Speech Delay

Speech
1. Verbal production of language
Language
1. Processing of communication
Receptive Language
1. Language comprehension
Expressive Language
1. Conveyance of ideas via speech, writing or visual expressive forms (e.g. drawing)

Prevalence of speech or language disorders
1. One in 8 children ages 2-5 years old in the U.S.

See Language Milestone
See Language Milestone Red Flags
See Developmental Red Flags
See Speech Exam
See Congenital Anomaly
Language and Speech Delay impact the speed of skill attainment
1. However, children with speech and Language Delay typically have the capacity to acquire the skills at a slower rate
2. Managing speech and language deficits allows for decreased barriers to learning and the associated social and academic impact

Developmental Speech and Language Delay
1. Delayed speech despite normal comprehension, intelligence, Hearing, socialization, articulation
2. Most common of the primary language disorders
3. Expect normal speech by school age with parent and therapist intervention
Expressive Language Disorder
1. Presents in similar fashion to Developmental Speech and Language Delay
2. Active intervention is critical as this does not correct spontaneously
3. Childhood onset fluency disorders
  1. Stuttering
  2. Cluttering (fast or irregular speech resulting in dysfluency)
4. Social communications disorder
  1. Social verbal and gestural disorder (e.g. eye contact, facial expressions, body language)
  2. Interventions to promote social interaction, role-play
Receptive Language Disorder
1. Delayed speech characterized as sparse, agrammatic, and with poor articulation
2. Example: Does not respond to "point to the picture of the girl?" or "where is the dog?"
3. Response to intervention is less than for other primary language disorders and longterm speech development is abnormal
Reduced vocabulary
1. Limits communication (both reception and expression)
2. Best outcomes if identified age <4 years and intervention to improve language use and comprehension

Autism
1. Associated with Echolalia, pronoun reversal, language regression and impaired communication
Cerebral Palsy
1. Associated with Incoordination of Tongue, Hearing Loss, cognitive delay
Childhood Apraxia of Speech
1. Difficulty creating sound in the correct order (speech is difficult to understand)
Dysarthria
1. Severity ranges from slurred articulation to completely incomprehensible speech
Hearing Loss
1. Before spoken language established (esp. at birth or first few months of life)
  1. Distorted speech sounds
  2. Significant impact on language development
2. After spoken language established
  1. Gradual decline in articulation, and lack of progress in expanding vocabulary
  2. Evaluate for underlying cause
  3. Establish alternative communication modalities (e.g. sign language)
  4. May respond to Hearing Aids, Cochlear Implants
Cognitive Disorder or Global Developmental Delay
1. See Developmental Milestones
2. Overall Developmental Delay
Intellectual Development Disorder
1. Intellectual Function deficit with associated deficits in social judgment, behavior, communication
2. Disorders include Down Syndrome, Fragile X Syndrome, Williams Syndrome, Rett Syndrome
Selective Mutism
1. Refusal to speak in certain social situations
Craniofacial Disorders
1. Cleft Lip and Cleft Palate
2. Dental malocclusion
3. Macroglossia
4. 22q11.2 Deletion Syndrome
Functional disorders
1. Vocal Cord Dysfunction
2. Myofunctional disorder
  1. Tongue thrust at rest or with Swallowing

Books for parents
1. Schwartz (2003) New Language of Toys
  1. Paid link to Amazon.com (ISBN 1890627488)
2. Hamaguchi (2010) Childhood Speech, Language, and Listening Problems
  1. Paid link to Amazon.com (ISBN 0470532165)
Web
1. American Speech-Language Hearing Association
  1. http://www.asha.org

Indications
1. See Language Milestone Red Flags
2. Speech or Language Milestone regression
3. Delayed vocabulary (<50 words at age 24 months)
4. Incomprehensible speech at 24 months
Consultants
1. Early intervention programs (see resources, CDC "act early" program below)
  1. Self-referral and government supported for under age 3 years in U.S.
2. Speech and language pathologist
3. Early intervention program
4. Audiologist
5. Public school (as of age 3 years old)

Early diagnosis and treatment prior to school age results in best outcomes
Speech and language disorders starting in preschool that extend into elementary school have worse prognosis
1. Associated with other learning disabilities (in contrast with better outcomes with early intervention)
2. Associated with longterm reading difficulty, lower skilled employment and higher unemployment rates
3. Associated with longterm behavioral and psychosocial impacts
4. Snowling (2006) J Child Psychol Psychiatry 47(8): 759-65 [PubMed]

Universal Hearing screening
1. See Pediatric Auditory Screening for schedule
Early exposure to language (first 6 months of life) has a significant impact on a child's mastery of language
Parents and Caregivers should start early in their communication with children, engaging them in social interaction
1. Frequent communication with simple sentences and clear word pronunciation
2. Incorporate language in everyday tasks, steadily broadening vocabulary
Encourage less Screen Time in favor of activities that build communication skills
1. Reading and writing
2. Social interaction

Early intervention programs (CDC "act early" program)
1. https://www.cdc.gov/ncbddd/actearly/index.html