{
 "topic": "Language Delay",
 "slug": "language-delay",
 "category_id": 15101,
 "passage_count": 14,
 "source_chars": 12180,
 "enough_material": true,
 "references": [
  {
   "title": "Signs and Symptoms in Pediatrics",
   "author": "Henry M. Adam,Jane Meschan Foy",
   "pages": [
    884
   ]
  },
  {
   "title": "Cover",
   "author": "Vitalsource Download",
   "pages": [
    1304,
    1305
   ]
  },
  {
   "title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
   "author": null,
   "pages": [
    379
   ]
  },
  {
   "title": "MedStudy Pediatrics Core 11th Edition 2024-2025",
   "author": null,
   "pages": [
    95
   ]
  },
  {
   "title": "Berkowitz's Pediatrics",
   "author": "Berkowitz, Carol D.;",
   "pages": [
    246,
    248,
    250
   ]
  },
  {
   "title": "Pediatrics for Practitioner (Sharad Thora)",
   "author": null,
   "pages": [
    204,
    205
   ]
  },
  {
   "title": "AAP Developmental and Behavioral Pediatrics",
   "author": "AAP Section on Developmental and Behavioral Pediatrics,Robert G. Voigt,Michelle M. Macias ,Scott M. Myers ,Carl D Tapia",
   "pages": [
    373,
    385
   ]
  },
  {
   "title": "Illustrated Textbook of Paediatrics (Tom Lissauer, Will Carroll)",
   "author": "Lissauer, Tom,Carroll, Will",
   "pages": [
    66
   ]
  }
 ],
 "passages": [
  {
   "source": "Signs and Symptoms in Pediatrics, p. 884",
   "text": "_Maris Rosenberg, MD; Nancy Tarshis, MA, MS_ ## \ufffd **INTRODUCTION** Speech and language delay, arguably the most common developmental concern parents have about their young children, occurs with an estimated prevalence of 2% to 19%.[1\u20135] Th e delay can occur alone, or signal the presence of other developmental disorders such as intellectual disability, autistic spectrum disorders, or hearing impairment. In keeping with the recommendations of the American Academy of Pediatrics (AAP),[6] the pediatrician should perform developmental surveillance and screening to identify children at risk, refer for appropriate evaluation, and implement intervention as early as possible. Speech and language impairments have academic, social, and behavioral implications, and appropriate intervention can maximize a child\u2019s outcome."
  },
  {
   "source": "Cover, p. 1304",
   "text": "A language delay occurs when the progression of language development is occurring in the correct sequence, but at a rate slower than typical. Language delays occur more frequently in boys and when there is an established family history of language delay, speech/language disorders, or language-based learning disabilities. Additional risk factors include prematurity, lack of appropriate developmental stimulation, and lower socioeconomic status. Language delays should not be attributed to birth order (having siblings who \u201cspeak for\u201d the child) or to the child being exposed to multiple languages. By 4 years of age, many children with a history of speech and language delays, especially those who have experienced a lack of appropriate language stimulation before receiving appropriate early intervention and early childhood special education services, will \u201ccatch up\u201d and not have persistent language difficulties. However, many children will continue to exhibit persistent language delays. Preschoolaged children with"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 379",
   "text": "## **Diagnostic Evaluation** A developmental delay indicates abnormally slow timing relative to same- age peers in the development of the skill. A language delay becomes a language disorder when it persists to school age; is functionally impactful in terms of communication, social skills, or learning and cognition; or is qualitatively different from normal patterns or sequences of development. Language and communication skills should be interpreted within the context of that child\u2019s overall cognitive, social, and physical abilities. A multidisciplinary evaluation of a child with language delay or disorder is often warranted. At a minimum, the diagnostic evaluation should include psychologic or neurodevelopmental evaluation, including an assessment of social skills, a speech- language evaluation, an audiologic assessment, and a pediatric examination. ## Psychologic or Neurodevelopmental Evaluation"
  },
  {
   "source": "MedStudy Pediatrics Core 11th Edition 2024-2025, p. 95",
   "text": "by an audiologist. This is not to be done in a pediatrician\u2019s office, where the conditions are less than ideal. Delayed language development often accompanies chronic middle ear effusion and specific causes of developmental delay and intellectual disability, such as autism, dysarthria, dyspraxia, maturation delay, degenerative neurologic disorders, closed head injury, and abuse/neglect. Do not accept rationaliza- tions, such as a bilingual home, sex, family history of speech delay, or \u201cthe child does not speak but understands every- thing,\u201d as an explanation for speech delays. Up to 50% of children with delayed language development have delays in other areas. Common causes of delayed language development include: + Hearing deficit * Intellectual disability * Genetic factors (Language disorders tend to cluster in families.) * Impairment in ability to program speech musculature to organize and initiate speech (apraxia) * Structural anomalies of the lip/palate/oropharynx * Child abuse/neglect"
  },
  {
   "source": "Berkowitz's Pediatrics, p. 250",
   "text": "- w Inappropriate vocal quality, pitch, or intensity at any age and developmental language problems. Developmental language disorders produce speech or language delays in children in the absence of hearing loss, anatomic abnormalities of the vocal tract, intellectual disability, or global developmental delay. \u201cLate talkers,\u201d that is, children with normal comprehension but who simply begin speaking late, have mild developmental language problems. Children who are completely nonverbal have more severe problems. Anatomic abnormalities may also result in speech and language delays. Cleft palate is the abnormality most commonly associated"
  },
  {
   "source": "Pediatrics for Practitioner (Sharad Thora), p. 205",
   "text": "- _Mental retardation_ : It is the most common cause of language delay, accounting for about 50% of the cases. Expressive and receptive, both components are affected. There is a global developmental delay, and generally the speech development is relatively more delayed in these children than the other fields of development. **185** chapter 30 ApproAch To A child WiTh delAyed Speech ## **Flow chart 1** Important causes of speech delay ![](/tmp/pdf-images/pdf-0205-04.png) - _Hearing loss_ : Hearing loss at an early stage of development leads to profound speech delay. Hearing loss can be conductive (due to middle ear effusion or malformations) or sensorineural (caused by intracranial infections, ototoxic drugs, kernicterus, congenital anamolies, certain syndromes, etc.). Measures like hearing aids, auditory training and lip-reading training are used. In sensorineural deafness, cochlear implantation may be necessary."
  },
  {
   "source": "Pediatrics for Practitioner (Sharad Thora), p. 204",
   "text": "Receptive language refers to the child\u2019s ability to understand the verbal and nonverbal communications. Expressive language refers to the child\u2019s ability to formulate and express an idea. Language can be delayed or deviant. Examples of deviant language are echolalia (repetition of some phrases without meaning), pronoun reversal, sing-song or monotonous voice. ## **Epidemiology and Etiopathogenesis** Exact prevalence of speech delay in children is difficult to obtain because of confused terminology, differences in diagnostic criteria, unconfirmed parental observations and lack of reliable diagnostic procedures. It can be said, however, that speech delay is a common childhood problem that affects 3\u201310% of children. The disorder is three to four times more common in boys than in girls. The important causes of speech delay are listed in Flow chart 1."
  },
  {
   "source": "AAP Developmental and Behavioral Pediatrics, p. 373",
   "text": "A speech-language or communication disorder is defined as an impairment in the ability to receive, send, process, and/or comprehend verbal, nonverbal, or graphic symbol systems.[14] The most common variation in language development is language _delay._ The word _delay_ inherently implies that catch-up will occur. Of children with early language delays, approximately 60% will catch up by 4 years of age with no persistent problems.[5] Another variation is language _dissociation._ This can occur either within the language domain, as seen when developmental rates differ between expressive and receptive language, or between different domains (eg, language and motor skills). _Deviation_ in language development occurs when language development deviates from the norm, for example when children learn more advanced languagebased concepts before they have mastered early language milestones. An example of this is a child who is able to recite the alphabet or TV jingles but is not yet able to communicate needs using"
  },
  {
   "source": "Illustrated Textbook of Paediatrics (Tom Lissauer, Will Carroll), p. 66",
   "text": "Figure 4.5 The different types of cerebral palsy. 52 ## **Disordered speech and language development** A child may have a deficit in either receptive or expressive speech and language, or both. The deficit may be a delay or a disorder. Speech and language _delay_ may be due to: - [ hearing loss] - [ global developmental delay] - [ difficulty in speech production from an ] anatomical deficit, e.g. cleft palate, or oromotor incoordination, e.g. CP - [ environmental deprivation/lack of opportunity for ] social interaction - [ normal variant/familial pattern.] Speech and language _disorders_ include disorders of: - [ language comprehension] - [ language expression \u2013 inability or difficulty in ] producing speech whilst knowing what is needing to be said - [ intelligibility and speech production such as ] stammering (dysfluency), dysarthria or verbal dyspraxia - [ pragmatics (difference between sentence meaning ] and speaker\u2019s meaning), construction of sentences, semantics, grammar"
  },
  {
   "source": "Berkowitz's Pediatrics, p. 248",
   "text": "## **Differential Diagnosis** The various causes of delayed language development include hearing loss, disorders of central nervous system processing, anatomic abnormalities, and environmental deprivation (Box 33.2). Although birth order (eg, the belief that younger children speak later than firstborn children because older siblings speak for them), laziness (eg, \u201cDon\u2019t give him what he wants when he points. Make him ask for it\u201d), and bilingualism are commonly believed to result in speech and language delay, these factors have never been proved to have a contributory role in such delay. For a complete discussion of hearing loss, refer to Chapter 88. Disorders of central nervous system processing include global developmental delay, intellectual disability, ASD (see Chapter 132), **224 PART 3: HEALTH MAINTENANCE AND ANTICIPATORY GUIDANCE**"
  },
  {
   "source": "AAP Developmental and Behavioral Pediatrics, p. 385",
   "text": "While therapy may improve the degree of impairment and prognosis, many children do not \u201coutgrow\u201d speech and language disorders, although these disorders manifest in different ways over time. A child who has early language delays may have difficulty in reading, written expression, learning a foreign language, or learning appropriate social interactions.[49,50] Developmental promotion of language and early identification and intervention for speech and language disorders are vital to providing the greatest long-term functional benefits. ## **References** 1. Glascoe FP. Can clinical judgment detect children with speech-language problems? _Pediatrics._ 1991;87(3):317\u2013322 2. Law J, Boyle J, Harris F, Harkness A, Nye C. Prevalence and natural history of primary speech and language delay: findings from a systematic review of the literature. _Int J Lang Commun Disord._ 2000;35(2):165\u2013188"
  },
  {
   "source": "Berkowitz's Pediatrics, p. 246",
   "text": "The development of language skills in a normal sequence but at a slower pace than normal is referred to as _language delay;_ language delays may affect only expressive language or both receptive and expressive language (eg, a mixed receptive-expressive language delay). An atypical sequence of language skill acquisition is referred to as a _language disorder_ . Children with developmental language disorders have persistent and significant limitation in their ability to receive or express language. ## **Epidemiology** The prevalence of specific language impairment in school-age children with no hearing loss or obvious genetic or neurologic condition is approximately 7%. Speech and language disorders are more common in boys than girls and in children with a family history of language, speech, or reading disorders. Good evidence exists that early language impairment is associated with later difficulties learning to read. **221**"
  },
  {
   "source": "Cover, p. 1305",
   "text": "Children with a language disorder, also known as a specific language impairment, struggle to use language to express themselves and have difficulties understanding the messages of others. Children with language disorders can have discrepant delays in all or just 1 of the components of language (phonology, morphology, syntax, semantics, and pragmatics). These problems with language development are not secondary to hearing loss or to a language delay that is observed as a component of a global developmental delay. Children with language disorders by definition are not globally delayed, and most have typical nonverbal abilities, adaptive functioning, and social skills. Children with language disorders may initially present with a chief complaint of \u201cdelayed speech.\u201d However, once they start to use words, they may continue to struggle with following directions, being able to form sentences or use verb tenses correctly, or having a conversation."
  },
  {
   "source": "Cover, p. 1304",
   "text": "many children will continue to exhibit persistent language delays. Preschoolaged children with dissociated delays in their language development currently meet DSM-5 criteria for a diagnosis of language disorder. However, children with persistent language delays as they enter school are at significant risk for developing language-based learning disabilities."
  }
 ]
}