Evaluation and Management of Language and Speech Disorders in Preschool Children

Heidi M. Feldman

doi:10.1542/pir.26-4-131

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Heidi M. Feldman, MD, PhD*

^*Ronald L. and Patricia M. Professor of Child Development, Children’s Hospital of Pittsburgh; Professor of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa

Objectives

After completing this article, readers should be able to:

Describe key milestones in the development of language and speech.
List indications for further evaluation of language and speech delays.
Differentiate global delays, autism, and specific language impairment.
Generate a differential diagnosis for language and speech delay.
Evaluate management options for a child who has hearing loss.
Justify referral to early intervention for children who have global delays.
Discuss treatment of language impairments in autism.
Evaluate the effectiveness of language and speech therapy for language and speech disorders.

Introduction

Language is the expression of human communication through which ideas, information, emotions, and beliefs can be shared. Typically developing children master the fundamentals of language and speech in the toddler-preschool era. Language and speech skills serve a pivotal role in learning and social relationships. Delays in the early development of language and speech skills, which are prevalent in the population, may affect several domains of function. Management and treatment can improve language and speech skills substantially and reduce the functional impact of persistent disorders. Therefore, identifying children who have language and speech delays in the toddler-preschool period should be a priority for the pediatric clinician. This article reviews the normal process of language development up to school age, discusses the use of screening measures and parent report inventories to verify parental reports of delays, provides a differential diagnosis of language and speech delay, and suggests an approach to the child who has language or speech problems in the absence of history or physical findings suggestive of a specific medical condition associated with language and speech disorders. In addition, the review discusses general management of language and speech disorders and provides updates about management of some of the underlying causes of speech and language delay.