On July 7, the U.S. Preventive Services Task Force (USPSTF) released its final recommendation statement(www.uspreventiveservicestaskforce.org) on screening for speech and language delays and disorders in children age 5 years or younger, declaring that current evidence is insufficient to assess the balance of benefits and harms of routine screening for this group -- an I statement.(www.uspreventiveservicestaskforce.org)
The USPSTF looked at evidence on whether routine formal screening of young children for speech and language delays and disorders in a primary care setting leads to improvements in speech, language or outcomes such as academic achievement. Task force members decided that more evidence is needed to determine how accurately this type of screening identifies children who need interventions and whether that identification benefits children down the road.
"Learning to speak and use language correctly is a complex process and a critical component of child development," said USPSTF member Alex Kemper, M.D., M.P.H., M.S., in a news release.(www.uspreventiveservicestaskforce.org) "We need a better understanding of how to identify at-risk children in primary care settings and which treatments are effective once children with speech and language delays and disorders are found."
- The U.S. Preventive Services Task Force (USPSTF) posted its final recommendation for speech and language delay and disorders in children age 5 or younger, finding that evidence is insufficient to assess the balance of benefits and harms of routine screening.
- The AAFP's newly released recommendation statement on this topic mirrors that of the USPSTF.
- In response to public comments submitted after the release of the draft recommendation, the USPSTF clarified a number of points, including that the recommendation applies only to asymptomatic children whose parents have no specific concerns.
The AAFP's newly released recommendation statement on this topic mirrored that of the USPSTF, also concluding that the current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in this age group. Moreover, the current recommendation statements for both groups mimic, in essence, the statements each released in 2006.
After the draft recommendation on this topic was issued in November, AAFP News spoke with Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division. Frost noted at the time that 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."
In response to public comments on the draft recommendation, the USPSTF clarified that this recommendation statement applies only to asymptomatic children whose parents or clinicians do not have specific concerns about their speech, language, hearing or development. Task force members also emphasized that the recommendation applies only to screening in primary care settings, noting the difference between screening performed in such settings and diagnostic testing, which may occur in other settings.
In addition, the task force noted, the current recommendation statement does not pertain to screening for autism spectrum disorder, which it will address in a separate recommendation statement.
The widely used American Academy of Pediatrics' Bright Futures guidelines(brightfutures.aap.org) include speech and language milestones to be covered at each well-child visit. But during the 2006 USPSTF 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 studies and 19 fair-quality studies) that evaluated the accuracy of 20 different screening tools. Although the ages of the children in the studies varied, the majority of them included children ages 2-3.
Test performance characteristics differed widely, with parent-administered screening tools generally outperforming other tools. Among parent-administered tools, sensitivity was generally higher for the Communicative Development Inventory, the Infant-Toddler Checklist and the Language Development Survey.
The recommendation explained 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 was unable to identify any studies on the accuracy of surveillance of speech and language development by primary care clinicians.
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