What Kind Of Service S Are Provided If My Son Qualifies As Language Delayed

Spoken language and Language Filibuster in Children

Am Fam Doc. 2011 May 15;83(ten):1183-1188.

Patient information: Come across related handout on oral communication delay in children, written by the author of this article.

• Abstract
• Definition of Speech and Linguistic communication
• Prevalence and Prognosis
• Screening
• Normal Evolution
• Atypical Evolution
• Indications for Referral
• Therapies
• Parent Counseling
• References

Article Sections

• Abstruse
• Definition of Spoken language and Language
• Prevalence and Prognosis
• Screening
• Normal Development
• Atypical Development
• Indications for Referral
• Therapies
• Parent Counseling
• References

Speech and linguistic communication delay in children is associated with increased difficulty with reading, writing, attention, and socialization. Although physicians should be alert to parental concerns and to whether children are coming together expected developmental milestones, there currently is insufficient evidence to recommend for or confronting routine use of formal screening instruments in primary care to detect speech and language delay. In children not coming together the expected milestones for speech and language, a comprehensive developmental evaluation is essential, because atypical language evolution can be a secondary characteristic of other physical and developmental problems that may first manifest as language problems. Types of principal speech and language filibuster include developmental speech and language delay, expressive language disorder, and receptive language disorder. Secondary speech and linguistic communication delays are owing to another condition such as hearing loss, intellectual disability, autism spectrum disorder, concrete speech problems, or selective mutism. When speech and linguistic communication delay is suspected, the chief care physician should hash out this concern with the parents and recommend referral to a speech-language pathologist and an audiologist. In that location is good evidence that spoken communication-linguistic communication therapy is helpful, specially for children with expressive language disorder.

Definition of Speech and Language

• Abstruse
• Definition of Speech and Language
• Prevalence and Prognosis
• Screening
• Normal Development
• Atypical Development
• Indications for Referral
• Therapies
• Parent Counseling
• References

Speech is the verbal production of language, whereas language is the conceptual processing of advice. Language includes receptive language (understanding) and expressive language (the ability to convey information, feelings, thoughts, and ideas). Language is commonly thought of in its spoken form, but may besides include a visual form, such as American Sign Language.

SORT: Cardinal RECOMMENDATIONS FOR PRACTICE

Clinical recommendation	Testify rating	References	Comment
The evidence is bereft to recommend for or confronting the routine utilise of cursory, formal screening instruments in primary care to detect speech and language delay in children up to five years of age.	C	13	U.Southward. Preventive Services Task Forcefulness evidence-based guideline
All children with suspected spoken language and language delay should be referred to a speech-language pathologist or local early on intervention plan for formal cess.	C	xxx, 31	Usual doxxx and a consensus-based practice guideline31
All children with suspected speech and language filibuster, or in whom there is business concern about hearing loss, should be referred to an audiologist.	C	30–32	Usual practice30 and consensus-based do guidelines31 , 32
Oral communication-linguistic communication therapy is effective for primary expressive language disorders. The effect of speech-linguistic communication therapy for children with receptive language disorder appears to be much smaller than it is for other groups.	A	18	Cochrane review
For children receiving speech-language therapy, parent-provided therapy nether the guidance of a clinician is as effective every bit clinician-provided therapy.	A	xviii	Cochrane review
Spoken language-linguistic communication therapy interventions lasting longer than 8 weeks may exist more constructive than those lasting less than eight weeks.	B	xviii	Cochrane review

---

Prevalence and Prognosis

• Abstract
• Definition of Oral communication and Linguistic communication
• Prevalence and Prognosis
• Screening
• Normal Evolution
• Atypical Evolution
• Indications for Referral
• Therapies
• Parent Counseling
• References

The reported prevalence of language filibuster in children 2 to seven years of age ranges from 2.3 to 19 percent.i–5 Severe speech and language disorders in immature children tin can negatively affect later educational achievement, even later intensive intervention.6 Several studies have shown that children with speech and language issues at 2 and a half to five years of historic period take increased difficulty reading in the elementary school years.7–9 Children in whom speech and language impairments persist past five and a half years of age have an increased incidence of attention and social difficulties.10 Children with specific speech and language impairments at vii and a half to xiii years of age have been shown to have dumb writing skills, with marked deficits in spelling and punctuation compared with children without voice communication and language impairments.eleven The likelihood of persistent difficulties for young children with voice communication and language problems appears to be direct related to the range of language functions that are impaired, with the best prognosis for children who take a developmental speech delay.12

Screening

• Abstract
• Definition of Speech and Linguistic communication
• Prevalence and Prognosis
• Screening
• Normal Development
• Atypical Development
• Indications for Referral
• Therapies
• Parent Counseling
• References

The U.Due south. Preventive Services Task Force found that there was insufficient show to recommend for or confronting routine use of brief, formal screening instruments in primary care to detect voice communication and language delay in children up to 5 years of age. Specific groups of children known to exist at higher-than-average risk of speech and linguistic communication delay, such as those with hearing deficits or craniofacial abnormalities, were not included in this review. Studies of other hazard factors for spoken communication and language delay prove inconsistent results, and so the U.S. Preventive Services Chore Forcefulness was unable to develop a list of specific risk factors to guide primary care physicians in selective screening. The most consistently reported risk factors were a family history of speech communication and language delay, male sex, prematurity, and low nascency weight. Other adventure factors that were reported less consistently included levels of parental pedagogy, childhood illness, belatedly birth gild, and larger family size.thirteen

The physician should arm-twist any concerns that parents have about their kid'due south spoken communication and language. In improver to observing the kid's speech in the dispensary setting, the physician should inquire the parents if this behavior is typical of that at home, at school, and in other social environments. The American Academy of Pediatrics publishes Bright Futures guidelines that include speech communication and language milestones to exist covered at each well-child visit.14 A free PDF download of the pocket version and a PDA version that tin be purchased are available at http://brightfutures.aap.org/3rd_Edition_Guidelines_and_Pocket_Guide.html. The Milcom Well-Child Record System, parts of which were reviewed and canonical by the Society of Teachers of Family unit Medicine, includes historic period-advisable screening questions for spoken communication and language milestones, and is bachelor for purchase at http://www.briggscorp.com.

Normal Development

• Abstract
• Definition of Speech and Language
• Prevalence and Prognosis
• Screening
• Normal Evolution
• Atypical Development
• Indications for Referral
• Therapies
• Parent Counseling
• References

Speech and language developmental milestones are noted in Table one.14,fifteen It is important for the physician to have an agreement of these milestones to determine whether children have a delay in speech or language. Normal speech communication progresses through stages of cooing, blathering, words, and discussion combinations, whereas normal language progresses through stages of understanding and expressing more circuitous concepts. Development of proficiency in vocabulary and language employ depends heavily on family and early school experiences. Families tin assistance their children'south language development by telling stories, playing word games, reciting rhymes and songs, engaging in questions and chat, and reading books together.14

Tabular array 1.

Developmental Milestones for Speech and Language in Children

Age	Receptive	Expressive
6 months	Turns to rattling sound*	Laughs* Vocalizes (cooing)*
	Turns to voice†
9 months	—	Babbles, unmarried syllables* Says "mama" or "dada," nonspecific† Waves "farewell-bye"†
12 months	Follows ane-stride command15	Babbles* Imitates vocalizations and sounds* Says 1 discussion† Waves "cheerio-bye"†
15 months	—	Says one word* Says iii words† Waves "goodbye-bye"*
18 months	Points to at least one body office	Says three words* Says vi words†
two years	Points to two pictures*	Combines words Names ane picture†
	Follows ii-step command15
2.five years	Points to six body parts*	Knows ii actions Names one motion picture* Speech one-half understandable†
three years	—	Knows two adjectives† Names four pictures* Names one color† Speech all understandable†
4 years	—	Defines v words† Names iv colors† Speech all understandable*

---

The proportion of a kid's speech that should be understandable to a stranger in the absence of whatever contextual cues increases with historic period. Milestones for this can exist remembered by using the "rule of fours": if the child's age in years is divided by four, the caliber is approximately equal to the amount of oral communication that should be understandable. Thus, a one-year-onetime should exist understandable 25 per centum of the time, a two-year-onetime 50 pct of the time, a three-yr-former 75 percentage of the fourth dimension, and a four-year-sometime close to 100 percent of the time.15

BILINGUAL Linguistic communication LEARNING

Children growing up in a bilingual environment will typically take some degree of mixing of the 2 languages, which decreases with a growth in linguistic communication development.sixteen These children usually become practiced in both languages by 5 years of age.17 Bilingual language learning does non typically necessitate services from a speech-linguistic communication pathologist unless there is a difficulty in the master language. Bilingual children should be referred based on the same criteria used for monolingual children.

Singular Development

• Abstract
• Definition of Speech and Language
• Prevalence and Prognosis
• Screening
• Normal Development
• Atypical Development
• Indications for Referral
• Therapies
• Parent Counseling
• References

In children not meeting the expected developmental milestones for oral communication and language, a comprehensive developmental evaluation is essential. Singular language development can be a secondary characteristic of other physical and developmental problems that may first manifest as language problems. Some of the many conditions that tin can account for speech and language bug in children are outlined in Table 2.12,18–29 These tin be divided into primary speech and language problems, in which no other etiology can be found, and secondary speech and linguistic communication issues, which are owing to another condition.

Table two.

Voice communication and Language Problems in Children

Disorder	Clinical findings and comments	Treatment and prognosis
Primary (not attributable to another condition)
Developmental speech and language delay	Spoken communication is delayed.	Spoken language-language therapy interventions are effective. Parent-provided therapy under the guidance of a clinician is equally constructive equally clinician-provided therapy. Interventions lasting longer than eight weeks may exist more effective than those lasting less than eight weeks.18 Prognosis is fantabulous. Children typically have normal speech communication past the age of school entry.12
	Children have normal comprehension, intelligence, hearing, emotional relationships, and articulation skills.12
Expressive language disorder	Voice communication is delayed.	Active intervention is necessary considering this disorder is not cocky-correcting. Speech-language therapy interventions are effective. Parent-provided therapy nether the guidance of a clinician is as effective equally clinician-provided therapy. Interventions lasting longer than eight weeks may exist more effective than those lasting less than eight weeks.18
	Children take normal comprehension, intelligence, hearing, emotional relationships, and articulation skills.
	Expressive linguistic communication disorder is hard to distinguish at an early on age from the more common developmental speech and language delay.
Receptive language disorder	Speech is delayed, and also sparse, agrammatic, and indistinct in articulation.	The effect of speech-linguistic communication therapy is much smaller than it is for other groups. Parent-provided therapy under the guidance of a clinician is every bit effective as clinician-provided therapy. Interventions lasting longer than 8 weeks may be more effective than those lasting less than viii weeks.xviii It is rare for these children to develop normal oral language capacity.19
	Children may not look at or point to objects or persons named past parents (demonstrating a arrears in comprehension).
	Children accept normal responses to nonverbal auditory stimuli.
Secondary (attributable to another condition)
Autism spectrum disorder	Children have a diversity of speech abnormalities, including speech communication filibuster (especially with concurrent intellectual disability), echolalia (repeating phrases) without generation of their own novel phrases, difficulty initiating and sustaining conversations, pronoun reversal, and speech and linguistic communication regression.	Children should be referred for developmental evaluation. Children benefit from intensive, early on intervention that focuses on increasing communication.21 Language training programs have been shown to assistance children communicate.22
	Children have impaired communication, impaired social interaction, and repetitive behaviors/circumscribed interests.20
Cerebral palsy	Speech delay in children with cognitive palsy may be due to difficulty with coordination or spasticity of tongue muscles, hearing loss, coexisting intellectual disability, or a defect in the cerebral cortex.	Speech communication-language therapy services can include introducing augmentative and culling communication systems, such every bit symbol charts or speech synthesizers, enhancing natural forms of communication, and grooming advice partners. A Cochrane review did not find business firm evidence of the positive effects of spoken language-language therapy, just did find positive trends toward improved advice skills.23
Childhood apraxia of spoken communication	Apraxia of speech is a physical problem in which children have difficulty making sounds in the right order, making it hard for their speech to be understood by others.	Many different oral communication-language therapy techniques have been used. A Cochrane review concluded that at that place were no high-level evidence studies in the literature, and could not definitively advocate a particular approach for clinical practice.24
	Children communicate with gestures only take difficulty with speech (demonstrating motivation to communicate, but lack of speech power).
Dysarthria	Dysarthria is a physical problem in which children can have speech difficulties ranging from balmy, with slightly slurred joint and low-pitched vocalisation, to profound, with an inability to produce any recognizable words.	Pocket-size, observational studies have suggested that for some children, speech-language therapy might exist associated with positive changes in intelligibility and clarity of spoken communication. A Cochrane review did not find firm bear witness of the effectiveness of speech communication-language therapy to improve the speech of children with dysarthria acquired before iii years of age.25
	Children communicate with gestures but accept difficulty with speech (demonstrating motivation to communicate, merely lack of speech ability).
Hearing loss after spoken language established	Speech and language are often gradually afflicted, with a decline in the precision of speech articulation and a lack of progress in vocabulary acquisition.	Children with hearing loss should be referred to an audiologist. The audiologist, as role of an interdisciplinary team of professionals, will perform an evaluation and advise the most appropriate intervention plan. Early family-centered intervention promotes language(spoken and/or signed) and cognitive evolution. Children identified with hearing loss who begin services early on may exist able to develop language (spoken and/or signed) on par with their hearing peers.26
	Parents may report that the kid does non seem to be listening, or depict the kid speaking better than listening.
Hearing loss before onset of speech	Speech is delayed.	Children with hearing loss should exist referred to an audiologist. The audiologist, as office of an interdisciplinary team of professionals, volition perform an evaluation and propose the most appropriate intervention plan. Early on family-centered intervention promotes language(spoken and/or signed) and cognitive development. Children identified with hearing loss who begin services early may be able to develop language (spoken and/or signed) on par with their hearing peers.26
	Children may have distortions of speech communication sounds and prosodic patterns (intonation, rate, rhythm, and loudness of voice communication).
	Children may not look at or betoken to objects or persons named by parents (demonstrating a arrears in comprehension).
	Children have normal visual communication skills.
Intellectual inability	Speech is delayed.	Children should be referred for developmental evaluation. This may include referral to a tertiary-level child development center that can provide interdisciplinary evaluations (including oral communication-language therapy and audiology). Referral should include consultation with a medical geneticist to aid in diagnosing the crusade of the intellectual disability.27
	Use of gestures is delayed, and there is a generalized filibuster in all aspects of developmental milestones.
	Children may not await at or indicate to objects or persons named past parents (demonstrating a deficit in comprehension).
Selective mutism	Children with selective mutism show a consistent failure to speak in specific social situations (in which there is an expectation for speaking [e.g., at school]) despite speaking in other situations.20	Children should be referred to a speech-linguistic communication pathologist for evaluation, and to a therapist for behavioral and cognitive behavior therapies, which appear to be effective. Parents and teachers can exist referred to the Selective Mutism Information and Inquiry Clan for advice.28 Combined intervention including behavioral modification, family participation, school involvement, and in severe cases, treatment with fluoxetine (Prozac) is promising.28,29

---

Indications for Referral

• Abstruse
• Definition of Speech and Language
• Prevalence and Prognosis
• Screening
• Normal Development
• Singular Evolution
• Indications for Referral
• Therapies
• Parent Counseling
• References

When speech and language delay is suspected, children should exist referred to a speech-language pathologist or local early intervention program, and an audiologist.thirty–32 Tabular array 3 lists red flags that suggest a need for immediate evaluation.30 Close monitoring before referral may be appropriate when a speech and language delay is suspected, simply this arroyo should be used with caution, because 2-thirds of children younger than three and a half years with speech and linguistic communication delay will demand speech therapy after one year without intervention.33 There is no certain way to decide which children volition meliorate with the watchful waiting approach solitary, only a speech-language pathologist's judgment of a kid'due south communicative functioning appears to be the nearly significant predictor of linguistic outcome.33

Tabular array 3.

Reddish Flags Suggesting Need for Immediate Speech-Language Evaluation

Historic period	Receptive	Expressive
12 months	—	Does not blubbering, point, or gesture
fifteen months	Does not look at or indicate to 5 to 10 objects or persons when named by parents	Does not use at to the lowest degree three words
18 months	Does not follow one-step directions	Does non say "mama," "dada," or other names
two years	Does not indicate to pictures or body parts when named	Does not utilize at least 25 words
ii.5 years	Does not verbally answer or nod/shake caput to questions	Does non use unique two-give-and-take phrases, including noun-verb combinations
3 years	Does not understand prepositions or activity words Does not follow two-step directions	Does not employ at to the lowest degree 200 words
		Does not ask for things past name
		Repeats phrases in response to questions (echolalia)
At whatever age	—	Has regressed or lost previously caused speech/language milestones

---

For children with wellness insurance, options for referral include those organizations that contract with their insurance groups. Medicaid programs typically cover oral communication therapy, although smaller organizations may not take those plans. Children without health insurance may be able to access therapy through services funded past grants under the Individuals with Disabilities Educational activity Human action and administered by individual states. State-administered early intervention services are available from birth to three years of historic period. After three years of age, children who qualify may receive oral communication therapy through the public school system. Uninsured children who practise non qualify for these services may be able to admission an organisation with a sliding calibration fee based on the family unit'due south economical status.

Therapies

• Abstract
• Definition of Voice communication and Language
• Prevalence and Prognosis
• Screening
• Normal Development
• Atypical Development
• Indications for Referral
• Therapies
• Parent Counseling
• References

Table 2 lists some of the many causes of voice communication and linguistic communication problems, and briefly outlines treatment principles.12,18–29 The chief goals of therapy are to teach children strategies for comprehending spoken language and producing appropriate communicative behavior, and to help parents learn ways of encouraging their children's communication skills. There are good data available to back up the effectiveness of spoken communication-language therapy, particularly for children with primary expressive language disorder.eighteen The effect of speech-linguistic communication therapy for children with receptive language disorder appears to be much smaller than it is for other groups.18 Parents can effectively administrate spoken communication-language therapy, only must showtime receive preparation, typically from a spoken communication-language pathologist. The response to handling is more varied when using parent administrators, which suggests that some parents may be more than suited for providing therapy than others. Therapies lasting longer than eight weeks appear to be more effective than those lasting less than 8 weeks.xviii

Parent Counseling

• Abstract
• Definition of Spoken language and Language
• Prevalence and Prognosis
• Screening
• Normal Evolution
• Singular Development
• Indications for Referral
• Therapies
• Parent Counseling
• References

When a child is not meeting the expected developmental milestones for speech and linguistic communication, it is important to avert making a specific diagnosis until a formal evaluation has been completed. Parents can be counseled that, once a diagnosis is made, at that place are professionals who can work with the child and parents, and that many times children evidence a positive response to this intervention. If the child has other developmental or behavioral bug, these bug may persist, or they may improve as the kid's communication skills ameliorate.

At follow-up visits, the doctor can review the child's progress with the parents. Information technology is frequently helpful to focus on positive changes that the kid has fabricated since the previous visit, rather than only noting the child's electric current condition compared with age-based norms. The medico can also focus on what the parents can do to aid their kid, including recommending books for the parents to read. Two books were recommended in a recent article30: The New Linguistic communication of Toys: Teaching Communication Skills to Children with Special Needs: A Guide for Parents and Teachers,34 which provides specific suggestions for using toys and books in a developmentally appropriate manner to encourage communication, and Childhood Oral communication, Language, and Listening Issues: What Every Parent Should Know,35 which explains different communication problems and advises parents on available resources. The American Speech-Language-Hearing Association Web site (http://www.asha.org/) may too be helpful. It offers information on babyhood speech communication and linguistic communication disorders, and provides links to national organizations.

To meet the full article, log in or buy access.

The Author

bear witness all author info

MAURA R. McLAUGHLIN, Doctor, is an assistant professor of family unit medicine at the University of Virginia School of Medicine, Charlottesville....

Address correspondence to Maura R. McLaughlin, MD, University of Virginia School of Medicine, P.O. Box 800729, Charlottesville, VA 22908 (e-mail: mr9me@virginia.edu). Reprints are non available from the author.

Writer disclosure: Nothing to disclose.

The author thank you Karen Knight, MSLS, for assistance with the literature search, and Sherry L. Comer, SLP, for data regarding speech-language pathology services.

REFERENCES

testify all references

1. Burden 5, Stott CM, Forge J, Goodyer I. The Cambridge Language and Speech Project (Clasp). I. Detection of language difficulties at 36 to 39 months. Dev Med Kid Neurol. 1996;38(seven):613–631. ...

two. Stevenson J, Richman Northward. The prevalence of language delay in a population of three-year-former children and its clan with general retardation. Dev Med Child Neurol. 1976;18(4):431–441.

3. Silva PA, McGee R, Williams SM. Developmental language delay from three to vii years and its significance for low intelligence and reading difficulties at age seven. Dev Med Child Neurol. 1983;25(6):783–793.

4. Rescorla 50, Hadicke-Wiley Grand, Escarce E. Epidemiological investigation of expressive language delay at age two. Outset Linguistic communication. 1993;13:5–22.

5. Wong Five, Lee Pow, Lieh-Mak F, et al. Language screening in preschool Chinese children. Eur J Disord Commun. 1992;27(3):247–264.

6. Stern LM, et al. The Adelaide preschool linguistic communication unit: results of follow-up. J Paediatr Child Health. 1995;31(3):207–212.

7. Catts HW, Fey ME, Tomblin JB, Zhang X. A longitudinal investigation of reading outcomes in children with language impairments. J Speech Lang Hear Res. 2002;45(6):1142–1157.

viii. Scarborough HS, Dobrich Due west. Development of children with early on language filibuster. J Speech Hear Res. 1990;33(i):70–83.

9. Silva PA, Williams Southward, McGee R. A longitudinal study of children with developmental language delay at historic period three: later intelligence, reading and behaviour problems. Dev Med Child Neurol. 1987;29(5):630–640.

10. Snowling MJ, Bishop DV, Stothard SE, Chipchase B, Kaplan C. Psychosocial outcomes at fifteen years of children with a preschool history of speech-language impairment. J Child Psychol Psychiatry. 2006;47(8):759–765.

xi. Bishop DV, Clarkson B. Written linguistic communication as a window into residual linguistic communication deficits: a study of children with persistent and residual spoken communication and linguistic communication impairments. Cortex. 2003;39(two):215–237.

12. McRae KM, Vickar E. Simple developmental voice communication filibuster: a follow-upwardly study. Dev Med Kid Neurol. 1991;33(10):868–874.

13. U.South. Preventive Services Task Force. Screening for speech and linguistic communication delay in preschool children: recommendation statement. Rockville, Doctor.: Agency for Healthcare Enquiry and Quality; 2006.

xiv. Green M, Palfrey JS, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 2nd ed., revised. Arlington, Va.: National Center for Education in Maternal and Child Health; 2002.

15. Coplan J. Evaluation of the child with delayed oral communication or linguistic communication. Pediatr Ann. 1985;14(3):203–208.

16. Redlinger WE, Park TZ. Language mixing in immature bilinguals. J Child Lang. 1980;7(2):337–352.

17. Leung AK, Kao CP. Evaluation and management of the child with speech delay. Am Fam Doc. 1999;59(11):3121–3128.

18. Constabulary J, Garrett Z, Nye C. Speech and language therapy interventions for children with primary speech and language delay or disorder. Cochrane Database Syst Rev. 2003;(3):CD004110.

19. Whitman RL, Schwartz ER. The pediatrician'south approach to the preschool child with language delay. Clin Pediatr (Phila). 1985;24(1):26–31.

xx. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th ed. Washington, DC: APA; 1994.

21. Paul R. Interventions to improve communication in autism. Child Adolesc Psychiatr Clin Due north Am. 2008;17(4):835–856.

22. Parr J. Autism. Clin Evid. 2010;1(322):1–19.

23. Pennington L, Goldbart J, Marshall J. Spoken language and linguistic communication therapy to improve the communication skills of children with cerebral palsy. Cochrane Database Syst Rev. 2003;(iii):CD003466.

24. Morgan AT, Vogel AP. Intervention for childhood apraxia of speech. Cochrane Database Syst Rev. 2008;(3):CD006278.

25. Pennington L, Miller N, Robson S. Speech therapy for children with dysarthria acquired before three years of historic period. Cochrane Database Syst Rev. 2009;(4):CD006937.

26. American Speech-Language-Hearing Association. Effects of hearing loss on evolution. http://www.asha.org/public/hearing/disorders/effects.htm. Accessed November 22, 2010.

27. Daily DK, Ardinger HH, Holmes GE. Identification and evaluation of mental retardation [published correction appears in Am Fam Physician. 2000;62(v):961–963]. Am Fam Physician. 2000;61(4):1059–1067.

28. Keen DV, Fonseca S, Wintgens A. Selective mutism: a consensus based care pathway of skilful practice. Arch Dis Child. 2008;93(10):838–844.

29. Manassis Grand. Silent suffering: understanding and treating children with selective mutism. Expert Rev Neurother. 2009;ix(ii):235–243.

30. Schum RL. Language screening in the pediatric role setting. Pediatr Clin N Am. 2007;54(iii):425–436.

31. American University of Pediatrics, Articulation Committee on Infant Hearing. Year 2007 position argument: Principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120(four):898–921.

32. Harlor Advertizement Jr, et al. Hearing assessment in infants and children: recommendations beyond neonatal screening. Pediatrics. 2009;124 (4):1252–1263.

33. Roulstone Due south, Peters TJ, Glogowska Yard, Enderby P. A 12-month follow-up of preschool children investigating the natural history of voice communication and language delay. Child Care Health Dev. 2003;29(4):245–255.

34. Schwartz S, Miller JEH. The New Language of Toys: Didactics Communication Skills to Children with Special Needs: A Guide for Parents and Teachers. Bethesda, Md.: Woodbine House; 1996.

35. Hamaguchi PM. Childhood Voice communication, Language, and Listening Problems: What Every Parent Should Know. New York, NY: Wiley; 1995.

Copyright © 2011 by the American Academy of Family Physicians.
This content is endemic by the AAFP. A person viewing it online may make one printout of the material and may employ that printout but for his or her personal, not-commercial reference. This fabric may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or afterwards invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Virtually RECENT ISSUE

Mar 2022

Access the latest issue of American Family unit Medico

Read the Consequence

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up At present

Source: https://www.aafp.org/afp/2011/0515/p1183.html

Posted by: kisertany1937.blogspot.com

Share this post