الفهرس 
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Abstract
SUMMARY
anguage is a useful marker for the child’s overall development. Language is the system that defines the manner in which humans communicate. Normal language development is predicated considering normal hearing and adequate environmental or social experience of the child during early life.
Language delay was considered when the child ability to understand (receptive) or use (expressive) language falls below age expectations.
DLD had serious effect in early child development especially in the preschool years as language is essential for the child school entery, academic and social challenges.
The study was done to identify main factors affecting early language development, to identify main causes of language delay among preschool children who are seeking medical advice in Ain-Shams University faculty of Postgraduate Childhood Studies, Special Needs Centre and to assess the child development and different language parameters in children with unidentified cause for language delay (primary language delay).
This study was done on 300 child with language delay who attended the outpatient pediatric clinic of Special Need Center, Faculty of Postgraduate Childhood Studies, Ain Shams University. They were 213 males and 87 females and their ages ranged from 1.5 years till 5 years. The study extended from the period of December 2017 till December 2018.
All patients were subjected to full history taking, complete clinical examination, clinical psychiatric interview, audiological evaluation, cognitive abilities assessment. Those with unidentified cause (primary language delay) underwent developmental assessment using Griffiths mental development scale, and language assessment using Modified Preschool Language scale ”Arabic Edition” fourth edition.
In this study, language delay were more common in boys (71%), the sample was classified according to their ages into four groups. The largest frequency was in children aged 4-5 years which occupied (56.7%). (7.3%) of childen were the only child in family, and (92.7%) had other siblings (30.0% were first birth order and 27.4% were second birth order). Also; (53.3%) of children had consanguinuos parents.
The socioeconomic factors, (42.0%) of fathers and (40.7%) of mothers were university graduate, (94.7%) of fathers and only (21.3%) of mothers were working, 87.7% were living in urban areas.
For parent- child interaction in this study, through daily media exposure (64.0%) of patients had > 2 hours daily media exposure while (19.0%) had < one hour daily media exposure, also nursery\ kindergarten attendance (56.7%) of patients were not attending nursery neither kindergarten, while (43.3%) were attending (24.7% irregular nursery attendance, 13.3% regular nursery attendance and 5.3% kindergarten attendance). The number of stories and toys at home, 64.3% of patients had no stories while 7.7% had no toys at home.
The perinatal factors in studied patients were 63% of patients had no prenatal complications, 66.0% of patients were delivered by cesarean section, 91.0% were full birth term, 87% were average birth weight, 74.7% had no NICU admission, 38.4% of patients were breast fed, and 34.1% were both (breast fed & artificial fed), and there was significant difference between the studied patients as regard prenatal complications, mode of delivery, birth term and weight (P value<0.005).
Most of cases (70%) of patients had no significant previous illness or complications, and (76%) of patients had positive family history of language delay.
The clinical examination of studied patients, (71.0%) of patients had no abnormalities detected at clinical examination; while (29%) had abnormal clinical examination such as 9.3% had abnormal general examination including organomegally and heart murmers, and 7% had dysmorphic features.
The cognitive Abilities in this study, (36.7%) of patients had below average cognitive abilities, (49.6%) had low cognitive abilities (29.3% mild, 18% have moderate, and 2.3% severe degree), and (13.7%) had average cognitive abilities.
For hearing assessment in studied patients, (10.3%) of patients had hearing loss (48.4% of patients had SNHL, 32.2% of them had CHL, and 19.4% had MHL) and the severe degree of HL was the most frequent one (29.0%), then moderate- severe degree and moderate degree (25.8% for each of them).
The most frequent causes of language delay in studied patients were DLD due to intellectual disability (21.3%), followed by DLD due to below average mentality (16.7%), then DLD due to ASD (16.3%), then DLD due to environmental deprivation (12.7%), then DLD due to hearing loss (10.3%) then DLD due to neurological disorders (8%), then primary language delay (unidentified cause) (6.7%).
The developmental assessment of studied patients with unidentified cause of language delay (primary language delay), (70%) had mild developmental delay (DQ 70- 85), and (30%) had normal developmental Quotient (DQ 85- 114).
The language test of studied patients with unidentified cause of language delay language test help to evaluate expressive and receptive language age of SLI cases; and determine different types of language characteristics affected. For receptive age, 35% of patients had language age less than chronological age for 6 months, while the expressive age, 45% of patients had language age less than chronological age for 2 years and 4months. Also, 40% of patients had phonological programming type, and another 40% had syntactic- phonological type, and 20% had semantic pragmatic type and there was statistically significant difference regarding types of language characteristics and DQ (P value<0.005).
So, early identification of risk factors of language delay, early diagnosis, and early intervention had better linguistic, cognitive, social, behavioral, and academic outcomes.