Diagnosis, Management, and Follow-up care for Articulation Disorders

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Protocol for diagnosing, management, and follow-up care of Growth and Development and psychosocial issues

Pediatric patients are subject to several growth and development issues that require an early diagnosis and management. The pediatrics grows from infancy to adolescence and suffers from growth and development and psychosocial issues that arise. It is important for an advanced practice nurse to care for the patients by recognizing the red flags and selecting age-appropriate assessment and treatment options. The essay helps to design an age-specific protocol for the diagnosis, management and follow-up care for a 36-month-old toddler with delayed articulation. Also included is a reflection of how culture impacts the care of the patients that have the disorder.

Articulation disorder is a severe form of growth and developmental issue that involves speech and language disorders. The children with articulation disorders are likely to delete some sounds, substitute some sounds, add some sounds, or distort some sounds. There are individual sounds that develop by age, and if not developed by the expected age, the child is likely to have an articulation disorder. At age 3 (36 months), children should be able to pronounce the sounds h, w, n, b, p, and f. Children begin to develop the language skills from birth because they listen and attempt to produce some sounds which later become meaningful.

The prevalence for language delay in children aged two to seven years of age ranges from 2.3 to 19 percent. The severe speech and language disorders in the young children affect their later educational achievement regardless of an intervention. Several studies show that the children with speech and language problems at age two to five have increased the difficulty in reading. By the first grade, an estimate of 5 percent of children has noticeable speech disorders, and there is an estimate that more than 3 million Americans stutter (Shetty, 2012).

Diagnosis, Management, and Follow-up care

The history and the physical examination of the child are important in the evaluation of the child with a speech delay. The physician checks at the nature of babbling by the age of 12 to 15 months, not able to understand simple commands by the age of 18 months, not talking by the age of 2 years, and not making sentences by the age of 3 years. The assessment for speech and language disorder involves several approaches and uniformly accepted screening tests for the primary care setting. The diagnosis involves the use of parent questionnaires, ages and stages questionnaires, and the Denver developmental screening test (Dodd, 2013). The utilization of the early language milestone scale tool helps to assess the language delay for the children younger than three years of age. The test has a focus on the expressive, receptive, and the visual language. The early language milestone scale helps the clinicians to implement the need to address the developmental needs of children from birth to age 3. The test has different items arranged regarding auditory expression, auditory receptive, and visual. The children with speech disorder are referred for audiometry in which tympanometry is a useful diagnostic tool (Shetty, 2012).

After diagnosis, it is necessary to have a management plan which ought to be individualized. The plan involves the engagement with a language pathologist, an audiologist, an occupational therapist, as well as a social worker. The goal is to teach the child the strategies applicable in comprehending the spoken language and generating linguistic and communicative behavior (Dodd, 2013). The speech-language pathologist helps the parents learn the ways of encouraging and improving the communicative skills of the child. Psychotherapy helps the autistic children to have speech acquisition and also have behavior therapy. Speech therapy can occur in various settings that include speech and language specialty clinics, home, school, and the classrooms. The direct therapy is given by the clinician, the caretaker, and the teacher is child-specific and includes naming objects, modeling, reading, and conversations (Bishop & Leonard, 2014).

The follow-up care for the child with articulation disorders requires that the child goes o the physician for a review of the progress with the parents. It is helpful to focus on the positive changes made by the child since a previous visit and not only recording the current status of the child based on the age. The follow-up care also focuses on advising the parents what to do to help the child that includes recommending books for them to read (Bishop & Leonard, 2014).

Reflection of the impact of culture to care for patients with articulation disorders

It is likely that culture impacts the care of the patients who present with the growth and development issues. Articulation disorders and culture have a close association in which the culture has a significant effect on the perceptions and subsequent handling of persons with language and speech disorders. There is a correlation between the cultural beliefs and language and speech disorders in which some cultures ignore the management procedures of language and speech disorders. There is a predictable cultural diversity in the language acquisition in which the language and speech skills of children are affected by the cultural beliefs, family values, and experiences. The sounds that a child acquires are determined by the language the child is exposed. Thus, the culture has a significant impact on the natural order of language acquisition and development.


Bishop, D. V., & Leonard, L. (2014) Speech and language impairments in children: Causes,          characteristics, intervention, and outcome. Psychology press

Dodd, B. (2013). Differential diagnosis and treatment of children with speech disorder; John        Wiley &Sons

Rockhill, C., Kodish, I., DiBattisto, C., Macias, M., Varley, C., & Ryan, S. (2010). Anxiety          disorders in children and adolescents. Current Problems in Pediatric and Adolescent     Health Care, 40(4), 66–99.

American Academy of Pediatrics, Committee on Psychosocial Aspects of Child and Family         Health and Task Force on Mental Health. (2009). The future of pediatrics: Mental health      competencies for pediatric primary care. Pediatrics, 124(1), 410–421. Retrieved from             http://pediatrics.aappublications.org/content/124/1/410.full.pdf+html?sid=b8a3f390-         00f6-472c-a9ed-a8dc1c650ed3

Shetty, P. (2012). Speech and language delay in children: A review and the role of a pediatric      dentist. Journal of Indian Society of Pedodontics and Preventive Dentistry, 30(2), 103

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