Screening for communication and cognitive disorders in infants and toddlers

Screening for communication and cognitive disorders in infants and toddlers

Pediatric NursingNov-Dec, 2007   by Frances Scheffler,   Donald Vogel,   Rachel Astern,   Jeanel Burgess,   Tara Conneally,   Kathy Saler

Table 1. Common Conditions Co-Morbid with Language/Cognitive




Condition                      Cognitive Disorder


Congenital, permanent          Language delay, speech

  hearing loss                   disorders

Otitis Media with Effusion     Language delay, speech

  and concomitant conductive     disorders

  hearing loss

Autism                         Language disorder, cognitive


Specific Language              Language disorder

  Impairment (SLI)

  (often familial)

Cranio-facial disorders        Speech disorders, language

                                 disorders, cognitive disorders,

                                 hearing disorders

Cerebral palsy                 Speech disorders, language delay

Poor social conditions         Language delay, language disorder

  (poverty, parental

  substance abuse)

Mental retardation             Cognitive delay, language delay,

                                 speech delays


Table 2. SCCIT Questions, Examples of Tests that Probe with Similar/

Related Questions, Rationale for Inclusion, and Disorder Group(s)

Most Likely to Show This Feature


SCCIT              Tests with          Comments/Rationale

Criterion          Probes              for Inclusion


Is parent          DDST (a);           This question allows

concerned about    Rossetti (b)        parents to express general

feeding, speech,                       concerns. Parents have

hearing?                               been found to reliably

                                       identify problems in their

                                       young children (Rosetti,

                                       1990; Stokes, 1997).

                                       Mothers report concern

                                       over feeding difficulties

                                       in their children with

                                       cerebral palsy (Motion,

                                       Northstone, Emond, &

                                       Stucke, 2002).


Does baby          DDST; MCHAT (c);    Loud sounds should produce

ignore loud        REEL-3 (d);         a startle response in

sounds?            Rossetti            normally developing infants

                                       and in toddlers.


Does baby          DDST                General feeding questions

have difficulty                        may be included in some

swallowing?                            tests  (e.g., Does baby

                                       drink from a cup?).

                                       Swallowing problems can

                                       occur in the first 12 months

                                       of life. Observing feeding,

                                       preferably in the home,

                                       is important (Reilly et

                                       al., 1996).


Is baby overly-    MCHAT; REEL-3;      Hypersensitivity to

sensitive to       Rossetti            auditory stimuli is a

loud sounds?                           symptom of autism and

                                       Williams syndrome (Borsel,

                                       Curfs, & Fryns, 1997;

                                       Klein, Armstrong, Greer,

                                       & Brown, 1990; Koegel,

                                       Openden, & Koegel, 2004).


Is baby quiet      DDST; Rossetti      Babies are expected to

too often?                             gurgle, coo, babble, or

                                       utter other noises besides

                                       crying. Babbling is an

                                       important precursor for

                                       speech development.


Has baby had       Usually included    It is important to pay

3 or more ear      in case             attention to the language

infections         history             development of children

over the last 6    questions: not      with middle ear fluid

months?            included in         because although it is

                   language tests.     not conclusive, some

                                       researchers have found

                                       a negative effect on language

                                       development (Bess, 1985;

                                       Hooper, Ashley, Roberts.,

                                       Zeisel, & Poe, 2006).


Does baby          Quick Screen        Abnormal prosody has been

have an            for Voice           identified as a feature

unusual            Evaluation (e)      of autism (Paul, 2005).

voice?                                 Deficient respiration,

                                       abnormal laryngeal function

                                       can result in voice

                                       disorders in some infants.


Are there          DDST; REEL-3;       Paul (1991) considers

concerns about     Rossetti            children to have a language

how many                               delay if they produce less

words baby                             than 10 intelligible words

says?                                  by age 18-23 months. Parents

                                       have been found to reliably

                                       identify problems in their

                                       young children (Stokes,

                                       1997). Thai and Bates (1988)

                                       consider a language delay

                                       present when no two-word

                                       combinations are used by

                                       18-24 months.


Does baby          MCHAT               Repetitive/stereotypic

finger-fidget                          behaviors involving hand/

for long periods                       finger mannerisms are often

of time?                               found in children with

                                       autism (see Prater & Zylstra,

                                       2002 for a review).


Does baby          MCHAT; DDST;        Children with autism have

look at you as     REEL-3; Rossetti    been found to display less

you talk? Gaze                         eye gaze directed to people

toward an                              (Wetherby, Prizant, &

object you                             Hutchinson, 1998). Joint

point to?                              attention is important for

                                       language development

                                       (Wetherby et al., 1998).


Does baby          MCHAT; DDST;        Children with autism lack

show               REEL-3; Rossetti    symbolic play (Wetherby,

appropriate                            Cain, Yonclas, & Walker,

interest in                            1988). Typically

toys or books?                         developing children are

                                       likely to use joint

                                       attention, behavior

                                       regulation, and social

                                       interaction even in the

                                       prelinguistic stage (Watt,

                                       Wetherby, & Shumway, 2006;

                                       Wetherby et al., 1988). AAP

                                       suggests that a pediatrician

                                       be contacted if a child

                                       does not point to objects

                                       or pictures by 8-12 months

                                       of age.


Does baby          MCHAT; REEL-3;      During the first year of

respond to         Rossetti            life, babies begin to

his/her name?                          respond to their own

                                       name (ASHA, 2007;

                                       NIDCD, 2000).


Does baby          DDST; REEL-3;       Most early speech sounds

make speech        Rossetti            develop directly from

sounds?                                early babbling (Stoel-

                                       Gammon, 1998).


Does baby          MCHAT; DDST;        This represents evidence

understand         REEL-3; Rossetti    of early receptive

you?                                   language development.


Does baby          REEL-3; Rossetti    This should be well

gesture (e.g.,                         established by nine months

“hi”, “bye”,                           of age. Babies who are

“up”)?                                 developing good interactive

                                       skills will show evidence

                                       of interactive gestures.

                                       Babies with poor

                                       interactive skills will



Does baby          REEL-3; Rossetti    This represents evidence of

say 15 or                              the emergence of early

more words?                            expressive language



Are baby’s         REEL-3; Rossetti    Mothers and other caregivers

words understood                       should understand baby’s

most of the                            utterances. A parent’s or

time?                                  caregiver’s difficulty

                                       in understanding baby

                                       suggests atypical speech



Does baby          REEL-3; Rossetti    By 24 months of age, baby

say 50 words                           is expected to have at

or more and                            least 50-word vocabulary

combine                                and combine words

words into                             into short sentences.



SCCIT              Disorder Group Most Likely to

Criterion          Show Deficits in this Feature.)


Is parent          Hearing impairment, physical

concerned about     disability (e.g., cerebral palsy),

feeding, speech,   cognitive delay (e.g., mental

hearing?           retardation), cognitive disorder

                   (e.g., autism)


Does baby          Hearing impairment, cognitive

ignore loud        disorder (e.g., autism)



Does baby          Physical deficits (e.g., cerebral

have difficulty    palsy), cognitive delays (e.g.,

swallowing?        mental retardation)


Is baby overly-    Cognitive disorder (e.g., autism,

sensitive to       mental retardation)

loud sounds?


Is baby quiet      Language delay, cognitive delay

too often?         (e.g., autism), speech delay (e.g.,

                   cerebral palsy)


Has baby had       Speech delay, language delay

3 or more ear


over the last 6



Does baby          Autism, cerebral palsy, traumatic

have an            brain injury, some developmental

unusual            syndromes



Are there          Language delay, language disorder,

concern about      cognitive delay, cerebral

how many           palsy

words baby



Does baby          Autism, hearing impairment


for long

periods of time?


Does baby          Hearing impairment, autism

look at you as

you talk? Gaze

toward an

object you

point to?


Does baby          Autism, mental retardation




in toys or



Does baby          Hearing impairment, autism,

respond to         mental retardation

his/her name?


Does baby          Hearing impairment, language

make speech        delay, autism



Does baby          Hearing impairment, language

understand         disorder, receptive language

you?               delay, cognitive delays,

                   cognitive disorders

Does baby

gesture (e.g.,     Cognitive disorders (e.g.,

“hi”, “bye”,       autism).



Does baby          Late talkers, language disorders,

say 15 or          cognitive disorders, hearing

more words?        impairment, cerebral palsy


Are baby’s         Hearing impairment, speech

words understood   disorders (e.g., cerebral palsy),

most of the        language disorders



Does baby          Hearing impairment, speech

say 50 words       delays and disorders, language

or more and        delays and disorders, cognitive

combine            delays and disorders

words into



(a) DDST: The Denver Developmental Screening Test

(Frankenburg & Dodds, 1975).


(b) Rosetti: The Rosetti Infant-Toddler Language

Scale (Rosetti, 1990).


(c) MCHAT: The modified checklist for autism in

toddlers (Robbins, Fein, Barton, & Green, 2001)


(d) REEL-3: Receptive-Expressive Emergent Language

Scale (3rd ed.) (Bzoch, League, & Brown, 2000).


(e) Quick Screen for Voice Evaluation (Lee,

Stemple, Glaze, & Kelchner, 2004).



Supported  by

Yudhasmara Foundation Indonesia 

JL Taman Bendungan Asahan 5 Jakarta Indonesia 102010

phone : 62(021) 70081995 – 5703646

email :,


Copyright © 2009, Clinical Pediatric Online Information Education Network. All rights reserved.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s