Early Language Development: Implications for Clinical and Educational Practice

Jean Piaget's Theory of Cognitive Development

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A Cochrane review did not find firm evidence of the effectiveness of speech-language therapy to improve the speech of children with dysarthria acquired before three years of age. Speech and language are often gradually affected, with a decline in the precision of speech articulation and a lack of progress in vocabulary acquisition. Children with hearing loss should be referred to an audiologist. The audiologist, as part of an interdisciplinary team of professionals, will perform an evaluation and suggest the most appropriate intervention program.

Parents may report that the child does not seem to be listening, or describe the child speaking better than listening. Children may have distortions of speech sounds and prosodic patterns intonation, rate, rhythm, and loudness of speech. This may include referral to a tertiary-level child development center that can provide interdisciplinary evaluations including speech-language therapy and audiology. Referral should include consultation with a medical geneticist to aid in diagnosing the cause of the intellectual disability.

Use of gestures is delayed, and there is a generalized delay in all aspects of developmental milestones. Children with selective mutism show a consistent failure to speak in specific social situations in which there is an expectation for speaking [e. Children should be referred to a speech-language pathologist for evaluation, and to a therapist for behavioral and cognitive behavior therapies, which appear to be effective.

Parents and teachers can be referred to the Selective Mutism Information and Research Association for advice. Combined intervention including behavioral modification, family participation, school involvement, and in severe cases, treatment with fluoxetine Prozac is promising. Information from references 12 , and 18 through When speech and language delay is suspected, children should be referred to a speech-language pathologist or local early intervention program, and an audiologist.

Does not look at or point to 5 to 10 objects or persons when named by parents. Adapted with permission from Schum RL. Language screening in the pediatric office setting. Pediatr Clin North Am. For children with health insurance, options for referral include those organizations that contract with their insurance groups. Medicaid programs typically cover speech therapy, although smaller organizations may not accept those plans. Children without health insurance may be able to access therapy through services funded by grants under the Individuals with Disabilities Education Act and administered by individual states.

State-administered early intervention services are available from birth to three years of age.

After three years of age, children who qualify may receive speech therapy through the public school system. Uninsured children who do not qualify for these services may be able to access an organization with a sliding scale fee based on the family's economic status.

Table 2 lists some of the many causes of speech and language problems, and briefly outlines treatment principles. There are good data available to support the effectiveness of speech-language therapy, particularly for children with primary expressive language disorder. The response to treatment is more varied when using parent administrators, which suggests that some parents may be more suited for providing therapy than others.

Therapies lasting longer than eight weeks appear to be more effective than those lasting less than eight weeks. When a child is not meeting the expected developmental milestones for speech and language, it is important to avoid making a specific diagnosis until a formal evaluation has been completed. Parents can be counseled that, once a diagnosis is made, there are professionals who can work with the child and parents, and that many times children show a positive response to this intervention.

If the child has other developmental or behavioral problems, these problems may persist, or they may improve as the child's communication skills improve. At follow-up visits, the physician can review the child's progress with the parents. It is often helpful to focus on positive changes that the child has made since the previous visit, rather than only noting the child's current status compared with age-based norms.

The physician can also focus on what the parents can do to help their child, including recommending books for the parents to read. Two books were recommended in a recent article 30 : The New Language of Toys: Teaching Communication Skills to Children with Special Needs: A Guide for Parents and Teachers , 34 which provides specific suggestions for using toys and books in a developmentally appropriate manner to encourage communication, and Childhood Speech, Language, and Listening Problems: What Every Parent Should Know , 35 which explains different communication problems and advises parents on available resources.

It offers information on childhood speech and language disorders, and provides links to national organizations. Already a member or subscriber? Log in. Address correspondence to Maura R. Box , Charlottesville, VA e-mail: mr9me virginia. Reprints are not available from the author. Comer, SLP, for information regarding speech-language pathology services. Detection of language difficulties at 36 to 39 months. Dev Med Child Neurol.

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Stevenson J, Richman N. The prevalence of language delay in a population of three-year-old children and its association with general retardation. Developmental language delay from three to seven years and its significance for low intelligence and reading difficulties at age seven. Epidemiological investigation of expressive language delay at age two.

First Language. Language screening in preschool Chinese children. Eur J Disord Commun.

Stern LM, et al. The Adelaide preschool language unit: results of follow-up. J Paediatr Child Health.

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A longitudinal investigation of reading outcomes in children with language impairments. J Speech Lang Hear Res. Scarborough HS, Dobrich W. Development of children with early language delay. J Speech Hear Res. A longitudinal study of children with developmental language delay at age three: later intelligence, reading and behaviour problems. Psychosocial outcomes at 15 years of children with a preschool history of speech-language impairment.

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J Child Psychol Psychiatry. Bishop DV, Clarkson B. Written language as a window into residual language deficits: a study of children with persistent and residual speech and language impairments. Simple developmental speech delay: a follow-up study. Preventive Services Task Force. Screening for speech and language delay in preschool children: recommendation statement. Rockville, Md. Green M, Palfrey JS, eds. Arlington, Va. Coplan J. Evaluation of the child with delayed speech or language. Pediatr Ann. Language mixing in young bilinguals. J Child Lang.

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Evaluation and management of the child with speech delay. Am Fam Physician. Speech and language therapy interventions for children with primary speech and language delay or disorder.

Cochrane Database Syst Rev. The pediatrician's approach to the preschool child with language delay. William ElcockHow to believe Dillian Whyte vs. Please increase the for the equipment you was acquiring to email.

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