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common causes of speech delay problems in children.
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SPEECH DELAY
ByNorrifhan Akmal IsmailNur Atiqah Ab Rahman
OUTLINES
Definition Normal speech development Signs of speech delay History taking Causes of speech delay
DEFINITION
Child’s speech development is significantly below the standard for children of the same age.
Age Achievement
1-6 months Coos in response to voiceLaughs
6-9 months Babbling
10-11 months Imitate soundsSays mama, dada without meaning
12 months Says mama dada with meaningImitate 2-3 syllables words
16-18 months 10 wordsShows 2 parts of body
2 years >50 wordsTwo words phrases
3 years Talk constantly in 3-4 word sentences
4 years Ask questionsTell stories
5 years Fluent speechGood articulationKnows ABCNames 4 coloursTells time
SIGN OF SPEECH DELAY•Is
nt babbling or speaking in mock sentences at all.
1year•H
e hasn’t said one word
1.5 years
•Say only few words
•Communicate mostly through grunting and pointing
2 years
•Speaking in single syllables
•Didn’t have vocabulary of 50 words
2.5 years
•Speaks only simple two word phrase
•Strangers cant understand his pronunciation
3 years
HISTORY TAKING Developmental history Maternal illness in pregnancy Maternal use of alcohol Perinatal history Past medical history Use of medication Psychosocial history More than one language spoken to the
child Family history
EXAMINATION
Check ears Check for any dysmorphic features Distraction test Developmental assessment
AETIOLOGY Hearing loss Global developmental delay Anatomical disorder Oromotor dysfunction Autism Bilingualism Receptive aphasia Expressive language disorder
HEARING LOSS
Impairment in either one or both ears of any severity
Can be due to
› Sensorineural : caused by a lesion in the cochlea or auditory nerve.
› Conductive : abnormalities of the ear canal or middle ear.
SENSORINEURAL CONDUCTIVE
Genetic Otitis media with effusion
Antenatal and perinatal-Congenital infection-Preterm -Hypoxic-ischaemic encephalopathy-Hyperbilirubinemia(bilirubin can damage the vestibulocochlear nerve)
Eustachian tube dysfunction-Down syndrome-Cleft palate
Postnatal-Meningitis/encephalitis-Head injury-Drugs ; aminoglycosides, frusemide
Impacted wax
SENSORINEURAL CONDUCTIVE
Usually present at birth, irreversible
Usually due to middle ear disease such as otitis mediaMore common
Management - If severe, need amplification with hearing aids/ cochlear implants
Management-Conservative-Surgical repair-Amplification
• No response when called• Talk loudly• Watching TV at high volumes• Mispronouncing words
Symptoms
HEARING TESTAGE TYPE OF TEST COMMENTS
Newborn screening Automated Otoacoustic Emission (AOE) test
Determines cochlear function by creating echo response. Sound wave given via probe
Any age Brainstem Auditory Evoked Response (BAER)
Measures brainstem responses to sound and recorded as wave activity
7-9 months Infant Distraction Test (IDT)
Assess the ability to hear a sound and turn to locate it.
Infants Behavioural observation assessment (BOA) test
Identifies body reactions to sound
>2.5years Conditioned play audiometry
Earphones placed on child They need to perform the action each time they hear the sound
Older children Pure tone audiometry (PTA)
Patient presses a response button/raises hand when the test tone is heard
GLOBAL DEVELOPMENTAL DELAY
Delay in all skill fields (gross motor, vision and fine motor, hearing and speech, language and cognition, social and behaviour)
i.e Down syndrome
DOWN’S SYNDROME Trisomy 21
Can be due to› Meiotic non-disjunction› Translocation› Mosaicism
Hearing impairment from secretory otitis media
Narrow Eustachian tube infection block glue ear hearing loss speech delay
Thyroid dysfunction hypothyroidism abnormal growth of brain mental retardation speech delay