Theme 2 Part 1

• Most common symptom of developmental delay in 0- to 3-year-olds is communication (speech & language) delay
• The best predictor of how a child will do at school is their early language development
• Early language development is a precursor to the development of literacy (reading & spelling)
• Early identification of children with delays in communication development is crucial
• Background information and risk assessment

  • Genetic screening
  • Hearing evaluation
  • Evaluation of all other senses and sensory integration
  • Oro-facial structural assessment
  • Oral-motor functioning
  • Feeding assessment
  • Comprehensive assessment of all speech-language areas and communication interaction, including emergent literacy development
  • General developmental functioning
  • Identify strengths and difficulties
• SASLHA Guidelines recommend that we assess the following areas in the 0-3-year-old population
• Diagnosis


  Term originates from a medical model of disability
• Assumption that diagnosis dictates outcome
• Much remains unknown about contribution of various factors to communication delay
• Need to "diagnose" becomes less important, especially for 'at-risk' children
• Very seldom is actual intervention dramatically different based on diagnosis
• Linear cause-and-effect model


  Direct one-to-one relationship between cause & effect
• Transactional Model

  Reciprocal relationship between child's environment and constitution
• Interactional model

  Cause of delay = interaction between child's constitution & environment
• Established risk


  Infant is born with an early identified condition that is known to be associated with challenges to one or more domains of typical development
• At risk


  Biological & Social/environmental risk factors that interfere with child's ability to interact with environment in a normal manner
• Established risk conditions


  • Chromosomal / genetic disorders
  • Neurological disorders
  • Congenital malformation
  • Inborn errors in metabolism (e.g. PKU)
  • Sensory disorders
  • Atypical developmental disorders (e.g. autism)
  • Severe toxic exposure
  • Chronic medical illness
  • Severe infectious diseases
  • Treacher Collins syndrome
  • Williams syndrome
  • Angelman syndrome
  • Trisomy 21
  • Spina bifida
  • Microcephaly
  • Hydrocephaly
• At risk factors


  • Serious concerns expressed by parent (P) /primary caregiver (PC) about child's development
  • P/PC has chronic or acute mental illness / developmental disability / intellectual disability
  • P/PC with developmental history of loss/abuse
  • Family medical/genetic history characteristics
  • P/PC with severe or chronic illness
  • P/PC with drug/alcohol dependence
  • Acute family crisis
  • Chronically disturbed family interaction
  • P/PC-child separation
  • Adolescent mother
  • Parental education less than Gr 9/neither parent employed/single parent
  • Inadequate health care
  • Limited prenatal care
  • Parent has 4 or more preschool children
  • Lack of stable residence / homelessness / dangerous living conditions
  • Physical or social isolation / lack of social support
  • Atypical or recurring accidents on the part of the child
  • Chronic otitis media
  • Severe prenatal complications
  • Severe perinatal complications
  • Asphyxia (APGAR score <7 at 5 minutes)
  • Very low birthweight (<1500 g)
  • Small for gestational age (<10th percentile)
  • Excessive irritability, crying, tremulousness on part of infant
• Prematurity


  Birth before 37 weeks gestation
• Categories of prematurity


  • Moderate to late preterm: 32 to <37 weeks
  • Very preterm: <28 to <32 weeks
  • Extremely preterm: <28 weeks
• 1. 18% is the range of preterm birth rates across 184 countries of the world
• Over 80% of preterm births occur between 32-37 weeks of gestation and most of these babies can survive with essential newborn care
• 13.4 million babies were born preterm in 2020 (before 37 weeks gestation)
• Preterm birth complications is considered to be the leading cause of death among children under 5 years of age → +/- 900 000 deaths in 2019
• The rate of preterm birth ranges from 4–16% of babies born in 2020 across all countries
• Low birth weight


  < 2500 g
• Very low birth weight

  < 1500 g
• Extremely low birth weight

  < 1000 g
• Survival rate for VLB and ELBW have increased with technological advances BUT risk for sensory-motor and intellectual deficits increase with smaller BW
• Assessment areas & procedures


  • Background information
  • Risk assessment
  • Genetic screening
  • Hearing evaluation
  • Evaluation of all other senses and sensory integration
  • Oro-facial structural assessment
  • Oral-motor functioning
  • Feeding assessment
  • Comprehensive assessment of all speech-language areas and communication interaction, including emergent literacy development
  • General developmental functioning
  • Identify strengths and difficulties
• Parent interview / case history

  Obtain relevant information from parent/caregiver/close family member on medical history, family history, developmental milestones, current functioning
• Traditional vs. ethnographic approach

  Need to get information that helps you understand the disability, but also the client's/family's perception of the disability and its effects
• APGAR scores


  A quick test performed on a baby at 1 and 5 minutes after birth to determine how well the baby tolerated the birthing process and is doing outside the mother's womb