Appendix G - Developmental Surveillance Recommendations for Children At Risk for Communication Delays

  1. When in-depth speech/language assessment finds that a child has a speech/language problem, but the developmental assessment indicates no general developmental delay or other developmental problems, then it may be useful to consider if the child has the following:
    • a delay in expressive language but normal language comprehension, and no other specific language impairments
    • a specific language impairment [D1]

    Children with severe speech/language delays

  2. For children at age 18-36 months who have had an in-depth assessment that indicates a severe delay and who have no other apparent developmental problems, it is recommended that formal speech/language therapy be initiated. A severe delay may be indicated by:
    • at 18 months, no single words
    • at 24 months, a vocabulary of fewer than 30 words
    • at 36 months, no two-word combinations [B]
  3. It is also recommended that children with a severe speech/language delay receive a comprehensive health assessment to look for medical conditions that might be causing or contributing to the delays. [D2]

    Children with milder expressive delays only

  4. When deciding to initiate speech/language therapy for children age 18 to 36 months who have a delay in expressive language only and no other apparent developmental problems (normal language comprehension, no hearing loss, and typically developing in all other ways), it is important to:
    • assess if the child has a higher or lower likelihood of continuing to exhibit a language delay
    • recognize that predicting whether a child has a higher or lower likelihood of continuing to have a language delay requires experienced clinical judgment [D1]
  5. In assessing the likelihood that a child with a current mild delay in expressive language will continue to have ongoing language problems or will catch up with typically developing peers, it may be useful for the speech language pathologist to consider the extent to which the child exhibits the factors predicting continued language delay as shown in Table III-7. [D1]
  6. For children with a current delay who exhibit more of the prognostic factors in Table III-7, it is recommended that:
    • formal speech/language therapy be tried
    • ongoing monitoring of the child's progress and activities to promote language development (described in the part on Enhanced Developmental Surveillance) be continued
    • children receive periodic in-depth assessment of their communication level and progress (whether or not speech/language therapy is initiated) [D1]
  7. For children with current delay who exhibit fewer of the prognostic factors listed in Table III-7, it is recommended that:
    • formal speech/language therapy not be initiated at this time
    • activities to promote language development be continued, along with the parents' ongoing monitoring of the child's progress
    • the child be reevaluated by the speech language pathologist in no more than 3 months to assess progress in communication development
    • the child's need for speech/language therapy be reconsidered at the time of re-evaluation depending on the child's progress [D1]

Note: Each guideline recommendation is followed by one of the strength of evidence ratings described below, which is intended to indicate the quality, clinical applicability and amount of scientific evidence used as the basis for that guideline recommendation.

[A]Strong evidence is defined as evidence from two or more studies that met criteria for adequate evidence and had high quality and applicability to the topic, with the evidence consistently and strongly supporting the recommendation
[B]Moderate evidence is defined as evidence from at least one study that met criteria for adequate evidence and had high quality and applicability to the topic, and where the evidence supports the recommendation
[C]Limited evidence is defined as evidence from at least one study that met criteria for adequate evidence and had moderate quality or applicability to the topic, and where the evidence supports the recommendation
[D]Panel consensus opinion (either [D1] or [D2] below):
[D1]Panel consensus opinion based on information not meeting criteria for adequate evidence, on topics for which a systematic review of the literature was done
[D2]Panel consensus opinion on topics for which no systematic literature review was done

Next
Back to Index