PEDIATRICS: Language Guidelines for Referral to Speech-Language Pathologists (SLPs)

REFERRAL:Pediatric Language Referral Guidelines, Page 1 of 2 by ASHA
Most Common Etiologies:
• Autism
• Developmental delay
• Fetal alcohol syndrome
• Hearing loss

Related Terms:
Agnosia, aphasia, apraxia of speech, babbling, developmental delay, echolalia, emotional lability, hemiparesis, hemiplegia, jargon, learning disabilities, paraphasia, perseveration, pragmatics, vocalization

Potential Consequences:
• Difficulty communicating basic needs (such as safety, pain, toileting, or hunger/thirst)
• Difficulty exchanging routine information (such as following directions or stating preferences)
• Difficulty functioning at level of independence expected for age (such as doing homework or household chores)
• Difficulty engaging in social interactions; risk for frustration or depression
• Difficulty meeting educational potential; loss of previous academic status
• Risk for personal injury due to communication limitations

Behaviors1 That Should Trigger an SLP Referral
Receptive language

By 2 years* does not
• identify basic body parts
• understand simple commands like “give me” without gestures
• demonstrate action words (e.g., eat)
By 4 years* does not
• understand comparisons
• make inferences
By 5 years* does not
• understand complex directions
• understand concepts
School-age receptive language/learning
• difficulty understanding teacher’s instructions and class discussion; following directions/rules; comprehending conversation and/or movies; differentiating between sound and/or words and relating them to meaningful information
• difficulty with reading comprehension across subjects, particularly abstract material with complex grammatical structure, and technical vocabulary; differentiating between letters and/or words and learning the meaning of visual symbols
• difficulty in mathematical reasoning, learning numbers, and/or understanding numeric concepts and applications
Receptive language with recent decline in function
• exhibits sudden or significant gradual loss in ability to understand and/or respond to oral and/or written language
• exhibits fluctuations in ability to understand and/or respond to language (e.g., 3-year-old may respond to simple questions most of the time but have difficulty during recurring periods of days or weeks)
1Behaviors are clustered to indicate different levels of function and/or patterns commonly associated with different medical conditions or etiologies.

Expressive language

By 2 years* does not
• refer to self by name
• speak using 1–2 words at a time (e.g., “Dan hat”)
• use new words frequently; use at least 50 words
By 2½ years* does not
• respond to hello and/or bye-bye consistently
• use short sentences (e.g., “Daddy go bye-bye”)
• name one color
By 3 years* does not
• relate experiences verbally
• state own first and last name
• count to 3
By 4 years* does not
• use short but grammatically correct sentences
• speak abstractly
By 5 years* does not
• use complex sentences
• explain how to do something
• respond to “why” questions with a reason
School-age expressive language/learning
• difficulty learning appropriate word production and usage, and relationships of words, phrases, and sentences to express needs/desires; may result in frustration or embarrassment
• difficulty with expression affects interactions with peers
• communication intent often misunderstood
• odd/unusual language
– echolalia
– delayed or no response to others
– difficulty using pronouns appropriately
– sounds that are not true words
– immature or inappropriate language in comparison to peers
– one-sided conversations with others
– social isolation/severely reduced interest in communication
• difficulty in oral expression, including appropriate use of words, grammar, and underlying meaning of words to report information, express ideas, and draw conclusions and/or inferences; usually affects social communication, particularly the ability to effectively explain situations and experiences
• difficulty in written expression, including appropriate letter formation, word selection, spelling, grammar, and use of sentences and paragraphs to complete schoolwork
• difficulty in basic reading skills, including the ability to decode letters and words to attain information, draw inferences and conclusions, and make associations, in the school, home, and community
• difficulty with mathematical calculations, including reasoning to perform mathematical applications and equations, money management, measurement and projections, and/or calculations of time
Expressive language with recent decline in function
• sudden loss or significant gradual loss in production of spoken and/or written language