Preschool+Speech+and+Language+Screenings



//Communication// is an activity that involves sending, receiving, processing, and comprehending concepts and messages that are presented verbally, nonverbally or graphically (American Speech-Language-Hearing Association (ASHA), 1993). An impairment in any of the above processes results in a communication delay or disorder (ASHA, 1993; [|ASHAs Definitions] ). Both communication and communication disorders can further be delineated through realization of the difference between //language// and //speech//.

//Language// is defined as a set of symbols used to communicate ideas as dictated and arranged by convention and can be further divided into expression (production) and reception (comprehension) (Law, Boyle, Harris, Harkne & Nye, 1998). Language can be expressed through varying means including speaking, writing, and other symbolic or gestural systems (Paul, 2007). Language can be further divided into different components including: syntax, morphology, phonology semantics, and pragmatics. While language can be divided into the entities listed above, Bloom and Lahey also provided descriptions of the three components of language including form, content, and use (Bloom and Lahey, 1978, as cited in Paul, 2007).
 * Syntax- The order and combinations in which components of language (words) are expressed as governed by rules and conventions known as grammar (ASHA, 1993).
 * Morphology- The rules governing the meaning and structure of word forms and units (ASHA, 1993).
 * Phonology- The rules governing the sound units and combinations (ASHA, 1993).
 * Semantics- Vocabulary, or the set of words and meanings that correspond to the conventions of a particular language (ASHA, 1993).
 * Pragmatics- The social aspects and use of language that arises from the interaction of all the above components (ASHA, 1993).
 * Form-Includes syntax, morphology, and phonology (Paul, 2007).
 * Content- Includes semantics, or vocabulary and knowledge about objects and events (Paul, 2007).
 * Use-Includes pragmatics, or the function, context, and rules for use of language (Paul, 2007).

// Speech //is the physical production of language, which includes an organized set of sounds that are used to convey meaning and are created by movement and coordination throughout the vocal tract including the processes of respiration, phonation, resonance, and articulation (Bernthal, Bankson & Flipsen, 2009; Law et al., 1998). The [|University of Minnesota Duluth]'s website provides descriptions of the processes involved in speech production listed below, and [|Stanford]'s website provides more information. Speech can be further defined into several areas of production were disorders can occur including:
 * Respiration- The inward and outward flow of air that allows the below processes that drive speech production.
 * Phonation- Sound or speech signal production at the level of the larynx through vibration of the vocal folds.
 * Resonance- The amplification and dampening of the signal by properties of the vocal tract and cavities such as size and shape.
 * Articulation- The movement of structures to shape the signal into sounds of speech.
 * The articulators include the oral and nasal cavities, the hard and soft palate, the tongue, the teeth, and the lips.
 * Articulation- The production of speech sounds, from which disorders can present as distortions, submissions, and omissions of speech sounds which degrade intelligibility (ASHA, 1993).
 * Fluency- The flow of speech, from which disorders can present as repetitions, prolongations, atypical rate or prosody, and excessive tension or struggle behaviors (ASHA, 1993).
 * Voice- The vocal quality, loudness, pitch, resonance, and duration, all of which can be disordered as noted by deviances from age and sex normative data by various psychological, physiological, and anatomical factors (ASHA, 1993).

[|Speech Versus Language: More Information] [|Speech and Language Disorders In Depth]

**__Historical Perspective__**

As cited in De Montfort Supple & Soderpalm (2010), the earliest known documentation of child language impairments occurred in the 19th century, by Franz Gall a physician. Despite Gall's mention of language impairments, other authors have been mentioned as describing various communication disorders including stuttering and articulation difficulties in earlier years (De Montfort Supple & Soderpalm, 2010). Following Gall's publications were the findings of pioneers such as Raphael Coen, Leon Vaisse, Leopold Treitel, Hermann Gutzmann and Albert Liebmann, all of which contributed to the initial body of research including areas such as the etiology of speech and language impairments, the contributions of cognitive functions to language, and classification of childhood language disorder in the case of the latter (De Montfort Supple & Soderpalm, 2010; Nettelbladt, 2001).

In the late 19th century and early 20th century, the origins of the notions of the assessment and treatment of speech and language disorders lead to the birth of the field of speech-language pathology (De Montfort Supple & Soderpalm, 2010). The neurologist Samuel Orton has been described as the founder of the study of childhood language disorders, as he described the neurological implications of language disorders and the connections between neurology and behavioral descriptions around the 1930's, even including areas such as reading and writing (Paul, 2007). Benton further added to the findings of Orton by delineating childhood communication disorders from those of adulthood in the 1950's-60's (Paul, 2007). Additional persons from a variety of fields contributed to the beginnings the knowledge base surrounding child language disorders such as Gesell and Amatruda who were in developmental pediatrics and contributed to evaluation of language disorders in children, Ewing, Kleffner, MicGinnis and Goldstein who were educators and provided methods for teaching children with language disorders in the 1930's-50's, Morley who worked to develop diagnostic and treatment plans for children with communication disorders from a speech pathology perspective in the 1950's, and Myklebust who termed the field "language pathology" and developed diagnostic and categorical classification systems for language disorders in children in the 1950's (Paul, 2007).

Judy Duchan (2001-2011) has described the development of the field of speech-language pathology, beginning in 1900 as divided into stages: Formative Years, Processing Period, Linguistic Era, and Pragmatic Era, each are described briefly below. **(Scientific/ Academic)** || 1900-1945 || This period entailed the divergence of the profession from the medical field. The basic principles of intervention for speech and language disorders were explored, including educational approaches, sensory approaches, and motor approaches. The approaches to treatment often included moving from small components (speech sounds) to larger meaningful components (phrases/sentences). Additionally, patients were instructed using practice drills of items and articulatory exercises. ||
 * **Duchan’s Eras** || **Years** || **Description** ||
 * **Formative Years**
 * **Processing Period** || 1945-1965 || This period was comprised of the alteration of therapies to become more holistic. Therapies were aimed at less prominent yet more functional communicatory components including inner processes, mediation of responses, symbols of language, and words rather than speech sounds. * A special focus on the treatment of childhood language disorders (referred to then as aphasia) was also noted. ||
 * **Linguistic Era** || 1965-1975 || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">This period included the development of therapies to become more abstract, including targeting the phonological, syntactical, and morphological rules. The approach to therapy included behaviorism, or using practice and repetition of items. ||
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Pragmatic Era** || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">1975-2000 || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">The last period involved the inclusion of pragmatics, or how language is used and perceived socially. The therapies included targeting communication in activities of daily living and natural contexts rather than always relying on services within the clinic. ||

For complete details of the development of the field please refer to [|her webpage at the University at Buffalo's site].

**__Speech and Language Development__**

<span style="font-family: Arial,Helvetica,sans-serif;">The development of speech and language has been described by researchers as a dynamic process that provides information about a child's general and cognitive development (Nelson, Nygren, Walker & Panoscha, 2006). The developmental process involves the acquisition of skills for communication including comprehension, processing, and production (Nelson et al., 2006). All of the above processes depend upon the aforementioned components of speech and language including syntax, morphology, phonology, vocabulary, and speech (Law et al., 1998). Despite the importance of the acquisition of the basic speech and language skills listed above, children also need to develop knowledge of the use of their skills in culturally and socially appropriate manners for successful communication (Nelson et al., 2006).

Nelson et al. (2006) provided a chart in their publication which includes the basic milestones of speech and language development for personal and professional reference:

**__Speech and Language Delays__**

Speech and language delays are present in approximately 5-8% of preschool children (Law et al., 1998; Nelson et al., 2006). Speech and language delays can be defined as skills that fall below what is chronologically expected, but continue to follow the general developmental sequence (Law et al., 1998). Delays may exists in language use or production, in language comprehension, in speech production, or in some combination of the processes due to the complex nature of their development (Law et al., 1998; Nelson et al., 2006). Though researchers have described variable definitions and types of such delays, there are several that are mentioned frequently:
 * Expressive Language Delay: delay in the use or production of language
 * Receptive Language Delay: delay in language comprehension
 * Mixed Expressive-Receptive Language Delay: delay in both the use, production, and comprehension of language
 * Speech Delay: delay in the verbal production of speech sounds

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">There are many //risk factors// for the development of speech and language delays and disorders, however of the most frequently mentioned in the literature are a family history of speech or language delays or disorders, being a male, and perinatal complications (Law et al., 1998; Nelson et al., 2006). Additionally, other researchers have mentioned low levels of parental education, low socioeconomic status, childhood illness, and familial factors such as size and birth order (Nelson et al., 2006).


 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">IDEA (2004), as cited in ASHA, 2008, established three //risk categories// for young children: established risk, biological risk, and environmental risk. According to ASHA, established risk is a diagnosed medical condition or disorder that has a known effect on developmental outcomes; biological risk is a history of prenatal, perinatal, neonatal, and developmental events that may individually or collectively affect development; environmental risk is early experiences that include health care, parental care, exposure to physical and social stimulation that if absent or limited may affect development (ASHA). Children in the established risk category are universally eligible for services under IDEA 2004 Part C; that is neither screening nor evaluation is necessary to establish eligibility for early intervention services.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Common //indicators// of speech and language delay described by researchers vary with the child's age and expected development. Concerns for a speech or language delay arise from: no verbalization by the age of one year, if the child’s speech is not clear, or if the speech or language is different from other children of the same age (U.S. Prevention Task Force, 2006). Wankoff (2011) additionally published a document with "warning signs" for various ages, please see the chart below for the signs of communication delay or disorder in children aged birth- 4 years.

<span style="background-color: transparent; display: block; font-size: 110%; text-align: left; vertical-align: baseline;">** Table 1. Checklist for Language and Communication Warning Signs in Children **
 * ~ <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">** Age range ** ||~ <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">** Communication language and speech warning signs ** ||
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Birth to 8 months of age || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">1. Notable feeding difficulties. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">2. Notable medical, motor, or sensory impairments (e.g., visual and hearing). ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">3. Little exploratory play. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">4. Limited range of affect display or affective engagement. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">5. Limited vocalizations. ||
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">8–12 months || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">1. Little to no joint attention or gestural communication. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">2. Little to no affect display. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">3. Little or no responsivity to others. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">4. Rarely produces communicative acts (e.g., requests and protests). ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">5. Babbling is restricted to not more than one consonant-vowel combination. ||
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">12–18 months || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">1. Lack of vocal, verbal, or gestural reciprocity. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">2. Lack of comprehension of simple words, concepts, or one-step directions. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">3. Limited object search and object play and lack of demonstrating an awareness of object function. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">4. Restricted range of meanings expressed (e.g., more, up, and bird) and/or restricted range of communicative functions expressed (e.g., requests, comments, greetings, etc.). ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">5. Very low frequency of communicative acts produced per minute (e.g., fewer than two per minute). ||
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">18–24 months || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">1. Does not combine objects in play or produce symbolic play (e.g., pretend play) schemas. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">2. Meager and slow growing vocabulary. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">3. Virtually no multiword utterances. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">4. Lack of reciprocal communication or “circles of communication.” ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">5. Rarely initiates but typically imitates or echoes the language heard. ||
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">2–3 year olds || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">1. Lack of elaborate play schemas; prefers to play alone; does not enjoy symbolic play; and does not take pleasure in peer interactions. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">2. Lack of grammatical complexity (e.g., relatively few sentences with more than one verb). ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">3. Does not express a range of meanings (e.g., “more juice,”“no cookie,” and “pretty baby”) or a range of pragmatic intentions (e.g., requesting objects, requesting action, protesting, and greeting). ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">4. Rarely initiates but typically imitates or echoes the language heard. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">5. Is not typically producing a substantial number of contingent or topic-related utterances and at least five communicative acts per minute. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">6. Poor intelligibility for family members, as well as strangers. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">7. Persistent dysfluencies (e.g., hesitations, repetitions, prolongations, and interjections). ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">8. Typically noncompliant (i.e., does not follow instructions but rather “follows their own agenda”). ||
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">3–4 year olds || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">1. Typically not intelligible to strangers. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">2. Little or no conversational competence, i.e., lack of topic initiation, maintenance, or change; little turn-taking. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">3. Little or no vocabulary growth. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">4. Minimal use of grammatical markers for tense, person, and number. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">5. Does not discuss non-present events; has not begun to tell narratives. ||
 * ^  || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">6. Apparent noncompliance, inattentiveness, anxiety, or oppositionality, which can be comorbid with language comprehension deficits. ||

<span style="font-family: Arial,Helvetica,sans-serif;">Despite the notion that delays are transient in nature, researchers report that a significant percent of children with delays have persistent speech and language impairments in the future which affect their academic and social functioning (US Preventive Services Task Force, 2006). Preschoolers with speech and language delays are at greater risk for learning disabilities, reading and writing difficulties, generalized academic problems, and lower IQ scores (Nelson et al., 2006). Additionally, behavioral and psychosocial problems have been mentioned by researchers as negative prognostic indicators for the future recovery of children with severe speech and language delays (Law et al., 1998). The prevalence of persistence of difficulties following untreated speech and language delays ranges from 40-60% (Nelson et al., 2006), and may be later identified as speech and language disorders, which are characterized by a pattern of development that varies from the general developmental sequence (Law et al., 1998).

**<span style="font-family: Arial,Helvetica,sans-serif;">__Speech and Language Screenings__ **

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Early identification of speech and language delays can assist in the prevention of persistent impairments through the utilization of early diagnosis and subsequent intervention. Early speech and language screenings are one method of early identification. There is currently no widespread or conventional screening measure for speech and language delay, however there are multiple tools available, which target specific aspects of communication. According to the American Speech and Hearing Association (ASHA, 2006), screening for communication needs in infants and toddlers is a process of identifying young children at risk so that evaluation can be used to establish eligibility, and more in-depth assessment can be provided to guide the development of an intervention program. **The purpose of screening is to make a clinical decision as to whether a child is likely to show deficits in communication development. Screening is also an important component of prevention, family education, and support which is particularly relevant for young children and their families.**

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;"> Screening children for speech and language delay and disorders can involve a number of approaches. There is currently no universal screening technique for use in the primary care settings; however, milestones for speech and language development in young children are typically used as a reference. There are a multitude of screening measures available. Screening measures may involve direct interactions with the children, parent report or questionnaire, or a combination of the aforementioned items. Parents have been found to be reliable and accurate reporters regarding their child’s communication development (Crais, 2011). In addition, the validity of screening measures actually increase when professional-administered and parent-completed measures are combined. For screening purposes, either standardized testing or parent report is adequate, providing the measure being used is psychometrically sound. It is the SLP’s responsibility to choose an appropriate screening measure that meets the criteria for fairness, efficiency, and cultural-linguistic appropriateness (Crais, 2011).

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Once the screening is completed, the SLP should inform the family with the results. If the child passed the screening process, the family is reassured that the child’s communication development is proceeding well. The family should be encouraged to ask questions or express any thoughts and concerns. In addition, if the family continues to have concerns about their child’s communications, they may request testing (Crais, 2011). If the child fails the screening process, an evaluation is recommended to determine if the child is eligible for services.



**<span style="font-family: Arial,Helvetica,sans-serif;">__The Perspective of the Speech-Language Pathologist__ **

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">The first perspective that relates to the prevention of communication disorders as dictated by ASHA and upheld by speech-language pathologists. [|ASHA's Powerpoint on Prevention]

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">The prevention of communication disorders and disabilities can be understood through three levels, which will be discussed below.
 * 1) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">**Primary prevention** refers to the notion of inhibiting the onset or development of a disorder, and therefore reducing the incidence (ASHA, 1988; Nelson et al., 2006; Paul, 2007).
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: 24px;">There are various methods that can be used to prevent the onset of a disorder, however reducing a person’s susceptibility and exposure are included in the process.
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: 21px;">More specific examples to the prevention of communication disorders in children include prenatal and pediatric care, genetic counseling, environmental control, and government action (Paul, 2007).
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: 21px;">Speech-language pathologists may not be involved in all of the above processes, but can be involved in general wellness promoting practices, such as increasing a person’s well being in the areas of physical, psychosocial, and behavioral well being (Paul, 2007).
 * 1) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">**Secondary prevention** refers to the practices of early detection and treatment to slow down or eliminate the development of a communication disorder (ASHA, 1988; Paul, 2007).
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: 21px;">In other words, the aim of secondary prevention is to reduce the prevalence of the disorder by shortening the duration and impact through early identification (Nelson et al., 2006).
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;"> The methodology for secondary prevention includes screening measures such as those for the hearing of newborns and our topic of interest, // those for speech and language in the preschool and kindergarten populations //.
 * 1) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">**Tertiary prevention** includes the reduction of impairment and therefore disability caused by a communication disorder via treatment and efforts to restore functioning (ASHA, 1988; Paul, 2007).
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: 24px;">The treatment or rehabilitation of communication disorders falls within the tertiary level of prevention, as it works to remediate the disability (Paul, 2007).

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">The prevention of communication disorders can occur through the utilization of many methods, however speech and language screenings are of the most common used to identify delays in young children. Following early identification, speech-language pathologists work to determine whether the child is at risk for the development of a speech and language disorder or if they show positive indications for natural recovery from the delay. Despite no universal guidelines for decisions regarding enrollment in treatment following identification of a delay, several factors described by Law et al. (1998) can be taken into consideration including:
 * **The Child's age-** The older the child is, the less likely the delay will resolve without intervention.
 * **The severity of the delay**- How far behind chronologically matched peers is the child? The greater the gap is between the child's skills and the chronologically expected skills, the more likely the child would benefit from intervention.
 * **The range of communication areas affected**- These can include, speech, expressive language, and receptive language: the more areas implicated, the greater perceived benefit from services.
 * **General ability of the child**- Does the child have non-verbal skills within the normative range for chronologically matched peers? Weaknesses in other skill areas can be negative prognostic indicators.
 * **Additional risk factors**- Does the child have additional diagnoses that should be considered as increasing the risk for persistence? These can include: medical and neuropsychological factors and other factors such as hearing loss.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">The SLP works to provide information and service to families and children with delays or disorders in communication including language and speech, emergent literacy, and/or feeding and swallowing (ASHA, 2008). The SLP serves the following functions:
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Prevention of communication disorders
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Screening, evaluation, and assessment
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Planning and implementing intervention
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Consultation with and education of team members, including families and other professionals
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Transition planning
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Advocacy
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Awareness and advancement of the knowledge base in early intervention.




 * __The Perspective of the Parents__**

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">When assessing speech and language in young children, formal or standardized assessment measures are difficult and time consuming to complete. Over the past twenty years, researchers have turned to parent report as an efficient and appropriate measure to assess speech and language in children under the age of 3 (Rescorla & Alley, 2001). Parents are able to provide in-depth information related to their child's overall development that may be otherwise unattainable for the professionals. The information can be accessed in several manners including parental concerns and reports, which may utilize informal observations, checklists, and standardized measures (Glascoe & Dworkin, 1995). Parental reports have been described as useful due to their nature, as the child does not have to cooperate, they provide a sampling of a variety of skills, and they can be administered flexibly (Glascoe & Dworkin, 1995). Westerlund, Berglund, & Eriksson (2006) also suggest that parental reports are more appropriate when assessing young children, as they have been used in large scale studies of language development in infants and toddlers.

There are two parent checklists that have been used in several research studies involving toddlers (Rescorla & Alley, 2001):
 * 1) MacArthur Communicative Development Inventory: Words and Sentences (CDI:WS)
 * Contains a vocabulary checklist of 680 words and items to assess grammatical development
 * Designed for children aged 16-30 months
 * Has acceptable test-retest reliability and concurrent validity
 * 1) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Language Development Survey (LDS)
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Parent report of vocabulary and word combinations: 310 words in 14 semantic categories
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Specifically designed to identify early language delay in children
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Has acceptable test-retest reliability and internal consistency
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Can be completed in approximately 10 minutes
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Easy to score
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">No professional experience required to administer

__**<span style="font-family: Arial,Helvetica,sans-serif;">Areas of Future Research **__

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Despite a vast amount of research that supports the notions of persistence and later complications arising from speech and language delays, no specific guidelines exist for professionals to utilize during the screening process. Additionally, no guidelines exist for determination of decisions beyond the screening including: ongoing evaluation, enrollment in services, etc. The gap in the literature regarding specific tools and recommendations for various persons including parents and professionals would be best served by ongoing research. Though the research has not provided a specific universal screening or set of accepted screening measures, several syntheses completed by various authors are reported on below for tools and recommendations:

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">**Available Screening Measures**

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Formal instruments for assessment of speech and language were designed for diagnostic purposes rather than screening. Some instruments available are constructed to assess multiple developmental components, but also include speech and language components, such as the Ages and Stages Questionnaire, Clinical Adaptive Test/Clinical Linguistics and Auditory Milestone Scale, and Denver Developmental Screening Test. Some instruments that are specific to communication include the MacArthur Communicative Developmental Inventory, Ward Infant Language Screening Test, Assessment, Acceleration, and Remediation (WILSTAAR), Fluharty Preschool Speech and Language, Early Language Milestone scale, and several others. Parent questionnaires are also used to detect preschool speech and language delays (U.S. Prevention Task Force 2006).

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Some professional organizations have recommended developmental assessment/screening tools for preschool children. (U.S. Prevention Task Force 2006). The American Academy of Pediatrics provides detailed interview and examination parameters for physicians, developmental screening, and screening of infants to pre-kindergarten children. Additional guidelines for physicians includes the Harriet Lane Handbook which devotes a chapter to development and behavior describing milestones and recommendations. For example a specific language screening tool for infants and toddlers is the Clinical Linguistic and Auditory Milestone Scale, and for preschool aged children the Denver Developmental Assessment-Language Scales. The American Academy of Child and Adolescent Psychiatry has recommendations for older children, however, none were specific to preschool children. ( U.S. Prevention Task Force 2006).

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Although these guidelines do exist, the evidence underlying the effectiveness is lacking. It is also unclear how consistently clinicians screen for speech and language delay in primary care practices. According to the U.S. Prevention Task Force (2006), in one study, 43% of parents reported that their young children (age 10 to 35 months) did not receive a developmental assessment at their primary care visit, and 30% of parents reported that their child’s physician had not discussed how the child communicates. Potential barriers to screening include lack of time, no clear protocols, and the competing demands of the primary care visit.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">**Recommendations**

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">The U.S. Prevention Task Force (2006) conducted a literature search on the available screening measures and guidelines available. Studies of techniques to assess speech and language were included if they focused on children age 5 years and younger, could be applied to a primary care setting, used clearly defined measures, compared the screening technique to an acceptable reference standard, and reported data allowing calculation of sensitivity and specificity. Techniques taking more than 30 minutes to administer or those that could only be administered by specialists were considered inappropriate for routine screening in primary care. In general, if the instrument was administered by primary care physicians, nurses, research associates, or other non-specialists for the study, it was assumed that it could be administered by non-specialists in a clinic. Broader developmental screening instruments were included, such as the Ages and Stages Questionnaire and Denver Developmental Screening Test, if they provided outcomes related to speech and language delay specifically. Outcome measures were considered if they were obtained at any time or age after screening and/or intervention as long as the initial assessment occurred while the child was age 5 years or younger. Outcomes included speech and language measures as well as other functional (e.g., social behavior, self-esteem, peer interaction and school performance) and health outcomes.

<span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Of the measures reviewed by Nelson et al. (2006), quality ratings were completed and revealed several studies in the fair-good range based upon their psychometric properties:
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: 33px;">Early Language Milestone Scale
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: 33px;">Clinical Linguistic and Auditory Milestone Scale
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: 33px;">Language Development Survey
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: 33px;">Levett-Muir Language Screening Test
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%; line-height: 33px;">Screening Kit of Language Development



__**<span style="font-family: Arial,Helvetica,sans-serif;">What Does This Mean for Educators **__

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">In the preschool years, educators represent a large source of interaction, as over 75% of children attend a center-based care for a portion of their day (Justice, Kottone, Mashburn & Rimm-Kaufman, 2008). In addition, research has shown that positive high-quality relationships between preschoolers and their teachers correlate directly with future academic performance and social relationships (Justice et al., 2008). Researchers have documented the importance of positive relationships between students and their teachers, particularly in the case of students at risk for developmental delays. For students at risk, forming a stable and comforting relationship may serve as a protective role in their development and offset other lower-quality relationships (Justice et al., 2008). There are several factors that contribute to the strength of the relationship between students and their teacher, which include: gender, temperament, and language skills (Justice et al., 2008). Children who are experiencing difficulties in such areas, particularly in language, may exhibit a withdrawn personality, display behavioral problems, appear less sociable, and present with lower self esteem (Justice et al., 2008). Since language has been cited as of the greatest contributors to the development of relationships between individuals, children who exhibit deficits often have difficulty developing relationships (Justice et al., 2008). Based on the above information, educators play a large role in the recognition and response to the language and consequential behavioral or social difficulties experienced by children.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Based upon an educator's concerns or observations, interaction and consultation with various professionals may be warranted. Ongoing collaboration supports comprehensive and holistic education, from which the both the professionals and student will benefit. Speech language pathologists have been cited to rely on coordination with teachers regarding their caseload on an average of 2.5-3.5 hours per week (Peters-Johnson, 1996). The amount of time spent interacting is dependent upon the service delivery model utilized by the school or organization.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">In addition to the above, responsiveness to Intervention (RTI) has been described as <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 120%;"> a variety of approaches implemented by school districts, primarily in the early grades, to optimize the academic success of all students, prevent learning failure by the smaller group at risk, and improve the accuracy of identifying any students in the smallest group, who actually have learning disabilities (LD) (Ehren & Nelson, 2005). <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">RTI can also be utilized in the identification and intervention for children with language impairments. According to Ehren & Nelson (2005), RTI is a possible alternative to cognitive referencing for identifying and establishing language impairment eligibility. RTI also serves as a model of prevention, universal screening, tiered instruction/intervention, and teach-test-reteach approach (Ehren & Nelson, 2005). According to the RTI model, in Tier I, the focus is universal screening for all students in the classroom and speech language pathologists (SLPs) consult with the general education teachers regarding instruction and screening. In Tier II, the focus is on intervention in the general education classroom, and SLPs collaborate with the teachers to administer further language assessments (spoken and written) and to plan small-group interventions. Lastly, Tier III focuses on the identification of learning disability and/or language impairment. The students who do not succeed in Tier II are now considered to need intensive therapeutic intervention from the SLP. The SLP collaborates with the general education teachers to determine language impairment eligibility based on the child's lack of responsiveness to prior intervention.

[|Speech and Language Disorders In the School]

__**<span style="font-family: Arial,Helvetica,sans-serif;">Additional Resources **__

<span style="font-family: Arial,Helvetica,sans-serif;">
 * Milestones for speech and language can be found through various sources including <span style="font-family: Arial,Helvetica,sans-serif;">[|ASHA Early Speech and Language Milestones], <span style="font-family: Arial,Helvetica,sans-serif;">[|University of Michigan Speech and Language Milestones], and [|the Virginia Department of Education's website] **

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15px; line-height: 0px;"> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 15px; line-height: 0px;">
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Example speech and language screeners for children of various ages, for educators, professionals, and parents to complete (from the [|Virginia Department of Education:]) **
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Descriptive figure of the screening process for the identification of speech and language delay or disorder, ****<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15px;">from the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality, 2006: **





__**References**__

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