Therapy for Speech and Language Delay
Which therapies are effective in children with primary speech and language delay?
Speech and language therapy is effective in children who have problems with expressive vocabulary and pronunciation. There is insufficient evidence regarding interventions for receptive disorders and mixed results for interventions to improve expressive grammar and sentence structure.
Primary speech disorder is defined as a speech and language delay in a child without behavior, hearing, or neurologic impairment. Children with primary speech disorder have a variety of deficits. In adolescence, about one half of children with primary speech disorder have long-term problems with reading and spelling. Speech and language difficulties are common, and there is a range of presentations and etiologies. Some patients have transient, isolated difficulties. Others have more persistent problems with disordered speech and expressive or receptive language.
To evaluate treatments, Law and colleagues searched for randomized, controlled trials on speech and language therapies for children and adolescents with primary speech and language disorders. They found 25 studies of children younger than 15 years that met their selection criteria. Results varied considerably among studies and had wide confidence intervals, but the authors were able to reach some tentative conclusions.
There is some evidence to support speech and language therapy in children with difficulty producing clear speech and expressive vocabulary if difficulties with receptive language are not present. Limited evidence suggests that children with receptive language difficulties may receive less benefit from such therapy. Trained parents and clinicians achieved similar results. Limited data show that group and individual phonology therapy achieved similar results. Interventions lasting more than eight weeks seem to be the most effective. Using peers with normal language as models in intervention is beneficial.
The American Academy of Child and Adolescent Psychiatry1 has published practice parameters for patients with language and learning disorders. For children ages six to 12, the group recommends a clinical diagnostic assessment, including a parent interview, child interview, medical and psychiatric histories, school evaluation, and family history. In the face of limited evidence regarding effective speech and language therapy, these guidelines can help physicians pursue a reasonable diagnostic and treatment plan.