Pediatric Grand Rounds University of Texas Health Science 21 October 2011 Center at San Antonio My Child Isn’t Talking: Speech ‐ Language Disorders in Children Nhung T. Tran, MD, FAAP Developmental ‐ Behavioral Pediatrics Associate Professor BaylorScott&White Health McLane Children’s Hospital Texas A&M University Health Science Center Texas Pediatric Society 2016 Annual Meeting Disclosures Policies and standards of the Texas Medical Association, the Accreditation Council for Continuing Medical Education, and the American Medical Association require that speakers and planners for continuing medical education activities disclose any relevant financial relationships they may have with any entity producing, marketing, re ‐ selling, or distributing health care goods or services consumed by, or used on, patients whose products, devices or services may be discussed in the content of the CME activity. Disclosures The planners and speakers have no relevant relationships to disclose. I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation. 1
Pediatric Grand Rounds University of Texas Health Science 21 October 2011 Center at San Antonio Objectives Describe the difference between speech and language Describe the screening, evaluation and management of speech ‐ language disorders in children Know how to interpret results of speech ‐ language evaluations Overview Speech ‐ language delays are prevalent ~10 ‐ 15% of preschoolers Difficult to assess in a well ‐ child visit Definitions: Communication Language: receptive versus expressive Speech Requirements for speaking Social Verbal Brain Oral Hearing Interactions Input Function mechanisms Supportive Adequate Intact Healthy Functioning 2
Pediatric Grand Rounds University of Texas Health Science 21 October 2011 Center at San Antonio Pre-speech Period (0-10 months) Localizing sounds is the Cooing (3 months) earliest step in receptive language Cooing is one of the earliest steps in expressive language Pre-speech Period (0-10 months) Adults assist Reduplicate babbling development of language by giving sounds meaning Pre ‐ speech Period (0 ‐ 10 months) Age Receptive Expressive Makes sound other than crying (e.g., 1 month Startles to loud noise throaty noises) Coos (vowels), chuckles, vocalizes when 3 months Regards speaker talked to Responds to name, stops Reduplicate babble (consonants + 6 months momentarily to “no”, vowels), listens then vocalizes, smiles gestures “up” and vocalizes to mirror Enjoys gesture games, Says “mama” & “dada” nonspecifically, 9 months orients to name well non ‐ reduplicate babble 3
Pediatric Grand Rounds University of Texas Health Science 21 October 2011 Center at San Antonio Naming Period (10-18 months) 1 st words (12 months) Naming Period (10 ‐ 18 months) Age Receptive Expressive 10 months Waves “bye ‐ bye” back Waves bye ‐ bye, says “dada” specifically 1 st word (not mama or dada), proto ‐ Follows 1 ‐ step command 12 months imperative pointing, uses several with gesture gestures with vocalizing Looks when asked 13 months Immature jargoning ”Where’s the ball?” Point to 1 body part, gets 3 ‐ 5 words, proto ‐ declarative pointing, 15 months object from another room names 1 object Word Combo Period (18 ‐ 24 months) Age Receptive Expressive Points to 2 out of 3 objects, 3 10 ‐ 25 words, giants words (“all 18 months body parts, self, familiar gone”), environmental sounds, people names 1 picture Holophrases (“Mommy?”), 2 ‐ word 20 months Point to 3 pictures combinations (adjective + noun), answers requests with “no” Follows 2 ‐ step commands, 2 ‐ word sentences (noun + verb), 50+ 24 months understands “me” and “you”, words, 50% intelligibility, refers to points to 5 ‐ 10 pictures self by name, names 3 pictures 4
Pediatric Grand Rounds University of Texas Health Science 21 October 2011 Center at San Antonio Preschool aged Age Receptive Expressive 200+ words, 3 ‐ word sentences, Points to parts of pictures, 36 months pronouns, asks questions, 75% understands action words intelligible Follows 3 ‐ step commands, Tells stories, uses feeling words, 100% 48 months understands objects by intelligible function 60 months Understands adjectives Defines simple words, retells stories School aged Reading is a language ‐ based skill Requires mapping sounds (phonemes) to letters (graphemes) Relies on verbal and visual memory Is highly associated with phonemic awareness (rhyming, word games, etc.) Role of the provider What is Is there a Do I Do I suspect a Can I next, when speech- suspect a more determine a speech- language speech- significant the language delay? language developmental etiology? disorder is disorder? disorder? Typical vs. identified? Refer for atypical Refer to Refer for medical Treatment SLP for additional evaluations Screening Anticipatory evaluation evaluations /studies tool guidance 5
Pediatric Grand Rounds University of Texas Health Science 21 October 2011 Center at San Antonio Screening What is Is there a Do I Do I suspect a Can I next, when speech- suspect a more determine a speech- language speech- significant the language delay? language developmental etiology? disorder is disorder? disorder? Typical vs. Refer for identified? atypical Refer to Refer for medical Treatment SLP for additional evaluations Screening Anticipatory evaluation evaluations /studies tool guidance Screening Tools Ages & Stages Questionnaire (ASQ) Batelle Developmental Inventory Screening Tool (BDI-ST) Bayley Infant Neurodevelopmental Screen (BINS) Brigance Screens-II Child Development Inventory (CDI) Denver-II Developmental Screening Test Parents’ Evaluation of Developmental Screen (PEDS) *See AAP 2006 for detailed description. Identification What is Is there a Do I Do I suspect a Can I next, when speech- suspect a more determine a speech- language speech- significant the language delay? language developmental etiology? disorder is disorder? disorder? Typical vs. identified? Refer for atypical Refer to Refer for medical Treatment SLP for additional evaluations Screening Anticipatory evaluation evaluations /studies tool guidance 6
Pediatric Grand Rounds University of Texas Health Science 21 October 2011 Center at San Antonio Do I suspect speech ‐ language d/o? Refer to speech ‐ language pathologist for formal evaluation Early Child Intervention (0 ‐ 3 years) – will evaluate all developmental domains School (3 ‐ 5 years) – may help identify learning issues Rehabilitative therapy agency (any age) Do I suspect other developmental d/o? “can’t speak” “doesn’t understand” Articulation d/o Mixed receptive ‐ expressive language d/o Dysarthria Pragmatic (social) communication d/o Dyspraxia Intellectual disability Stuttering Autism spectrum disorders Voice, resonance d/o Expressive language d/o Speech & Language Phonology Speech Sounds Morpho ‐ syntax Voice & Resonance Semantics Fluency Pragmatics 7
Pediatric Grand Rounds University of Texas Health Science 21 October 2011 Center at San Antonio Language Phonology: sounds, rules Morpho ‐ syntax: grammar Semantics: meanings Pragmatics: social functions Language disorder Receptive, expressive and/or pragmatic disorder Degree of impairment Mild ( ‐ 1.5 to ‐ 2.0 SD) SS: 55 70 85 100 115 130 145 Moderate ( ‐ 2 to ‐ 2.5 SD) Severe ( ‐ 2.5 to ‐ 3SD) Language disorder Treatment: language therapy + language stimulation Prognosis: depends on severity SS: 55 70 85 100 115 130 145 8
Pediatric Grand Rounds University of Texas Health Science 21 October 2011 Center at San Antonio Speech & Language Speech Sounds Voice & Resonance Fluency Speech sounds Requires (in addition to hearing): Motor planning (towards execution) Coordination of mouth/tongue and breathing Articulation (production) Speech sound disorders: Dyspraxia Dysarthria Articulation Disorder Articulation (Sander, 1972) p, m, h, n, w b k, g, d t, ng f, y r, l s ch, sh z j v th (thin) th (then) zh Age 2 3 4 5 6 7 8 9
Pediatric Grand Rounds University of Texas Health Science 21 October 2011 Center at San Antonio Articulation disorder Difficulty with producing speech sounds, often consonants Features: errors consistent, better with imitation Treatment: speech therapy Prognosis: good Dysarthria Difficulty with neuromotor function involving oral & speech subsystems (e.g., respiration, phonation) Uncommon except in neurological disorders Features: consistent with overall movement patterns (spastic, hypotonic, ataxic) Treatment: speech therapy May have additional goals for swallowing/feeding (e.g. dysphagia) Prognosis: depends on underlying disorder Dyspraxia (a.k.a., Childhood Apraxia of Speech) Difficulty with motor planning Often suspected if low response to therapy Features: errors inconsistent and/or unusual pattern of consonant errors and vowel distortion; worse with imitation; often observable physical struggle Treatment: intensive ST, often needing Augmentative & Alternative Communication Prognosis: depends on severity 10
Recommend
More recommend
