complete evaluation child w speech delay

7/28/2019 Complete Evaluation Child w Speech Delay

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Complete evaluation of the child referred for speech delay Instructional course # 4713-1

Complete Evaluation of the Child Referred for Speech Delay

Instructional Course 4713-1

Otolaryngologist: Dr. Kenneth Grundfast ///// Neurodevelopmental Disability Specialist: Dr. Elliott Gersh

American Academy of Otolaryngology Head and Neck Surgery September 12, 2012

I. Speech Delay Evaluationa. Criteria for speech delay evaluation1,2

Concern by the parent, teacher, professional, or other caregiver about the child's speech

or language

Slowed or stagnant speech and language development

Excessive drooling

Difficulty sucking, chewing, or swallowing

Difficulty coordinating movements of lips, tongue, and jaw

No babbling by nine months

No first words by 15 months

No consistent words by 18 monthsNo word combinations by 24 months

Speech is difficult for parents to understand at 24 months

Speech is difficult for strangers to understand at 36 months

Dysfluencies (stutters) consist of more than tension-free whole-word repetitions

Child is frustrated by communication difficulty

Child is teased by peers for "talking funny"

Child avoids talking situations

Child acquires vocabulary and sentence structure but does not use language

appropriately for communicative purposes

Language is unusual or confused, or ideas are not expressed clearly

Child cannot follow instructions without supplemental visual cues

Loss of milestones

Poor memory skills at five to six years

b. Screening tools for developmental delay:http://www.commonwealthfund.org/Resources/2007/Dec/Part-II--Guides-to-Facilitate-Your-

Choice-and-Use-of-Screening-Instruments.aspx

II. Voice, Speech and Language2,3a. Voice: sound produced by pushing air past vocal folds, causing vibrationsb. Speech: expression of language, requiring intact neural language centers and properly

coordinated muscle action of the tongue, lips, jaw, and vocal tract

c. Language: set of shared rules guiding effective communication through speech, the writtenword, or gestures

III. Development of Speech and Language4a. Requires consistent exposure to speech during the critical period of the first 3 years of life, when

cognitive language centers are most rapidly developing
http://www.commonwealthfund.org/Resources/2007/Dec/Part-II--Guides-to-Facilitate-Your-Choice-and-Use-of-Screening-Instruments.aspxhttp://www.commonwealthfund.org/Resources/2007/Dec/Part-II--Guides-to-Facilitate-Your-Choice-and-Use-of-Screening-Instruments.aspxhttp://www.commonwealthfund.org/Resources/2007/Dec/Part-II--Guides-to-Facilitate-Your-Choice-and-Use-of-Screening-Instruments.aspxhttp://www.commonwealthfund.org/Resources/2007/Dec/Part-II--Guides-to-Facilitate-Your-Choice-and-Use-of-Screening-Instruments.aspxhttp://www.commonwealthfund.org/Resources/2007/Dec/Part-II--Guides-to-Facilitate-Your-Choice-and-Use-of-Screening-Instruments.aspx


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Age Achievement

1 to 6

months

Coos in response to voice

6 to 9

months

Babbling

10 to 11months

Imitation of sounds; says mama/dada without meaning

12 months Says mama/dada with meaning; often imitates two - and three-syllable words

13 to 15

months

Vocabulary of four to seven words in addition to jargon; < 20% of speech understood by strangers

16 to 18

months

Vocabulary of 10 words; some echolalia and extensive jargon; 20% to 25% of speech understood by

strangers

19 to 21

months

Vocabulary of 20 words; 50% of speech understood by strangers

22 to 24

months

Vocabulary > 50 words; two-word phrases; dropping out of jargon; 60% to 70% of speech

understood by strangers

2 to 2

years

Vocabulary of 400 words, including names; two- to three-word phrases; use of pronouns;

diminishing echolalia; 75% of speech understood by strangers

2 to 3

years

Use of plurals and past tense; knows age and sex; counts three objects correctly; three to five words

per sentence; 80% to 90% of speech understood by strangers

3 to 4 years Three to six words per sentence; asks questions, converses, relates experiences, tells stories; almost

all speech understood by strangers

4 to 5 years Six to eight words per sentence; names four colors; counts 10 pennies correctly

Information from Schwartz ER. Speech and language disorders. In: Schwartz MW, ed. Pediatric primary

care: a problem oriented approach. St. Louis: Mosby, 1990:696700.

IV. Causes of Speech Delaya. Hearing abnormalities

i. Congenital hearing loss or early hearing loss without intervention greatly impairsdevelopment of speech production

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ii. Currently in the US universal newborn hearing screen is mandated1. Auditory Brainstem Response (ABR) or Ootoacoustic Emissions (OAE) methods

iii. Auditory Neuropathy Spectrum Disorder (ANSD)61. Normal/near-normal OAE + absence of normal middle ear reflexes +

abnormal/absent ABR

2. Functional inner ear that cannot relay signals to brain properly3. Evaluation and management

a. Highly variable deficits in hearing and speech recognition abilitiesb. Presence of hearing difficulties could signify underlying cognitive

disabilityc. ANSD babies should be followed closely, many isolated cases resolve

spontaneously

iv. Otitis Media 7,81. Controversy exists over resulting speech delay due to recurring middle ear

effusions (MEE) and whether tympanostomy improves future development

b. Structural abnormalities9,10i. Ankyloglossia


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1. Can present early with breast feeding difficulties, most commonly poor latchingand maternal nipple pain

2. Controversy exists over tongue tie and speech delay3. A child with tongue tie and speech delay should be evaluated by speech

pathologist before operating

4. Managementa. First seek speech therapyb. Surgical therapy indicated if speech therapy fails

i. Frenuloplastyii. Fren-Z-Plasty

c. Language abnormalities11i. Abnormalities in comprehension (receptive) and word production (expressive)ii. Pervasive Developmental Disorders (PDDs) [NOTE: Autism, Asperger Syndrome and

PDD-NOS fall under the term Autism Spectrum Disorder]

1. AutismDisordera. Defect in social and communication capacitiesb. Delayed language comprehension/production, delayed echolalia,

formulaic speech (repetitive word choice), odd word-choice, gaze

avoidance, avoidance of meaningful verbal communication

c. Some children illustrate normal progression followed by regression ofskills

2. AspergerSyndromea. Milder form of autism, often with less affected language/cognitive

deficits

3. RettDisordera. Exclusively in females, characterized by normal development followed

by global deterioration of skills

4. ChildhoodDisintegrativeDisorder (CDD)a. Similarly to Rett disorder, a child who exhibits progression in language,

social and motor function experiences dramatic regression in skills

5. PDD-NotOtherwiseSpecified (PDD-NOS)a. A child who presents impaired social and language development with

stereotyped behaviors of ASD but does not meet the criteria for any of

the above diagnoses

iii. Neurogenetic Syndromes1. Angelman Syndrome11, 12

a. Global developmental defects, profound speech delay, seizures,stereotypically happy demeanor

b. Global reduction in white matter tract development/function2.

Fragile X Syndrome

a. In males, most common etiology of Autism Disorder and mentalretardation thus often presents with speech and language delay

b. Morphology: long face, large ears, flat feet, hyperextensible joints,large testes

d. Neurological defects6i. Apraxia: Impairment in transmission of motor control to speech producing musculature;

1. Often caused by hemispheric lesion


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ii. Dysarthria: focal damage (Stroke/Tumor/Palsy) can impair language centers orassociated ascending/descending fibers

1. Commonly associated with dysphagia, other focal difficultiese. Constitutional speech delay (late-talkers)13

i. Often follows parental pattern of speech developmentii. Signs

1. Parents note they were late bloomers2. Receptive language intact appears to understand3. Gesturing often used for communication4. Child presents positive progression of language use, despite slow rate

iii. Evaluation1. History taking, family history of speech development2. Eval of other developmental markers often late-talkers are of normal

intelligence

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Resources and references

1. Up-To-Date. Evaluation and treatment of speech and language disorders in children. (Updated May 3, 2012).http://www.uptodate.com/contents/evaluation-and-treatment-of-speech-and-language-disorders-in-

children?source=search_result&search=speech+delay&selectedTitle=2~45#.[Aug 12, 2012].

2. McLaughlin MR. Speech and Language Delay in Children. Am Fam Physician. 2011 May 15;83(10):1183-1188.http://www.aafp.org/afp/2011/0515/p1183.html

3. National Institute of Deafness and Communication. (Updated May 13, 2011).http://www.nidcd.nih.gov/health/voice/Pages/Default.aspx. [Aug 26, 2012].

4. Schwartz MW, ed. Pediatric primary care: a problem oriented approach. St. Louis: Mosby, 1990:696700.5. Leung AK. Evaluation and Management of the Child with Speech Delay.Am Fam Physician. 1999 Jun 1;59(11):3121-

3128.,http://www.aafp.org/afp/1999/0601/p3121.html

6. Roush, Patricia. Auditory neuropathy spectrum disorder: Evaluation and management. Hearing Journal, Nov 2008,Vol61;11, pp 36,38-41.

http://journals.lww.com/thehearingjournal/Fulltext/2008/11000/Auditory_neuropathy_spectrum_disorder__Evaluati

on.8.aspx?WT.mc_id=HPxADx20100319xMP

7. Paradise JL, Dollaghan CA, Campbell TF, Feldman HM, Bernard BS, Colborn DK, Rockette HE, Janosky JE, Pitcairn DL,Kurs-Lasky M, Sabo DL, Smith CG. Otitis media and tympanostomy tube insertion during the first three years of life:

developmental outcomes at the age of four years. Pediatrics. 2003 Aug;112(2):265-77

8. Feldman HM, Dollagen HM, Campbell TF Paradise JL. Parent-reported language skills in relation to otitis mediaduring the first 3 years of life. J Speech Lang Hearing Res. 2003 Apr;46(2):273-87

9. Messner AH, Lalakea ML. The effect of ankyloglossia on speech in children. Otolaryngol Head Neck Surg. 2002Dec;127(6):539-45.

10. Suter VG, Bornstein MM. Ankyloglossia: facts and myths in diagnosis and treatment . J. Periodontol 80(8) 2009:1204-19

11. Johnson CP, Myers SM. American Academy of Pediatrics Council on Children With Disabilities. Identification andevaluation of children with autism spectrum disorders. Pediatrics 2007; 120:1183.
http://www.uptodate.com/contents/evaluation-and-treatment-of-speech-and-language-disorders-in-children?source=search_result&search=speech+delay&selectedTitle=2~45http://www.uptodate.com/contents/evaluation-and-treatment-of-speech-and-language-disorders-in-children?source=search_result&search=speech+delay&selectedTitle=2~45http://www.aafp.org/afp/2011/0515/p1183.htmlhttp://www.aafp.org/afp/2011/0515/p1183.htmlhttp://www.nidcd.nih.gov/health/voice/Pages/Default.aspxhttp://www.nidcd.nih.gov/health/voice/Pages/Default.aspxhttp://www.aafp.org/afp/1999/0601/p3121.htmlhttp://www.aafp.org/afp/1999/0601/p3121.htmlhttp://www.aafp.org/afp/1999/0601/p3121.htmlhttp://journals.lww.com/thehearingjournal/Fulltext/2008/11000/Auditory_neuropathy_spectrum_disorder__Evaluation.8.aspx?WT.mc_id=HPxADx20100319xMPhttp://journals.lww.com/thehearingjournal/Fulltext/2008/11000/Auditory_neuropathy_spectrum_disorder__Evaluation.8.aspx?WT.mc_id=HPxADx20100319xMPhttp://journals.lww.com/thehearingjournal/Fulltext/2008/11000/Auditory_neuropathy_spectrum_disorder__Evaluation.8.aspx?WT.mc_id=HPxADx20100319xMPhttp://www.uptodate.com/contents/screening-tools-for-autism-spectrum-disorders/abstract/2http://www.uptodate.com/contents/screening-tools-for-autism-spectrum-disorders/abstract/2http://www.uptodate.com/contents/screening-tools-for-autism-spectrum-disorders/abstract/2http://www.uptodate.com/contents/screening-tools-for-autism-spectrum-disorders/abstract/2http://www.uptodate.com/contents/screening-tools-for-autism-spectrum-disorders/abstract/2http://www.uptodate.com/contents/screening-tools-for-autism-spectrum-disorders/abstract/2http://www.uptodate.com/contents/screening-tools-for-autism-spectrum-disorders/abstract/2http://www.uptodate.com/contents/screening-tools-for-autism-spectrum-disorders/abstract/2http://journals.lww.com/thehearingjournal/Fulltext/2008/11000/Auditory_neuropathy_spectrum_disorder__Evaluation.8.aspx?WT.mc_id=HPxADx20100319xMPhttp://journals.lww.com/thehearingjournal/Fulltext/2008/11000/Auditory_neuropathy_spectrum_disorder__Evaluation.8.aspx?WT.mc_id=HPxADx20100319xMPhttp://www.aafp.org/afp/1999/0601/p3121.htmlhttp://www.nidcd.nih.gov/health/voice/Pages/Default.aspxhttp://www.aafp.org/afp/2011/0515/p1183.htmlhttp://www.uptodate.com/contents/evaluation-and-treatment-of-speech-and-language-disorders-in-children?source=search_result&search=speech+delay&selectedTitle=2~45http://www.uptodate.com/contents/evaluation-and-treatment-of-speech-and-language-disorders-in-children?source=search_result&search=speech+delay&selectedTitle=2~45


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12. Wilson BJ, Sundaram SK, Hug AH. Abnormal language pathway in children with Angelman syndrome. Pediatr Neurol.2011 May;44(5):350-6.

13. Late Blooming or Language Problem?http://www.asha.org/public/speech/disorders/LateBlooming.htm ASHAWebsite

14. Lang Hearing Res. 2003 Apr;46(2):273-87Note:

Dr. Grundfast and Dr. Gersh will bring with them to the instructional course for distribution to

all course attendee hard copy handouts of their entire Powerpoint presentations. In addition,

course attendees will receive a brochure produced by the American Speech-Language Hearing

Association entitled How Does Your Child Hear and Talk.

NOTES:

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http://www.asha.org/public/speech/disorders/LateBlooming.htmhttp://www.asha.org/public/speech/disorders/LateBlooming.htmhttp://www.asha.org/public/speech/disorders/LateBlooming.htmhttp://www.asha.org/public/speech/disorders/LateBlooming.htm

complete evaluation child w speech delay

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