50 Years Ago in The Journal of Pediatrics:

Article Outline

• Copyright

Lehrohoff I. J Pediatr 1958;52:91-5

In his 1958 article, Irwin Lehrhoff discusses the classification and etiology of common forms of speech difficulties and recommends intervention in most cases by 4 years of age. He dismisses notions that children outgrow speech difficulties and emphasizes the long-term emotional and social insecurities that accompany the lack of constructive intervention by peers, siblings, parents, and speech therapists.

Since that time, pediatricians have become increasingly aware of clinical studies demonstrating that intervention is critical before 3 years of age to prevent lifelong deficits in speech and language acquisitions and the associated emotional and social stigmas. These studies indicate that extensive intervention with older children improves cognitive and developmental outcomes; however, outcomes are profoundly enhanced with earlier recognition and commencement of therapy. Toward this end, most newborns are now screened for common causes of speech difficulties (and other disorders) with a view to intervention by 6 months of age. Passage of Public Law 99-457 in 1986, revised in 1990 as the Individuals with Disabilities Education Act (IDEA), provides access to federally-funded early intervention programs that optimize a child’s potential.

Availability of the internet as a resource to both families and physicians serves as a major contributor to both the awareness of, and access to, pediatric healthcare and provides guidelines, policies, benchmarks, and therapy recommendations. Developmental screening programs and referral guidelines have become important components in training programs for care providers. Recognition that language disorders involve hearing impediments, language processing or expression, stuttering, and autism has culminated in the implementation of neonatal screening programs at most hospitals and subsequent assessment at each well visit.

Despite these marked improvements over 50 years, many physicians continue to use informal subjective impressions to evaluate childhood speech development and tend to allay parent’s concerns with reassurances and delays in lieu of testing and intervention. Implementing standardized screening and follow-up for speech and hearing difficulties is paramount to objective assessment of childhood development and ensures referral and treatment as early as possible. Finally, mandating neonatal screening programs by all State Legislatures will ensure the necessary government funding.