According to the American Speech-Language-Hearing Association, speech sound disorders affect 10 percent of children overall. Language difficulty is estimated to affect between 2 percent and 19 percent of preschool-age children, and specific language impairment is one of the most common childhood disorders, affecting 7 percent of children. Of the more than 2 million Americans who stutter, half are children.
Yet despite these statistics, screening for these issues hasn't proved to be either effective or ineffective.
The U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation statement(www.uspreventiveservicestaskforce.org) on Nov. 18 that re-examined screening for speech and language delay and disorders in children age 5 or younger and found that current evidence is insufficient to assess the balance of benefits and harms of routine screening.
Update to 2006 Recommendation
Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that this draft recommendation is essentially unchanged from the USPSTF's 2006 recommendation, which the Academy adopted at that time.
"In 2006, the USPSTF also concluded that there was insufficient evidence to recommend for or against routine use of brief, formal screening instruments to detect speech and language delay in children up to age 5," she said. "They readdressed the evidence and found that there is still little evidence on this topic."
- The U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation statement on Nov. 18 that said current evidence is insufficient to assess the balance of benefits and harms of routine screening for speech and language delay and disorders in children age 5 or younger.
- This draft recommendation is largely unchanged from the USPSTF's 2006 recommendation, which the Academy adopted at that time.
- The USPSTF is providing an opportunity for public comment on this draft recommendation statement and draft evidence review until Dec. 15.
Even so, said Frost, most family physicians do routine developmental screening at well-child visits, which includes screening for language and speech.
"Unfortunately, there is not evidence to prove that the screening tools are accurate or that screening and subsequent interventions improve outcomes," she said. "That does not mean that physicians should stop screening. There is not evidence that proves it is effective, but there also isn't evidence that proves it is ineffective or harmful. It is an area where more research is required to better guide physicians."
Draft Recommendation Overview
Screening for speech and language disorders is recommended for inclusion in routine developmental screening in primary care. But during the 2006 evidence review, 55 percent of parents reported that their toddler did not receive any type of developmental assessment at his/her well-child visit, and 30 percent reported that their child's health care professional had not discussed with them how their child communicates.
To reassess evidence supporting routine screening for the current recommendation, the USPSTF's evidence review focused on studies conducted in children age 5 or younger in which any child who screened positive received formal diagnostic assessment for speech and language delays and disorders by age 6. The evidence review included randomized, controlled trials and other systematic reviews, as well as cohort studies of screening and surveillance for speech and language delay and disorders.
The USPSTF identified 24 studies (five good-quality and 19 fair-quality) that evaluated the accuracy of 20 different screening tools. The majority of studies included children ages 2-3.
Test performance characteristics varied widely. Parent-administered screening tools generally performed better than other tools, the draft recommendation said. Among parent-administered tools, sensitivity was generally higher for the Child Development Inventory, the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist, and the Language Development Survey.
The draft recommendation went on to explain that applicability of the evidence to screening in primary care was limited by several factors. Most studies focused on prescreened populations with relatively high prevalence of language delays and disabilities (usually greater than 10 percent).
The USPSTF report also said the group found it difficult to compare the performance of individual screening tools across different populations because different studies used different tools and outcome measures in different populations and settings. The group identified no studies on the accuracy of surveillance for speech and language development by primary care clinicians.
The USPSTF is providing an opportunity for public comment on this draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) until Dec. 15.
The AAFP is reviewing the draft recommendation and will update its own 2006 speech and language delay recommendation after the USPSTF publishes its final recommendation in 2015.
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American Family Physician: Speech and Language Delay in Children