Screening for Speech and Language Delays and Disorders in Children Age 5 Years or Younger: A Systematic Review for the U.S. Preventive Services Task Force
Berkman ND, Wallace I, Watson L, et al. Screening for Speech and Language Delays and Disorders in Children Age 5 Years or Younger: A Systematic Review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 Jul. (Evidence Syntheses, No. 120.)
To evaluate the evidence on screening and treating children for speech and language delays or disorders for the U.S. Preventive Services Task Force (USPSTF).
PubMed/MEDLINE®, the Cochrane Library, PsycInfo®, ClinicalTrials.gov, HSRProj, the World Health Organization International Clinical Trials Registry Platform, and reference lists of published literature (through July 2014).
Two investigators independently selected studies reporting on benefits and harms of screening; accuracy of screening tools compared with diagnostic evaluations; and benefits or harms of treatment of speech and language delays or disorders compared with placebo, watchful waiting, or wait-list interventions. To provide context for evaluating our Key Questions, we also included studies describing screening instruments and risk factors for speech and language delays or disorder.
One reviewer extracted data and a second checked accuracy. Two independent reviewers assigned quality ratings using predefined criteria.
No included studies examined the effects of screening on speech and language or other functional outcomes. We included 23 studies evaluating the accuracy of speech and language screening in primary care settings to identify children for diagnostic evaluations and interventions. Among instruments in 13 studies in which parents rated their children’s skills, sensitivity ranged from 50 to 94 percent and specificity ranged from 45 to 96 percent. Of the three instruments widely used in the United States, the MacArthur Bates Communication Development Inventory (CDI) and the Language Development Survey (LDS) outperformed the Ages and Stages Questionnaire (ASQ) Communication Domain, especially in terms of their specificity, correctly identifying, on average, 82 percent (CDI) and 91 percent (LDS) compared with 58 percent (ASQ) of children without a language disorder. The ASQ and CDI have versions for infants, toddlers, and preschool-age children, with the CDI being more robust across age groups. The accuracy of professionally or paraprofessionally administered instruments was more variable across studies, and many did not perform as well as parent-rated instruments. Because few studies examined the same instrument in different populations or in different ages, it is unclear how professionally or paraprofessionally administered instruments for multiple ages fare more broadly or whether there is an optimal age for screening. We found no studies addressing adverse effects of screening, such as deleterious consequences of false conclusions from screening. We also found no studies concerning the role of enhanced surveillance by a primary care provider.
We included 13 studies examining treatment for speech and language delays or disorders. Although the treatmentapproaches sometimes overlap, we organized our findings by outcome: language (including expressive and receptive language and more specific aspects of language, such as vocabulary, syntax/morphology, and narratives), speech sounds (including articulation, phonology, and speech intelligibility), and fluency (stuttering). Although results were mixed, the majority of studies found treatment to be effective. Characteristics of effective studies include higher intensity, treating children with more severe delays, and individualizing treatment to the child. We found little evidence concerning other functional outcomes or adverse effects of treatment.
Risk factors that were generally associated with speech and language delays or disorders in multivariate analyses of cohort populations included being male, a family history of speech and language concerns, and lower levels of parental educational achievement.
As in the earlier review, we did not find any well-conducted trials that could address our overarching question of whether screening leads to improved outcomes. Many screening studies do not include unselected samples from the population but rather participants with and without language delays. Intervention studies did not consistently control for additional community services that children may have been receiving and varied greatly in treatmentapproach and outcome measurement. Also, because young children with disabilities are entitled to treatment, it may not be possible for future studies in the United States to examine treatment versus no treatment.
Our review yields evidence that two parent-rated screening instruments, the CDI and LDS, can accurately identify children for diagnostic evaluations and interventions and likely can be interpreted with little difficulty in the primary care setting. Some treatments for young children identified with speech and language delays and disorders may be effective.