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Screening for speech and language delay and disorders in children 5 years or younger
Evidence report and systematic review for the US preventive services task force
Feltner, C., Wallace, I. F., Nowell, S. W., Orr, C. J., Raffa, B., Middleton, J. C., Vaughan, J., Baker, C., Chou, R., & Kahwati, L. (2024). Screening for speech and language delay and disorders in children 5 years or younger: Evidence report and systematic review for the US preventive services task force. JAMA, 331(4), 335-351. https://doi.org/10.1001/jama.2023.24647
IMPORTANCE: Children with speech and language difficulties are at risk for learning and behavioral problems.
OBJECTIVE: To review the evidence on screening for speech and language delay or disorders in children 5 years or younger to inform the US Preventive Services Task Force.
DATA SOURCES: PubMed/MEDLINE, Cochrane Library, PsycInfo, ERIC, Linguistic and Language Behavior Abstracts (ProQuest), and trial registries through January 17, 2023; surveillance through November 24, 2023.
STUDY SELECTION: English-language studies of screening test accuracy, trials or cohort studies comparing screening vs no screening; randomized clinical trials (RCTs) of interventions.
DATA EXTRACTION AND SYNTHESIS: Dual review of abstracts, full-text articles, study quality, and data extraction; results were narratively summarized.
MAIN OUTCOMES AND MEASURES: Screening test accuracy, speech and language outcomes, school performance, function, quality of life, and harms.
RESULTS: Thirty-eight studies in 41 articles were included (N = 9006). No study evaluated the direct benefits of screening vs no screening. Twenty-one studies (n = 7489) assessed the accuracy of 23 different screening tools that varied with regard to whether they were designed to be completed by parents vs trained examiners, and to screen for global (any) language problems vs specific skills (eg, expressive language). Three studies assessing parent-reported tools for expressive language skills found consistently high sensitivity (range, 88%-93%) and specificity (range, 88%-85%). The accuracy of other screening tools varied widely. Seventeen RCTs (n = 1517) evaluated interventions for speech and language delay or disorders, although none enrolled children identified by routine screening in primary care. Two RCTs evaluating relatively intensive parental group training interventions (11 sessions) found benefit for different measures of expressive language skills, and 1 evaluating a less intensive intervention (6 sessions) found no difference between groups for any outcome. Two RCTs (n = 76) evaluating the Lidcombe Program of Early Stuttering Intervention delivered by speech-language pathologists featuring parent training found a 2.3% to 3.0% lower proportion of syllables stuttered at 9 months compared with the control group when delivered in clinic and via telehealth, respectively. Evidence on other interventions was limited. No RCTs reported on the harms of interventions.
CONCLUSIONS AND RELEVANCE: No studies directly assessed the benefits and harms of screening. Some parent-reported screening tools for expressive language skills had reasonable accuracy for detecting expressive language delay. Group parent training programs for speech delay that provided at least 11 parental training sessions improved expressive language skills, and a stuttering intervention delivered by speech-language pathologists reduced stuttering frequency.
