J Dev Behav Pediatr. 2021 Aug 1;42(6):512-514. doi: 10.1097/DBP.0000000000000989.
An almost 5-year-old girl is referred to a developmental-behavioral clinician for developmental evaluation because of language and learning concerns. Her developmental screening in the primary pediatrics office showed scores concerning for delays in communication, social-emotional, gross, and fine motor domains. Her mother has concerns about her language. Her mother's primary language is Spanish, but the patient and her siblings speak primarily English. She speaks in short phrases and sentences with grammatical errors. Her mother understands approximately 75% of what she says, and strangers understand approximately 50%. She uses gestures and facial expression, is social and friendly, demonstrates pretend play, and plays well with her siblings and other children her age. She has occasional meltdowns, but there are no other major behavioral concerns. She feeds herself with utensils and is able to dress herself. She toilet trained recently, at about age 4.5 years.She did not receive early intervention before age 3 years and had no previous evaluations. She did not attend preschool or child care. Her mother reported that they were referred to the school district twice, but she had trouble requesting the evaluation.She lives with her parents and 2 brothers. The patient's parents immigrated to the United States from Mexico 7 years ago. They are both farm workers, and extended family members are in Mexico. On reviewing family history, the clinician learns that the patient's mother had trouble learning and attended school until she was 12 years old. She did not receive extra help at school. The child's mother said that she forgets things and "has trouble with reading and writing fast." The patient's 10-year-old brother has an individualized education plan and is in a substantially separate classroom. He has inclusion activities of recess, art, and music. He receives speech-language therapy and academic support for reading and writing. The patient's mother becomes tearful and shares that Child Protective Services was notified because of her inability to request the school evaluation, but a case was not opened.Developmental evaluation reveals expressive language at a 33-month-old level and receptive language at a 39-month-old level. Cognitive testing shows extremely low verbal comprehension, borderline visual spatial skills, and fluid reasoning in the low average range. Working memory and processing speed fall in the borderline range. The clinician learns at a follow-up visit that the patient's mother was evaluated by state disability services and has mild intellectual disability.What is your next step in management? What feedback or resources would you provide to the pediatric clinician and family?
一位将近 5 岁的女孩因语言和学习问题被转介给发育行为临床医生进行发育评估。她在初级儿科诊所的发育筛查显示，在沟通、社会情感、大运动和精细运动领域存在发育迟缓的分数令人担忧。她的母亲对她的语言能力感到担忧。她的母亲的主要语言是西班牙语，但患者和她的兄弟姐妹主要说英语。她用短词组和有语法错误的句子说话。她的母亲大约能理解她所说的 75%的内容，而陌生人大约能理解 50%的内容。她会使用手势和面部表情，善于社交和友好，会进行假装游戏，与兄弟姐妹和其他同龄孩子相处融洽。她偶尔会情绪崩溃，但没有其他重大行为问题。她用餐具自己进食，能够自己穿衣。她最近（大约 4.5 岁时）接受了如厕训练。她在 3 岁之前没有接受过早期干预，也没有接受过之前的评估。她没有上过学前班或托儿所。她的母亲报告说，他们曾两次被学区转介，但她在请求评估时遇到了困难。她和父母以及 2 个兄弟住在一起。患者的父母 7 年前从墨西哥移民到美国。他们都是农场工人，有一些亲戚在墨西哥。在回顾家族病史时，临床医生了解到患者的母亲在学习方面有困难，她一直上到 12 岁。她在学校没有得到额外的帮助。孩子的母亲说她健忘，“阅读和书写速度快时会有困难。”患者 10 岁的哥哥有个别化教育计划，在一个完全分开的教室上课。他有包括课间休息、艺术和音乐在内的融合活动。他接受言语语言治疗和阅读和写作方面的学业支持。患者的母亲泪流满面，并分享说，由于她无法请求学校评估，儿童保护服务机构已收到通知，但未立案。发育评估显示，表达性语言处于 33 个月龄水平，接受性语言处于 39 个月龄水平。认知测试显示，言语理解能力极低，视觉空间技能处于边缘状态，流体推理能力处于中下水平。工作记忆和处理速度处于边缘范围。临床医生在后续访问中了解到，患者的母亲接受了州残疾服务评估，患有轻度智力障碍。下一步管理措施是什么？您将向儿科临床医生和家庭提供哪些反馈或资源？
