Thursday, July 15, 2010
Speech delays in children do not necessarily mean autism

By Dr. Anthony Policastro I frequently see patients who come in with a complaint about speech delay. In most cases, the child is about two years of age. When they arrive, the complaint is usually that they are only saying a few words. While the complaint may be the same, there are several different types of delays. The first are the children who begin saying words late. Instead of starting at 12 months, they started at 18 months. Between 18 and 24 months their vocabulary has gradually increased. These children have a delay in starting speech but then follow a normal pattern. They will usually do fine and just need to be observed. The second are the children who started saying words at 12 months. They continued learning new words until about 18 months. Progression stopped and they need to be evaluated. They need a hearing test done because they might have fluid behind their eardrum interfering with hearing. They also need to be evaluated by a speech therapist. The third are the children who started saying words at 12 months. By 24 months they have only learned a few words. They too need to have the same evaluation as those who stopped learning new words. The fourth are the children who began saying words at 12 months. However, at some point they no longer learned new words. They then began forgetting words that they already knew. This is very rare. It usually suggests the need for a full pediatric evaluation to make sure that there are not other areas that have regressed as well. In addition to the questions about speech itself, there are other important questions at this age. Many of them involve asking about symptoms of autism. While there is speech delay in autism, that is only one symptom. For that reason, speech delay does not usually mean autism. Speech delay is not the only speech problem exhibited by autistic children. They may say things that they hear over and over and use words or phrases repeatedly. This overuse will be so severe that it bothers others around them. There are two other groups of symptoms that must be present to make the diagnosis of autism. One of those is a problem with social behavior. These children do not like to play with other children and they do not interact well with family members. They are not affectionate. Many other social related symptoms can be present. The other group of symptoms is called stereotypic behavior. These children have rituals that they follow. They may line their toys up in a certain way and they don't like it if someone interferes. They may open and close doors for hours at a time and turn light switches on and off for extended periods of time. I will have parents come see me with a child who has none of these other symptoms. However, the parents are concerned about autism simply because of the speech delay. I sometimes will not see children with speech difficulties until they are three years of age. By three years of age children should be talking in sentences. The first part of the evaluation is the same as for those seen at age two years of age. We need to know if there is normal progression or not. We need to know if speech stopped at some point and if it has regressed. The big difference when they hit age three is related to the evaluation. Before age three the State program, Child Development Watch, does the evaluation and they will refer the child to a speech therapist if necessary. After age three, the local school district does the evaluation and any necessary speech therapy. Most parents do not realize that they can get help from the schools at this point because they don't think their child is old enough. While many children seem to have speech delays, there are a lot of different aspects to these delays. How we handle the delay depends on the story and other factors.

Nanticoke among top hospitals Nanticoke Memorial Hospital has been recognized with a 2009-2010 Hospital Value Indexª: Best in Valueª Award, from Press Ganey Associates. Nanticoke Memorial Hospital ranked among the top tier of all hospitals nationwide, achieving high marks in quality, affordability and efficiency, and patient satisfaction. The Hospital Value Indexª is the first and only performance indicator to focus on the value hospitals provide to their community and utilizes the latest publicly available data, including Hospital Compare from July 2009, to recognize these accomplishments. The Hospital Value Indexª pulled data from approximately 4,500 general acute-care hospitals, serving approximately 30 million consumers.

The full study and list of findings can be found at

Family caregiver training The Alzheimer's Association, Delaware Valley Chapter, sponsors The Family Caregiver Education Series four times a year in each of Delaware's three counties. Cadbury of Lewes, at 17028 Cadbury Circle in Lewes, will host the training on Wednesday, July 28, from 8 a.m. to 4 p.m. This training for family caregivers is free and lunch will be provided by Cadbury of Lewes, therefore pre-registration is required by July 21. For more information or to register, call Jamie Magee, branch office coordinator, at 854-9788 or 1-800-272-3900.

Healthy recipes contest Nanticoke Memorial Hospital and the Western Sussex Farmers Market are looking for your heart healthy recipes that use local seasonal produce. Submit your heart healthy recipes for a chance to win. On Saturday, Aug. 21 at 10 a.m., three entries will be prepared and shared at the Western Sussex Farmers Market (located at the Western Sussex Boys & Girls Club) and will win a Nanticoke Memorial Hospital gift basket. Each recipe must: 1.Be your own original creation and not based on any other published recipe. 2.Include a list of all required ingredients including measured amounts (teaspoons, tablespoons, cups, etc.) 3.Include preparation and cooking instructions including cooking times and temperatures. 4.Include the number of servings per recipe. 5.Include at least one selection of local fresh seasonal produce. 6.Be a recipe easily reproducible by others. All recipes will be evaluated on originality, use of seasonal produce, being "heart healthy," texture, visual appearance and taste. Submission deadline is July 31. For complete contest rules, e-mail, visit, or call 629-6611, ext. 8948.

Cancer support group at Nanticoke The Wellness Community-Delaware offers a General Cancer support group for people affected by cancer and their loved ones at Nanticoke Memorial Hospital in Seaford. The support group meets in the second floor conference room of the Cancer Care center on the third Monday of each month from 4:30 to 6 p.m. The next meeting is July 19. The Wellness Community is dedicated to helping people affected by cancer enhance their health and well-being through participation in a professional program of emotional support and hope. Facilitators are trained mental health professionals with a master's degree or more. For more information or to register, call 645-9150. All support groups are free of charge. This program is made possible by the support of the Nanticoke Memorial Hospital in Seaford. For more information, visit

Bereavement support group Compassionate Care Hospice, The Wellness Community-DE and Nanticoke Memorial Hospital will collaborate to present a monthly bereavement group, The Next Step. The group focuses on issues of loss that continue beyond the early stages of grief. Mary Van House, bereavement coordinator, will facilitate the group at 10 a.m. on the third Tuesday of each month, at the Nanticoke Cancer Care Center, second floor conference room. To register, call Lisa at 629-6611, ext. 2378.

Breast cancer support group Delaware Breast Cancer Coalition, Inc. (DBCC) has expanded its Beginning Your Pink Ribbon Journey, a program for women newly-diagnosed with breast cancer, by partnering with Nanticoke Memorial Hospital Cancer Center in Seaford. The free, monthly program is offered at the Cancer Center located at 801 Middleford Road, Seaford, the third Thursday of each month from 3 to 4 p.m. The program is facilitated by Nanticoke Memorial Hospital Cancer Center professional staff - Terri A. Clifton, MS, NCC, Cancer Care coordinator; Mary Brown, RN, DSN, manager Cancer Care Center; and Wendy Polk, nutritionist - with assistance from Lois Wilkinson, DBCC special projects manager, who helps facilitate the program at Bayhealth. Of particular value to newly-diagnosed women is DBCC's Peer Mentor Program through which they are paired with a long-term survivor for one-on-one support. To learn more about Beginning Your Pink Ribbon Journey at Nanticoke Memorial Hospital Cancer Center, call Lois Wilkinson at 672-6435. Registration is required and light refreshments and small gifts are provided.