Early Language Delay, Predictors and Risk Factors

Question 1

predictors and risk factors for early language delay

Answer 1

• hearing impairment
• family hx
• twins
• genetic, developmental, and neurological conditions
• high social risk
• abuse, neglect, trauma
• prematurity
• low birth weight

Question 2

abuse, neglect, trauma: the younger the child…

Answer 2

the greater the impact

Question 3

abuse, neglect, trauma: what area of language suffers more? expressive or receptive?

Answer 3

expressive

Question 4

which has a greater impact on language development: severe neglect or abuse alone?

Answer 4

severe neglect

Question 5

abuse, neglect, trauma

Answer 5

under-identified and under-served

Question 6

___ of ___ on the developing brain make it harder to benefit from tx

Answer 6

pervasive impact, trauma

Question 7

prematurity causes

Answer 7

• smoking
• drinking
• other drug use

Question 8

prematurity facts

Answer 8

• multiple births (63% preterm)
• birth spacing (<18 months)
• access to prenatal care (health insurance)

Question 9

prematurity: maternal age in order of highest risk to lowest risk

Answer 9

40+
30-39
<20
20-29

Question 10

low birth weight causes

Answer 10

language, cognitive, sensory, and motor impairments

Question 11

LBW: preterm

Answer 11

< 37 weeks

Question 12

LBW: late preterm

Answer 12

34-36 weeks

Question 13

LBW: very preterm

Answer 13

• < 32 weeks

Question 14

what is considered LBW?

Answer 14

< 5 lb, 8 oz

Question 15

what is considered VLBW?

Answer 15

< 3 lb, 4 oz

Question 16

preterm birth rate by race/ethnicity (US, 2019-2021 average)

Answer 16

• Hispanic: 10.0%
• White: 9.3%
• Black: 14.4%
• American Indian/Alaska Native: 11.8%
• Asian/Pacific Islander: 9.0%
• total: 10.3%

Question 17

LBW data

Answer 17

• 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

Question 18

who is eligible for Early Intervention services in age?

Answer 18

birth to 3 years old

Question 19

to be eligible for EI, infants and toddlers who have at least 1 of these

Answer 19

• 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)

Question 20

negative consequences of NICU and necessary medical interventions

Answer 20

• oral defensiveness/aversion
• trauma, damage to larynx
• over or lack of stimulation
• caregiver PTSD

Question 21

prematurity and age correction

Answer 21

using a preterm child’s adjusted age to set goals and administer assessments

Question 22

calculating for age correction

Answer 22

• 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

Question 23

using only adjusted age to determine eligibility for services, goals, progress may

Answer 23

mask deficits and frame them as (temporary) delays

Question 24

how should we use a preterm child’s adjusted age?

Answer 24

report and consider actual and adjusted age when you can for preterm children age 5 and under

Question 25

drug and alcohol exposure

Answer 25

- prenatal opiate and cocaine exposure - fetal alcohol syndrome (FAS)/fetal alcohol spectrum disorder (FASD)/prenatal alcohol syndrome (PAS)

Question 26

prenatal opiate and cocaine exposure

Answer 26

- lower weight, height, head circumference - slower growth - similar outcomes from prenatal exposure to meth based on preliminary research

Question 27

prenatal opiate and cocaine exposure deficits

Answer 27

- reflexes - tone - irratibility - alertness (particularly < 6 months)

Question 28

drug and alcohol exposure, growing consensus (receptive and expressive language delays)

Answer 28

- syntax - higher level language, discourse 3 and 4 years - behavior, attention, language, cognition difficulties 4-13 years

Question 29

drug and alcohol exposure: SLP's role

Answer 29

- feeding - assessment of alertness/sleepiness cycle and triggers of irritability - facilitating medical staff/parent/caregiver positive interactions and bonding - parent/caregiver education and counseling

Question 30

fetal alcohol syndrome (FAS)/fetal alcohol spectrum disorder (FASD)/prenatal alcohol syndrome (PAS)

Answer 30

- leading identifiable, preventable, nonhereditary cause of intellectual disability + birth defects in the US - spectrum disorder - physical, cognitive deficits that are irreversible

Question 31

FAS/FASD/PAS: physical effects

Answer 31

- small head - epicanthal folds - smooth philtrum - underdeveloped jaw - low nasal bridge - small eye openings - short nose - thin upper lip

Question 32

FAS/FASD/PAS: hallmarks are facial malformations, delayed growth, and CNS abnormalities

Answer 32

- 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

Question 33

FAS/FASD/PAS: phonological development

Answer 33

- slightly lower overall intelligibility - more consonant errors and some differences in order of mastery - nonword repetition, auditory discrimination deficits - literacy and spelling delays

Question 34

FAS/PAS research update

Answer 34

- 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

Question 35

what is in a name?

Answer 35

- language delay - language impairment - language difficulty - late talker

Question 36

late talker

Answer 36

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

Question 37

kids identified as later talkers at 2 had significantly more or less speech errors than at 4-5

Answer 37

more speech errors, especially polysyllabic words

Question 38

toddlers between 18 and 24 months with language delay had significantly more of what type of problems compared to toddlers without language delay

Answer 38

socioemotional and behavioral problems

Question 39

developmental language disorder (DLD)

Answer 39

1. language impairment is the most salient challenge 2. biological cause of disorder is not known 3. no other diagnostic label is appropriate

Question 40

things to know about DLD

Answer 40

- 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