Speech, language, hearing delays: Time for early intervention?

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Applied Evidence

Speech, language, hearing delays: Time for early intervention?

J Fam Pract. 2015 March;64(3):E1-E9

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References

1. Wankoff LS. Warning signs in the development of speech, language, and communication: when to refer to a speech-language pathologist. J Child Adolesc Psychiatr Nurs. 2011;24:175-184.

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3. Denver Developmental Materials, Inc. Denver II Online. Denver Developmental Materials, Inc Web site. Available at: http://denverii.com/denverii/. Accessed January 24, 2015.

4. Guralnick MJ. The Effectiveness of Early Intervention. Baltimore, MD: Brookes Publishing; 2013.

5. Schwartz HD. A Primer on Communication and Communicative Disorders. Boston, MA: Pearson Education; 2012.

6. Heward WL. Exceptional Children: An Introduction to Special Education. 10th ed. Boston, Mass: Pearson Education; 2013.

7. Hallahan DP, Kauffman J M, Pullen PC. Exceptional Learners: An Introduction to Special Education. 13th ed. Upper Saddle River, NJ: Pearson Education; 2015.

8. American Speech-Language-Hearing Association. How does your child hear and talk? American Speech-Language-Hearing Association Web site. Available at: http://www.asha.org/public/speech/development/chart.htm. Accessed January 24, 2015.

9. Roth FP, Troia GA, Worthington CK, et al. Promoting awareness of sounds in speech: An initial report of an early intervention program for children with speech and language impairments. Appl Psycholinguistics. 2002;23:535-565.

10. Busari JO, Weggelaar NM. How to investigate and manage the child who is slow to speak. BMJ. 2004;328:272-276.

11. American Speech-Language-Hearing Association. Identify the Signs of Communication Disorders. Identify the Signs of Communication Disorders Web site. Available at: http://identifythesigns.org/. Accessed January 24, 2015.

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16. Moeller MP, White KR, Shisler L. Primary care physicians’ knowledge, attitudes, and practices related to newborn hearing screening. Pediatrics. 2006;118:1357-1370.

17. National Institute on Deafness and Other Communication Disorders. Your baby’s hearing and communicative checklist. National Institute on Deafness and Other Communication Disorders Web site. Available at: http://www.nidcd.nih.gov/health/hearing/silence.asp. Accessed January 24, 2015.

18. American Speech-Language-Hearing Association. Effects of hearing loss on development. American Speech-Language-Hearing Association Web site. Available at: http://www.asha.org/public/hearing/Effects-of-Hearing-Loss-on-Development/. Accessed January 24, 2015.

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Language impairments

One study noted that primary care physicians had low confidence in providing information to families about early intervention resources. Language impairments affect 3 domains of language: form (grammar/syntax), content, or use. These domains are governed by rules specific to the language spoken in the home. Language impairment can interfere with comprehension and formulation of messages. About 2% to 3% of preschoolers have language disorders.¹²

Language impairments may be observed in one or more of the language components, including phonology (rules of the sounds in the language), lexicon (vocabulary), morphology (word markers—eg, final “s” to make the plural of “cat”), syntax (word order) and pragmatics (socially appropriate speech, gesture, eye contact, and language use).

While there is great variability in typical development, atypical language development can be a secondary characteristic of other physical or developmental problems attributed to other conditions such as autism spectrum disorder (ASD), cerebral palsy, childhood apraxia of speech, dysarthria, intellectual disability, or selective mutism.¹³

Verbal communication difficulties may appear in expressive and receptive language.¹⁴Receptive language is the ability to comprehend language communicated by another person.⁶ Receptive language (processing) skills can be demonstrated as follows. If a child is asked “Do you like cats?” she must first decide to whom the question is directed (to her and not someone else). She must then search her long-term memory for the word/concept “cat” (compared with dog, a similar concept; or with mat, a similar-sounding word), and process the word “like” (compared with “dislike”). Now the child understands the question and can decide on an answer.

Expressive language is a child’s ability to speak; the mental process used to produce speech and communicate a message.⁶ To answer, “Yes, I like cats,” the child retrieves the concept “cat” from memory (cognition and semantics: the meanings of words, their relationships and usage), finds the right words (vocabulary), puts them in the right order (syntax), uses the right verb tense (grammar/morphology), assembles the right sounds in order, initiates the neuromotor acts (phonology/speech production), and communicates that she understands what cats are and that she likes them (pragmatics; socially/contextually appropriate responses).

Resources on language development. Typical language development, the length of which varies among children, must be practiced in a rich linguistic environment. Some children are adventurous with language. They babble, talk, and communicate in a carefree manner. Others are cautious. They may wait until they are sure of their skills before attempting a new word. Usually, concern about a child’s speech and language development arises if there is no speech, if speech is not clear, or if speech or language is different from that of peers.

The Centers for Disease Control and Prevention, under their “Learn the signs. Act early” campaign (www.cdc.gov/actearly), has published checklists of children’s developmental milestones from 2 months to 5 years of age on social, communication, cognitive, and motor skills. Health care providers helping parents determine if their child’s communication is developing normally can find information and materials at http://www.cdc.gov/ncbddd/actearly/hcp/index.html.¹⁵

Hearing impairments

Moeller et al¹⁶ surveyed 1968 primary care physicians on their attitude, practices, and knowledge of universal hearing screenings for newborns. They noted limitations in awareness of EI options for infants with hearing loss: proper times and places for referrals, available communication modalities, cochlear implant candidacy, and professionals in their locale with expertise on hearing loss. These knowledge gaps involved some medical issues, such as hearing loss genetics and later-onset hearing loss in infants and children. They also found low confidence in providing information to families about how to proceed with EI and in discussing intervention needs and resources.

Early management of hearing impairment can improve language, especially for children with a severe or profound hearing loss. Adverse effects of hearing loss. Hearing loss can be unilateral or bilateral, conductive or sensorineural, and can range in severity from mild to profound. According to the National Institute on Deafness and Communication Disorders (NIDCD), one in every 350 infants is born with a significant hearing loss, and others become deaf due to childhood illness or injury.¹⁷ According to ASHA,¹⁸ hearing loss can affect children in 4 major ways:¹⁹ delays in the development of receptive (comprehension) and expressive communication skills; a language deficit that causes learning problems and reduces academic achievement; communication difficulties that often lead to social isolation and poor self-concept; and impact on vocational choices and options.²⁰ NIDCD provides a checklist to determine a child’s hearing status at http://www.nidcd.nih.gov/health/hearing/silence.asp.¹⁷

Timing of intervention is significant. EI is critical in minimizing the deleterious effects of hearing loss and in optimizing speech and language development. Severity of hearing loss influences EI outcome, and treatment options depend on the hearing loss having occurred either before language development (prelingually) or after (postlingually). Early management of hearing impairment can improve language, especially for children with a severe or profound hearing loss.²¹