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Warning Signs in the Development of Speech, Language, and Communication: When to Refer to a Speech-Language

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Warning Signs in the Development of Speech, Language, and Communication: When to Refer to a Speech-Language Journal of Child and Adolescent Psychiatric Nursing ISSN 1073-6077 Warning Signs in the Development of Speech, Language, and Communication: When to Refer to a Speech-Language Pathologistjcap_292 175..184 Lorain S. Wankoff, PhD Lorain S. Wankoff, PhD, is Speech-Language Pathologist, Windward School, White Plains, New York, USA. Search terms: TOPIC: Because of the link between communication impairments and psychiatric Collaboration, communication, speech and disorders, it is important for nurses and other healthcare professionals to know the language delay, speech and language warning signs for the need for a communication/speech/language evaluation for evaluation, speech-language pathology children during infancy through early childhood. Author contact: PURPOSE: This article presents an overview of the role of speech-language [email protected]; [email protected], pathologists (SLPs); the expected developmental achievements for youngsters from with a copy to the Editor: [email protected] infancy to age 5 in speech, language, and communication; and the clinically signifi- cant warning signs that indicate a need for speech/language assessment. doi: 10.1111/j.1744-6171.2011.00292.x SOURCES: Sources for this article included published literature on the topic along with the clinical judgment and expertise of the author, a certified SLP. CONCLUSIONS: Warning signs for referral to an SLP may be subtle and may present in developmental, academic, behavioral, or social–emotional realms. Col- laboration between nurses and communication professionals will allow for early identification and intervention. Early detection of speech and language disabilities is key to maximizing the effects of early intervention, resulting in more positive com- munication outcomes in later life. It has been found that speech and language delays and disorders, with symptoms left untreated, can cause difficulties in learning and socialization that can last into adolescence and beyond. Early identification of chil- dren with developmental delay or developmental disabilities may lead to interven- tion at a young age when chances for improvement may be best. higher risk for developing reading disabilities (Catts & When to Refer to a Speech-Language Kamhi, 2005). Other areas of interest to the SLP include the Pathologist (SLP): Language and child’s temperament, his or her cognitive development, and Communication Warning Signs in Children sensory and motor developments, as well as behavioral Healthcare providers and psychiatric professionals,who work regulation. with children and their families, are in a unique position to identify warning signs or symptoms of possible communica- What Are the Risk Factors for Speech and tion, language, and speech disabilities. Early detection of Language Disabilities? these warning signs and referral for a communication, lan- guage, and speech assessment is important for the well-being The most consistently reported risk factors for speech and of a particular child. Thus, collaboration and the sharing of language difficulties include a family history of speech and information between the mental health professional and language delay, male gender, premature delivery, and low speech-language pathologist (SLP) are of utmost importance. birth weight. Early identification of children with develop- Speech and language deficits can be indicators of psychiat- mental delay or developmental disabilities, such as marked ric conditions or developmental disorders. For example, hearing deficits or craniofacial abnormalities, will lead to youngsters with deficits in the pragmatic component of lan- intervention at a young age when chances for improvement guage (i.e., the social use of language) may be at greater risk may be best. It has been found that speech and language for autism (Prizant & Meyer, 1993). In the school-age years, delays and disorders with symptoms left untreated can cause children with rapid naming or word retrieval deficits are at difficulties in learning and socialization that can last into Journal of Child and Adolescent Psychiatric Nursing 24 (2011) 175–184 © 2011 Wiley Periodicals, Inc. 175 Warning Signs in the Development of Speech, Language, and Communication: When to Refer to a Speech-Language Pathologist adolescence and beyond. Particular evidence has been found especially in the areas of autism and specific language impair- for the efficacy of speech and language intervention for ment (Dale, Price, Bishop, & Plomin, 2003; Tager-Flusberg expressive, phonological, and vocabulary deficits (Abbeduto et al., 2009; Wetherby et al., 2004). However, this article is not & Boudreau, 2004; Law, Garrett, & Nye, 2003; U.S. Preventive meant to be a primer on specific language and speech disor- Services Task Force [USPSTF], 2006). ders. For further study, there are scholarly and popular resources that are available, which outline the predictors and risk factors for language growth in children, as well as symp- What Is the Link Between Psychiatric toms of specific speech and language disabilities (Agin, Geng, Disorders and Speech and Communication & Nicholl, 2003; Brinton et al., 2007; Chapman, 2007; Paul, Disorders? 2007; Weismer, 2007). The link between communication impairments and psychiat- ric disorders is evident to most mental health professionals What Is the Current Domain of the SLP? (Nelson, Benner, & Cheney, 2005). The Diagnostic and Statis- tical Manual, Fourth Edition–Text Revision of the American The domain of the SLP was expanded and dramatically Psychiatric Association (2000) described the developmental revised beyond simply articulation, voice, and stuttering as a disabilities that include speech and language deficits as part of result of the“linguistics revolution”in 1957 (Chomsky,1957). the criteria for diagnosis, e.g., mental retardation, pervasive Since then, “SLPs” have developed standardized and non- developmental disorder, and autism spectrum disorders. In standardized methods of assessing the essential components addition, there are behavioral and/or emotional disabilities of language including form (syntax, morphology, phonology, where speech and language deficits may be comorbid and and suprasegmental features of language, such as intonation, often do co-occur (e.g., attention deficit disorder, opposi- pitch, volume, stress, and juncture), content (semantics), and tional defiant disorder, conduct disorder, overanxious disor- use (pragmatics), as well as the essential features of speech der, or dysthymia; American Psychiatric Association, 2000; including articulation, voice, and fluency (Lahey, 1988). It is Giddan, 1991). only in the last decade that the scope of practice for the SLP According to the USPSTF (2006), “speech and language has broadened to include the domains of reading and writing delay affects 5% to 8% of preschool children.” These delays (American Speech-Language-Hearing Association, 2001; often persist into the school years and may be associated with Foster & Miller, 2007). lowered school performance and psychosocial problems. In a SLPs also assess and treat speech-related deficits in oromo- recent epidemiological study, Pinborough-Zimmerman et al. tor functioning, which impact feeding, sucking, or swallow- (2007) found a great degree of overlap between speech and ing abilities or dysphagia. It should be noted that feeding language impairments and other psychiatric disabilities. abilities are required for the health and development of the Their results indicated that the prevalence of communication youngster and are prerequisite to the development of early disorders among 8-year-olds in one area of the United States communication skills (American Speech-Language-Hearing was 6.3% of the population (of 1,000 children). Furthermore, Association, 2008; Kent & Vorperian, 2007). the percentage of communication disorder cases with autistic The social–emotional development of the child is of para- spectrum disorder was 3.7%, and the overall proportion of mount importance because children with significant attach- communication disorder cases with intellectual disability was ment and regulatory disorders may display communication 4%. The most frequent emotional/behavioral disorder delays. For example, for the very young infant, parental con- co-occurring with communication disorders was attention cerns may be expressed regarding the baby that is difficult to deficit hyperactivity disorder (6.1%) followed by anxiety dis- engage or soothe. Deficits in social–emotional development order (2.2%), and conduct disorder (1.1%). and/or sensory regulation may be coupled with difficulties Research indicates that a large proportion of children initiating or maintaining engagement with others. Similarly, admitted for psychiatric care have language challenges and toddlers or preschoolers may be reported or observed to be that most children with substantial language disabilities have excessively shy, quiet, anxious, inattentive, or withholding psychosocial difficulties. Unfortunately, these problems (Geller & Foley, 2009; Gerber & Wankoff, 2010; Greenspan, worsen for adolescents with language impairment, as the DeGangi, & Weider, 2001; Guralnick, 2005). challenges in older children are linked not only to psychiatric As cognitive abilities are linked to language abilities during disorders but to teenage suicide as well (Baltaxe,2001; Benner, a young child’s growth and development, researchers in child Nelson, & Epstein, 2002; Fujiki, Brinton, & Clarke, 2002; language have learned to view play as a window to the cogni- Toppleberg, Medrano, Pena
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