Yudianita Kesuma

Growth Development – Social Pediatric Division

Child Health Department of Universitas Sriwijaya –
Moh. Hoesin Hospital
Curriculum Vitae
• Nama : Dr. dr. Yudianita Kesuma, Sp.A(K), M.Kes
• Tempat / tgl lahir : Palembang, 17 Maret 1970
• Riwayat Pendidikan:
• S1 : FK Unsri 1995
• Sp1 / S2 : FK Unsri 2010
• Fellowship : FKUI 2012 Tumbuh Kembang Pedsos
• Sp2 : FK UI 2016
• S3 Kedokteran : FK UI 2018
• Pelatihan Denver, Peds, CAT/CLAMs Medan 2010
• Pelatihan ToT Kekerasan terhadap Anak Bandung 2010
• Pelatihan Konselor Laktasi 40 Jam Perinasia Jakarta 2011
• Pelatihan General Movements Surabaya 2012
• Pelatihan Early Childhood Developmental Melbourne 2013
• Riwayat Pekerjaan:
• 1997 - 2003 : Kepala Puskemas Cihideung Udik – Ciampea, Bogor
• 2010 – sekarang: Staf Divisi Tumbuh Kembang – Pediatri Sosial
• 2014 – sekarang: Anggota Satgas Remaja PP IDAI
• 2015 – 2018 : Anggota P2TP2A Provinsi Sumatera Selatan
Introduction
 Salah satu keluhan terbanyak masalah
perkembangan

Dampak terhadap masalah Kognitif (Language

development is the best single predictor for later
cognitive development)

Introduction Dampak emosional, sosial, perilaku, dan

performance sekolah

Berkaitan dengan kemampuan membaca dan

mengeja

Dapat berlanjut sampai dewasa

Introduction
 Speech delay :
seringkali tak sekedar “terlambat”

Speech delay

Speech delay and disorder

Speech and language delay and disorder

Speech and language difficulty

4
 Dimensi
bicara & bahasa
Definition
Definition
Prevalence
The Difference between speech and language
 Primary speech-language delay/disorder
• Developmental speech-language delay/disorder
• Expressive speech-language delay/disorder
• Receptive speech-language delay/disorder
• Receptive-expressive language imparment (RELI)
Secondary speech-language delay/disorder
• Gangguan pendengaran
• Disabilitas intelektual
• Gangguan spektrum autisme
• Mutisme selektif
• Palsi serebral
• Apraksia, dll

Speech-language delay/disorder
Historical Information in
the Evaluation of •Psychosocial deprivation,
•elective mutism
Speech Delay in •Autism
Children •Mental retardation •Bilingualism
•Maturation delay •cerebral palsy
•Hearing loss SPEECH
•Hearing loss DELAY
•mental retardation
Past health •one language
•Mental retardation
Encephalitis, •Psychosocial
•cerebral palsy history
Family history meningitis
Recurrent otitis
•Hearing loss - Speech delay
media
•mental retardation Perinatal - Chromosomal Mumps
history abnormalities Hypothyroidism
•Hypoxia Head trauma
•Speech delay •Prematurity
- Prader-Willi
•Cerebral palsy
Maternal syndrome, etc Seizures
illness/ use of •Birth trauma
•Mental retardation •Intracranial
drug during
pregnancy hemorrhage
•Kernicterus
Development •Intrauterine
history infection
•Maternal
•Delay in language
milestone phenylketonuria,
•Delay in motor Hypothiroid,use
milestone of drugs
•Generalized delay •Placental
insufficiency

Leung AKC, Pion Kao C. Evaluation and management of the child with
speech delay. American Academy of Family Physician, June 1999.
Physical findings
in the Evaluation of
Speech Delay in Microcephaly,
Children macrocephaly

extensor
plantar Deformities of
response, Mental retardation, auricle or
contractures external ear
canal
cerebral palsy,

hearing lossETIOLOGY
POSSIBLE

Hearing loss
Upward slanting
Spasticity, Down syndrome eyes, Brushfield
hyperreflexia, spot, epicanthic
clonus, Autism folds, brachycephaly,
simian creases
Cerebral palsi
Leung AKC, Pion Kao C.
Evaluation and
management of the
child with speech delay.
Lack of eye American Academy of
repetitive Family Physician, June
contact,
motor activity 1999
stereotyped
 Table 1. Signs of speech or language delay by type of disability

Language feature Auditory expressive

Auditory visual
receptive
Etiology content intelligibility

Hearing loss variable normal

Mental retardation

Developmental language disorders variable normal

Autism normal

Dysarthria variable normal normal

Parker S, Zuckerman B, Augustyn M. Developmental and Behavioral Pediatrics(2nd ed): Language Delays.
Philadelphia: Lippincott Williams & Wilkins,2005
Five main types of speech defects :
(1) articulation problems, such as the inability to produce
certain sounds
(2) stammering, cluttering (rapid, slurred speech), and other
fluency problems
(3) voice disorders, including problems of pitch, voice quality,
and volume
(4) delayed speech, characterized by a child's slow language
development
(5) aphasia, the partial or total loss of the ability to speak or
understand language.

Adapted from:
www.pediatrics.org at Indonesia:AAP Sponsored on May 4, 2008
Speech Therapy http://www.a2zpsychology.com/psychology_guide/speech_therapy.htm
 Algorithme for evaluating
of the Child with a Language Disorder
 Child with a Language Disorder
A History
Language Test C
B Physical Examination

D Findings of underlying condition or disorder ?

NO YES

E Audiology Assessment

Normal Hearing Loss

F Conductive Sensorineural G

H Assess pattern of development disorder/delay

I Multiple Domain Language Domain

Development Language Disorder J Speech Disorder K

Feldman HM. Language disorders. Dalam : Berman S, penyunting. Pediatric Decision Making. Edisi ke-4. Philadelphia: Mosby, 2003.h.94-97
In all cases of suspected speech and
language delay, audiometry and a
good clinical evaluation of the
central nervous system and ear,
nose, and throat are mandatory.
 Identify and treat
underlying condition or disorder :

 Neurologic disorder
 Genetic syndrome / disorder
 Metabolic disorder
 Endocrine disorder
 Mental health disorder
 Social deprivation

BACK
Sensorineural Hearing Loss

Refer to :
 Audiologist
 Speech clinician

BACK
Conductive Hearing Loss

Identify and treat :

 Acute otitis media
 Otitis media with effusion
 Anatomic abnormalities

BACK
 Multiple Domain
Identify :
 Global development delays
 Mental retardation
 Autism spectrum disorder
 Social deprivation

Refer to :
 Behavioral / developmental
 pediatrician
 Early intervention program

Consider :
 Mental health professional
 Social service agency BACK
Development Language Disorder

Refer to :
 Early intervention program
 Speech clinician

BACK
 Speech Disorder

Identify : Identify :
 Phonologic disorder  Trancient
 Verbal apraxia Dysfluency
 Stuttering

Refer to : Follow up :
 Speech Clinician  Observe

BACK
 • Beragam, selaras dengan variasi gangguan
bicara-bahasa
• Bentuk/jenis
• Pendekatan
• Durasi
Terapi wicara- • Intensitas
• Setting terapi : rumah sakit/klinik, rumah,
bahasa sekolah
• Secara individual atau kelompok
• Pelaksana : klinisi/terapis wicara, orang
tua/pengasuh yang terlatih
 Terapi wicara-bahasa
area intervensi dan luaran

• Fonologi
Ekspresif • Sintaks
• Kosakata

• Fonologi
Reseptif • Sintaks
• Kosakata

• Harus ada keselarasan antara area intervensi dan luaran yang dinilai
• Dalam satu sesi terapi dapat dikombinasikan intervensi ekspresif dan
reseptif dalam ketiga subset
 Terapi wicara-bahasa : efikasi ?
3 meta analisis
1) Law J, Garrett Z, Nye C. Speech and language therapy intervention for
children with primary speech and language delay or disorder. Cochrane
Database Syst Rev 2003 (last updated 2010)
2) Law J, Garrett Z, Nye C, Zoe G. The efficacy of treatment for children
with developmental speech and language delay/disorder: a meta
analysis. J Speech, language, and Hearing Res 2004;47(4):924-43
3) Law J. The implication of different appraaches to evaluating
intervention: evidence from the study of language delay/disorder. Folia
Phoniatrica et Logopaedica 2004;56(4):199-219
Terapi wicara-bahasa : outcome ekspresif fonologi

Perbaikan bermakna
kemampuan ekspresif fonologi
Terapi wicara-bahasa : outcome ekspresif sintaks

Tidak ada perbaikan bermakna

kemampuan ekspresif sintaks
 Terapi wicara-bahasa : outcome ekspresif sintaks

Effect size intervensi terapi wicara-bahasa : aspek ekspresif sintaks

Terapi wicara-bahasa : outcome ekspresif kosakata

Tidak ada perbaikan bermakna

kemampuan ekspresif kosakata keseluruhan
Terapi wicara-bahasa : outcome ekspresif kosakata
Terapi wicara-bahasa : outcome reseptif fonologi

Tidak ada perbaikan bermakna

kemampuan reseptif fonologi
Terapi wicara-bahasa : outcome reseptif sintaks

Tidak ada perbaikan bermakna

kemampuan reseptif sintaks
Terapi wicara-bahasa : apakah durasi berpengaruh?

Effect size intervensi terapi wicara-bahasa durasi > 8 minggu

 TERAPI WICARA-BAHASA
terapis versus orang tua terlatih
Tidak ada perbedaan
 Masih banyak kesenjangan

• Variasi terapi wicara-bahasa antar penelitian : format terapi, durasi per

sesi terapi, frekuensi per minggu, durasi total terapi, dll
• Belum ada kesepakatan standardisasi terapi wicara
• RCT efikasi terapi wicara pada gangguan bahasa reseptif sangat terbatas
• gangguan bahasa reseptif atau kombinasi ekspresif-reseptif (RELI)
lebih berdampak pada kemampuan kognitif dan aspek-aspek lain
• Terapi wicara-bicara di setting sekolah ?
• Review sistematis (Cirrin & Gillam, 2008)
• 21 RCT : anak usia sekolah dengan spoken language disorder
• Intervensi terapi wicara-bahasa di sekolah
• Keterbatasan jumlah subyek, kelemahan metodologis
 Take home messages
• Keterlambatan/gangguan bicara dan bahasa perlu
ditangani secara dini dan komprehensif
• Modalitas intervensi terapi wicara-bahasa dan penilaian
luarannya beragam
• Evidences efikasi terapi wicara-bahasa yang tersedia saat
ini sebagian besar pada area ekspresif
• Evidences efikasi terapi wicara-bahasa pada area reseptif
masih sangat terbatas