Speech and Language Development: Monitoring Process and Problems

Abstract

1. Susan McQuiston, PhD* 2. Nancy Kloczko, MD† 1. *Pediatric Psychologist. 2. †Developmental-Behavioral Pediatrician, Baystate Children's Hospital, Springfield, MA. After completing this article, readers should be able to: 1. Describe the progression of normal speech-language development. 2. Recognize delayed and disordered speech-language development and indications for referral. 3. Understand possible biologic and environmental contributions to delayed language. 4. Implement appropriate management strategies. You are seeing a 2½-year-old boy for a routine health supervision visit. On a general developmental screening questionnaire, his mother reports that he is not yet talking. She has not been too concerned because the child's father was a late talker and they live in a bilingual household. Although the boy has had several episodes of otitis media, she feels strongly that there is no question of hearing loss because he seems to understand what is said to him. Other domains of development are reported as age-appropriate. His physical examination results are normal, and he appears to be a socially engaging toddler. However, you have concerns about his apparent low frustration tolerance and tendency to throw tantrums. It has been said that all typically developing children in all cultures master the basics of their language by 4 years of age. (1) However, 5% to 8% of children experience speech-language delays or disorders by the preschool years, which may be associated with later learning, socioemotional, or behavioral problems. The primary clinician often is the first professional to whom parents turn when a developmental problem is suspected, and in the course of routine health supervision visits, the clinician may encounter any of the following language-related questions or concerns: