Behs343 project scenario 6

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The Examination of a Child Not Speaking as Expected by the Parent
Lot in Life Research Paper
Professor: Dr. Crystal Neal
Student: Modupe Olayinka Sarratt
Assignment Due Date: 3/10/2013
The Process of Parenting
Course: BEHS343 Section6382
Scenario 6 Intern Examination for Speech and language Delay in two years old girl
Revised: February 23, 2013

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Abstract
To examine a child for language issues require the guardian or parent(s) to schedule an
appointment even though is just a concern or worry about a child not thriving as expected based
on beliefs. Many parents believe speaking occurs as a child grows, especially when a child starts
walking, but usually that is not the case. Research for language development indicates that is the
process, through parenting, begins between the ages of two and five. According to Jane Brooks,
parenting is “how parents help children make sense of the world around them and develop sense
of self to learn to express them” (Brooks, 2011 p. 234). Therefore, speech disorders are difficult
to diagnose at two years because that is when a child is beginning to connect and transfer
gestures, signals or expressions into words. At two years old, children are able to transfer a few
simple words from gestures to language such as, “bye, mommy or daddy”. According to
research for children development, “children progress from having about 50 words at nineteen
months to 10,000 words at age six” depending on the parenting style (Brooks, 2011 p. 235). The
process to diagnosing speech delays start with consultation, observation, and neurophysiological
exams to rule out hearing impairment.

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Content
Introduction 4
Encounter 5
Consultation 6
Initial visit 7
Subsequent visit 8
Physical exam 9
Assessment Chart 10
Test 11
Finding 12
Recommendation 14
Plan 14
Reference 16

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Introduction
Language is the expectation that every parent places on his or her children for addressing
society and culture. Therefore, worrying about a child not speaking is a concern because
speaking is imitation of what is heard, ‘we speak what we heard’ (Sarratt, 2013), but speaking
and language are two different things despite the connection. To be able to speak a language
depends on the parenting style, choices for words, culture, and the environment. In some culture,
making a distinct sound such as crackle is an act of speaking. Speaking is vocal while language
is dialect. The commonalities for dialect in most societies are by creating words to represent
actions or to mean something. How children comprehend the words depend on the parent and the
environment. By age six, it is possible that a child is able to have a vocabulary of enough words
to speak complete sentences or able to comprehend enough words to talk effectively. For a child
to be able to convey language or a dialect to speak depends on how old the child is, instead of
how well the language is taught. Although language and speech are similar, there is a difference.
Speaking is vocalizing something, such as mumbling or babbling, while language is what the
parent and society teaches.
In order to examine a child, who is not speaking, requires discussions with the parent to
clarify the difference between languages, speaking, and hearing. The medical procedure to
examine language is the examination for neurophysiological development, the ability of child to
be able to speak, learn, and relate to others. The medical procedure for speech is to test a child
for ability to vocalize, which is not necessary if no visible birth defects, such as cleft lip. The
medical procedure for hearing is to test a child for the ability to listen and respond to sounds. In

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addition, the medical procedures require testing a child for emotional development, the ability to
associate and connect.
Encounter
On December 03, 2012, a meeting was held with a mother to discuss her concerns about
her two year old daughter who did not express the same speech skills, compared to other children
of the same age. Modupe Sarratt, the intern examiner explained to the mother that speaking is
associated with hearing, according to academic journal article written by Amy R. Lederberg,
Brenda Schick, and Patricia E Spencer (2013). The article suggests that, “Language development
has long been recognized as the most important area affected by hearing loss. Although the
relation between the degree of hearing loss and an individual's access to spoken language is
complex, hearing loss is often categorized as mild, moderate, moderately-severe, severe, severe-
profound, or profound. Children with milder losses typically achieve access to speech when
fitted with hearing aids; however, any degree of loss raises the risk of language delays”
(Lederberg et al 2013).
A research for language development suggests that children understand words more than
they can use them. “At age two, children have a vocabulary of about three hundred words. By
age two, toddlers have also made the leap to putting two words together to form a sentence”,
according to Jane Brooks in the process of parenting (Brooks, 2011 p. 213). The acts of
speaking begin when babies develop in the womb. Sucking and crying after birth is a way of
speaking using emotional reactions in different atmosphere to indicate ‘I am here’, ‘I not
comfortable in this environment’, ‘can you help me’, making the parent feel the need to cuddling
and protect the baby. Babies speak or vocalize naturally with signals and expressions such as,

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crying, sucking, smiling, cooing, and laughing, but the parents have to teach the children how to
connect speaking to language. Therefore, how children develop languages depends on the
parenting style and word choices. For example, if a child learns from the parent that making
noises or sounds is way to speak, the child would grow using just sounds as their language. If
word use is slumber, slow, not active, or incoherent, then children imitate or use those patterns as
a way of speech. During child development, parents help children to associate signals with words
that a child develops as a language. Currently, there is no specific test for speech for two year
olds, except hearing tests to eliminate deafness. Children develop language from parents
speaking them; parents choice of words and style to teach language is very crucial because that is
how a child learns to speak.
As intern explained to the mother, the medical protocol for examining her daughter
includes scheduled initial visit for consultation to gathering information, subsequent visits for
examination, possible referring the child for testing, and follow-ups to discuss the findings. As a
professional intern, understanding the family history and being able to evaluate the child for
speech delay requires clarifying the differences between languages and speaking, analyzing and
discussing finding for language development and the causes for speech delay, while observing
the child’s behavior and perception to provide recommendations.
Consultation
On December 04, 2012, a mother comes in concerned that her two years and three
months old daughter has not begun speaking and it seems as if the daughter does not interact as
much with other children on social occasions. Explained to the mother the factors for speech and
language development of two years old depends on the process of cell development of the

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muscle and the nervous system, as well as the environment. At two, a child words increases
from babbling to joining of words to associating objects and actions with words. For example,
‘mommy go, bye mommy, doggie eat’ etc. In addition, a child developing the ability to
understand an adult may not be clear at two, but is being built into child development.
Moreover, at two years of age, a child may not be able to speak a particular language. A
suggestion to the parent, when speaking to the daughter, look directly at her, so that the daughter
can connect the facial expressions into the meaning of words that are used. Use actions to help
the child associate particular words with objects and events. Inform parents that to help a child
develop language is by constantly exposing a child to sound of voices, particularly words that
require verbal response. For example, associate yourself as ‘mommy’ and ask your daughter to
call for mommy. Schedule follows up in a week to examine for neurophysiological development.
Initial visit
December 11, 2013, examined daughter for neurophysiological development by
observing the daughter interacting with other children at receptionist area, designed for children
to play with toys, play with other children, listen and respond to instructions as depicted in the
image by Talking Point.Org for children communication.
(Bing Images)
Impression:

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 Appearance and grooming- child is well dress, no rash or injury
 Skin tone: normal
 Muscle tone: interacting with other, picking up and playing with objects:
within normal limit for second year.
 Facial expression for interaction- normal-no muscle weakness
 Movement, daughter line up according for group action and name calling
in the audio sound of a talking toy.
 Neurologic physiology structure and function within normal for age
Assessment for motor skills with a reflex test was conducted. A reflex test is a simple physical
test with a light knee tap with hammer to test for the function of the nervous system, eliminating
neuromuscular deficit such as, spinal bifida. The results for the daughter are normal.
Examination of head, neck, and spine indicates no abnormalities or bruising.
Schedule follow up in 2 weeks to address the issues
Subsequent visit
On December 25, 2012, the daughter was examined for emotional development skills.
Explained to the parent that the emotional development of a child requires a child being able to
associate, connect, and interact with other family member, which requires immediate family
members to initiate conversation in the level for a child to converse. In addition, at age two,
children understand that people’s feelings lead to actions for conversing or talking, in her case,
for speaking. Explain that communication for two years old usually uses simple words and
gestures, and sometimes they are able to echo what they hear or mix a few words with babbling.
The mother is twenty-seven years old, single, and works full-time at local grocery store. The
mother and her daughter reside in two bedroom apartment, the father comes and goes, and

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occasionally stays for few days via arrangement, grandmother is fifty years of age with medical
history of a mild stroke two years ago, and helps to care for the daughter while mother work
while the mother works. Mother had a normal delivery at nine months, and no history of birth
defects. The daughter is two years old and three months on December 27, 2012 and utters few
words such as, ‘bye mommy, happy, bottle hot, grandma and daddy’. The daughter responds to
simple commands such as, “pick up the bottle” and “come here”. However, she does not respond
to commands in long statements such, saying ‘I love my daddy and mommy’ and daughter
follows gestures to say ‘goodbye! The child prefers to play with toy, sit in her grandmother’s lap,
and watch TV in the presence of other children or peers, instead of interacting with them.
 Daughter is not taken any current medication
 Vaccination is up to date according to mother
Vital Signs: Height: 34 inches, Average, within normal limit for 2 years old, Weight: 29 lbs.,
Average, within normal limit for 2 years old, Respiration: 22 per minutes, normal for 2 years old
Temperature: Afebrile, normal temperature, Blood Pressure: not perform Pulse: 100 and regular
Allergies: No known of any drug allergy or environmental
Physical Examination
Physical examination is essential for evaluating general wellbeing, including the
appearance for well-developed, well-nourished for two years olds. Evaluation of the head and
neck for normal growth, clear throat, normal tonsil, quality teeth, and the neck with no carotid
bruits; all of these evaluations seems normal. Vision is within normal limits for two year olds, as
she was able to follow and recognize objects from a distance. Hearing evaluation indicates a
slightly abnormal reaction to quiet speech with whispering, the child steering indicates lack of
clarity. The lungs are normal, no wheeze, no crackling or bubbling sound heard during

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evaluation. Abdomen sound is also within normal for bowel movement, no masses or tenderness
felt with gentle pressure for palpation exam. Extremities observations were normal with no
cyanosis and the peripheral pulses were intact. Schedule follows up in 2 week to discuss child
emotional development.
Assessment chart for emotional development
Are you worried because your daughter seems late in starting to talk
Mother: Yes
Is there a concern that your daughter cry without a reason or do you think that your daughter
cries unnecessarily? Mother response: no, not really
How would you describe your daughter when she express anger, do you think when she is
angry, there is a reason for her to be angry? Mother response: I think when she angry she has a
reason, but sometimes I wish she tells me what is wrong.
Note: crying and tantrum are children ways for expressing conflict. According to Jane Brooks,
“anger represent 23 percent for emotional development and parent-child interactions account for
71 percent, and parents usual response is not to comfort but to give the child a practical,
problem-solving response” (Brooks, 2010 p 237).
Does your daughter seem to be developing normally in other ways such as, understanding and
responding with physical skills to command? for example, picking up a toy if she is ask or do
you have to repeat what you said or increase you voice for her to respond.
Mother response: no, not all the time
Mother: Sometimes, I have to repeat myself for her to respond, the sometimes for when I wonder
if she hears me.
Clarification: Do you think something may be going on during the sometimes when you feel

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Test
The test perform to rule out hearing impairment was patient referral to an audiologist, a
specialist for hearing tests and neurologic evaluations performed in the office to rule out sensory
and motor defects. There is no test for speech at second year because there is no history of birth
defects, such as cleft lip, an upper lip congenitally divided into two parts that have been only
partially reunited by surgery. In addition, there is no problem with vocalization because speech
is a selective process taught by the parent. According to an abstract of academic journal by Lori
like she did not hear you, what is sometimes to you?
Mother: sometimes is like when she is acting clumsy or maybe not feeling good or sometimes
when she is focusing on something.
Note: eliminate the possibility for hearing defect by referring for hearing test.
Is she able to join two words together, for example, Bye mommy or mommy go.
Mother: Yes
Clarification: Is she able to say the words clearly
Mother: Yes
Noted: It is a common knowledge that “hesitation in speaking is normal for children” because is
a stage that most young children go thru due to the excitement of new discovery such as, new
word for growing brain to develop knowledge. Because of the brain, working faster to expand
knowledge of new words and things affect the children to hesitate about talking that were
normal for social development. For social development, some children developed self-seeking
word of their own or imitates activities of their favorite word such as “No” for social response.
(Sarratt, 2013)

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B. Astheimer and Lisa D. Sanders In Developmental Cognitive Neuroscience 2(1):120-128
indicated that “directing attention to word onsets may be important for speech processing in
young children who would otherwise be overwhelmed by the rapidly changing acoustic signals
that constitute speech.” Technically, neurological function for speech processing in the children
is between “3- to 5-year-old” (Lori & Lisa (2011). Schedule follows up in 2 week to review the
result for hearing test.
Finding
The findings for daughter examination suggested that language development for speaking
were normal and there was no reason for daughter not speaking. The hearing test result for the
daughter was normal. There was no neurological impairment for speech delay, daughter was able
to speak more than 50 words, able to links words to action such as, “bye mom when mom is
asked to leave the room, observation of daughter playing and interacting with peer and adult
were normal for two years old. According to Jane Brooks, the indication for physical and
neurophysiological development were normal between ages two and five for these reason, “
children grow from about 34 inches and 29 pounds at age two to 42 inches and 42-45 pounds by
age five ‘children’s brains are active primed for learning 5.5 words per day, or having about 50
words by two.’” Moreover, at “three-year-old, children brain develop twice as many synapse for
connection among the brain cells and is twice more active to increases children neurotransmitter
to processing information for cognition and social functioning” (Brooks, 2011 p. 235). In
addition, research by Longobardi, Rossi-Arnaud and Spataro indicated, “both verbal and non-
verbal variables predicted the level of language development at 23 months ‘early individual
differences in the use of words and gestures were associated with later differences in linguistic
abilities’” (Longobardi, Et. al 2011).

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Further information provided to parent include brief explanation for “intellectual
development” of children depend on what children observe others doing in actions with words
for interaction would increase a child ability for “verbal skills” and children develop the
“motivation when parents are warm, encouraging, and open in conversation with their children,”
stated in the process of parenting by Jane Brooks. (Brooks, 2011 p. 235)
Explained to the mother, there is no reason for her daughter not speaking; my advice is
for the mother to interact more with her daughter with clear pronunciation of expression or
words, and to include family member to speak clearly to the child. Indicated that research for
children development by Mayo Clinic said, “Every child grows and develops at his or her own
pace” (MFMER 1998-2013). Her daughter tends to follow a fairly predictable path, the
predictable path for language skills as follow: a child is able to “speaks about 50 words, answers
simple question, links two words together, uses some adjectives (big, happy), and able to speaks
clearly enough for parents to understand some of the words” (MFMER 1998-2013). However,
parent could help to improve a child speech developmental by develop a pattern by which to
speak to the child for her to respond in his or her own term. Otherwise, a child would speak
when he or she is ready. Possible cause is lack of stimulation otherwise; the child is developing
normally for two years old. Lack of stimulation to interact usually is because the parent(s) is not
communicating enough to get the child attention and case like hers is common among working
couple and single parent. Occasional raise of voice or repeat to get daughter attention is because
the daughter is used to mom tone that sometimes sound like monotone for her to just looks at
mom instead of action, for example is as if the parent is talking to the wind. Advice mother, there
is no obvious medical reason for daughter not speaking.

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Recommendation
Patient guidance was referral to community outreach service for parenthood and child
development at local public health located in Annapolis. Recommend mother to seek psychiatric
counseling for dealing with the pressure of being a single mother. Provide a booklet on how to
help children develop language, and admonish to read medical journal on child development
especially on the topic for speech and language and to get involve more with interaction for
daughter and mom talk for conversation.
Plan
The plan was an intervention to provided support to the mother and the child by
contacting two local community agencies to obtain information for language development and
for parenting skills. Visit to Annapolis Outreach Clinic on February 15, 2013 inquiry about
language development, personal communication with the nurse and the visiting physician
inferred “there is no specific test for language at age two beside neurological examination with
hearing test to rule out deafness” (Sarratt, 2013). The visit to Anne Arundel County Department
of Health on February 05, 2013 for parenting assistant referenced parent and child to attend a 14-
session program designed to strengthening the families. Conferring with the director of the
program, the program provides training to parent on how to help a child develop social skills and
life skills that structured with family activities and games. Many people from the Arundel
County Department of Health contributed to the input of strengthening the families programs to
help provide stability for struggle family. The cost for 14-session depends on the assessment of a
child needs and the parent ability to pay. (Sarratt 2013) The families program encourages the
parent to talk with the children about what they see and to ask the children for what they like or

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dislike. According to Anne Arundel County Department of Health (2013), the benefits of
program to the parent and the child were as follow:
• Improve family communication,
• Provide effective discipline,
• Set constructive limitations,
• Use attention and rewards to improve their children’s behavior, and
• Understand the negative impact of substance abuse on family relationships.
What children gain through Strengthening Families, the Strengthening Families Program
helps children to:
• Develop better communication and social skills,
• Understand their feelings, Solve problems,
• Resist peer pressure,
• Learn the consequences of substance abuse, and
• Comply with family rules.
One parent experience suggested that having a ritual to practice talking or speaking
would encourage a child to develop language for speaking. Children are inventive at age two
from what children heard or learned. Once a child mastered the words for expression, he or she
will speak; the child could surprise the parent with long sentence. For some children, speaking
depends on when the child feel should could put the word together that would make a logical
sense. Therefore, some children may delay speaking until he or she feels confidence that what he
or she is saying make sense to the parent or the people around them.

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References
ASHA. (1997-2013). American Speech-Language-Hearing Association
http://www.asha.org/public/speech/development/schoolsFAQ.htm
Bing Images. (2013). Talking Point.Org, the first stop for information on children’s
communication http://www.talkingpoint.org.uk/EY-worker.aspx
Brooks, J. (2011). The process of parenting (8th ed.). NY: McGraw-Hill.
Informal Interview. (2013, February 15). Annapolis Outreach Clinic 92 Washington Street,
Annapolis, Maryland
Informal Interview. (2013, February 05). Anne Arundel County Department of Health,
Informal Behavioral Health Building 122 North Langley Rd, Suite A, Glen Burnie,
Maryland
Lederberg, A. R., Schick, B., & Spencer, P. E. (2013). Language and literacy development of
deaf and hard-of-hearing children: Successes and challenges. Developmental Psychology,
49(1), 15-30. doi:10.1037/a0029558
Longobardi, E., Rossi-Arnaud, C., & Spataro, P. (2011) A longitudinal examination of
early communicative development: Evidence from a parent-report questionnaire.
British Journal Of Developmental Psychology, 29(3), 572-592.
doi:10.1348/026151010X523473
Lori B. A., & Lisa D., S. (2011) Elsevier Ltd, Temporally selective attention supports speech
processing in 3- to 5-year-old children. Developmental Cognitive Neuroscience, 2120-
128. doi:10.1016/j.dcn.2011.03.002.
MFMER, (1998-2013). Mayo Foundation for Medical Education and Research
Sarratt, M. (2013 February 05 & 15) Personal Communication

Behs343 project scenario 6

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