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言語発達遅滞(小児科)

著者: 小枝達也 国立成育医療研究センター こころの診療部

監修: 五十嵐隆 国立成育医療研究センター

著者校正/監修レビュー済:2019/12/13
患者向け説明資料

概要・推奨   

  1. 言語発達遅滞の原因を特定することは難しい。
  1. 発語のみの遅れの場合、幼児後半期には追いつくことが多い。
  1. 聴覚障害は言語発達に重大な影響を及ぼす。
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要とな
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要とな
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
小枝達也 : 特に申告事項無し[2021年]
監修:五十嵐隆 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 定期レビューを行い、主に表記と発生頻度・基準について改訂を行った。 

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 子どもはおよそ5歳までに基本的な言語構造を獲得する。それまでの発達過程に問題があった場合に言語発達遅滞が生じ得るが、その原因は多種多様である。
  1. 言語発達遅滞とはコミュニケーション能力が年齢相当の水準に達していない状態を指すが、言語発達は運動発達に比較して個人差が大きく、言語発達遅滞の定義は曖昧である。
  1. 発達過程における一過性の遅延であることもあり、原因疾患、基礎疾患を鑑別できない場合も多い。
  1. 小児科外来において、発達遅滞を示す疾患では言語発達遅滞を主訴とすることが多い。
  1. 言語発達遅滞の原因となる精神遅滞は一般人口あたり約1%で、自閉スペクトラム症も約1%の発生頻度とされる。
 
  1. 言語発達遅滞の原因を特定することは難しい。
  1. 5歳以下の言語発達遅滞児72名に代謝機能検査、遺伝子検査、脳画像検査を施行したが、原因が特定できたのは4%のみであった[1]
 
  1. 聴覚障害は言語発達に重大な影響を及ぼす。
  1. 重度の聴覚障害は、6~7歳において言語発達遅滞をもたらす[3]
問診・診察のポイント  
問診:
  1. 問診では以下の点に着目する。

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文献 

著者: M I Shevell, A Majnemer, P Rosenbaum, M Abrahamowicz
雑誌名: J Pediatr. 2000 Nov;137(5):633-7. doi: 10.1067/mpd.2000.109604.
Abstract/Text OBJECTIVE: To determine the etiologic yield in young children with single domain developmental delay (either developmental language disorder or isolated motor delay) after a specialty diagnostic evaluation.
METHODS: During an 18-month period, all children <5 years of age, who were consecutively referred to pediatric neurology or developmental pediatric clinics at a single tertiary pediatric center, were prospectively enrolled. Etiologic yield was determined after completion of clinical assessments and selected laboratory studies requested by the evaluating physician.
RESULTS: Seventy-two children (60 boys) were found to have a developmental language disorder, and 22 children (11 boys) had isolated motor delay, of whom 6 had an associated diagnosis of cerebral palsy. An etiologic diagnosis was rarely made in the children with developmental language disorder (3/72, 4.1%). Laboratory investigations (metabolic, cytogenetic, imaging), aside from audiometry, were uniformly uninformative. In those children with isolated motor delay, an etiology was apparent in more than half (13/22, 59%). Slightly more than half (7/13, 54%) of etiologies identified in this group were potentially preventable. Successful etiologic determination in children with motor delay often had an impact on recurrence risk estimation, medical management, or specific therapy offered (8/13, 62%). The presence of physical findings on initial assessment was found to be highly predictive of successful etiologic determination in children with isolated motor delay (13/17 vs 0/5, P =.002).
CONCLUSION: Etiologic yield differs substantially according to the subgroup of single domain developmental delay.

PMID 11060528  J Pediatr. 2000 Nov;137(5):633-7. doi: 10.1067/mpd.2000・・・
著者: J Law, J Boyle, F Harris, A Harkness, C Nye
雑誌名: Health Technol Assess. 1998;2(9):1-184.
Abstract/Text
PMID 9728296  Health Technol Assess. 1998;2(9):1-184.
著者: M Wake, Z Poulakis, E K Hughes, C Carey-Sargeant, F W Rickards
雑誌名: Arch Dis Child. 2005 Mar;90(3):238-44. doi: 10.1136/adc.2003.039354.
Abstract/Text BACKGROUND: Better language outcomes are reported for preschool children with hearing impairment (HI) diagnosed very early, irrespective of severity. However, population studies of older children are required to substantiate longer term benefits of early detection.
AIMS: To study impact of age of diagnosis and severity of HI in a population cohort of 7-8 year old children.
METHODS: Eighty eight 7-8 year old children born in Victoria, who were (a) fitted with hearing aids for congenital HI by 4.5 years and (b) did not have intellectual or major physical disability were studied. Main outcome measures were Clinical Evaluation of Language Fundamentals (CELF) and Peabody Picture Vocabulary Test (PPVT). Predictors were pure tone average (0.5, 1, 2 kHz) in better ear at diagnosis and age at diagnosis. Marginal (adjusted) means were estimated with general linear models.
RESULTS: Response rate was 67% (n = 89; 53 boys). Mean age at diagnosis was 21.6 months (SD 14.4); 21% had mild, 34% moderate, 21% severe, and 24% profound HI; mean non-verbal IQ was 104.6 (SD 16.7). Mean total CELF score was 76.7 (SD 21.4) and mean PPVT score 78.1 (SD 18.1). Age of diagnosis, adjusted for severity and IQ, did not contribute to language scores. In contrast, adjusted mean CELF and PPVT language scores fell sequentially with increasing severity of HI.
CONCLUSIONS: More severe HI, but not later diagnosis, was strongly related to poorer language outcomes at 7-8 years. Further systematic study is needed to understand why children with hearing impairment have good or poor outcomes.

PMID 15723906  Arch Dis Child. 2005 Mar;90(3):238-44. doi: 10.1136/adc・・・
著者: C Yoshinaga-Itano, A L Sedey, D K Coulter, A L Mehl
雑誌名: Pediatrics. 1998 Nov;102(5):1161-71.
Abstract/Text OBJECTIVE: To compare the language abilities of earlier- and later-identified deaf and hard-of-hearing children.
METHOD: We compared the receptive and expressive language abilities of 72 deaf or hard-of-hearing children whose hearing losses were identified by 6 months of age with 78 children whose hearing losses were identified after the age of 6 months. All of the children received early intervention services within an average of 2 months after identification. The participants' receptive and expressive language abilities were measured using the Minnesota Child Development Inventory.
RESULTS: Children whose hearing losses were identified by 6 months of age demonstrated significantly better language scores than children identified after 6 months of age. For children with normal cognitive abilities, this language advantage was found across all test ages, communication modes, degrees of hearing loss, and socioeconomic strata. It also was independent of gender, minority status, and the presence or absence of additional disabilities.
CONCLUSIONS: Significantly better language development was associated with early identification of hearing loss and early intervention. There was no significant difference between the earlier- and later-identified groups on several variables frequently associated with language ability in deaf and hard-of-hearing children. Thus, the variable on which the two groups differed (age of identification and intervention) must be considered a potential explanation for the language advantage documented in the earlier-identified group.

PMID 9794949  Pediatrics. 1998 Nov;102(5):1161-71.
著者: Colin R Kennedy, Donna C McCann, Michael J Campbell, Catherine M Law, Mark Mullee, Stavros Petrou, Peter Watkin, Sarah Worsfold, Ho Ming Yuen, Jim Stevenson
雑誌名: N Engl J Med. 2006 May 18;354(20):2131-41. doi: 10.1056/NEJMoa054915.
Abstract/Text BACKGROUND: Children with bilateral permanent hearing impairment often have impaired language and speech abilities. However, the effects of universal newborn screening for permanent bilateral childhood hearing impairment and the effects of confirmation of hearing impairment by nine months of age on subsequent verbal abilities are uncertain.
METHODS: We studied 120 children with bilateral permanent hearing impairment identified from a large birth cohort in southern England, at a mean of 7.9 years of age. Of the 120 children, 61 were born during periods with universal newborn screening and 57 had hearing impairment that was confirmed by nine months of age. The primary outcomes were language as compared with nonverbal ability and speech expressed as z scores (the number of standard deviations by which the score differed from the mean score among 63 age-matched children with normal hearing), adjusted for the severity of the hearing impairment and for maternal education.
RESULTS: Confirmation of hearing impairment by nine months of age was associated with higher adjusted mean z scores for language as compared with nonverbal ability (adjusted mean difference for receptive language, 0.82; 95 percent confidence interval, 0.31 to 1.33; and adjusted mean difference for expressive language, 0.70; 95 percent confidence interval, 0.13 to 1.26). Birth during periods with universal newborn screening was also associated with higher adjusted z scores for receptive language as compared with nonverbal ability (adjusted mean difference, 0.60; 95 percent confidence interval, 0.07 to 1.13), although the z scores for expressive language as compared with nonverbal ability were not significantly higher. Speech scores did not differ significantly between those who were exposed to newborn screening or early confirmation and those who were not.
CONCLUSIONS: Early detection of childhood hearing impairment was associated with higher scores for language but not for speech in midchildhood.

Copyright 2006 Massachusetts Medical Society.
PMID 16707750  N Engl J Med. 2006 May 18;354(20):2131-41. doi: 10.1056・・・

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