Chettinad Health City Medical Journal Volume 4, Number 2

Original Article
Assessment of Speech and Language Delay using Language Evaluation
Scale Trivandrum(LEST 0-3)
Ganavi R*, Anitha E**, Uma Devi L***
*Assistant Professor, ** Senior Resident, *** Professor & HOD, Dept. of Pediatrics, Chettinad Hospital & Research Institute,
Chennai, India.
Dr.R.Ganavi presently working as Assistant Professor Department of Pediatrics, obtained her M.B.B.S
degree from the Vijayanagar Institute of Medical Sciences, Bellary, Karnataka in 2000 and her M.D
degree in Paediatrics from Bangalore Medical College and Research Institute, Bangalore, Karnataka in
2010. She worked in JJ Group of Hospitals, Grant Medical College, Mumbai for a year following
Postgraduation. She is a BPNI Certified Infant and young child feeding counseling specialist. She joined
the present institution as Assistant Professor in 2012 and her area of interest is developmental Pediatrics
and she has been qualified as developmental pediatrician after completing the course of postgraduate
diploma in development neurology from Child development center, University of Kerala and under went
training at KEM hospital Pune last year and currently running the neurodevelopment clinic in the Dept.
of Pediatrics.
Corresponding author - Ganavi R ([email protected])
Chettinad Health City Medical Journal 2015; 4(2): 70 - 74

Abstract
Developmental Delay in speech and language domain is the most common developmental disorder in children.
Awareness of the delay is very important because early identification definitely paves a way for appropriate
intervention and prevention of consequences.
Aims and Objectives: To assess the prevalence of speech and language delay among 0-3 year old children using
Language Evaluation Scale Trivandrum(LEST). To study the modifiable risk factors in speech and language delay
among 0-3 year old children.
Study design & period : Descriptive study & 6 months
Study population: Children attending well baby clinic and daily pediatric clinic of a tertiary care centre, Chettinad
hospital and Research institute, of age group birth to three years. Children with severe illnesses admitted in the
hospital and those with developmental delay in other domains like gross motor, fine motor and social were
excluded.
Sample size: 200 Children
Study tools: 1. LEST 0-3 years, 2. Risk factor assessment questionnaire
Results : Of the 200 children, 6.5% had delay,18% had questionable delay and another 18% had suspectable delay.
The effect of home environment on speech and language delay showed that in poor home environment 43% of
children had delay and 57% were normal .Language delay was more prevalent among first birth child. There was
no association found between the other demographic variables.
Conclusion : Using this simple tool LEST scale, we can identify those children with delay in language development
and intervene early to prevent further consequences and abnormalities.
Key Words: Speech, Language delay, LEST

Introduction and secondly, the expressive language where the child

In children speech and language development is a says or does convey, what he/she wants to
dynamic process. Speech relates to mechanics of oral communicate4.
communication or the motor act of communication of
verbal expressions. Language includes the understand- Several forms of speech and language disorders have
ing, processing, and production of communication1. been described1. Speech problems consists of stutter-
Language encompasses every means of communication ing or dysfluency, articulation disorders, or disorders
in which thoughts and feelings are symbolized, so as to related to unusual voice quality. Expressive language
convey meaning to others. It includes such widely delay may exist without receptive language delay, but
differing forms of communication as writing, speaking, they often are found together in children.
sign language, facial expression, gesture and art2,3.
Language development occurs in a sequential fashion Some children may also have disordered language
and as age advances the child has more to communi- These language problems can be in relation to
cate, first learning to listen and understand language difficulty with grammar (syntax), words or vocabulary
before they learn to talk. (semantics), the rules and system for speech sound
production (phonology), units of word
Language can be divided into two major components. meaning(morphology), and the use of language
70 particularly in social contexts (pragmatics ). Speech and
Firstly, the receptive language where the child under-
stands from verbal and non- verbal communication, language problems can exist together or separately5,6.
Original Article Assessment of Speech and Language Delay using Language Evaluation Volume 4, Number 2
Scale Trivandrum (LEST 0-3)

There are number of approaches for assessing children age; education and occupational status were also
for speech and language delay aalthough there is no assessed .Place of residence, type of family, numbers of
uniformly accepted screening technique for use in a family members were also noted. The socioeconomic
primary care setting. Milestones for speech and class is assessed using Modified Kuppuswamy Scale26.
language development in young children are usually
looked into during the well baby visits7. Concerns for Then we asked the parents to fill in pre designed
delay arise if there are no verbalizations by the age of 1, proforma, home screening questionnaire, where 30
if speech is not clear, or if speech or language is differ- questions were designed about how the child’s time is
ent from that of other children of the same age and its spent and some of the activities of your family like
usually by the parent. So , parent questionnaires and visiting relatives house, talking to the baby, reading
parent concern are often used to detect delay8. books, telling stories, baby sitters or anyone to take
care of the child, any pets at home, any plants at home,
The reported prevalence of language delay so far , in how many hours spent playing with the child,
children two to seven years of age ranges from 2.3 to 19 shopping, television viewing and so on. A score was
percent9-13 .Severe speech and language disorders in given to each of the response. The total score was
young children can definitely have negative impact in calculated. Interpretation of the total score ≤19 means
the later educational achievement, even after intensive child has Negative home environment and total score of
intervention14. Several studies also have shown that ≥20 means child has a Positive home environment .The
children with speech and language disorders at two and speech and language assessment was done using
a half to five years of age present with difficulty reading Language Evaluation Scale Trivandrum (LEST) which
in the elementary school years15-17. Children in whom was developed by Child Development Centre,
speech and language impairments has been found to Trivandrum4.
persist past five and a half years of age have an
increased incidence of attention and social LEST (0-3 years) is a valid simple Indian tool for identi-
difficulties18. Children who have specific speech and fying children of 0-3 years with language delay in the
language impairments at seven and a half to 13 years of community with an acceptable sensitivity,
age have impaired writing skills, with marked deficits specificity,positive predictive value and likelihood
in spelling and punctuation compared with children ratios. First chronological age of the child was noted,
without speech and language impairments19,20. and then a scale was kept vertically at the point corre-
sponding to the chronological age of the child in
Preschool children with speech and language delay months given horizontally in the X axis. All the items
show a tendency of being at increased risk for learning [shown in the blocks] completed fully to the left side of
disabilities once they reach school age21. They may have the scale were expected to be done by the child. If not
difficulty reading in grade school18, exhibit poor attained by the child for that age, that item delay will be
reading skills at age 7 or 817,18 and have difficulty with assumed for the child. The interpretation is done in four
written language19, in particular. This may lead to ways as in table 1.
overall academic underachievement14, and, in some
cases, lower IQ scores11 that may persist into young Normal-All items Suspect-Two items not
adulthood22. As adults, children with phonological done done
difficulties may hold lower skilled jobs than their Questionable –one Delay – Three or more
siblings who don’t have any such difficulties23. In item not done items not done
addition to persisting speech and language related
Table 1 - Interpretation of language delay using LEST
underachievement (verbal, reading, spelling),
language delayed children exhibit more behavior The data collected was then analyzed by using chi
problems and impaired psychosocial adjustment24,25. square test, to find out the association between the
Early identification and early intervention in children language delay and other factors like socio demo-
speech and language delay can prevent other conse- graphic factors, birth related factors, home environ-
quences. ment and p value was calculated. P value below or equal
to 0.05 was considered to be statistically significant for
Material and methods a 95% confidence interval.
This descriptive study was conducted in the Dept. of
Pediatrics Chettinad Hospital and Research Institute, The prevalence of speech and language delay was
Kelambakkam, Tamil Nadu, with 200 children attend- calculated as normal, questionable, suspect and delay
ing Paediatric Out patient department of a tertiary care which was the outcome variables. Each item was
centre,of age group birth to three years over 6 months compared with the sociodemographic profile and home
period. Ethics committee approval was obtained for the environment. The results were represented as tables
study. Children with severe illnesses admitted in the and graphs. The statiscal software SPSS was used for
hospital and those with developmental the analysis of the data and Microsoft excel was used to
delay in other domains like gross motor, fine motor and generate tables.
social were excluded.
Results and discussion : Of the 200 children
The study was done using a predesigned proforma screened for language delay ,62% of the babies were
consisting of the socio demographic parameters like below the age of 24 months ,52.5% of them were girl
age, sex, religion, family order. Birth details like mode babies, 80.5% of them were first child in their
of delivery, birth weight, any antenatal, natal or post family,23.5% of the babies were with the birth weight 71
natal problems. Maternal details and paternal details of of less than 2500gms.Most of them hailed from upper
 Original Article Assessment of Speech and Language Delay using Language Evaluation Volume 4, Number 2
Scale Trivandrum (LEST 0-3)

Fig 1 - LEST Scale

socio economic status and upper middle class. 89.5% of LEST

them were residing in urban area. Regarding the type DELAY Interpretation No Percentage %
of family 74% of them were nuclear. 57% had normal scale
language development, 18.5% had questionable delay, 0 No delay 114 57.0
18% suspectable delay and 6.5 % had total delay[table Questionable
1 item delay 37 18.5
2].70% the children in the age group of 7 to 12 months delay
are slightly having higher prevalence of language 2 item
Suspect delay 36 18.0
delaythan other age group children [table 3].There was delay
no association between the sex and language develop- 3 item
Total delay 12 6.0
ment of the child. The birth order of the child and its delay
association with language development indicates more 4 item
Total delay 1 .5
delay occurs among the first order child compares to delay
others. There was no association between the birth Table 2 - Distribution of language delay groups
weight and language development of the child. according to LEST .

There was no significant association between the Prevalence of language delay and socio-economic
language development of the child and age of the status (table 4). No association exists between the
child’s mother or her educational status. There was no place of residence of the child and their language devel-
significant association between the language develop- opment. No association exists between the type of
ment of the child and age of the child’s father or his family of the child and their language development. No
educational status. No association exists between association exists between the home environment of

Language development Chi-square test Degrees of

Variable P-value
Abnormal Normal value Freedom
No. % No. %
Childs age
A 0-6 4 20.0 16 80.0 11.585 5 0.041
B 7-12 25 59.5 17 40.5
C 13-18 6 35.3 11 64.7
D 19-24 23 50.0 23 50.0
E 25-30 9 33.3 18 66.7
72 F 31-36 19 39.6 29 60.4
Table 3 - Association between the language development and age of the child
Original Article Assessment of Speech and Language Delay using Language Evaluation Volume 4, Number 2
Scale Trivandrum (LEST 0-3)

Language development Chi-square test Degrees of

Variable p-value
Abnormal Normal value Freedom
No. % No. %
Socio-economic status
26-29(Upper) 45 46.9 51 53.1 8.675 3 0.034
16-25(Upper Middle) 35 43.8 45 56.2
11-15(Lower Middle ) 3 15.0 17 85.0
5-10 (Upper
3 75.0 1 25.0
Lower)
<=5 (L:ower )
Table 4 - Association Between the Language Development and Socio Economic Status of the Child’s Family

Language development Chi-square Degrees of

Variable p-value
Abnormal Normal test value Freedom
No. % No. % No. %
Home Environment
Poor 51 42.1 70 57.9 0.091 1 0.763
Good 35 44.3 44 55.7
Table 5 - Association Between the Language Development and Home Environment

the child and their language development[table 5]. No Conclusion

association exists between the delivery details and the
language delay of the child. Delay in speech and language development is the most
common developmental disorder in children. Aware-
ness of the delay is important for early identification
Discussion and appropriate intervention. So using this simple tool
Out of 200 children screened using LEST scale 57% had LEST scale, we can identify those children with delays
normal language development, 18.5% had question- in language development and intervene early to
able delay ,18% suspectable delay and 6.5 % had total prevent further consequences and abnormalities.
delay. Abraham et al showed that prevalence of Acknowledgement: We thank all the
language delay was 13.7%27.MKC Nair study from students(nursing students/CRRI/Post graduates) for
Child development centre Trivandrum, showed their help and extend our gratitude to my statistician
approximately prevalence of 4.5 % language delay4. Mr. Felix and Mr.Nagaraj [technichian in cardiology
Shiji Jacob showed that prevalence of language delay of department] for technical assistance. we also thank all
5.5 %28. Children in the age group of 7 to 12 months are my patients and their parents and guardians who
slightly having higher prevalence of language participated in this study without whom this study
delay[60%] than other age group children. According would not have been possible.
to Abraham et al, most of the delay [26.7%] was seen in
2-3 years age group27.In MKC Nair study ,language
The authors declare no conflict of interest
delay was observed for the age group 0-12 months4.
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