Developmental delay (language)

Question 1

An otherwise well 3-year-old boy is referred as he can speak only in single words and struggles to follow instructions. These concerns have been raised by the boy’s childcare carers. His mother is less concerned as she believes this is due to the fact multiple languages are spoken at home. His father was also reportedly a late talker as well.

Answer 1

Impression
Given the child at three years of age is only able to speak in single words and cannot follow instructions, I am concerned about a language delay. Notably, the child is from CALD/NESB, and this may simply represent normal development. However, it would be important to consider pathological causes of this presentation including;
- Global developmental delay,
- Congenital disorders: Down syndrome, other syndromal, fragile X
- Autism spectrum disorder
- psych: selective mutism, ADHD, conduct?, adverse childhood experiences
- Chronic otitis media (glue ear)

Question 2

Language delay - History

Answer 2

History
Collateral with Childs carers
- PC: since when developing language, how many words, what degree of instructions can be followed, at school/pre-school/child-care? Any regression of milestones? Newborn SWISH test result?
- other developmental domains
o motor: tiptoe walking, tricycle,
o social: cooperative play, pretend play
o language:
REDFLAGS: regression on milestones
- Screen for differentials: ASD, ID
- PMHx: other chronic medical conditions, recent illnesses,
- FAMHx: explore fathers late development,
- Psychosocial: home environment, abuse/trauma, confirm number of languages spoken at home

Collateral history from childcare/preschool teachers

Question 3

Language delay - Examination

Answer 3

Examination
- Observe child in play for developmental milestones
- Confirm growth parameters, vital signs
- Neurological examination (vision + hearing mainly)

Question 4

Language delay - Investigations

Answer 4

Investigations
- Formal hearing and vision assessment
- Parent evaluation of developmental status questionnaire
- Child psychology/paeds assessment for diagnosis - griffiths developmental screen
- Genetic testing
- Bloods: lead levels (if broken hill)

Question 5

Language delay - Management

Answer 5

Management
- MDT with paediatrician, speech path, audiology, GP, etc
- referral to paediatrician for further assessment and management input
- early intervention is key for improving developmental outcomes for ongoing development
o critical age for language development is 1-7 yrs
- parent education + counselling
- incorporate