USPSTF: Data Lacking for Speech, Language Screening in Kids

Susan London

July 07, 2015

Evidence is lacking to support routine primary care screening of young children for speech and language problems, according to an updated recommendation from the US Preventive Services Task Force (USPSTF) published online July 6 in Pediatrics.

"[C]urrent evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children aged 5 years or younger," the task force concludes. The task force, chaired by Albert L. Siu, MD, MSPH, from the Mount Sinai School of Medicine, New York City, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York, graded the statement as an I statement to denote the insufficiency of the evidence.

"This recommendation applies only to asymptomatic children whose parents or clinicians do not have specific concerns about their speech, language, hearing, or development. It does not apply to children whose parents or clinicians raise those concerns; these children should undergo evaluation and, if needed, treatment," the task force notes.

In addition, "[t]his recommendation discusses the identification and treatment of 'primary' speech and language delays and disorders (ie, in children who have not been previously identified with another disorder or disability that may cause speech or language impairment)."

The updated recommendation replaces the initial USPSTF recommendation on this topic issued in 2006, which had essentially the same conclusion.

"This persistent lack of evidence accumulated across nearly a decade reveals that unlike simple laboratory screening for lead toxicity or dyslipidemia, child development represents a drastically more complex phenomenon that may present insurmountable obstacles to the process of simple screening," write Robert G. Voigt, MD, from the Department of Pediatrics, Baylor College of Medicine, Houston, Texas, and Pasquale J. Accardo, MD, from the Department of Pediatrics, Virginia Commonwealth University, Richmond, in an accompanying commentary.

Pediatricians are in a good position to perform screening for developmental issues, given their longitudinal relationships with children and families and their access to relevant information from the history, they note. However, current mandatory training of pediatrics residents is limited to a 4-week subspecialty experience in developmental-behavioral pediatrics.

"A substantial expansion of required subspecialty exposure to developmental evaluation and diagnosis during pediatric residency training should lead to increased confidence in using clinical judgment to address developmental concerns just like any other commonly presenting concern in daily pediatric practice. Such enhanced pediatrician competence in evaluation and diagnosis of the basic science of pediatrics might ultimately provide evidence for improved outcomes, which has so far been lacking in the USPSTF studies of screening," the commentators conclude.

To derive their recommendation, the USPSTF commissioned a systematic review of the evidence on screening for speech and language delay and disorders in children aged 5 years or younger, performed by Ina F. Wallace, PhD, from RTI International, Research Triangle Park, North Carolina, and colleagues. Results were based on 87 studies and two systematic reviews.

Twenty-four studies evaluated the accuracy of various screening tools, finding that their performance for identifying speech and language delay and disorders varied widely. No studies assessed the accuracy of surveillance (active monitoring) of speech and language development by primary care clinicians.

A single randomized controlled trial of screening for language delays was excluded from consideration because of its poor quality.

Thirteen studies on the potential benefits of treatment for children having diagnosed speech and language delays and disorders yielded inconsistent findings with respect to speech and language outcomes, and four showed inconsistent findings when it came to other outcomes, such as socialization, reading comprehension, and child well-being.

None of the included studies assessed the potential harms of screening for speech and language delays and disorders in primary care, and the two assessing potential harms of treatment had inconsistent results.

The USPSTF notes that the recommendation does not address screening young children for autistic spectrum disorder, which will be addressed separately. In addition, they continue to recommend screening of all newborns for hearing loss.

Dr Siu and the authors of the commentary have disclosed no relevant financial relationships.

Pediatrics. Published online July 6, 2015.

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