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Definition of Speech and Language
Speech is the verbal production of language, whereas language is the conceptual processing of communication. Language includes receptive language (understanding) and expressive language (the ability to convey information, feelings, thoughts, and ideas). Language is commonly thought of in its spoken form, but may also include a visual form, such as American Sign Language.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | References | Comment |
|---|---|---|---|
| The evidence is insufficient to recommend for or against the routine use of brief, formal screening instruments in primary care to detect speech and language delay in children up to five years of age. | C | 13 | U.S. Preventive Services Task Force evidence-based guideline |
| All children with suspected speech and language delay should be referred to a speech-language pathologist or local early intervention program for formal assessment. | C | 30, 31 | Usual practice30 and a consensus-based practice guideline31 |
| All children with suspected speech and language delay, or in whom there is concern about hearing loss, should be referred to an audiologist. | C | 30-32 | Usual practice30 and consensus-based practice guidelines31,32 |
| Speech-language therapy is effective for primary expressive language disorders. The effect of speech-language therapy for children with receptive language disorder appears to be much smaller than it is for other groups. | A | 18 | Cochrane review |
| For children receiving speech-language therapy, parent-provided therapy under the guidance of a clinician is as effective as clinician-provided therapy. | A | 18 | Cochrane review |
| Speech-language therapy interventions lasting longer than eight weeks may be more effective than those lasting less than eight weeks. | B | 18 | Cochrane review |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.xml.
Prevalence and Prognosis
The reported prevalence of language delay in children two to seven years of age ranges from 2.3 to 19 percent.1-5 Severe speech and language disorders in young children can negatively affect later educational achievement, even after intensive intervention.6 Several studies have shown that children with speech and language problems at two and a half to five years of age have increased difficulty reading in the elementary school years.7