Speaking Clearly

Early Speech and Language Delays Case Study:
The Educational Value of a Parent’s Intuition
by Elyse Burton, M.C.D, CCC/SLP

A parent listens with great anticipation for her child’s first words. What if there’s a delay? Then the questions start flooding her mind: Am I expecting too much? Is she too young for evaluation? Is there someone who can give me some guidance? These unanswered questions, coupled with parental intuition, often directs the parents to early intervention.

The first time I saw Natalia she was 19 months old. She was adopted about six months prior from an orphanage in Russia and was accompanied to the evaluation by her parents and 8-year-old brother. At 19 months old, she was petite and looked closer to 1 year of age. Her mother reported that she mastered walking two months ago and that her greatest area of concern was Natalia’s language skills. Natalia communicated exceptionally well by pointing and after a speech and language evaluation, Natalia was diagnosed with having a motor planning/programming disorder (often referred to as dyspraxia or apraxia of speech). The evaluation team readily agreed to make Natalia eligible for speech-language services. At 20 months, she began intervention to address her expressive language skills through the state’s early prevention program called Babies Can’t Wait (BCW), (See sidebar).

Infants and children are at risk for language delays
Children at risk for speech and language delays include babies who are born prematurely, babies with recurrent middle ear infections, babies adopted from foreign countries (often coming from orphanages with little to no language stimulation) and babies who are hearing impaired.

Take early action to determine language development
For parents concerned about a child’s speech and language skills, no age is too early to listen to your intuition and to take action. It is often beneficial to first talk to your child’s pediatrician about your concerns. Pediatricians will frequently refer parents to a speech and language pathologist (SLP) if a child’s speech and language skills are delayed. However, a parent alone can make the appointment without a medical referral.

For a child under the age of 3, BCW may be a good place to start to determine needs and appropriate services and anyone concerned about a child can make the referral. Many SLP’s are trained in assessing a baby’s feeding skills such as sucking and swallowing if this is an area of concern with a newborn.

For children over the age of 3, the local public school is an option to receive free services if the child meets certain eligibility requirements. SLP’s also have private practices. In all cases, an evaluation will be made during the initial visits.

A language evaluation is comprehensive and standardized
The SLP will assess a child’s comprehension and use of language, based on both parent report and observation of the child. A standardized testing instrument, such as the Preschool Language Scale-4, is utilized to compare a child’s language skills to that of his peers. Evaluation tasks may include picture pointing and symbolic play skills, as well as oral motor/ feeding skills.

Receptive language assessment questions include:

1. Does the child recognize and respond to changes in tone of voice and turn and look to the direction of a sound?
2. Does the child recognize and respond to his name consistently?
3. Can the child identify objects, pictures and body parts?
4. Does the child follow simple and complex verbal directions?
5. Does the child demonstrate comprehension of concepts such as big/little, wet/dry, up/down?

Expressive language skills assessment questions include:

1. Does the child cry differently for different needs?
2. Does he vocalize pleasure and displeasure?
3. Can the child put two sounds together such as “da” or “ga” and do.
   

Elyse Burton, M.C.D., CCC-SLP, is a private speech and language pathologist and can be reached at burtonspeech@mindspring.com. 

Articulation Skills
Developmental Acquisition Norms – Recommended ages of acquisition for phonemes (speech sounds), based on the age at which 90% of children correctly produced the
sound.

Iowa and Nebraska norms, taken from Smit, Hand, Freilinger, Bernthal, and Bird (1990). Journal of Speech and Hearing Disorders, 55, 779-780