Randomized Trial of a Population-Based, Home-Delivered Intervention for Preschool Language Delay

Wake, Melissa; Tobin, Sherryn; Levickis, Penny; Gold, Lisa; Ukoumunne, Obioha C; Zens, Naomi; Goldfeld, Sharon; Le, Ha; Law, James; Reilly, Sheena

doi:10.1542/peds.2012-3878

Cited by 30 publications

(55 citation statements)

References 32 publications

(31 reference statements)

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“…Another trial involving 4-year-olds with specific language impairments tested a manualized intervention that addressed individualized language goals, phonological and print awareness, and letter knowledge. 59 The intervention had no significant effect on expressive, receptive, or pragmatic language. A third trial tested the effects of a strategy called recasting (repeating what is said by a child, with correct articulation or with a grammatical expansion of the child's utterance).…”

Section: Languagementioning

confidence: 94%

Screening for Speech and Language Delay in Children 5 Years Old and Younger: A Systematic Review

et al. 2015

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BACKGROUND AND OBJECTIVES: No recommendation exists for or against routine use of brief, formal screening instruments in primary care to detect speech and language delay in children through 5 years of age. This review aimed to update the evidence on screening and treating children for speech and language since the 2006 US Preventive Services Task Force systematic review.METHODS: Medline, the Cochrane Library, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and reference lists. We included studies reporting diagnostic accuracy of screening tools and randomized controlled trials reporting benefits and harms of treatment of speech and language. Two independent reviewers extracted data, checked accuracy, and assigned quality ratings using predefined criteria. RESULTS:We found no evidence for the impact of screening on speech and language outcomes. In 23 studies evaluating the accuracy of screening tools, sensitivity ranged between 50% and 94%, and specificity ranged between 45% and 96%. Twelve treatment studies improved various outcomes in language, articulation, and stuttering; little evidence emerged for interventions improving other outcomes or for adverse effects of treatment. Risk factors associated with speech and language delay were male gender, family history, and low parental education. A limitation of this review is the lack of well-designed, well-conducted studies addressing whether screening for speech and language delay or disorders improves outcomes.CONCLUSIONS: Several screening tools can accurately identify children for diagnostic evaluations and interventions, but evidence is inadequate regarding applicability in primary care settings. Some treatments for young children identified with speech and language delays and disorders may be effective.

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Section: Languagementioning

confidence: 94%

Screening for Speech and Language Delay in Children 5 Years Old and Younger: A Systematic Review

et al. 2015

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“…Intervention Figure 1 summarizes the intervention's timeline and content (for more details, see the trial's published protocol 10 and interim results 15 ). The replicable program was manualized (modeled on that of Boyle 14 ) and sufficiently standardized for population-based delivery by nonspecialists, yet flexible enough to meet the varying needs of children at this age.…”

Section: Randomization and Blindingmentioning

confidence: 99%

“…15 Travel was valued at a standard unit cost of AU$0.80 per kilometer, materials were valued at market price, and parent time was valued at the Australian average wage of AU $35.60 per hour. 16 Children's time was assigned a value of $0.…”

Section: Program Costsmentioning

confidence: 99%

“…Table 4 shows the costs of all service use related to child speech and language concerns between child age 4 and 6 years. The intervention costs were AU$3231 to government 15 plus AU$694 cost of parent time devoted to the intervention. Across the trial, 29% of families reported using additional health services for their child's speech and language concerns (outside the Language for Learning program) between 4 and 5 years and 24% between 5 and 6 years, most commonly speech pathologists, pediatricians, general practitioners, and hearing specialists.…”

Section: Figurementioning

confidence: 99%

“…Interim results at age 5 years (immediately postintervention) suggested improved phonological awareness and letter knowledge, as well as weak evidence of benefit to expressive, but not receptive, language. 15 We hypothesized a priori that at 6 years (well over a year after the program ended) lasting benefits to the intervention group would include better mean scores on the following:…”

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confidence: 99%

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Two-Year Outcomes of a Population-Based Intervention for Preschool Language Delay: An RCT

et al. 2015

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OBJECTIVE: We have previously shown short-term benefits to phonology, letter knowledge, and possibly expressive language from systematically ascertaining language delay at age 4 years followed by the Language for Learning intervention. Here, we report the trial's definitive 6-year outcomes.METHODS: Randomized trial nested in a population-based ascertainment. Children with language scores .1.25 SD below the mean at age 4 were randomized, with intervention children receiving 18 1-hour home-based therapy sessions. Primary outcome was receptive/expressive language. Secondary outcomes were phonological, receptive vocabulary, literacy, and narrative skills; parent-reported pragmatic language, behavior, and health-related quality of life; costs of intervention; and health service use. For intention-to-treat analyses, trial arms were compared using linear regression models.RESULTS: Of 1464 children assessed at age 4, 266 were eligible and 200 randomized; 90% and 82% of intervention and control children were retained respectively. By age 6, mean language scores had normalized, but there was little evidence of a treatment effect for receptive (adjusted mean difference 2.3; 95% confidence interval [CI] -1.2 to 5.7; P = .20) or expressive (0.8; 95% CI -1.6 to 3.2; P = .49) language. Of the secondary outcomes, only phonological awareness skills (effect size 0.36; 95% CI 0.08-0.65; P = .01) showed benefit. Costs were higher for intervention families (mean difference AU $4276; 95% CI: $3424 to $5128).CONCLUSIONS: Population-based intervention targeting 4-year-old language delay was feasible but did not have lasting impacts on language, possibly reflecting resolution in both groups. Long-term literacy benefits remain possible but must be weighed against its cost.

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Screening for Speech and Language Delay and Disorders in Children 5 Years or Younger

Feltner,

Wallace,

Nowell

et al. 2024

JAMA

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ImportanceChildren with speech and language difficulties are at risk for learning and behavioral problems.ObjectiveTo review the evidence on screening for speech and language delay or disorders in children 5 years or younger to inform the US Preventive Services Task Force.Data SourcesPubMed/MEDLINE, Cochrane Library, PsycInfo, ERIC, Linguistic and Language Behavior Abstracts (ProQuest), and trial registries through January 17, 2023; surveillance through November 24, 2023.Study SelectionEnglish-language studies of screening test accuracy, trials or cohort studies comparing screening vs no screening; randomized clinical trials (RCTs) of interventions.Data Extraction and SynthesisDual review of abstracts, full-text articles, study quality, and data extraction; results were narratively summarized.Main Outcomes and MeasuresScreening test accuracy, speech and language outcomes, school performance, function, quality of life, and harms.ResultsThirty-eight studies in 41 articles were included (N = 9006). No study evaluated the direct benefits of screening vs no screening. Twenty-one studies (n = 7489) assessed the accuracy of 23 different screening tools that varied with regard to whether they were designed to be completed by parents vs trained examiners, and to screen for global (any) language problems vs specific skills (eg, expressive language). Three studies assessing parent-reported tools for expressive language skills found consistently high sensitivity (range, 88%-93%) and specificity (range, 88%-85%). The accuracy of other screening tools varied widely. Seventeen RCTs (n = 1517) evaluated interventions for speech and language delay or disorders, although none enrolled children identified by routine screening in primary care. Two RCTs evaluating relatively intensive parental group training interventions (11 sessions) found benefit for different measures of expressive language skills, and 1 evaluating a less intensive intervention (6 sessions) found no difference between groups for any outcome. Two RCTs (n = 76) evaluating the Lidcombe Program of Early Stuttering Intervention delivered by speech-language pathologists featuring parent training found a 2.3% to 3.0% lower proportion of syllables stuttered at 9 months compared with the control group when delivered in clinic and via telehealth, respectively. Evidence on other interventions was limited. No RCTs reported on the harms of interventions.Conclusions and RelevanceNo studies directly assessed the benefits and harms of screening. Some parent-reported screening tools for expressive language skills had reasonable accuracy for detecting expressive language delay. Group parent training programs for speech delay that provided at least 11 parental training sessions improved expressive language skills, and a stuttering intervention delivered by speech-language pathologists reduced stuttering frequency.

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Randomized Trial of a Population-Based, Home-Delivered Intervention for Preschool Language Delay

Cited by 30 publications

References 32 publications

Screening for Speech and Language Delay in Children 5 Years Old and Younger: A Systematic Review

Screening for Speech and Language Delay in Children 5 Years Old and Younger: A Systematic Review

Two-Year Outcomes of a Population-Based Intervention for Preschool Language Delay: An RCT

Screening for Speech and Language Delay and Disorders in Children 5 Years or Younger

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