From the Guidelines
For a child with language delay, I recommend referring them to a multidisciplinary care center that includes speech and language specialists, when available, for comprehensive evaluation and treatment. This approach is supported by the American College of Medical Genetics and Genomics (ACMG) 1, which emphasizes the importance of a team approach in evaluating and treating children with language delays. You can find these multidisciplinary care centers through your child's pediatrician, local children's hospital, or early intervention programs.
Some key specialists to look for in a multidisciplinary care center include:
- Otolaryngologists
- Clinical geneticists
- Genetic counselors
- Audiologists
- Speech and language specialists
- Early hearing intervention and family support specialists
Early intervention is crucial as language delays can impact social development and academic performance if left untreated. The evaluation process typically includes standardized assessments, observation of communication skills, and a detailed case history. Treatment plans are individualized based on the child's specific needs and may involve direct therapy sessions, parent coaching, and home practice activities. While waiting for the formal evaluation, encourage language development at home by reading together daily, narrating daily activities, and creating opportunities for communication through play and conversation. Additionally, pediatricians play a crucial role in making referrals and signing prescriptions for assistive-technology systems, and should confer with members of the team who have evaluated the child, especially the speech-language pathologist, before writing a letter of medical necessity 1.
From the Research
Referral Options for Children with Language Delay
When referring a child with language delay for evaluation and treatment, several options are available:
- Speech-language pathologists (SLPs) can assess and provide therapy for children with language delays 2, 3
- Audiologists can evaluate the child's hearing to rule out any hearing-related issues that may be contributing to the language delay 3, 4
- Primary care physicians can discuss concerns with parents and recommend referrals to SLPs and audiologists 3
- Pediatric annals suggest that all infants and preschool children should undergo routine language screening as part of health care maintenance, and diagnostic evaluation should be done by a psychologist, a speech/language pathologist, or both 4
Evaluation and Treatment
Evaluation of the child with speech or language delay should answer questions about the child's descriptive diagnosis, etiologic diagnosis, appropriate intervention strategy, and long-term prognosis 4
- A comprehensive developmental evaluation is essential for children not meeting expected milestones for speech and language 3
- Speech-language therapy has been shown to be helpful, particularly for children with expressive language disorder 3
- Interventions can improve speech and language outcomes, as well as other functional outcomes such as socialization skills and self-esteem 5
Considerations for Referral
When referring a child with language delay, consider the following:
- Family history of speech and language delay, male gender, and perinatal factors are consistently reported risk factors 5
- The performance characteristics of evaluation techniques, such as sensitivity and specificity, should be considered when selecting a screening tool 5
- Collaboration between nurses, communication professionals, and primary care physicians can allow for early identification and intervention 2