Guidelines for Referral for a Speech-Language Assessment for Toddlers
I recently found a great article written by Marilyn Agin, M.D., and author of The Late Talker. It was written for a pediatrics journal, but it also has great information for parents who might be on the fence wondering if their child will catch up on his own, or if they should go ahead and be referred for a speech-language evaluation.
I love the beginning quote so much that I’d like to share it here:
“Not all children with delayed speech are “little Einsteins” or garden variety “late bloomers.” Some have a speech-language disorder that will persist unless warning signs are recognized and intervention comes early.”
She also includes a set of risk factors for pediatricians (and parents) to look for which might also inhibit language development:
- Family history, such as a strong heritability factor. There’s a higher risk of continued delay if one of a toddler’s parents or siblings had long-term language and learning difficulties.
- Otitis media with effusion causing a fluctuating hearing loss during the period of speech development. (This means frequent ear infections. If your child has had several, and?especially if he’s had to have tubes during infancy or toddlerhood, this could be a major contributing factor to his speech-language delay.)
- Low socioeconomic status and educational level. These families are more likely to have a child with a poor outcome.
- Parental characteristics that may inhibit speech, including the way parents interact with the child. Parents need to follow a child’s lead and provide a language model using simplified speech. Use of “parentese,” the way that many parents instinctively talk to infants in a high-pitched, sing-song voice, actually fosters language development by attracting the infant’s attention and resembling the pitch of the sounds he makes.
- Missed language explosion. Most children experience a vocabulary spurt around the age of 18 months, but late talkers don’t. Some late talkers have an “explosion” of speech later between 24 and 30 months. If a child has not had a vocabulary spurt by 30 months, he is at considerable risk of continued language delay.
She also includes information I’ve cited in other places on the site with the signs that a child should get an early speech-language assessment including:
One major review in the speech pathology literature paints a profile of toddlers 18 to 24 months old who are at risk of persistence of language impairment at 36 to 48 months and who should receive early intervention.6 The greater the number of warning signs a child exhibits (especially the closer he gets to 3 years of age), the greater the need for early assessment. Those signs include6:
- little sound play or babbling as an infant, with limited number of consonant sounds and, possibly, vowel distortions as a toddler
- poor verbal imitation skills; reliance on direct model and prompting
- immature play skills; little pretend play
- interactions with adults more than peers
- few communicative gestures (the late bloomer who caught up with his peers within a year used significantly more gestures than the child who had persistent delay)
- impaired social skills or behavior problems
- small vocabulary for age; less diverse verb repertoires
- comprehension delay of six months or greater relative to chronologic age
This might also be a great resource for your pediatrician, especially if he or she is of the “wait and see” variety. Printing this article and taking it with you to an appointment might be a great?way to start (or re-start) a conversation about your concern with your child’s language skills.
You can read the full article at this link.