LANGUAGE DELAY

1. LANGUAGE DELAY

2. Cognitive Development LANGUAGE

3. LANGUAGE DELAY Failure to speak single words by 18 months and phrases by 30 months

4. (Speech and Language Impairment) PREVALENCE • 10-15% of toddlers • 3% are at risk of persistent speech and language problems and learning disability • 4 –5 % beyond 3 years

5. DIFFERENTIAL DIAGNOSIS OF "DELAYED" SPEECH • Mental retardation • Hearing impairment • Autism • Emotional and Behavioral Disorders • Environmental deprivation • Developmental language disorder

6. MENTAL RETARDATION • Most common cause of language delay • (> 50 % of cases) • Speech delay is “universal” among • retardates

7. MENTAL RETARDATION DEFINITION A significantly subaverage generalintellectual functioning which manifests itself during the developmental period and is characterized by inadequacy in adaptive behavior. INCIDENCE About 3% of the population

8. ETIOLOGY OF MENTAL RETARDATION • Congenital syndromes, genetic Chromosomal Single gene defect Major malformations Presumed genetic B. Congenital syndromes, nongenetic Intrauterine infection Maternal systemic disease Maternal drug ingestion Maternal gestational disorders

10. DOWN SYNDROME • Trisomy 21 • Incidence: 1:800-1,000 babies • Clinical features • Medical problems • 40-50% - congenital heart disease • 50% - visual/hearing impairment • 10% - intestinal malformations • 15-20% - Alzheimer’s disease/dementia • Increased risk of thyroid problems/leukemia • Average life span: 55 years

11. ETIOLOGY … C. Perinatal and Postnatal Factors Prematurity and its complications Birth asphyxia Head trauma CNS infection Toxins Hypoxic events Chronic severe systemic disease Nutitional deficiencies Socioeconomic deprivation D. Unknown

13. Distribution of Classification of Mental Retardation MOD-SEV

15. Mental Retardation • Language problem: immaturity of overall language skills. • Language as well as the other developmental streams, particularly the visual-motor stream and adaptive skills are delayed. Global developmental delay

16. DIAGNOSIS Neurodevelopmental Assessment: • Comprehensive history. • Complete physical and neurological examination. • Appropriate laboratory studies. • Developmental screenings. • Judicious referrals to supporting professionals. MULTIDISCIPLINARY APPROACH

17. MANAGEMENT Role of the physician is limited; management is generally psychoeducational.

18. AUTISM • mostdeviant degree of communicative disorder • characterized by a triad of impairments Impaired social relatedness Impaired communication and play Stereotypic/ritualistic activities

28. HEARING LOSS/ IMPAIRMENT PREVALENCE: 5-6 per 1000 births Congenital SNHL: 1/1000 births At age 5 years, 10-15% of children fail hearing screening

29. RISK FACTORS • A family history of hereditary childhood sensorineural hearing loss • Congenital infections known to be associated with hearing loss • Cranifacial anomalies • Birthweight less than 1500 gms • Hyperbilirubinemia at a serum level requiring exchange transfusion.

30. RISK FACTORS … • 6. Ototoxic medications • Bacterial meningitis • Apgar score of 0-4 at 1 minute or 0-6 at 5 minutes • Mechanical ventilationfor 5 days or longer • Stigmata of a syndrome known to include hearing loss

31. DEGREES OF HEARING IMPAIRMENT Level of HL Description Etiology

32. DEGREES OF HEARING IMPAIRMENT Level of HL Description Etiology

33. AVERAGE AGE OF IDENTIFICATION MILD SNHL – 3 to 4 years old MODERATE TO PROFOUND SNHL – 23 months UNILATERAL OR HIGH FREQUENCY LOSSES – 5 to 6 years old

34. Comprehension deficit leads to delay in the acquisition of speech and language forms • Most frequent complaints: • Lack of response to speech/noise • Poor speech development • Less frequent complaints: • Behavior problems • Balance problems/ear fingering

35. HEARING EVALUATION METHODS: • Auditory brainstem evoked response • (ABR, BAER, BERA) • Behavioral play audiometry • Otoacoustic emission (OAE) • Tympanometry

36. MANAGEMENT • MEDICAL • ASSISTIVE DEVICES • - hearing aids • - cochlear implants • EDUCATION

37. BEHAVIORAL/EMOTIONAL PROBLEMS HYPERACTIVE; “DISTURBED” CHILD Impaired comprehension and production of linguistic forms in relationship to social communicative abilities

38. ENVIRONMENTAL DEPRIVATION Delay in speech as a result of lack of stimulation and attention

39. SPECIFIC LANGUAGE IMPAIRMENT (Developmental Language Disorder) (Developmental Dysphasia) • Inadequate acquisition of language in the absence of a hearing loss, documented neurologic lesion, mental retardation, or primary emotional disorder. • Prevalence ( DSM-IV ) : 3-5 % of children

40. DEVELOPMENTAL LANGUAGE DISORDER • PATHOGENESIS/ETIOLOGY: • unrelated to perinatal risk factors, early language deprivation, bilingualism • genetic contribution is the only factor that has been implicated to any substantial degree • “62% of DLD children studied had an affected parent” • Tallal, et.al

41. LANGUAGE ASSESSMENT Difficult • Reasons: • Most parents do not really focus on early language milestones. • Difficult to assess language directly in the well baby setting.

42. PARENTAL CONCERNS Sensitivity of 72% Specificity of 83 % Middle-class community • SCREENING TESTS • Early language Milestone Scale (ELMS) • Denver II • Clinical Linguistic and Auditory Milestone Scale (CLAMS) • Gessell Schedules of Infant Development

43. DIAGNOSTICS • Audiological Evaluation • The first step is to rule out a hearing deficit. It is not enough to rely upon parents’ report or screening in pediatric office, because unilateral or mild hearing deficit, which can cause speech impediment is likely to be missed in the office.

44. Diagnostics … • Neuropsychological Assessment • Speech/Language Evaluation

45. MANAGEMENT • Individualized • Multidisciplinary