Understanding and assessing communicative disorders in children.

The pediatrician is frequently confronted with the problem of diagnosis and treatment of preschool-aged children suspected of having middle ear disease and speech / language impairments. Guidelines for referral of these children (otolaryngologist, audiologist, speech therapist) have not been clearly defined. The use of tympanometry and acoustic reflex testing was described to assist in the diagnosis of middle ear pathology, to provide an objective way to monitor spontaneous or antibiotic-induced remissions and to determine more accurately when a referral for surgical intervention is needed. A 35-item screening test is described, permitting speech and language assessments in the office and quantifying and comparing with age peers: vocabulary, articulation, receptive language and expressive language abilities. These office interventions enhance the physician's ability to judiciously recommend consultations.