Screening for Speech and Language Delay in Preschool Children--updated Literature Search PDF Download
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Author:
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ISBN:
Category : Developmental disabilities
Languages : en
Pages : 119
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Author:
Publisher:
ISBN:
Category : Developmental disabilities
Languages : en
Pages : 119
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Author: U. S. Department of Health and Human Services
Publisher: CreateSpace
ISBN: 9781490510521
Category : Medical
Languages : en
Pages : 180
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Speech and language development is considered a useful indicator of a child's overall development and cognitive ability by experts and is related to school success. Identification of children at risk for developmental delay or related problems may lead to intervention services and family assistance at a young age when chances for improvement are best. This rationale supports preschool screening for speech and language delay, or primary language impairment/disorder, as a part of routine well child care. This evidence synthesis focuses on the strengths and limits of evidence about the effectiveness of screening and interventions for speech and language delay in preschool age children. Its objective is to determine the balance of benefits and adverse effects of routine screening in primary care for the development of guidelines by the U.S. Preventive Services Task Force (USPSTF). The target population includes all children up to age 5 years without previously known conditions associated with speech and language delay, such as hearing and neurological impairments. The evidence synthesis emphasizes the patient's perspective in the choice of tests, interventions, outcome measures, and potential adverse effects, and focuses on those that are available and easily interpreted in the context of primary care. It also considers the generalizability of efficacy studies performed in controlled or academic settings and interprets the use of the tests and interventions in community-based populations seeking primary health care. Key questions addressed include: Key Question 1. Does Screening for Speech and Language Delay Result in Improved Speech and Language as well as Improved Other Non-speech and Language Outcomes? Key Question 2. Do Screening Evaluations in the Primary Care Setting Accurately Identify Children for Diagnostic Evaluation and Interventions? 2a. Does Identification of Risk Factors Improve Screening? Key Questions 2b and 2c. What Are Screening Techniques and How Do They Differ by Age? What Is the Accuracy of Screening Techniques and How Does It Differ by Age? 2d. What Are the Optimal Ages and Frequency for Screening? Key Question 3. What Are the Adverse Effects of Screening? Key Question 4. What Is the Role of Enhanced Surveillance by Primary Care Clinicians? Key Question 5. Do Interventions for Speech and Language Delay Improve Speech and Language Outcomes? Key Question 6. Do Interventions for Speech and Language Delay Improve Other Non-Speech and Language Outcomes? Key Question 7. Does Improvement in Speech and Language Outcomes Lead to Improved Additional Outcomes? Key Question 8. What Are the Adverse Effects of Interventions? Key Question 9. What Are Cost-Effectiveness Issues?
Author: Heidi D. Nelson
Publisher:
ISBN:
Category :
Languages : en
Pages :
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CONTEXT: Speech and language development is a useful initial indicator of a child's overall development and cognitive ability. Identification of children at risk for delay may lead to interventions, increasing chances for improvement. However, screening for speech and language delay is not widely practiced in primary care. OBJECTIVE: To determine the strengths and limits of evidence about the effectiveness of selecting, testing, and managing children with potential speech and language delay in the course of routine primary care. Key questions examined a chain of evidence about the accuracy and feasibility of screening children age 5 years and younger in primary care settings, role of risk factors in selecting children for screening, effectiveness of interventions for children identified with speech and language delay, and adverse effects of screening and interventions. DATA SOURCES: Relevant studies were identified from multiple searches of MEDLINE, PsycINFO, and CINAHL (1966 to November 19, 2004). Additional articles were obtained from recent systematic reviews, reference lists of pertinent studies, reviews, editorials, and websites, and by consulting experts. STUDY SELECTION: Eligible studies had English-language abstracts, were applicable to U.S. clinical practice, and provided primary data relevant to key questions. Studies of children with previously diagnosed conditions known to cause speech and language delay were not included. Only randomized controlled trials were considered for examining the effectiveness of interventions. Studies with speech and language outcomes as well as non speech and language health and functional outcomes were included. DATA EXTRACTION: Data were extracted from each study and entered into evidence tables. DATA SYNTHESIS: Studies were summarized by descriptive methods and rated for quality using criteria developed by the USPSTF. A large descriptive literature of potential risk factors for speech and language delay in children is heterogeneous and results are inconsistent. A list of specific risk factors to guide primary care physicians in selective screening has not been developed or tested. The most consistently reported risk factors include a family history of speech and language delay and learning difficulties, male sex, and perinatal factors. A total of 44 studies about evaluations taking 30 minutes or less to administer that could be administered in a primary care setting were considered to have potential for screening purposes. Studies included many different instruments, there were no accepted gold standards or referral criteria, and few studies compared the performance of 2 or more tests. Studies utilizing evaluations taking 10 minutes or less and rated good to fair in quality reported wide ranges of sensitivity and specificity when compared to reference standards (sensitivity 17% to 100%; specificity 45% to 100%). Studies did not provide enough information to determine how accuracy varied by age, setting, or administrator. Fourteen good and fair-quality randomized controlled trials of interventions reported significantly improved speech and language outcomes compared to control groups. Improvement was demonstrated in several domains including articulation, phonology, expressive language, receptive language, lexical acquisition, and syntax among children in all age groups studied and across multiple therapeutic settings. Improvement in other functional outcomes, such as socialization skills, self-esteem, and improved play themes, were demonstrated in some, but not all, of the 4 studies measuring them. In general, studies of interventions were small, heterogeneous, may be subject to plateau effects, and reported short-term outcomes based on various instruments and measures. As a result, long-term outcomes are not known, interventions could not be directly compared, and generalizability is questionable. CONCLUSIONS: Use of risk factors to guide selective screening is not supported by studies. Several aspects of screening have been inadequately studied to determine optimal methods including what instrument to use, what age to screen, and what interval is most useful. Trials of interventions demonstrate improvement in some outcome measures, but conclusions and generalizability are limited. Data are not available addressing other key issues including the effectiveness of screening in primary care settings, role of enhanced surveillance by primary care physicians prior to referral for diagnostic evaluation, non speech and language and long-term benefits of interventions, adverse effects of screening and interventions, and cost. KEYWORDS: speech and language delay, preschool children, screening.
Author:
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ISBN:
Category :
Languages : en
Pages :
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Author: J. Boyle
Publisher:
ISBN:
Category : Language disorders in children
Languages : en
Pages : 184
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Author: Irla Lee Zimmerman
Publisher:
ISBN: 9780158659459
Category : Education
Languages : en
Pages : 276
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Author: Nancy D. Berkman
Publisher:
ISBN:
Category :
Languages : en
Pages : 210
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PURPOSE: 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). DATA SOURCES: PubMed/MEDLINE(r), the Cochrane Library, PsycInfo(r), ClinicalTrials.gov, HSRProj, the World Health Organization International Clinical Trials Registry Platform, and reference lists of published literature (through July 2014). STUDY SELECTION: 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. DATA EXTRACTION: One reviewer extracted data and a second checked accuracy. Two independent reviewers assigned quality ratings using predefined criteria. DATA SYNTHESIS: 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 treatment approaches 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. LIMITATIONS: 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 treatment approach 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. CONCLUSION: 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.
Author:
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ISBN: 9780708720578
Category :
Languages : en
Pages :
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Author: John R. Beech
Publisher: CUP Archive
ISBN: 9780415078818
Category : Medical
Languages : en
Pages : 298
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Assessments in Speech Therapy is designed to guide speech therapists in choosing the most appropriate assessments for evaluation, monitoring and intervention. By providing guidance on defining the issues in assessment, it shows how to make sure that the process will produce a result relevant to the therapist's own needs and those of his or her clients.
Author: Ina Wallace
Publisher: RTI Press
ISBN:
Category : Education
Languages : en
Pages : 18
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In the past decade, American and Canadian pediatric societies have recommended that pediatric care clinicians follow a schedule of routine surveillance and screening for young children to detect conditions such as developmental delay, speech and language delays and disorders, and autism spectrum disorder. The goal of these recommendations is to ensure that children with these developmental issues receive appropriate referrals for evaluation and intervention. However, in 2015 and 2016, the US Preventive Services Task Force (USPSTF) and the Canadian Task Force on Preventive Health Care issued recommendations that did not support universal screening for these conditions. This occasional paper is designed to help make sense of the discrepancy between Task Force recommendations and those of the pediatric community in light of research and practice. To clarify the issues, this paper reviews the distinction between screening and surveillance; the benefits of screening and early identification; how the USPSTF makes its recommendations; and what the implications of not supporting screening are for research, clinical practice, and families.
