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Language Delay

Developmental language delay is the most common language disorder. An important part of mental retardation is language delay. And then permanent hearing loss and stuttering and a few others that we will talk about. What are the warning signs? Nine-month-olds need to respond to name. And for babbling, actually about 11 months if your child is not doing what we call canonical babbling, if they are not going "Da-da-da-da-da, ma-ma-ma-ma-ma" that indicates that you have a major language problem. In fact, that can be a sign of profound deafness on the childís part. Eighteen-months-of-age youíve got to have a word other than mama and dada. So again, it usually comes in about two or three words. Remember, at about a year of age but itís got to be there by 18 months. Twenty-four-month-olds, we talked about you have two words at two years.

Thirty months; if the parents canít understand anything at 30 months, thatís a big problem. They should have some simple sentences. Three years, we talked about the intelligibility and then a five-year-old who is making lots and lots of speech errors is something that you need to worry about. If their tís and their dís and their kís and things like that are still getting mixed up over and over again at five, thatís a problem. The letters that they tend to have problems with are these more complex sounds, but that can be okay all the way up to about seven-years-of-age, but beyond five-years-of-age or five or six-years-of-age any other of the consonant sounds, if they are making mistakes.

Okay, what are the screening tests and what do we do if we suspect language delay? One other thing also, if a parent comes in to you and says their child is language delayed, believe them. Parents are going to be accurate about 80% of the time. Just like they are for global delay. If a parent says that they are worried that their child doesnít speak well enough, you need to take it seriously. Always do a hearing test. I donít care how well the child hears in the office.

Again, two tests just to know about; the Early Language Milestone Scale. If you guys have never used this, it looks like a Denver Development for Language. Itís got the same little bars with the 50, 75, 90% range for different receptive and expressive language milestones. Another one that can be used is the CLAMS, the Clinical Linguistic and Auditory Milestone Scale. So if you have a child who has language delay and you want to do a further test in the office, those are two tests that you can do.

Okay, when do you want to test the hearing? Again, parental concern. If mom or dad have any concern that the child canít hear, regardless of how well they hear in your office, you need to have them tested. Weíll talk in a second about universal hearing testing. Any speech delay, test the hearing. Kids who have persistent otitis media, especially with effusion, you might want to test their hearing at some point. Kids who spend some time in the NICU, kids especially with birth weights under 1500 grams, family history of deafness, anybody with a congenital infection especially something like CMV or things along those lines.

Routine hearing screening of all kids is now actually being mandated in California. We test all newborns in our nursery. The reason for that, and they may or may not touch bases on this - they probably wonít because itís still too recent - is that as pediatricians we actually do a poor job of picking up kids who are hearing delayed. The average age at which a kid with profound hearing loss is diagnosed is 10-12-months-of-age. A child who canít hear a thing.

Etiologies for sensorineural hearing loss; far and away, the most common is hereditary. And be aware that it can be autosomal dominant or autosomal recessive. It can be unilateral or bilateral and you can have congenital hearing loss that doesnít come on until later in life. Doesnít have to be present at birth. The most common form of hereditary hearing loss is an isolated autosomal recessive hearing loss without any other abnormalities. NICU-related problems are pretty self-evident.

This is the classification of hearing loss. A child with mild hearing loss has difficulty hearing normal speech. A child with moderate hearing loss really isnít going to hear much unless you are very very close to them. The kids with mild hearing loss may not yet have any abnormalities of language skill, except they may be a little slow in developing their language skills, in terms of words and sentences. Kids, by the time they have moderate hearing loss, they will definitely have problems with speech production.

Expressive language disorder. This is probably the most common thing you think of when youíve got the three-year-old and the four-year-old that just isnít talking. Heís the kid whose mom says, "You know, he understands everything I talk to him about, he seems smart, he knows whatís going on, he just wonít talk." And heís got maybe five words or ten words.

Stuttering. A lot of kids stutter from 2 Ĺ to 5-years-of-age. The key thing they might ask you on the test is when to refer. Is this kid having normal disfluency, or is this a kid who is stuttering bad enough that you need to refer? The indications for referral are really pretty simple. If it is persisting for more than about six months, or if it is persisting after five-years-of-age, thatís abnormal. Thatís beyond the normal range. Or if basically the child or the parent gets upset because of the stuttering.

Autism. The key thing on language delay and autism is itís not just delayed, itís funny, itís abnormal. It is not appropriate for what they are trying to communicate. She talked about echolalia where they will, days later, repeat a sentence that somebody said to them. Or they will suddenly repeat a sentence to you that has nothing to do with whatever you have been talking about.