Speech delay has long been a focus of nursing professionals working with children, as a result of the developmental difficulties that often accompany the disorder. Without question, speech delays can affect a child’s developmental trajectory for individual social, emotional and school based adjustment, upper level education, and ultimately career success later in life.
Speech delay may be indicative of numerous problems including economic deprivation, autism, cerebral palsy or hearing loss. It could also be a normal phase due to minor variants in the environment such as culture or bilingualism. It is important for nurses to understand what factors suggest speech delay and to able to carry out an assessment to either make a diagnosis or know the proper follow-up services and resources to which the family can be referred. Early diagnosis and intervention not only improve the outcomes for a child’s speech ability, but also can decrease or eliminate the social, emotional and cognitive sequelae of this disorder (Bishop & Leonard, 2014).
It is critical to take a comprehensive developmental history with a focus on language milestones including the understanding of simple sentences by 18 months, and the ability to use simple sentences by three years of age. If a general delay in all developmental language milestones is observed, developmental delay (including mental retardation) should be considered. Included in the history should be maternal illnesses, trauma, infections, use of medications or alcohol/illicit drugs, or other problems during pregnancy, gestation age at birth, birth weight, language spoken in the home, family history of speech disorders, delays or other language related difficulties (Berkman, Wallace, Watson, Coyne-Beasley, Cullen, Wood, & Lohr, 2015).
Charting the child’s height, weight and head circumference on the growth chart and reviewing the child’s growth trajectory can providing insight into the probability of incurring some form of speech or language delay. In additional these physical metrics, charts should also include signs of dysmorphia and/or findings of other physical abnormalities. Vision and hearing exams should also be conducted, along with a complete neurological exam.
For children under the age of three years, the Early Language Milestone Scale -2 (Copeland, 1993), can be used to evaluate basic language development including expressive, receptive and visual language. In children between two and a half and 18 years of age, comprehension can be further tested using the Peabody Picture Vocabulary Test-4 (Dunn and Dunn, 2012).
A complete developmental assessment is critical, as speech delay is often indicative of other issues, and is considered to be one of the foremost early predictors of functional deficits, either physically or intellectually. Among the most frequently utilized developmental screens for children and infants alike, is the Denver Developmental Screening Test (Frankenburg, Dodds, & Archer, 2003).
There are numerous tests designed to assess adaptive and intellectual functions in children, including the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), the Wechsler Intelligence Scale for Children-Revised (WISC-R), the Stanford-Binet Intelligence Scale, and the Bayley Scale of Infant Development. Such tests are invaluable for analyzing children who demonstrate markers for abnormal conditions, and who would benefit from the analytics derived from one of the above-referenced intelligence tests.
Often it has been noted that children raised in bilingual or multilingual households develop language use later than their peers. It is important to determine if a bilingual child is achieving language milestones at times similar to other bilingual children and not compare them to monolingual peers. Additionally, other cultural aspects can play a role in the appearance of language ability. For example, in some cultures children are taught not to speak to adults unless specifically addressed and then to only answer exactly what was asked without elaboration. Children coming from war torn countries may have apparent language delays that is the result of trauma not of a functional disorder. Finally, the scales used to screen children must be normed on a similar population to get accurate results.