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INTRODUCTION
Delayed development of speech and language are the most common symptoms of developmental disability in childhood, affecting somewhere between 5% and 10% of all children. l The busy pediatrician will see at least one or two speech/language delayed children every day. "Language" refers to any symbol system for the storage or exchange of information; examples include the spoken word, writing, braille, morse code, American Sign Language, etc. The term "delayed speech" is often used colloquially (and incorrectly) to refer not only to children with isolated speech delay, but to children with impaired language development. When assessing a preschool child, it is important to retain the distinction between speech production, and aural language comprehension. It is also useful to assess the preschool child's visual communication skills, since different etiologies of speech or language delay may affect one or another of these modalities variably. For example, the child who is dysarthric due to cerebral palsy will have severely impaired speech, but may have completely normal auditory comprehension and visual communication skills; the deaf child will have impaired auditory comprehension as well as delayed speech, but with normal visual communication skills, while the mentally retarded child will have delayed language, with delayed speech, delayed auditory comprehension, and delayed visual communication skills as well.
RECOGNITION OF SPEECH/LANGUAGE DELAY
Direct assessment of speech and language development in the infant and toddler may be difficult. Children are often reticent or fearful in the doctor's office, and the physician examiner may not have adequate time to establish sufficient rapport with the child to permit reliable developmental testing. A structured history from the parents is of far greater benefit than any cursory attempt to "eyeball" the child's development in the office. One must make systematic, separate inquiry about auditory expressive, auditory receptive, and visual communication skills.
By about I year of age, the average child will be speaking at least one word (other than "mama, " "dada, " or names of other family members), will be following at least one of the one-step commands unaccompanied by a gestural cue (eg, "Come here," "Give me . . ." etc.), and will be using index finger pointing to indicate desired objects (mnemonically easy to remember, since an upraised index finger also signifies "one"). By...