Speech and language delay — formative SAQs

SAQ 1 — Classification and first-line pathway (10 marks)

A 26-month-old boy is brought because he says fewer than ten words. He points to request, brings toys to share, and follows simple one-step instructions at home. Newborn hearing screening passed. There is no regression. Mother is worried; a relative said to wait until three. ^{[1] [2]}

Questions

1. Distinguish speech, language and social communication using this child’s presentation. (3 marks) ^[1]
2. List mandatory and high-yield next management steps in the medical home today. (4 marks) ^{[1] [2] [7]}
3. Explain why pure wait-and-see until age three is not an adequate plan. (3 marks) ^{[1] [2]}

Model answer

1. Distinctions (3)

• Speech: sound production/intelligibility — limited data here beyond few words.
• Language: meaning — expressive vocabulary is limited; receptive skills appear relatively stronger if instructions are followed.
• Social communication: use with people — pointing and sharing toys suggest social intent is present, lowering (not excluding) autism concern compared with absent joint attention. ^[1]

2. Today’s steps (4)

• Full developmental history including languages at home and red flags.
• Formal audiology despite passed newborn screen (hearing can change; clinic noise tests are inadequate).
• Speech-language pathology referral; consider early intervention entry by age/local rules.
• Parent coaching on contingent talk; document timed review and safety-net for regression.
• Concurrent, not serial, referrals. ^{[1] [2] [7] [13]}

3. Against pure wait-and-see (3)

• Cannot reliably predict which late talkers persist.
• Missed hearing or other causes cost intervention time.
• Caregiver concern plus clear expressive lag meets action thresholds in primary-care frameworks; supports can run while monitoring. ^{[1] [2]}