Learning Objectives Discuss normal language and speech development from birth to age five Use strategies to differentiate the Late Talker from a child with a al Language disorder Utilize activities for children and caregivers to cultivate healthy language development. Language : Background Information Language: A symbolic system for the storage or exchange of information Expressive language: The ability to generate symbolic output (writing, signing, or speech) Receptive language: The ability to decode the language output of others Mean Length of utterance: Number of words child strings together in a phrase or sentence on average Speech: The mechanical aspects of sound production Language disorder: Any defect in the ability to encode or decode information through symbolic means Who is on the Communication Spectrum of Concerns? According to a 2001 US Department of Education (DOE) report: an approximate 30 fold increase in the number of children with speech or language impairments since 1989: 7,801 cases of speech or language impairment among children born in 1983 (who turned 6 in 1989) Among children born in 1994, that number jumped to 211,984. Speech and language delays are the leading developmental concern in parents of children younger than 5 yrs Estimated 15% to 25% of young children have some type of communication disorder Overview of Normal Language : 0 5 Years
Typical Language : 0 1 month Acknowledges sound with startle; turns to sound and looks for source; quiets motor activity to sound; prefers human speech with high inflection Differentiated crying; body language of positive and negative response Typical Language : 0 1 month No response to pleasing sound when alert History of neonatal sepsis, meningitis, neonatal asphyxia, prematurity, congenital infection, familial deafness, renal abnormalities, aminoglycoside therapy in newborn period Typical Language : 2 4 Prolonged attention to sounds; responds to a familiar voice; enjoys rattle sound; attempts to repeat pleasing sounds with objects; shifts gaze back and forth between sounds Cooing; blows bubbles; enjoys using tongue and lips; reciprocal cooing; loudness varies No response to pleasing sounds Does not attend to voices Typical Language : 5 7 Seeks out speaker; localizes sounds; understands own name, familiar words; associates word with activity (e.g. bath, car, walk) Initiates sounds; pitch varies; babbles with labial consonants (ba, ma, ga); uses sound to get attention Decreased or absent vocalizations Typical Language : 8 12 Begins word comprehension; responds to simple commands (e.g. point to your nose, say bye bye ); knows names of family members; responds to a few words First words (about five); mama,dada ; inflected vocal play; repeats sounds and words made by others; intentional gestures (e.g. pointing, waving good bye) No babbling with consonant sounds No response to music Typical Language : 13 20 Single step element command (e.g. please put your shoes in the closet); identifies familiar objects Points to objects with vocalization; vocabulary of 10 50 words No comprehension of words Does not understand simple requests
Typical Language : 18 24 Recognizes many nouns; understands simple questions Telegraphic speech; vocabulary of 50 75 words; 2 word sentences (e.g. my book, big doggie) phrases; stuttering common Vowel sounds No consonants; no words Typical Language : 24 36 Understands prepositions; can follow story with pictures Identifies body part; vocabulary of 200 words; uses words for expressive needs; pronouns; early grammar No words/sentences Does not follow simple directions Typical Language : 3 4 years Understands three element commands (e.g. put your shoes in your closet, wash your hands and then come to dinner ) Child talks about what she/he is doing; vocabulary of 400 1500 words; speech intelligible to strangers; why questions; uses past and present tense; says colors; numbers 1 4; full name, knows his/her gender, four word sentences Speech not comprehended by strangers Still dependent on gestures Consistently holds hands over ears Speech without modulation Typical Language : 4 5 years Understands four element commands; links past and present events; decreasing ability for second language acquisition 2700 word vocabulary; defines simple words; fiveword sentences Stuttering Consistently avoids loud places Etiology of Speech and Language Impairment Multifactorial etiology: Environmental factors Genetics Prematurity The Late Talker Term used to describe children 18 to 20 old who have fewer than 10 words OR Those 21 to 30 old who have fewer than 50 words and no two word combinations. Typically, these children have no other problems.
al Language Disorder(DLD) or Specific Language Impairment (SLI) Most common developmental disorder in children aged three to 16 years, affecting approximately 3 to 10 % of children; NIH 7.6% of 5 yr olds Three to four times more common in boys than in girls More than half of language delays in children under age three resolve by 5 years of age Perhaps one third of these children will go on to develop a language based learning disability Warning Signs Little sound play or babbling as an infant Poor verbal imitation skills Immature play skills and little pretend play Interactions with adults more than peers Few communicative gestures Small vocabulary for age Comprehension delay of six or greater relative to chronologic age Clues from the History Family history of language delay Otitis media with effusion causing a fluctuating hearing loss during the period of speech development Low socioeconomic status and educational level of parents Parental characteristics that may inhibit speech Missed language explosion. Potential Screeners The Ages and Stages Questionnaire (ASQ) screens for developmental delay in infants from age 4 to 5 years. Parents' Evaluations of al Status (PEDS), focuses specifically on the parents' appraisal of areas of development, 0 8 yrs. Early Language Milestone (ELM) Scale, brief screening of a child's language abilities, 0 3 yrs Work Up Physical exam particular focus on oral and ear examination. HEARING TEST, Hearing test, hearing test! If physical exam indicates, consider chromosomal analysis EARLY INTERVENTION REFERRAL
Promoting Healthy Language Book Sharing: Recommend joint book sharing a couple minutes every day. Stress the importance of making reading part of the daily routine. For example, parents can share books with their children first thing in the morning or make it part of the bedtime routine. Suggest to the parents that they ask fun questions about the story when done reading. Recommend the family visit the local public library. Promoting Healthy Language Talk and Label: Suggest parents label and describe things they are doing. For example, when taking a walk, parents can name objects and describe what they are seeing. Listen: Recommend that parents take the time to listen to their child attempting to communicate. By doing so, the child is encouraged to practice talking. Promoting Healthy Language Questions: Parents can ask simple questions to start conversations. Sing: Singing is an enjoyable way for children to learn new words and practice the words already known. TV: Suggest the parents limit the amount of TV the child watches. If possible, recommend the parent watches TV with the child to make it more interactive. The Rule of 4 s Simple mnemonic to remember language milestones: Age Use of Intelligibility Language 1 year Single words 1/4(25%) 2 years 2-word 2/4 (50%) combinations 3 years Phrases 3/4(75 %) 4 years Sentences 4/4 (100%) Take Home Message In the first years of life, communication is critically important to a child s healthy development, for learning and for forming relationships For More Information AAP Caring For your Child Birth to Five excerpt, http://www.aap.org/pubserv/speech.htm First Signs Glossary, http://www.firstsigns.org/