Understanding and recognizing risk factors and clinical clues for communication disorders is an important way to identify children under the age of 3 with possible communication disorders. Some of these risk factors and clinical clues can be identified at a very early age; others are not as apparent and may not be recognized until caregivers or professionals notice that the child's use of language is delayed. In general, risk factors for communication disorders that can be identified early in infancy are those that are closely related to certain biological and social-environmental factors.

The presence of a particular risk factor or clinical clue is not sufficient to establish that a communication disorder exists. Risk factors and clinical clues for communication disorders are sometimes seen in children who are typically developing and do not have a communication disorder. Therefore, recognition of a risk factor or clinical clue is just the first step in the process of identifying children with communication disorders and merely indicates that further assessment is needed.

Table-1:
 

Risk Factors for Speech / Language Problems In Young Children

Prenatal complications

Prematurity*

Microcephaly

Dysmorphic child features

Genetic disorders

Fetal alcohol syndrome

Known exposure to a teratogen

Positive toxicology screen at birth

Ear and hearing problems (See Table III-2)

Oral-motor or feeding problems (See Table III-3)

Cleft lip/cleft palate

Tracheotomy

Autism (See Table III-4)

Persistent health/medical problems, chronic illness, or prolonged hospitalization

History of intubation

Lead poisoning

Failure to thrive

Family history of hearing or speech/language problems

Parents with hearing impairment or cognitive limitation

Children in foster care

Family history of child maltreatment (physical abuse or child neglect)

* The more premature the birth and the more complicated the perinatal course, the greater the risk is for communication disorders and other developmental problems.

Table-2:
 

Risk Factors for Hearing Problems in Young Children

Family history of hereditary childhood sensorineural hearing loss

Congenital infections known to be associated with hearing loss

Craniofacial anomalies

Birth weight less than 1,500 grams

A genetic syndrome known to include hearing loss

Low Apgar Scores (0-4 at one minute or 0-6 at five minutes)

Hyperbilirubinemia requiring exchange transfusion

Ototoxic medications

Bacterial meningitis

Mechanical ventilation for five days or longer

Recurrent or chronic otitis media with effusion

From: Joint Committee on Infant Hearing, 1994

Table -3:
 

Risk Factors And Clinical Clues For Oral-motor/Feeding Problems in Young Children

Craniofacial disorders or syndromes (of the head and neck)

Cleft lip/cleft palate

Tracheotomy

Cerebral palsy

Poor weight gain

Prolonged feeding time

Poor suck

Gagging

Excessive drooling

Hyper/hypo sensitivity

Undifferentiated cry sounds

Poor volume or quality of crying

Lack of reciprocal babbling

Reduced vocal play

Failure to thrive

Table-4

Clinical Clues of Possible Autism in Young Children

The clinical clues listed below represent delayed or atypical behaviors that are seen in children with autism (although some of these findings may also be seen in children who have a developmental delay or disorder other than autism).

If any of these clinical clues are present, further assessment may be needed to evaluate the possibility of autism or other developmental disorder.

Delay or absence of spoken language

Looks through people; not aware of others

Not responsive to other peoples facial expressions/feelings

Lack of pretend play; little or no imagination

Does not show typical interest in, or play near peers purposefully

Lack of turn taking

Unable to share pleasure

Qualitative impairment in nonverbal communication

Does not point at an object to direct another person to look at it

Lack of gaze monitoring

Lack of initiation of activity or social play

Unusual or repetitive hand and finger mannerisms

Unusual reactions, or lack of reaction, to sensory stimuli

From: Clinical Practice Guideline for Autism/Pervasive Developmental Disorder, New York State Department of Health, 1999.