User:Ayush.midha/sandbox

Screening:

- regular visits can identify red flags for language delay (basically just falling behind the healthy timeline)

- screening timeline: 9, 18, 24-30 months.

- 2-step screening: 1. Parents' Evaluation of Developmental Status (https://pedstest.com/) OR Ages & Stages Questionnaire (http://agesandstages.com/products-services/asq3/) and 2. evaluate ASD risk with Modified Checklist for Autism in Toddlers (https://pediatrics.aappublications.org/content/133/1/37?ijkey=9f5f3814d0a1d37b76116ea335178bbafcf2d75a&keytype2=tf_ipsecsha). Not all patients with language delay have autism so that screen alone is not sufficient

- no need to screen if patient already diagnosed with language delay or another language/speech disorder

Evaluation:

- History: onset and progression, past therapies

- PMH: complications in labor, other illnesses

- ROS: other signs and sx

- FH: FH of language disorders, developmental delay

- Psychosocial factors: guardians/caregivers, home life, stress, language exposure, childcare, education

- Physical exam: growth, oral exam

- Neuro exam: structural and functional assessments

- Audiological assessment: ear evaluation, sound field test

- Cognitive skills: development eval

- Symptoms of autism: communication, behaviors

= Language Delay =

Presentation
A language delay is most commonly identified around 18 months of age with an enhanced well-baby visit. It presents itself in many forms and can be comorbid or develop as a result of other developmental delays. It is important to remember that language delays act and develop differently individually. Language delay is different than individual variation in language development, and is defined by children falling behind on the timeline for recognized milestones.

Screening
Regular appointments with a pediatrician in infancy can help identify signs of language delay. According to the American Academy of Pediatrics (AAP), formal screening for language delay is recommended at three ages: 9, 18, and 24-30 months. Screening entails 2 steps: first, general developmental screening using the Parents' Evaluation of Developmental Status or Ages and Stages Questionnaire, and second, specific screening for autism spectrum disorder. Not all patients with language delay have autism spectrum disorder, so the AAP recommends both screens to assess for delays in developmental milestones.

However, the US Preventive Services Task Force has determined that there is insufficient evidence to recommend screening for language delay for children under the age of 5. Other national panels, including the UK National Screening Committee and Canadian Task Force for Preventive Health Care, also discourage the screening of all infants for language delay.

Early signs and symptoms (red flags)
There are several red flags in early infancy and childhood that may indicate a need for evaluation by a pediatrician. For example, language delay can present as a lack of communicative gestures or sounds. Language delay in children is associated with increased difficulty with reading, writing, attention, and/or socialization. In addition, an inability to engage in social exchanges is a sign of language delay at all ages.

Communicative deficits at specific ages and milestones might indicate language delay, including:


 * Not smiling at 3 months
 * Not turning the head toward sounds at 4 months
 * Not laughing or responding to sounds at 6 months
 * Not babbling at 9 months
 * Not pointing and using gestures at 12 months
 * Not producing more than 5 words at 18 months
 * Not producing more than 50 words at 24 months
 * Losing language and/or social skills after 36 months

Later in life, important signs include:


 * A lack of speech
 * An inability to comprehend, process, or understand language presented to the child

Identification
Many different screening tools are available to identify language delay in young children. The Language Development Survey (LDS; developed by Rescorla ) is a 10 minute, parent-administered and simple tool to help identify language delays in children at two years-old. It is a validated, suitable, and inexpensive screening tool that enables the early assessment of language delay.

There is currently insufficient evidence in literature to suggest an argument for or against routine use of formal screening instruments in to detect language delay in all children. However, if a child is not meeting expected language milestones, a comprehensive developmental evaluation is necessary.

Complications
Language delay is a risk factor for other types of developmental delay, including social, emotional, and cognitive delay. Even though speech and language delays may affect a smaller portion of the population in children, it still can have an incredible impact on their life and their accomplishments in the future. Some of these include problems with behavior, difficulty with reading, and other issues related to spelling and low IQ scores. Some children may grow out of these deficits, even coming to excel where they once lagged, while others do not. One particularly common result of language delay is delayed or inadequate acquisition of reading skills. Reading depends upon an ability to code and decode script (i.e., match speech sounds with symbols, and vice versa). If a child is still struggling to master language and speech, it is very difficult to learn another level of complexity (writing). Thus, it is crucial that children have facility with language to be successful readers.

Neuroscientist Steven Pinker postulated in 1999 that a certain form of language delay (dubbed "Einstein syndrome" by economist Thomas Sowell in 2001) may be associated with exceptional and innate analytical prowess in some individuals, such as Albert Einstein, Richard Feynman and Edward Teller.