Speech and Language Development

Needs Statement

There has been an ongoing increase in the number of pediatric referrals made to speech therapists over the past several years with a majority of the children referred being five years of age or younger. Many of these children are evaluated and found to have speech and/or language delays. At this time with full case loads it is difficult for staff to accommodate the growing demands, signaling a need to expand our speech and language services. As children are referred to outside centers at increasingly younger ages, we recognize the need to provide intervention to the child and the family as early as possible, before significant difficulties and unfavorable patterns of interaction are habituated. Intervention should begin early in order to minimize the severity of the impairment as well as the concomitant behavioral, social, and family disruptions, which have been found to be related to preschool language disorders (Wetherby & Prizant 1993). Intervention should begin early enough to
prevent later learning disabilities, which may require more intensive and long term intervention (National Deafness and Other Communication Disorders Advisory Board, 1991).

It is critical that early intervention programs involve the child's primary caregivers for various reasons. For example, the quantity and quality of parental input are reflected in the child's conversational skills (Lieven, 1978; Wells 1984) and a parent's responsiveness has been related to an accelerated rate of language development in normal children (Cross, 1978; Wells, 1984) and high-risk children (Rocissano & Yatchmink, 1983).

The following facts were compiled to underscore the importance of early language intervention in working with children and their families: It is estimated that approximately 8% to 12% of preschool children have some form of language impairment. (National Institute on Deafness and Other Communication Disorders, 1995).

* Nearly 2/3 of children identified as late talkers prior to 2 years of age, continue to exhibit delays in expressive language at 3 years of age. For more than half of these children who continue to display language difficulties by the age of 4, the risk of developing a learning disability is notably high (National Deafness and Other Communication Disorders Advisory Board, 1991).

* 60% of children who displayed language impairments at preschool required special education placements (Aram & Hall, 1989).

* 28-75% of preschoolers with language impairments displayed persisting speech and language problems in later childhood. Specifically, 53-95% of children who have language disorders show impairment in reading achievement (Scarborough & Dobrich, 1990)

* Verbal abilities at kindergarten have been found to be predictive of later reading achievement, (Catts & Kahmi, 1986; Scarborough & Dobrich, 1990). Many children with speech and language impairments have been shown to fall behind their normal-language peers in reading achievement by the early grades (Catts, 1993)

* Children with developmental delays or Autism Spectrum Disorders demonstrate significant language delays and disorders

* Language delays are often accompanied by difficulties with social interaction. Studies of socially withdrawn children have shown these children to be represented disproportionately in groups of adults who (a) receive dishonorable discharges from military services (Roff, 1961), (b) have mental health problems (Cowen, Pederson, Babijian, Izzo, & Trost, 1973), and (c) have repeated contacts with law enforcement agencies (Roff, Sells, & Golden, 1972)

* The child's failure to develop language normally has an enormous impact on the quality and quantity of parent-child interactions, often resulting in a mismatch between parental input and the child's specific linguistic requirements (Cross, 1984).

State implementation of Parts H and B of the Individuals with Disabilities Education Act mandates parent-driven, family-centered early intervention services for all special needs children from birth to age 5. The values reflected in Part H legislation requires a shift in intervention strategies. Professionals must now learn to function as agents of the family, empowering its members by promoting their capabilities and competence.

As the focus moves toward family-centered early intervention, effective language intervention for young children with language delays should involve the child's parents. A family-centered system recognizes that the family is the center of the child's life and the "absolute constant," while service providers are transitory (Silverstein, 1989). Many parents are eager and able to assume the role of primary intervention agents, and because they have more frequent and extensive contact with their children than do centerians and are generally motivated to persist (Blosser, 1996; Tannock, Girolametto & Siegel, 1992), they are able to effect more change in their children's language development. Parents can also provide intervention at more frequent intervals during the day, over a longer period of time, and under conditions which may be highly motivating to the child. By helping parents create the ideal learning environment, the children can be primed for language learning at an optimal pace (Girolametto, 1988). One widely used model of early language intervention involves training parents to be their child's language facilitator. This training is best provided in a group context so that learning is maximized through group discussion and interaction.

A parent training program:

* Provides families with the kind of intensive, family-focused service many of them want
* Provides service to a number of families at one time, thereby reducing the waiting period for service

* Provides parents with the foundational skills and knowledge that will enable them to participate actively in their child's intervention both during the program and over the course of the child's early years * May reduce the need for follow-up consultation. By minimizing the severity of the delay, it is anticipated that children will need less intensive speech and language services after they and their parents have participated in this program, thereby increasing cost-effectiveness. In addition, their parents will have gained the skills necessary for them to continue to assume a primary role in their child's intervention.