Clinical Practice Guideline: Report of the Recommendations. Communication Disorders: Assessment and Intervention for Young Children (Age 0-3 years)
NYS Department of Health. (1999).
Albany (NY): NYS Department of Health, (Publication No. 4219), 288.
This guideline provides recommendations for assessment and intervention of communication disorders in young children. The target audience of this guideline includes families, service providers, and public officials.
NY State Department of Health Early Intervention Program
A severe speech/language delay can be indicated by
<ul>
<li>no words at 18 months;</li>
<li>fewer than 30 words at 24 months; or </li>
<li>no word combinations at 36 months (Level B Evidence).</li>
</ul>
"It is important to focus on the child's communication skills rather than the child's skill in using the system" (Level D2 Evidence; p. 173).
"It is important to understand that regional, social, or cultural/ethnic variation of a language system is not considered a disorder of speech or language" (Level D2 Evidence; p. 55).
Strategies for supporting the development of natural speech should be included in the augmentative communication intervention plan for infants and young children (Level D2 Evidence).
<p>When developing the vocabulary for an augmentative or alternative communication system</p>
<ul>
<li>provide vocabulary that is appropriate for the child's developmental age and chronological age (Level D2 Evidence); and</li>
<li>include words for a variety of semantic/syntactic classes to provide the child with opportunities to learn and use language (Level D2 Evidence).</li>
</ul>
Particularly for children with severe dysarthria, "it is important to assess the need for augmentative communication, especially when speech is not an effective mode of communication for the child" (Level D2 Evidence).
In order to determine the likelihood of an ongoing mild expressive language delay, it may be beneficial for the clinician to determine the degree and number of predictive factors for continued language delay the child exhibits (Level D1 Evidence).
A child with a severe speech/language delay should receive a comprehensive health assessment to identify or rule out medical conditions that might be related to the delay (Level D2 Evidence).
The augmentative and alternative communication system should be:
<ul>
<li>easy to use;</li>
<li>understood by a variety of communication partners; and</li>
<li>motivating for the child to use in natural contexts (Level D2 Evidence).</li>
</ul>
<p>For children with a mild expressive language delay who exhibit fewer of the prognostic factors found in <a title="http://www.health.ny.gov/community/infants_children/early_intervention/memoranda/2005-02/appendix_f.htm" href="http://www.health.ny.gov/community/infants_children/early_intervention/memoranda/2005-02/appendix_f.htm">Appendix F (Table III-7)</a>, "it is recommended that:</p>
<ul>
<li>formal speech/language therapy not be initiated at this time;</li>
<li>activities to promote language development be continued, along with the parents' ongoing monitoring of the child's progress;</li>
<li>the child be reevaluated by the speech/language pathologist in no more than 3 months to assess progress in communication development; and</li>
<li>the child's need for speech/language therapy be reconsidered at the time of re-evaluation depending on the child's progress" (Level D1 Evidence; p. 92).</li>
</ul>
When selecting an alternative or augmentative communication system, the following factors should be considered:
<ul>
<li>the child's vision, hearing, and cognitive ability;</li>
<li>the intended audience; and</li>
<li>access, portability, adaptability, expansion capability, and maintenance (Level D2 Evidence).</li>
</ul>
<p>For children with a mild expressive language delay who exhibit more of the prognostic factors found in <a title="http://www.health.ny.gov/community/infants_children/early_intervention/memoranda/2005-02/appendix_f.htm" href="http://www.health.ny.gov/community/infants_children/early_intervention/memoranda/2005-02/appendix_f.htm">Appendix F (Table III-7)</a>, "it is recommended that:</p>
<ul>
<li>formal speech/language therapy be tried;</li>
<li>ongoing monitoring of the child's progress and activities to promote language development ... be continued; and</li>
<li>children receive periodic in-depth assessment of their communication level and progress (whether or not speech/language therapy is initiated)" (Level D1 Evidence; p.92).</li>
</ul>
For children between 18 and 36 months with a severe speech/language delay and no other apparent developmental issues, speech-language treatment should be initiated (Level B Evidence).
For children between 18 and 36 months with milder expressive language delays and no other developmental issues (including delays in language comprehension), experienced clinical judgment will be required to determine if the child has an increased or decreased likelihood of continuing to exhibit a delay (Level D1 Evidence).
