Feldman Heidi M
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
Pediatr Rev. 2019 Aug;40(8):398-411. doi: 10.1542/pir.2017-0325.
Pediatric clinicians are on the front line for prevention of language and speech disorders. This review uses prevailing theories and recent data to justify strategies for prevention, screening and detection, diagnosis, and treatment of language and speech disorders. Primary prevention rests on theories that language learning is an interaction between the child's learning capacities and the language environment. Language learning occurs in a social context with active child engagement. Theories support parent education and public programs that increase children's exposure to child-directed speech. Early detection of delays requires knowledge of language milestones and recognition of high-risk indicators for disorders. Male sex, bilingual environments, birth order, and chronic otitis media are not adequate explanations for significant delays in language or speech. Current guidelines recommend both general and autism-specific screening. Environmental and genetic factors contribute to primary language and speech disorders. Secondary and tertiary prevention requires early identification of children with language and speech disorders. Disorders may be found in association with chromosomal, genetic, neurologic, and other health conditions. Systematic reviews find that speech-language therapy, alone or in conjunction with other developmental services, is effective for many disorders. Speech-language interventions alter the environment and stimulate children's targeted responding to improve their skills.
儿科临床医生处于预防语言和言语障碍的第一线。本综述运用主流理论和最新数据，为语言和言语障碍的预防、筛查与检测、诊断及治疗策略提供依据。一级预防基于这样的理论，即语言学习是儿童学习能力与语言环境之间的相互作用。语言学习发生在儿童积极参与的社会环境中。这些理论支持对家长的教育以及增加儿童接触儿童导向性言语的公共项目。早期发现发育迟缓需要了解语言发展里程碑并识别障碍的高危指标。男性、双语环境、出生顺序和慢性中耳炎并不能充分解释语言或言语的显著延迟。当前指南推荐进行常规筛查和自闭症专项筛查。环境和遗传因素导致原发性语言和言语障碍。二级和三级预防需要早期识别患有语言和言语障碍的儿童。这些障碍可能与染色体、遗传、神经及其他健康状况相关。系统评价发现，言语治疗单独使用或与其他发育服务相结合，对许多障碍有效。言语干预改变环境并刺激儿童做出有针对性的反应，以提高他们的技能。
