Medical evidence in child abuse.

Abstract

Taitz and King suggest that the existence of 'speech delay' may be offered as evidence of serious deprivation in care proceedings.' We feel that the relations between language development, deprivation, and child abuse are more complex than Taitz and King imply. (1) 'Speech delay' is an imprecise term. Does it refer to poor articulation, limited vocabulary, immature syntax, inadequate social use of language, or poor comprehension? When is 'delay' significant? Speech therapists report 'delay' at varying levels on language testing, from less than-1 to-2 standard deviations from the mean. (2) There is wide variation in the rate of language acquisition even among normal children growing up in stable families,2 and a substantial part of this variation is determined by genetic and constitutional factors.3 (3) Although much has been written in a descriptive sense about early language acquisition, little is known about the minimum environmental requirements for this process. There is, however, a strong body of opinion that language acquisition is a very robust function and the variance attributable to different levels of 'stimulation' may be quite small.4 (4) 'Speech delay' is a symptom calling for differential diagnosis. Some children with delayed speech development turn out to have a true language disorder, but the differential diagnosis from 'simple' speech delay can be very difficult in a young child.

A profile of abuse.

“…This difference also indicates that delay in speech and development is more than merely an epiphenomenon in the child abuse spectrum. [22][23][24] The appreciably higher age distribution of the injured children is to some extent accounted for by the 'over-chastisement' of older children. In a proportion of these this appears to stem from intolerable disturbed behaviour due to neglectful or abusive parenting in the past.…”