From the Guidelines
The recommended approach for screening speech delay in a 2-year-old during a well visit involves using standardized developmental screening tools, particularly language-specific assessments, such as the Ages and Stages Questionnaire (ASQ) or the Parents' Evaluation of Developmental Status (PEDS) 1.
Key Considerations
- The American Academy of Pediatrics recommends formal developmental screening at the 9-, 18-, and 24- or 30-month visits, with specific attention to language milestones at the 2-year visit.
- By age 2, children typically should have a vocabulary of at least 50 words and be combining two words together.
- The screening should include direct observation of the child's communication skills and detailed parent interview about language milestones, including receptive language (understanding) and expressive language (speaking) 1.
Screening Tools
- Validated screening instruments such as the ASQ, PEDS, or the Modified Checklist for Autism in Toddlers (M-CHAT) which includes language components, should be used.
- The literature supports screening for developmental delay with parent-completed tools rather than directly administered tools 1.
Referral and Intervention
- If concerns are identified, prompt referral for comprehensive audiological evaluation is essential to rule out hearing loss, followed by referral to a speech-language pathologist for formal evaluation.
- Early intervention is critical as speech delays identified and addressed before age 3 have better outcomes due to greater neuroplasticity during this developmental window.
Barriers to Screening
- Multiple barriers to screening exist, including time constraints, competing clinical demands, cost burden, staffing requirements, lack of consensus on the most suitable tools for the general childhood population, and lack of physician confidence because of insufficient training and expertise 1.
Importance of Early Detection
- As many as one-half of American children with developmental delay will not be identified by the time they enter kindergarten, even though most will show mild developmental delays by two years of age 1.
- Regular and repeated screening combined with surveillance is needed to detect developmental delays.
From the Research
Screening for Speech Delay in 2-Year-Olds
To screen for speech delay in a 2-year-old during a well visit, the following approaches can be considered:
- Reliable milestone indicators and parent and physician questionnaires can help identify children in need of diagnostic evaluation 2
- The Language Development Survey (LDS), a vocabulary checklist, can be used as a screening tool for delayed language in toddlers, with excellent sensitivity and specificity for the identification of language delay 3
- Several screening tools can accurately identify children for diagnostic evaluations and interventions, but evidence is inadequate regarding applicability in primary care settings 4
Risk Factors for Speech and Language Delay
The following risk factors are associated with speech and language delay:
- Male gender 5, 4
- Family history of speech and language delay 5
- Low parental education 4
- Prematurity, low birth weight, late birth order, larger family size, and maternal intimate partner violence 2
Diagnostic Evaluation and Intervention
If speech and language delay is suspected, a comprehensive developmental evaluation is essential, and referral to a speech-language pathologist and an audiologist may be recommended 6