Age of identification of speech and communication disorders in children and the functioning of the referral system in Elbasan, Albania

Vollständiger Abstract

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Early recognition and referral of speech and communication problems are important for timely access to assessment and intervention, yet referral pathways remain insufficiently described in Albania. This retrospective, descriptive cross-sectional study examined the age and source of first recognition of warning signs and how families reached rehabilitation services in Elbasan. The study used a clinical convenience sample of children already receiving services in one public and one private rehabilitation center and is not representative of the general child population. Of 73 parents approached, 20 declined and 3 of 53 returned questionnaires were incomplete, leaving 50 analyzable records (68.5%). ‘First identification’ referred to recognition of warning signs rather than formal diagnosis. First identification occurred most often at 2–3 years (40.0%). Healthcare professionals were the first identifiers in 54.0% of cases and non-health sources in 46.0%. Full health-system referral was reported in 32.0%, partial support in 18.0%, and self-secured access in 50.0%. Full formal referral was more frequent after first identification by a healthcare professional than by a non-health source (51.9% vs. 8.7%; Fisher’s exact p = 0.002). Self-secured access was more frequent among families with monthly income ≥€501 than ≤€500 (78.9% vs. 32.3%; p = 0.003) and among children using any private-sector center rather than public-only services (88.2% vs. 30.3%; p < 0.001). Clearer referral pathways, stronger developmental surveillance in primary care, and standardized age-appropriate screening prompts in child health records are warranted.