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Speech development- Delay and other problems
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Transcript of Speech development- Delay and other problems
SPEECH DEVELOPMENT
Babu Appat
Language is the process whereby we communicate with others. It
involves an element of understanding and expression
(speech).
It is one of the most highly developed of all human skills,
giving us a framework for thought and allowing us to communicate
Disorders of speech and language are common, ranging from unclear
speech or a slight delay in development to more significant
difficulties associated with serious disorders
This presentation will give you an outline of the normal
development, assessment of the child presenting with these
difficulties and some of the more common causes
This presentation will give you an outline of the normal
development, assessment of the child presenting with these
difficulties and some of the more common causes
Normal speech development
The following is only a rough guide but there is a wide variation of normal speech development
1 to 6 months:
Turns to sound, startled by loud sounds, cooing and babbling sounds. Copies
smiles and laughs. Different sounds for different needs.
6 to 12 months:
Babbling initially 'da', 'ba' then combining syllables towards 7/8
months - da-da', 'ba-ba'
12 months:
says 'mama', 'dada' or another simple word with meaning
12 - 18 months:
vocabulary of 6-20 words, not necessarily understood by unfamiliar adults. Pretend play - for example,
pretending to talk on the phone
3-4 Years
Three to six words per sentence; asks and answers questions, relates
experiences, tells stories; almost all speech understood by strangers. Errors
with tense are normal - eg, 'runned' instead of 'ran'
4-5 Years
Six to eight words per sentence; names four colours; counts to ten
Variations in development versus
delay
It is important to clarify what the concern is, as
there can be a lot of variation in speech and language development
Consider whether either of the parents
was a late speaker
There tends to be a gender difference with girls developing slightly faster than boys and it is
traditionally said that bilingualism may delay speech
(although there is emerging evidence to the contrary
Parents are usually the first to express concern -
are they comparing to other children and simply
observing normal variation?
Examples of the need for referral include
There is no double syllable babble at a year.
There are fewer than six words, or there is persistent drooling, at 18 months
There are no two- to three- word sentences by 2½ years
Speech remains unintelligible by 4 years.
Epidemiology
Speech delay is a common childhood problem. It is estimated to affect around
6% of children.
However, this figure has been reported to be as high as 19%
The disorder is more common in boys than in girls.
• AetiologyPrimary• Primary speech and language delay. Delay is not caused by other conditions. Children have normal understanding, intellect, hearing, emotional relationships and articulation skills.• Expressive language disorder. Needs active intervention to improve.• Receptive language disorder.SecondaryProblems can arise from:• Speech or articulation difficulties:• Cleft lip• Tongue tie
Stammer
Cerebral palsy (can cause delay for several reasons)
Deafness.
Developmental problems:
Maturational delay (often familial)
Environmental deprivation and neglect
Learning disability
Communication difficulties:
Autism
Other
Selective mutism (the child selectively refuses to speak according to particular
circumstances)
Childhood apraxia of speech. Difficulty in making the right sounds in the correct
order.
Dysarthria. Motor difficulty in creating speech.
AssessmentThe questions to ask yourself are:
Is the child's hearing normal?Is this an articulation (speech) or
language problem?Is this an isolated problem or part of a
more global delay?Is there a communication disorder?
Assessment of the child to answer these questions can be complex - particularly beyond
toddlerhood - and a speech and language therapist assessment
may also be required
HistoryThese children may be
particularly shy about talking so obtain a good history from the
parents
Establish whether the child appears to have difficulty in hearing.Note whether the child seems to understand what the parent is saying. If they seem to understand, but respond with unintelligible speech, there is a speech problem. If there are comprehension difficulties too, there may be a language or other problem.Note whether there are delays in other physical or social skills which could suggest a more global delay.Establish whether there are abnormalities in nonverbal communication skills that might suggest autism.Obtain a complete developmental history.Check the past medical and perinatal history.Ask about a family history of deafness or language delay.
ExaminationObserve the child play and interact with the parent. Listen to any talking and note any imaginative play:A stammer is associated with normal comprehension; however, speech is immature, stuttered or unintelligible.Note that the ability to form interpersonal relationships is often normal in children with learning difficulties, as it is in all other causes except for autism.Autism and language disorders may both be associated with delays in other developmental areas.Ask the child simple questions about pictures or their play: note whether they seem to understand you. Assess motor and social skills.Note any anatomical abnormalities, and examine mouth and ears. Exclude tongue tie as a cause.
InvestigationsOrganise a formal hearing test by an audiologist. If you think that there is
some sort of language difficulty following your assessment, get a
speech and language evaluation too
ManagementManagement may sometimes be just explanation, simple advice and reassurance with the involvement of the health visitor.However, early detection and intervention for speech delay may prevent, or at least reduce, the educational, emotional and social problems that may be caused.A referral for speech therapy may be required. The effectiveness of therapy depends upon the cause for speech delay. There is some evidence for the effectiveness of interventions for expressive speech difficulties; the evidence for interventions for expressive syntax is mixed and there is no evidence for interventions for receptive language difficulties.[5]
There is currently no evidence for the best treatment of childhood apraxia of speech.[7] Also, there is no convincing evidence that speech and language therapy is effective for early acquired dysarthria.[8]
Multidisciplinary involvement may be required and the involvement of the parents is vital.Management is dependent on cause and associated problems such as hearing impairment.If the underlying problem is related to the auditory apparatus and surgery is required, children still need targeted language therapy to complete their rehabilitation.
Management
Management may sometimes be just explanation, simple advice and reassurance with the involvement of the health visitor.However, early detection and intervention for speech delay may prevent, or at least reduce, the educational, emotional and
social problems that may be caused.
Management
A referral for speech therapy may be required. The effectiveness of therapy depends upon the cause for speech delay. There is some evidence
for the effectiveness of interventions for expressive speech difficulties; the evidence for
interventions for expressive syntax is mixed and there is no evidence for interventions for
receptive language difficulties..
Management
There is currently no evidence for the best treatment of childhood apraxia of
speech. Also, there is no convincing evidence that speech and language therapy is effective
for early acquired dysarthria.Multidisciplinary involvement may be required
and the involvement of the parents is vital.
Management
Management is dependent on cause and associated problems such as hearing
impairment.If the underlying problem is related to the
auditory apparatus and surgery is required, children still need targeted language
therapy to complete their rehabilitation
There is no systematic child development and behaviour
screening policy in place as this was not recommended at the
last UK National Screening Committee (NSC) review. This is
currently under review
Prognosis
This is dependent on the cause of the speech delay.
The prognosis is improved with early detection and
intervention.
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