From the Guidelines
The best next step in evaluation of this 5-year-old boy with speech difficulties is a hearing test (option C). This child presents with significant speech intelligibility issues despite having good vocabulary and sentence formation, which suggests an articulation disorder rather than a language delay. Given his history of prematurity, mechanical ventilation, and pneumonia as a newborn, he has risk factors for hearing impairment that could be contributing to his speech difficulties. Hearing problems are a common and treatable cause of speech articulation issues in children, as noted in the practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder 1. Before pursuing more invasive testing like brain MRI or EEG, or dismissing concerns with reassurance, it's essential to rule out hearing loss. If hearing loss is detected, appropriate interventions can be implemented. If hearing is normal, the child would likely benefit from speech therapy for articulation disorder, and further evaluation could be considered at that point, including genetic testing as recommended by the American Academy of Pediatrics for children with developmental delays or autism spectrum disorder 1. Key considerations in the evaluation of this child include:
- Ruling out hearing loss as a cause of speech difficulties
- Assessing for other developmental delays or disorders, such as autism spectrum disorder
- Considering genetic testing if initial evaluations are inconclusive
- Providing appropriate interventions, such as speech therapy, to address identified needs.
From the Research
Evaluation of the Patient's Speech Concerns
The patient's symptoms, including mispronunciation of words and over 30% of speech being unintelligible, suggest a potential issue with hearing or speech development. Given the patient's history of premature birth and mechanical ventilation, as well as the family history of autism spectrum disorder, a thorough evaluation is necessary.
Potential Causes and Next Steps
- Hearing loss or impairment could be a contributing factor to the patient's speech concerns, as seen in studies 2, 3, 4.
- The patient's older sibling has autism spectrum disorder, which may increase the likelihood of similar developmental concerns.
- A hearing test is a non-invasive and essential step in evaluating the patient's speech concerns, as it can help identify any potential hearing impairments that may be contributing to the patient's symptoms.