them
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Correcting Misconceptions about
Speech and Language Delay
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ALL ARE FALSE!!!!!!!!!
Boys tend to be delayed > 6 months compared to girls
Boys tend to be only slightly delayed (1-2 months)
 Children from bilingual households are significantly delayed
Children MAY show mild delay and early mixing only!
 Otitis media causes language delay
Otitis media is associated with language delay
 Second- and third-borns let their older siblings speak for
them
Children have strong motivation to speak when able
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Background
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Speech and language delays are the leading
developmental concerns in parents of children
less than 5 years old
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Of children eligible for Early Intervention, 80%
have problems in the communication domain
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15-20% of young children have a
communication disorder
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Normal Milestones in the
Development of Language
and Speech
Age
Receptive Skills
Expressive Skills
Birth
Turns to source of sound
Shows preference for voices & interest in faces
Cries
2-4 months
Coos
Takes turns cooing
6 months
Responds to name
Babbles
9 months
Understands verbal routines (wave bye-bye)
Points
Says ma-ma, da-da
12 months
Follows a verbal command
Uses jargon
Says first words
15 months
Points to body parts by name
Learns words slowly
18-24 months
Understands sentences
Learns words quickly
Uses 2 word phrases
24-36 months
Answers questions
Follows 2 step commands
Phrases 50% intelligible
3 or more word sentences
Asks “what” questions
36-48 months
Understands much of what is said
Asks “why” questions
Phrases 75% intelligble
Masters m, b, y, n, w, d, p, h
48-60 months
100% intelligble and tells stories
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Risk Factors for Delays
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Family history - There's a higher risk of continued
delay if one of a toddler's parents or siblings had longterm language and learning difficulties.
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Otitis media with effusion - causing a fluctuating
hearing loss during the period of speech development.
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Low socioeconomic status and educational level These families are more likely to have a child with a
poor outcome.
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Warning Signs for Delay
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little sound play or babbling as an infant, with limited number of
consonant sounds and, possibly, vowel distortions as a toddler
poor verbal imitation skills; reliance on direct model and
prompting
immature play skills; little pretend play
interactions with adults more than peers
few communicative gestures (the late bloomer who caught up
with his peers within a year used significantly more gestures than
the child who had persistent delay)
impaired social skills or behavior problems
small vocabulary for age; less diverse verb repertoires
comprehension delay of six months or greater relative to
chronologic age
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Absolute Indications for Referral
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no babbling, pointing, or gesturing by 12
months
no single words by 16 months
no two-word spontaneous phrases by 24 months
any regression in language or social skills at any
age
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Language Impairment
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A child with a receptive or expressive language disorder, or both,
and no other developmental disability has specific language
impairment (SLI)
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AKA language-learning impairment, developmental language disorder,
developmental dysphasia, or developmental aphasia.
Incidence of SLI in 5 year olds - 7.6% (NIH)
Children with SLI are usually late talkers and most—67% to
84%—are boys.
At 3 or 4 years old, most children with SLI have a limited
vocabulary and speak in short phrases rather than sentences
The cause of SLI is unknown, but it appears to run in families.
If a child has SLI, there is a 25% chance that another family
member will be affected.
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Speech Disorders
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Include disorders of articulation and phonology
(dysarthria, apraxia, and phonologic disorder).
Articulation - individual speech sounds and how they
are pronounced
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All children, not just those with a speech disorder,
misarticulate sounds in the course of normal speech
development.
They may use sound substitutions such as "wady" for "lady";
omit sounds, saying "baw" instead of "ball"; or distort
sounds, so that "snake" comes out "snek," or "silly" comes
out "shhilly."
Concern arises when these errors continue beyond the time a
child normally outgrows them.
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Speech Disorders
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Phonologic development - the gradual process of acquiring
adult speech
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The majority of children pick up most phonologic rules by age 5. For
example, most children stop deleting the final consonant in words (as
when a child says "cuh" instead of "cup") between ages 2 and 3. And
children usually outgrow velar fronting by 3 years. An example of velar
fronting is, "Mommy, tan you div me one?" (for "Mommy, can you give
me one?"). In such cases, the child is replacing consonants made with the
tongue moving toward the back of the mouth, such as "k" and "g," with
consonants produced at the front of the mouth: "t" and "d."
Children with a phonologic disorder make sound substitutions
consistently but, when given auditory and visual cues, are able to
imitate correct sounds or words. Usually, they have normal oral
muscle tone.
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Speech Disorders
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Dysarthria - motor speech disorders that result from
nervous system injury
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There is a lack of strength and control of the muscles used
for both speech and non-speech functions, such as smiling
and chewing.
Many children with cerebral palsy have a dysarthric speech
pattern, slurring words, distorting vowels, and often
producing slow, labored, nasal speech.
Children with dysarthria have difficulty in the actual
production of speech sounds.
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In particular, they are more likely to distort consonant
sounds. This differs from apraxia, in which consonants are
omitted.
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Speech Disorders
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Verbal apraxia - neurologic motor speech impairment that
affects the planning, executing, and sequencing of speech
movements
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Causes a breakdown in the neural transmission of messages to the
muscles of the jaw, cheeks, lips, tongue, and palate (no muscle weakness)
These children may point, grunt, and become increasingly angry at their
inability to communicate
Sometimes the same word can come out four different ways. The more
these children try to talk, the more stymied they become and the harder
they are to understand.
They may drop the final consonant in single syllable words: "Cat come
home" becomes "Ca co hoe." They may transpose sounds within a word.
Instead of saying "elephant," they may say "efelant."
Often a history of limited babbling and vocal play
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Use of Screening Tools
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AAP policy statement recommends that
pediatricians conduct standardized
developmental screening tests on all infants and
children at their 9-, 18- and 24- or 30-month
well-child visits
Examples: Ages and Stages Questionnaire
(ASQ), Parents' Evaluations of Developmental
Status (PEDS), Denver II
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Evaluation and Management
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Lead testing for those with dev. delay
Some of these children spend a prolonged time in
the oral-motor stage of play
 An elevated lead level can cause behaviors that
resemble developmental delay, autism, and emotional
disturbance
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Referral to Early Intervention or Developmental
Pediatrician to help prevent later language-based
learning disabilities, including reading disabilities
(dyslexia)