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]

SAQ 2 — Red flags, terminology and equity (10 marks)

An 18-month-old in a language-discordant family has few words. Grandmother interprets. Parents report the child “used to say more.” Eye contact is limited and he does not point to share interest. [7] [11] [14]

Questions

1. Which features make this not a routine late-talker pathway? (3 marks) [7]
2. What is DLD in CATALISE terms, and why does terminology matter here? (3 marks) [4]
3. Outline an equitable assessment and referral plan including communication access. (4 marks) [13] [14]

Model answer

1. Not routine late talker (3)

• Possible regression (“used to say more”).
• Social-communication red flags (limited eye contact, no pointing to share).
• Needs urgent branching to medical review + autism identification pathway alongside hearing/SLP — not reassurance. [7] [11]

2. DLD terminology (3)

• CATALISE Phase 2 supports developmental language disorder for persistent language problems affecting function.
• Prefer clear terms over inconsistent older labels; when autism is the primary framework, describe language difficulties in that context rather than forcing an isolated late-talker label. [4]

3. Equity plan (4)

• Book professional interpreter for history and counselling; do not rely on grandmother alone.
• Concurrent audiology, SLP, and autism-specific screening/evaluation pathway as indicated.
• Early intervention referral; written plan in preferred language where possible.
• Closed-loop follow-up with named review date and safety-net. [11] [13] [14]