psychological disorders

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Approach to a Child with Language Delay

Communication is one of the important developmental domains that help a child to label, explore, and learn new things about him and the environment around. It exposes a child to new stimuli around and helps to build social connections so important for a developing young nervous system. It enables a child to express, understand, and share his joy and convey distress as well. Language and communication is the key towards good scholastic performance as phonological awareness, thought processing and expression are shaped when a child starts remembering and discriminating sounds or using words for describing objects.

Delay in language development can be because of various developmental or psychological disorders e.g. intellectual disability, learning disability, hearing impairment, language disorder, psychosocial deprivation, autism, selective mutism, bilingualism, receptive aphasia, cerebral palsy, etc. Early identification and intervention for these children can have a significant impact on the quality of their lives.

Speech is an act of production of sound. Challenges in speech may manifest in trouble with specific sounds, patterns of words, or intelligibility. Types of speech challenges include articulation or phonological disorders.

Language is the ability to use speech to make others understand what we express and comprehend what others say. The deciphering of the message and its correct delivery is language. A child with language challenges may not use proper sentence construction and grammar (e.g. “I go to the school) or may have trouble deciphering complex sentences or thoughts. The ability to express oneself is called expressive language ability. The ability to decipher and understand language is called receptive language ability.

Communication is the broadest category of them all. Communication not only includes spoken language but also includes many other non-verbal cues, which are essential for interacting and communicating with others. It is common that if a child or adult has proper speech and language, that they still struggle with communication. This could take the form of not understanding sarcasm, gestures, or facial expressions, which are also cues to what someone is trying to communicate to them. Children with autism spectrum disorders (ASD) often exhibit these characteristics. Speech, writing, art, body, and sign language are all methods of communication.  Because communication is central to the development of a child, the failure of a child to speak by the age of 1year 6 months should be taken seriously. Language problems interfere with a child’s ability to communicate effectively, both in the expression and understanding of ideas. The outcome of such a delay may have widespread consequences ranging from academic to social adjustments.

In children not meeting the expected milestones for speech and language, a comprehensive developmental evaluation is essential, because atypical language development can be a secondary characteristic of other physical and developmental problems that may first manifest as language problems. Types of primary speech and language delay include developmental speech and language delay, expressive language disorder, and receptive language disorder. Secondary speech and language delays are attributable to another condition such as hearing loss, intellectual disability, autism spectrum disorder, physical speech problems, or selective mutism. When speech and language delay is suspected, the primary care physician should discuss this concern with the parents and recommend referral to a child development team.

Several studies have shown that children with speech and language problems at two and a half to five years of age have increased difficulty reading in the elementary school years. Children in whom speech and language impairments persist past five and a half years of age have an increased incidence of attention and social difficulties. Children with specific speech and language impairments at seven and a half to 13 years of age have been shown to have impaired writing skills, with marked deficits in spelling and punctuation compared with children with-out speech and language impairments.

It is important for parents to have an understanding of milestones of speech and language so that the delay or deviation of any kind can be determined in early childhood. Normal speech progresses through stages of cooing, babbling, words, and word combinations, whereas normal language progresses through stages of understanding and expressing more complex concepts.

When to refer: When speech and language delay is suspected, the child should be referred to the early childhood developmental center for screening. Based on the screening results the multimodal intervention if needed should be developed by the team of early developmental interventionists. The primary goal of an evaluation should be to rule out cognitive deficits with language delay. Doing away with the myths as boys speak late, with age speech will come, let’s wait for some more time is the need of the hour. As professionals, we need to make discrimination between expression and understanding by going through the age-appropriate milestones. Taking parental concerns seriously and ruling out red flag signs should be a priority.

Management of language disorder is dependent on the type of processing error or expression. If the understanding, which manifests with poor expression, is affected, the focus of the therapies should be comprehension and cognitions. The primary goals of therapy are to teach children strategies for comprehending spoken language and producing appropriate communicative behavior to help parents learn ways of encouraging their children’s communication skills. There is good data available to support the effectiveness of a multidisciplinary intervention, which includes special education and speech-language therapy, particularly for children with a primary expressive language disorder. The effect of speech-language therapy for children with receptive language disorder appears to be much smaller than it is for other groups as the concern is understanding, which results in other associated behavioral problems as well. Hence the multidisciplinary developmental team approach is a must. Parents can effectively administer speech-language therapy, but must first receive training. The response to treatment is more varied when using parent administrators, which suggests that some parents may be more suited for providing therapy than others.

Parent Counseling:

Parents can be counseled that, once a diagnosis is made, there are professionals who can work with the child and parents, and that many times children show a positive response to this intervention. Looking at the increased incidence of developmental disorders like autism, communication disorder, social communication disorder it is advised that a child with presenting complaints of language delay with associated behavioral problems must be referred to a multidisciplinary team of child development consisting of a developmental pediatrician, psychologist, special educator, speech therapist and other allied rehabilitation professionals so that a comprehensive evaluation can be done as early as possible. Research shows that early diagnosis has a better prognosis than late identification and referral.

Imran Mushtaq
Research Scholar
Department of Clinical Psychology
Faculty of Behavioral Sciences
SGT University, Gurugram.

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