Brief, formal speech and language delay screening

Children Up to 5 Years of Age:  The USPSTF concludes that the evidence is insufficient to recommend for or against routine use of brief, formal screening instruments in primary care to detect speech and language delay in children up to 5 years of age. Rationale Speech and language delay affects 5 to 8 percent of preschool children, often persists into the school years, and may be associated with lowered school performance and psychosocial problems. The USPSTF found insufficient evidence that brief, formal screening instruments that are suitable for use in primary care for assessing speech and language development can accurately identify children who would benefit from further evaluation and intervention. Fair evidence suggests that interventions can improve the results of short-term assessments of speech and language skills; however, no studies have assessed long-term outcomes. Furthermore, no studies have assessed any additional benefits that may be gained by treating children identified through brief, formal screening who would not be identified by addressing clinical or parental concerns. No studies have addressed the potential harms of screening or interventions for speech and language delays, such as labeling, parental anxiety, or unnecessary evaluation and intervention. Thus, the USPSTF could not determine the balance of benefits and harms of using brief, formal screening instruments to screen for speech and language delay in the primary care setting. Clinical considerations It is the responsibility of primary care clinicians to seek and address parents' concerns and children's obvious speech and language delays despite the lack of evidence to support screening with brief formal instruments. Speech and language development is considered a useful early indicator of a child's overall development and cognitive ability, and clinical and parental concerns are important modes of identifying children with speech and language delay. Early identification of children with developmental delay (lateness in achieving milestones) or developmental disabilities,(chronic conditions that result from mental or physical impairments), such as marked hearing deficits, may lead to intervention and family assistance at a young age when chances for improvement may be best. Specific groups of children who already have been identified as at higher than average risk for speech and language delay, including children with other medical problems such as hearing deficits or cranio-facial abnormalities, are not considered in this recommendation. The results of studies of other risk factors are inconsistent, so the USPSTF was unable to develop a list of specific risk factors to guide primary care providers in selective screening. The most consistently reported risk factors, however, include a family history of speech and language delay, male gender, and perinatal factors, such as prematurity and low birth-weight. Other risk factors reported less consistently include levels of parental education, specific childhood illnesses, birth order, and larger family size. See:  http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/52490?xid=nl_mpt_DHE_2015-07-09&eun=g906366d0r See also:  http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/speech-and-language-delay-in-preschool-children-screening#copyright-and-source-information Albert L. Siu and on behalf of the US Preventive Services Task Force. Screening for Speech and Language Delay and Disorders in Children Aged 5 Years or Younger: US Preventive Services Task Force Recommendation Statement  Pediatrics peds.2015-1711; Published online July 7, 2015 (10.1542/peds.2015-1711)