Language Delays

Sri Sofyani

Description of the problem

Language : a symbolic system for the storage or exchange of information Expressive language: the ability to generate symbolic output, output: visual e.g. writing, signing or auditory (speech) Receptive language: ability to decode (i.e., extract meaning from) the language output of others

Speech: mechanical aspects of sound production (not the content) Language disorders: any defect in the ability to encode or decode information through symbolic means

Epidemiology
Most common developmental disorder of childhood, occurring in 5-10% of preschool children. Developmental language disorders (DLD) are rarely transmitted as simple autosomal dominant trait

Development of language
Language acquisition results from a complex interplay of innate biological capabilities and environmental stimulation. Infants acquire language through observation and through listening to speakers in their environment. Early efforts at imitation tend to be stimulus driven (i.e., automatic or unconscious), but by the latter half of the first year of live, infants appear capable of deliberate imitation of others language. Parents and caretakers: create a linguistically enriched environment.

By age 12 months, normal infants have grasped the notion that an arbitrary set of sounds ( a word) symbolically represents a specific objects or action. Likewise, a 12 month old knows that he or she can signify a desired object by pointing to it rather than reaching for it. This ability to represent objects or actions on symbolic form constitutes the central feature of language

Language proficiency correlates closely with overall cognitive development in normal children

etiology
Environmental Organic Developmental

Frequently observed in association with various social or emotional risk factors The degree of environmental stimulation Organic variables (nutritional status, lowlevel lead exposure, or low-grade iron deficiency)

Organic. Developmental language disorders are due to impairment of those portions of the brain that serve language. Postnatal maturation of brainstem auditory pathways in the first 12 months. Fluctuating mild to moderate conductive hearing loss during the first 12-24 month of live has been associated with subtle delays in language development. Early postnatal maturation of sensory pathways maybe accompanied by a similar critical period for cerebral acquisition of language. Failure to provide adequate language input during this period may produce changes in brain function that irrevocably compromise cerebral competence for language

Developmental Constitutional delay can be established only in retrospect. If a preschool childs speech pattern is deficient based on comparison with age norms, then action is called for. Adopting a wait-and- see attitude in a speech-delayed preschooler in the hope that his or her delay will prove to be constitutional is rarely justifiable.

Making the diagnosis

Signs and symptom History Physical examination

Tests
Language testing Auditory testing Developmental testing Referral

Language testing
The ELM Scale 2 ( language development from birth to age 36 months and intelligibility of speech from ages 24-48 months. It is designed for child care professionals expertise in early child development.

Auditory testing
All language-delayed children should have their hearing tested by a certified audiologist, regardless of the clinicians sub

Prognosis
Children with DLD initially manifest impaired intelligibility of speech and delayed emergence of phrases and sentences. Comprehension often appears normal, at least initially. Speech is usually improved by the time of school entry and often becomes normal with the passage of time

Children with language delay as preschoolers are more likely to manifest problems with auditory comprehension, short-term auditory memory, reading, or other signs of academic impairment. Children with constitutional delay may be virtually indistinguishable from children with mild DLD as preschoolers and can be differentiated from DLD only in hindsight (after speech has normalized and academic problems have failed to surface)

Tips for parents to promote language development

Dont try to force your child to speak; its unhelpful and demoralizing Read books aloud to your child Dont use complicated language. Talk a lot to your child Respond whenever your child speaks. Its important to reward every utterance Ask your child a lot of questions Accompany your words with gestures to make them more comprehensible Dont criticize grammatical errors Find a play group of children with language a little better than your childs