|
|
PERRI KLASS, M.D.
There is nothing simple about speech, and there is nothing simple about speech delay -- starting with the challenge of diagnosing it.
Every pediatrician knows the frustration of trying to quantify the speech and language skills of a screaming toddler. How many words can he say? Can she put two or more words together into a sentence? Can people besides you understand him when he talks? Questions like these, put to the parents, are the quick and somewhat crude yardsticks we often use.
Crude or not, the assessment is crucial: the earlier it is made, the earlier the speech-delayed child can get some help, and the earlier the help, the better the prospects.
"The physician who understands delayed speech understands child development," said Dr. James Coplan, a neurodevelopmental pediatrician in Rosemont, Pa., who created the Early Language Milestone Scale to measure children's language from birth to age 3.
Guidelines by age can be found on the Web site of the American Speech-Language-Hearing Association: asha.org/public/speech/development/chart.htm.
"Children within the first year start to understand much of what they hear around them," said Diane R. Paul, the group's director of clinical issues in speech-language pathology. One-year-olds, she continued, "start to use single words and follow simple directions and point to body parts and listen to simple stories." By about 2, they start putting words together; by 3, they should be using sentences of three words at the very minimum.
The early utterances may be simple, but what produces them is very complex. When a child is not meeting those milestones, there can be a multitude of reasons. Dr. Coplan, who is also the author of "Making Sense of Autistic Spectrum Disorders" (Random House, 2010), says he looks at speech delay in a very broad context, from cognition to communication. Is it purely a problem with speech and language, or is there some more global delay? Has something gone awry in the child's social connections?
The first question to ask is whether the child can hear. Nowadays, all newborns have their hearing screened before they leave the nursery, but later testing can pick up progressive or acquired hearing loss.
Click here to continue reading.
