IndoJPMR Vol.
13 - 2nd Edition - December 2024 | ORIGINAL ARTICLE Speech and language delay in Children:
Effects of medical and nonmedical Risk Factors Ika Rosdiana1.
Tanti Ajoe Kesoema2.
Henny Rio3.
Dinar Widanarti4 Ika Rosdiana.
Department of Physical and Rehabilitation Medicine Faculty of Medicine Universitas Islam Sultan Agung Semarang.
Islamic Sultan Agung Hospital Semarang.
Indonesia Tanti Ajoe Kesoema.
Department of Physical Medicine and Rehabilitation.
Faculty of Medicie Universitas Diponegoro.
Nasional Diponegoro Hospital.
Semarang.
Indonesia Henny Rio.
Department of Physical and Rehabilitation Medicine.
Wamena General Hospital.
Jayawijaya Wamena Papua Pegunungan.
Indonesia Dinar Widanarti.
Department of Physical and Rehabilitation Medicine.
General Hospital Gunawan Mangunkusumo Ambarawa.
Indonesia
ABSTRACT
Introduction: Speech and language delayed is defined as a childAos speech which is difficult to comprehend and fail to demonstrate language development equal as his/her chronological age.
It is characterized by sound patterns productions which are inappropriate for his age.
Children with speech delayed have a higher risk of experiencing social, emotional, behavioral, and cognitive problems in adulthood.
Previous research has shown that from 2.
3% to 19% of children aged 2-7 years, are estimated to have speech The purpose of this study was to know the effect of parentsAo education level on speech delayed incidence in childern and analyze the risk factors that might affect it.
Methods: The study was a cross sectional design with a total of 95 children aged 2-7 years who came to the Medical Rehabilitation Installation, 51 children with speech delayed and 44 normal speech children as controls.
Results: This study found that there was no statistical relationship between parentsAo education level and the incident of speech delayed in children according to the fatherAos education level p = 0.
151 and the motherAos education level p = 0.
There was a statistically significant association between history of asphyxia .
= 0.
, comorbid presence .
= < 0.
, noise exposure .
= 0.
and lack of stimulation .
= <0.
on speech delayed in children.
Conclusion: there is no relationship between parentsAo education level and speech delayed in children.
Some medical factors such as history of asphyxia and presence of comorbidities have a significant influence as mush as non-medical or environmental factors such as noise exposure in household environment and lack of stimulation in communication.
Keywords: Speech delayed, parentsAo education level, risk factors.
| IndoJPMR Vol.
13 - 2nd Edition - December 2024
ABSTRAK
Latar Belakang: Keterlambatan bicara dan bahasa didefinisikan sebagai gangguan bicara seorang anak yang sulit dipahami dan kegagalan anak dalam menunjukkan perkembangan bahasa sesuai usia kronologis dan ditandai dengan pola suara bicara yang tidak sesuai untuk anak seusianya.
Anak-anak dengan keterlambatan bicara memiliki risiko lebih tinggi mengalami masalah sosial, emosional, perilaku, dan kognitif di masa Penelitian sebelumnya telah menunjukkan bahwa antara 2,3% dan 19% anak-anak berusia 2-7 tahun diperkirakan mengalami keterlambatan bicara.
Tujuan dari penelitian ini adalah untuk melihat pengaruh antara tingkat pendidikan orang tua terhadap keterlambatan bicara dan bahasa pada anak dan untuk menganalisis faktor risiko yang dapat mempengaruhi keterlambatan bicara dan bahasa pada anak.
Metode: Desain penelitian ini adalah cross sectional dengan total 95 anak usia 2-7 tahun yang datang ke Instalasi Rehabilitasi Medik, 51 anak mengalami keterlambatan bicara dan bahasa dengan 44 anak yang tidak mengalami keterlambatan bicara sebagai kontrol.
Hasil: Hasil penelitian ini menemukan bahwa tidak ada hubungan statistik antara tingkat pendidikan orang tua dengan keterlambatan bicara dan bahasa pada anak, baik tingkat pendidikan ayah p=0,151 maupun tingkat pendidikan ibu p=0,660.
Terdapat hubungan yang signifikan secara statistik antara riwayat asfiksia .
=0,.
, adanya komorbid .
=< 0,.
, paparan kebisingan .
=0,.
dan kurangnya stimulasi .
=<0,.
terhadap keterlambatan bicara dan bahasa pada anak.
Kesimpulan: Tidak ada hubungan antara tingkat pendidikan orang tua dengan keterlambatan bicara dan bahasa pada anak, faktor medis yang berpengaruh adalah riwayat asfiksia dan adanya komorbiditas, sedangkan faktor lingkungan non-medis yang berpengaruh adalah paparan kebisingan di lingkungan tempat tinggal dan kurangnya stimulasi pada anak.
Kata kunci: Speech delay.
Tingkat pendidikan orang tua, faktor risiko.
INTRODUCTION
Correspondent Detail:
Ika Rosdiana Department of Physical and Rehabilitation Medicine Faculty of Medicine Universitas Islam Sultan Agung Semarang.
Islamic Sultan Agung Hospital Semarang.
Indonesia Email: ikadrkfr@unissula.
Language and speaking development are very important skills for preschoolers.
Language is a form of symbols that children use to communicate and adapt to their environment.
It involves cognitive, emotional, social, and environmental development, which is crucial for childrenAos future.
Speech and language delay is defined as a childAos speech that is difficult to comprehend and fails to demonstrate language development equal to his/her chronological age.
It is characterized by inappropriate sound pattern productions for IndoJPMR Vol.
13 - 2nd Edition - December 2024 | his age.
2 Naturally, children learn their native language through exposure to the spoken languages around them without requiring special instruction or stimulation.
Speech and language were developed through their ability to hear, see, understand, remember, and interact with others 3.
Children with speech and language delays have a higher risk of experiencing social, emotional, behavioral, and cognitive problems in adulthood.
There is an assumption that speech and language delays happen in the family and are not a severe problem.
intervention for speech and language delays and his parents is very important in language This interaction is reciprocal, where both parties initiate and respond to each other in communication.
Parents naturally imitate the sounds made by their babies and alternate making cooing .
uch as Augu-guA.
and babbling .
uch as Auma-maA.
Parents also talk to their babies in a way that helps them learn language.
Babies learn language from parents and family members around them through constant exposure and interaction.
Parents unconsciously teach and reinforce their childrenAos speech.
6 The learning environment at is often delivered too late.
Previous research has shown that in the range of 2.
3%-9% of children aged 2-7 years are estimated to have speech and language delayed.
home is not only shaped by direct interaction between parents and children, but also by facilities and atmosphere at home that encourage childrenAos enthusiasm for learning.
Four aspects of language development involving parent-child interaction, the first is the duration of interaction between parents and children, the second is the response to the childAos speech and language, the third is the amount and quality of linguistic .
input provided by parents, and the fourth is the use of language learning strategies by parents.
Thus, parental involvement is very important in childrenAos growth and development, including language development.
There are many risk factors that might affect speech and language delays.
Some of them are gender, premature birth, genetic factors, autism, mental disabilities, chromosomal abnormalities, hearing disease, attention deficit disorder, and hyperactivity.
Environmental factors, including poverty or disruption of social communication between parents and children, watching TV, and using gadgets, also have been considered to have a role in developing the disorder.
4 It is recommended that children should undergo a developmental screening to determine whether they have speech and language delays and possible hearing loss.
The latency in diagnosis and management in children with speech and language delayed might cause impairments in cognitive which leads to low intelligence (IQ), difficulty in communication, and illiteracy.
Parents are the prior role models of their The interaction between a child Higher parentsAo education level is correlated with improved language skills in children.
Previous research has suggested that early childhood development delayed, particularly in language and social skills, are linked to parentsAo education levels.
9 However, much remains unknown about the mechanisms underlying this relationship.
The specific factors in parentsAo education level that contribute to a childAos language development are not yet fully understood.
Recognizing | IndoJPMR Vol.
13 - 2nd Edition - December 2024 these risk factors as soon as possible is critical to detecting and treating speech and language delays as quickly as possible.
Early detection and intervention might reduce the negative impact of speech and language delays on childrenAos activities, including in the social, behavioral, emotional, educational, and occupational areas.
10 In previous research, early intervention by families was shown to be effective.
This intervention can improve the language and communication skills of early Thus, it can be used as a reference for clinical treatment.
It was also found that Speech and language delay is one of the most common developmental problems in early childhood.
This might have an impact on childrenAos communication skills, social interaction, and learning development.
Factors that can cause speech and language delays, as stated before are vary.
One of which is parentsAo education level and some other risk factors in the child himself.
This study aims to analyze the effect of parentsAo education on speech and language delayed in children, identify the risk factors associated with speech and language delayed and develop a risk prediction model parentsAo affection for the fetus during the prenatal period reduces problems in preschool This explains the strong influence of childrenAos behavior education by the family.
based on parentsAo education and risk factors in Speech and language delays might influence childhood social, emotional, and academic While on the other hand, socialemotional behavior also significantly affects the development of children with speech and language delays.
Children with speech and language delays need appropriate intervention programs supported by their families and surrounding environment.
The importance of holistic treatment should pay attention to language, social-emotional, and environmental Children with speech and language delays are more likely to have difficulty in school and have problems with social relationships.
Previous research has found the way mothers implement literacy practices in preschoolers, as well as the home learning environment, has a major influence on early childhood language and literacy development.
METHODS
This research used a quantitative research design with a cross-sectional approach.
The population was all pediatric patients aged 2-7 years who were diagnosed by physical medicine and rehabilitation specialists as children with speech and language delays at the Medical Rehabilitation Installation of four hospitals who were willing to be involved in this research with a large sample size using total sampling techniques, the number of children who experience speech and language delays and their children without speech and language delays during the period January-March 2024.
The research instrument used a questionnaire containing questions about the characteristics of the respondentAos data and postnatal risk factors up to the current age .
nder 7 year.
The risk factors analyzed include medical risk factors, including a history of persistent otitis media, history of seizures, history of asphyxia, low birth weight, prematurity, neonatal IndoJPMR Vol.
13 - 2nd Edition - December 2024 | jaundice, and other comorbidities .
erebral palsy.
ADHD.
Down Syndrom.
, family risk factors include multilingual use.
more than two languages, previous history of children with speech and language delay, multiparity of children over 3, divorce of parents, and last education of father and mother.
Environmental risk factors include noise of more than 65 dB.
There are five noise zones: Zone A with 3545 dB indicating a quiet environment.
Zone B with 45-55 dB representing residential areas.
Zone C with 55-65 dB for markets, offices, or continuous noise, and 65-75 dB well as interviews regarding postpartum risk The risk factors analyzed areAidata analysis using statistical test correlation of Spearman rank with cross-sectional study To examine the relationship between two categorical variables, namely parental education and speech and language delay, to determine the effect of parental education on speech and language delay and risk factors that affect speech and language delay.
This research has gone through analysis and review from the Bioethics Commission for Medicine/Health Research.
Faculty of Medicine.
Sultan Agung for continuous machine and factory noise, and lack of stimulation is an environment that stimulates the development of speaking and language skills can mean that the child does not receive enough quality verbal interaction, such as regular conversations, storytelling, or active responses from parents and their surroundings.
arents or caregivers who are quiet and never Data collection techniques include checking weight, height, head circumference, and interviews regarding postpartum risk The risk factors analyzed are Data collection techniques, including checking weight, height, and head circumference, as Islamic University.
Semarang and received approval with number No.
47/I/2024/Bioethics Commission RESULTS From a total sample of 95 children aged 2-7 years came to the Medical Rehabilitation Installation during the study who met the inclusion and exclusion criteria, there were 51 children who experienced speech and language delay and 44 children who did not experience speech and language delay.
Table 1.
Data demographic Age .
Gender Weight Loss .
Body Height .
Head circumference .
Boys Girl Speech and language delay .
06 A 15.
88 A 6.
66 A 10.
96 A 2.
Control .
84 A 15.
18 A 5.
15 A 11.
29 A 2.
| IndoJPMR Vol.
13 - 2nd Edition - December 2024 From the group of children with speech and language delay and the control group, data characteristics were obtained that children with speech and language delay who came were, on average, 47.
06 months A 15.
younger than children who did not experience speech and language delay who were on 84 months A 15.
The speech and language delay and control groups were mostly boys.
Thus, the weight, height, and head circumference of children with speech and language delays are lower than those who do not have speech and language delays.
Table 2.
Comparison of ParentsAo Education Levels among groups Speech and language delay and Control groups Speech and language delay n=51 Control n=44 Elementary School p= 0.
Junior High School 8 .
Senior High School 18 .
Higher Education 25 (.
Elementary School 1 .
Junior High School 5 .
Senior High School 14 .
Higher Education 31 .
Education factors FatherAos last education MotherAos last education Data was obtained that the most education of both parents in the study and control groups was Higher Education.
The results of the chisquare statistical test with Pearson obtained a value of p = 0.
151 and p = 0.
660, showing no significant relationship between the fatherAos education and speech and language delay in This means that the fatherAos education level has no influence on the likelihood of the p= 0.
child experiencing speech and language delay.
Meanwhile, the value of p = 0.
660 indicates that there is no significant relationship between maternal education and speech and language delay in children.
This means that the motherAos education level has no influence on the likelihood of the child experiencing speech and language delay.
IndoJPMR Vol.
13 - 2nd Edition - December 2024 | Table 3.
Comparison of Medical Risk Factors among groups Speech and language delay and Control groups Faktor Speech and language delay n=51 Control n=44 Otitis media persists 2 .
p= 0.
History of seizures 15 .
p= 0.
History of Asphyxia 14 .
p= 0.
Low Birth Weight 16 .
p= 0.
Premature Birth 8 .
p= 0.
Icteric Neonatorum 15 .
p= 0.
Cerebral Palsy 3 .
Autism / ADHD 12 .
Down Syndrome 2 .
Comorbid p= <0.
*p value <0.
05 is statistically significant Data obtained that the history of seizures .
= 0.
showed a tendency of possible relationships between history of seizures and speech and language delay.
Although it does not reach statistical significance .
< 0.
, it needs further investigation.
History of Asphyxia .
= 0.
showed a significant relationship between a history of asphyxia in newborns and the incidence of speech and language delay.
Children with a history of asphyxia have a higher risk of speech and language delay.
Low Birth Weight .
= 0.
and Preterm Birth .
= 0.
Although the results for low birth weight and preterm birth did not show a statistically significant association, there was a potential trend for association.
More research may be needed to confirm this with a larger History of persistent otitis media .
= 0.
and history of neonatal jaundice .
= 0.
showed no statistically significant association between persistent otitis media and neonatal jaundice and speech and language The table shows that comorbid has a very statistically significant relationship with speech and language delay in children with p values < 0.
This means that children with Cerebral Palsy.
Autism/ADHD, and Down Syndrome have a higher chance of experiencing speech and language delay | IndoJPMR Vol.
13 - 2nd Edition - December 2024 Table 4.
Comparison of Family Risk Factors among groups Speech and language delay and Control groups Speech and language delay n=51 Control n=44 Multilingual 15 .
p= 0.
Family History with Speech and language 7 .
p= 0.
1-2 children 37 .
3 children 13 .
>3 children 1 .
Divorce 1 .
p= 0.
Separated from Mother 0 .
p= 0.
Separated from Father 5 .
p= 0.
Working Moms 20 .
p= 0.
Factors in the family Number of children in the family Number of Children in the Family .
= 0.
These results indicate a possible trend in the relationship between the number of children in the family and speech and language delay.
Children in larger families may have a slightly increased risk of experiencing speech and language delays.
However, more research is needed.
Multilingualism .
= 0.
showed no significant association between multilingual use at home and speech delay.
Family History with Speech and language delay .
= 0.
p= 0.
showed that there was no significant association between family history and speech and language delay.
Marital Status of Parents with the occurrence of divorce .
= 0.
, separated from the mother .
= 0.
, separated from the father .
= 0.
) showed no significant relationship between divorce, separation from the mother, separation from the father and speech and language delay in children.
Mothers who worked outside the home .
= 0.
also showed no significant association with speech and language delay in children.
Table 5.
Comparison of environmental risk factors in the family among groups Speech and language delay and Control groups Environmental Factors in the family Noise Watch TV/ Gadgets 1-2 hour/day 3-6 hour/day >6 hour/day Lack of stimulation *p value <0.
05 is statistically significant Speech and language delay n=51 9 .
Control n=44 2 .
p= 0.
p= 0.
p= <0.
IndoJPMR Vol.
13 - 2nd Edition - December 2024 | Exposure to noise in the household environment .
= 0.
had a significant relationship with speech and language delay in children.
This showed that children who are often exposed to noise at home have a greater likelihood of experiencing speech and language delayed compared to children who are not exposed to Lack of stimulation .
= < 0.
shows that lack of language stimulation in the family environment has also been shown to have a very significant influence on speech and language delay in children.
Lack of language stimulation can be in the form of minimal verbal although most parents have a higher education and have access to various health resources, there is still a lack of knowledge about childrenAos normal developmental milestones, including speech and language delays.
Therefore, national initiatives are needed to encourage the active role of parents in monitoring their childrenAos growth and development.
interaction between parents and children, lack of storybook reading activities, or the absence of educational games that support childrenAos language development.
TV and Gadgets .
= .
from the results of the analysis showed that there was no significant relationship between the use of TV and gadgets with speech and language delay in children.
as well as five factors that are not statistically meaningful, which include otitis media, history of seizures, low birth weight, premature birth, and history of icteric neonatal.
Infants with ischemic hypoxia accompanied by electrolyte imbalance due to asphyxia in previous studies had a severe risk factor because it affects long-term neurological disorders.
Therefore, asphyxia at birth should be prevented with proper antenatal care and active and timely treatment during delivery.
Effective neonatal resuscitation and rapid correction of electrolyte imbalance might also help.
16 cerebral palsy, and developmental delay.
This study aims to determine the correlation between dyselectrolytemia and the degree of hypoxicischemic encephalopathy (HIE Children with low birth weight and/or asphyxia at birth have a higher risk of promoting developmental disorders (DD).
In that case, monitoring of growth and development in children must be carried out by public health officials.
This can be done directly or by developing outreach strategies, especially in underserved areas of health facilities.
17 In studies associated with IL6 levels, it was found that it was necessary to propose assessment standards for HIE
DISCUSSION
In this study, there was no relationship between parentsAo education level and speech and language delays in children.
More or less, the same thing was found in previous research conducted in Denmark, which concluded that parentsAo education level is less influential than the type of activity.
The study concluded that there were differences in the quality of parental language due to parentsAo education level through storytelling by the parents to their children, especially about parentsAo childhood.
This made children interested and participated in the stimulation process.
There was also no difference in the quality of interaction between mother and father.
14 Another study found that There are seven medical factors studied in this The history of asphyxia and comorbidity are 2 factors that might influence the development of speech and language delays, | IndoJPMR Vol.
13 - 2nd Edition - December 2024 (Hypoxic-Ischemic Encephalopath.
levels and IL-6 (Interleukin-.
levels as potential biomarkers of prognosis for mortality and morbidity due to neonatal asphyxia .
xygen deprivation in newborn.
that potential to experience growth and development disorders in the future due to asphyxia.
In this study, the correlation between comorbidity and speech and language delay has a very strong relationship with a value of p = <0.
While in another previous study, it was found that children with comorbid ASD (Autism Spectrum Disorde.
have a larger temporopolar volume .
rea in the In such conditions, a relationship was found between the severity of symptoms and language skills during the pre-language stage.
Other researchers even found that there were as many as 37 comorbidities associated with speech and language delays in children.
The study used a case-control study to analyze comorbidities in speech and language-delayed children.
The findings support the existence of speech and language-delayed comorbidities and identify new clinical relationship findings.
By recognizing and understanding these comorbidities, we could better understand the processes underlying speech and language delay in children.
The study is also expected to raise clinical awareness of other conditions accompanying language disorders in From non-medical aspects, the family influence has no statistically significant correlation with delayed speech and language.
Previous research has found that most parents know little about their childrenAos developmental Although mothers generally understand developmental stages more than fathers, parents21 are still weak in recognizing childrenAos developmental achievements beyond motor However, parents rarely look for reliable information about childrenAos development stages.
Therefore, increasing parental awareness about the stages of child development is expected to support optimal child growth and development.
22 While other researchers conducted their study about the influence of childrenAos cognition, they stated that a childAos cognitive development begins in the first year and continues to develop Good parenting is important for a childAos cognitive maturity and development.
Positive parenting helps children regulate emotions in dealing with problems.
The non-medical influence speech and language delay were 2 influential factors in the family: noise exposure and lack of stimulation from parents or It was supported by previous studies that observed that higher noise exposure was associated with reduced cortex thickness in the L IFG .
eft inferior frontal gyru.
Although noise exposure affects brain structure, this study did not find a direct relationship between noise and childrenAos language skills.
23 Other environmental factors in this study showed that there was no relationship between the use of gadgets or watching TV on childrenAos speech However, other studies stated that the balance between screen time and other activities, such as face-to-face interaction, is Outdoor play, conversation, book reading, and interactive games are essential to encourage speech development and reduce the negative effects of gadgets.
Involving parents or caregivers in co-viewing might lead children to nice, engaging, high-quality, ageappropriate media experiences that support IndoJPMR Vol.
13 - 2nd Edition - December 2024 | their language development.
The limitation of the study was that a relatively small sample .
children with speech and language delays and 44 children as control.
needed to expand the sample and reduce the bias in this study.
CONCLUSION
In this study, it was found that the level of education of parents did not affect speech and language delays in children.
The risk factors considered to have influenced the disorder were medical factors and nonmedical factors.
The medical factors were a history of asphyxia at birth and the presence of comorbidities (Cerebral Palsy.
Autism - ADHD.
Down Syndrom.
, while nonmedical or environmental factors were noise exposure in the household environment and lack of stimulation in children, which were unsuspected to have a high To manage in time when needed, it is necessary to pay attention to and screen the growth and development of children from newborns and provide adequate stimulation to reduce the occurrence of speech development disorders in children.
ACKNOWLEDGEMENT
Particularly addressed to .
Dean of Faculty of Medicine Unissula and Head of Sultan Agung Islamic Hospital Semarang.
Head of Diponegoro National Hospital.
Head of Wamena Papua Mountain Regional General Hospital and Head of Regional General Hospital dr.
Gunawan Mangunkusumo .
Parents of respondents who have agreed to be interviewed and allow their sons and daughters to be examined.
REFERENCES