Speech, language, hearing delays: Time for early intervention?

Devices and methods that promote communication development for students who are deaf or hard of hearing include the use of hearing aids to amplify residual hearing for oral or auditory-oral approaches; the manual approach stressing sign-language (American Sign Language or Signed English); or Total Communication using both the oral and sign-language methods.

With an infant, suspicion of a hearing problem warrants referral to an otorhinolaryngologist or an audiologist for thorough evaluation. In New Jersey, an EI referral typically triggers a referral to one of these specialists. TABLE 2 lists resources for early identification and intervention in communication disorders.

TABLE 2

Autism spectrum disorder

The fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5)²² has revised its diagnostic codes for ASD. An in-depth analysis of the new diagnosis is beyond the purview of this article, but it deserves a few comments.

The revised diagnosis of ASD consolidates the previously separate diagnoses of autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder/not otherwise specified.^22-24 According to DSM-5, an individual with ASD must have 1) persistent deficits in social communication and social interactions, 2) restricted, repetitive patterns of behavior, interests or activities, 3) symptoms present in early childhood (but may not become fully manifest until social demands exceed limited capacities), and 4) symptoms that limit and impair everyday functioning.^22,24

Children who don’t meet DSM-5 criteria for autism spectrum disorder may be included in a new category called social communication disorder. Onset of the disorder must be obvious before age 3 for a child to be eligible for EI. Children who do not qualify for an ASD diagnosis under the new DSM-5 definition may be included in a new category called social communication disorder (SCD) under “Communication Disorders” in DSM-5. SCD is defined as impairment in pragmatics that impacts development of social relationships and comprehension of social conversations. ASD must be ruled out before a diagnosis of SCD can be made.^23,24

Early intervention services

Individual states offer EI services to families to facilitate detection of developmental delays in children and to provide a comprehensive system of support designed to reduce the effects of disabilities (or to prevent learning and developmental problems later in life).⁵ The rationale for EI is that the earlier interventions are started, the less likely later interventions will be needed.²⁵ EI services are provided to children from birth through their third birthday; services are free of charge to eligible families or on a sliding payment scale determined by a family’s income.

Resources for information and referrals. To access EI services on behalf of a family, contact a local hospital or point them to the CPIR (http://www.parentcenterhub.org/repository/disability-landing/).² For families with disabled children older than 3, consider suggesting that parents contact the local school district (even if the child isn’t enrolled there) to arrange an evaluation under the Individuals with Disabilities Education Act (http://idea.ed.gov/).²⁶ Because individual states’ EI organizations may have slightly different procedures, it is best to consult one’s own state EI site for specific information regarding referrals (TABLE 3).

Efficacy of treatment

The prevalence of specific communication disorders varies widely, as do prognoses, possibly due to the variability of underlying causes (physical/biological/medical or environmental/educational).²⁷ Also, as described earlier, “communication disorder” is an umbrella term inclusive of problems as diverse as resonance (eg, hypernasality due to a submucous palatal cleft), severe language delay (eg, due to Down syndrome), or lisp (misarticulation of the “s” sound).