Early Language Delay, Predictors and Risk Factors Flashcards
predictors and risk factors for early language delay
- hearing impairment
- family hx
- twins
- genetic, developmental, and neurological conditions
- high social risk
- abuse, neglect, trauma
- prematurity
- low birth weight
abuse, neglect, trauma: the younger the child…
the greater the impact
abuse, neglect, trauma: what area of language suffers more? expressive or receptive?
expressive
which has a greater impact on language development: severe neglect or abuse alone?
severe neglect
abuse, neglect, trauma
under-identified and under-served
___ of ___ on the developing brain make it harder to benefit from tx
pervasive impact, trauma
prematurity causes
- smoking
- drinking
- other drug use
prematurity facts
- multiple births (63% preterm)
- birth spacing (<18 months)
- access to prenatal care (health insurance)
prematurity: maternal age in order of highest risk to lowest risk
40+
30-39
<20
20-29
low birth weight causes
language, cognitive, sensory, and motor impairments
LBW: preterm
< 37 weeks
LBW: late preterm
34-36 weeks
LBW: very preterm
- < 32 weeks
what is considered LBW?
< 5 lb, 8 oz
what is considered VLBW?
< 3 lb, 4 oz
preterm birth rate by race/ethnicity (US, 2019-2021 average)
- Hispanic: 10.0%
- White: 9.3%
- Black: 14.4%
- American Indian/Alaska Native: 11.8%
- Asian/Pacific Islander: 9.0%
- total: 10.3%
LBW data
- about 1 in 7 Black babies (about 13%)
- about 1 in 12 Asian babies (about 8%)
- about 1 in 13 Native American or Alaska Native
who is eligible for Early Intervention services in age?
birth to 3 years old
to be eligible for EI, infants and toddlers who have at least 1 of these
- a 25% delay in 1 or more areas of development
- a specialist’s determination that there is a delay even though it doesn’t show up on the assessments (called informal clinical opinion)
- a known physical or mental condition that has a high probability for developmental delays (such as Down Syndrom)
negative consequences of NICU and necessary medical interventions
- oral defensiveness/aversion
- trauma, damage to larynx
- over or lack of stimulation
- caregiver PTSD
prematurity and age correction
using a preterm child’s adjusted age to set goals and administer assessments
calculating for age correction
- preterm child’s chronological age minus weeks or months early they were born
- ex: 24 month old born 3 months early would have the adjusted age of 21 months
using only adjusted age to determine eligibility for services, goals, progress may
mask deficits and frame them as (temporary) delays
how should we use a preterm child’s adjusted age?
report and consider actual and adjusted age when you can for preterm children age 5 and under
drug and alcohol exposure
- prenatal opiate and cocaine exposure
- fetal alcohol syndrome (FAS)/fetal alcohol spectrum disorder (FASD)/prenatal alcohol syndrome (PAS)
prenatal opiate and cocaine exposure
- lower weight, height, head circumference
- slower growth
- similar outcomes from prenatal exposure to meth based on preliminary research
prenatal opiate and cocaine exposure deficits
- reflexes
- tone
- irratibility
- alertness (particularly < 6 months)
drug and alcohol exposure, growing consensus (receptive and expressive language delays)
- syntax
- higher level language, discourse 3 and 4 years
- behavior, attention, language, cognition difficulties 4-13 years
drug and alcohol exposure: SLP’s role
- feeding
- assessment of alertness/sleepiness cycle and triggers of irritability
- facilitating medical staff/parent/caregiver positive interactions and bonding
- parent/caregiver education and counseling
fetal alcohol syndrome (FAS)/fetal alcohol spectrum disorder (FASD)/prenatal alcohol syndrome (PAS)
- leading identifiable, preventable, nonhereditary cause of intellectual disability + birth defects in the US
- spectrum disorder
- physical, cognitive deficits that are irreversible
FAS/FASD/PAS: physical effects
- small head
- epicanthal folds
- smooth philtrum
- underdeveloped jaw
- low nasal bridge
- small eye openings
- short nose
- thin upper lip
FAS/FASD/PAS: hallmarks are facial malformations, delayed growth, and CNS abnormalities
- poor condition, balance
- ID
- poor memory
- attention problem
- hyperactivity
- difficulty with reasoning and problem-solving
- difficulty identifying consequences of choices
- poor judgment skills
- trouble adapting to change or switching from 1 task to another
- problem with behavior and impulse control
- poor concept of time
- problems staying on task
- difficulty planning or working toward a goal
FAS/FASD/PAS: phonological development
- slightly lower overall intelligibility
- more consonant errors and some differences in order of mastery
- nonword repetition, auditory discrimination deficits
- literacy and spelling delays
FAS/PAS research update
- Kipplin et al. compared language and literacy outcomes for adolescents with and without prenatal alcohol exposure (PAE)
- young people with PAE generally had weaker vocabulary skills, verbal learning, memory, reading, and spelling skills than their non-PAE peers
- many of the language scores did not fall into the disordered range (greater than 1.5 standard deviations) but may still impact communication and educational attainment
what is in a name?
- language delay
- language impairment
- language difficulty
- late talker
late talker
a large body of research suggests that even those who seem to catch up with peers often continue to show subtle weaknesses in language function
kids identified as later talkers at 2 had significantly more or less speech errors than at 4-5
more speech errors, especially polysyllabic words
toddlers between 18 and 24 months with language delay had significantly more of what type of problems compared to toddlers without language delay
socioemotional and behavioral problems
developmental language disorder (DLD)
- language impairment is the most salient challenge
- biological cause of disorder is not known
- no other diagnostic label is appropriate
things to know about DLD
- late talkers that don’t catch up to their peers (3+)
- formally known as language impairment/disorder
- heterogenous
- spectrum disorder
- high prevalence among school-age population
