andrew and speech (answers)

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Andrew comes to see you with his mother. He is 40 months old and has recently started nursery. His mother has noticed that the other children have much better speech and language than Andrew does.

Andrew’s past history is unremarkable. At his 18 month check, he could say, Mama, Dada and Ta! and he passed his health-visitor distraction test at the second attempt.

Andrew plays happily in the surgery, looking at books and vocalising a fair amount. His mother can identify at least 20 words although they are difficult to understand. He will string words together but tends to back up his language with enthusiastic non-verbal clues. He frequently omits consonants, particularly off the end of words, and has many phonetic substitutions. He manages to recognise things by their function and will correctly identify size and colour.

Andrew’s mother reports that he can ride his bike with stabilisers, feeds himself washes and dresses with some supervision.

Case discussion: Pure language delay

  • Exclude hearing loss.
  • Discuss with a speech therapist as regards further assessment and management, but remember that speech therapists are not Secondary Care specialists.
  • Speech development is probably the developmental parameter that can vary most. There is a strong genetic influence on language development, and a positive family history of speech delay can often be found.
  • At the age of 4 years, one in six children have a language level one year below the mean, and 10% of children may at some point show evidence of speech delay. The majority recover with no ill effects.
  • Psycho-social deprivation, wider-stimulation and child abuse can all cause speech delay, often with associated delay in social development or non-organic failure to thrive.
  • Being bi-lingual, a twin, a boy or left-handed is no excuse for delayed speech development.

Factors associated with a poor prognosis include:

  • severe delay
  • receptive problems only slow “catch-up” with intervention
  • deviant or qualitatively abnormal speech
  • bizarre/aberrant sounds not experienced in normal language
  • other medical developmental problems
  • abnormal socialisation
  • a clear history of speech regression.
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