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"My child is not talking" is a concern voiced by many parents and families. Possible etiologies for developmental language disorders and articulation disorders are many: mental retardation, craniofacial disorders, cerebral palsy, autism, traumatic brain injury, hearing loss. Sometimes there will be a single etiology; however, most times there are multiple etiologies, mild in nature, that come together to produce speech and language delay. As health care providers, therapists, and educators it is essential that we assist the child's family in finding answers to their questions. We are wise to seek the advice of an interdisciplinary team of professionals to determine whether the child's communication abilities are developing normally or whether professional intervention is needed. It has been well documented that early diagnosis and treatment for speech and language problems greatly improve the child's overall prognosis, and can often prevent the development of additional disorders in the areas of behavior, learning, reading, and social development.
At some point in our professional lives we will all encounter a child who is not talking in a way that is appropriate for age and developmental status. As committed proponents of early intervention, we will then embark on a journey to discover why the child is not talking.
Meeting the challenges that lie ahead will depend upon our skillful analysis of six important factors:
1. What is the child like (a general overview of the child's developmental status)?
2. What physical and environmental factors have shaped the child's development?
3. What is the status of the child's communication abilities?
4. What is the cause of the child's inability to talk?
5. What are the variables that may be relevant to its maintenance?
6. What procedures or treatments might be used or adapted to reduce the problem?1
Determining the nature of communication problems is no small task. It requires that clinicians recognize that all children are unique, the product of unique and varying environments.1 Typically clinicians will begin the diagnostic process by gathering a comprehensive history, carrying out a complete physical examination, and performing screening evaluations. The information gathered would determine what additional tests are needed, and what referrals will be most productive for the child.
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