USPSTF: No Thumbs Up for Screening All Kids for Speech Delay

— Draft recommendation cites insufficient evidence on potential benefits of primary care screening

by
Jennifer Henderson, Enterprise & Investigative Writer, MedPage Today
July 25, 2023

The U.S. Preventive Services Task Force (USPSTF) concluded that there is not enough evidence to make a recommendation on primary care screening for speech and language problems in children 5 years and younger who do not show any signs.

Specifically, the Task Force again found a lack of evidence on whether such screening leads to improvements in speech, language, and other outcomes like school performance, according to a draft recommendation statement and draft evidence review issued Tuesday that concurs with recommendations from 2015.

“Evidence suggests that school-age children with speech or language delays may be at increased risk of learning and literacy disabilities, including difficulties with reading and writing,” the document said. “Observational cohort studies suggest that children with these conditions may also be at higher risk for social and behavioral problems in addition to learning problems, some of which may persist through adulthood.”

However, the Task Force stopped short of backing primary care screening for all young kids, reiterating that gaps exist when it comes to assessing whether or not early screening can help to ward off other issues down the line.

“Speech and language are critical parts of development, and delays and disorders can be challenging for children and their families,” Tumaini Rucker Coker, MD, MBA, of Seattle Children’s and the University of Washington School of Medicine in Seattle, said in a statement. “Caring for children with speech and language delays and disorders is incredibly important, but unfortunately, there is not enough evidence to tell us whether or not it is helpful to screen all children 5 years and younger in the primary care setting.”

The USPSTF differs from the American Academy of Pediatrics, which recommends routine developmental surveillance at all well-child visits and developmental screening — not specific to speech and language — with validated tools at 9-month, 18-month, and 30-month visits.

Checking for speech and language delay and disorders is common as part of routine development surveillance and screening in primary care settings, the USPSTF noted. Roughly 30% of kids ages 9 to 35 months received a parent-completed developmental screening in the last year.

General screening instruments with speech and language components are the most used tools. And it is unclear how many clinicians use tools specific to speech and language development.

“Implementation of screening and treatment protocols remain a challenge,” the Task Force further noted. Data from the 2012 National Health Interview Survey showed that half of children ages 3 to 17 years with a speech and language disorder received an intervention in the last year. And racial and ethnic disparities exist in rates of referral or services for those identified as having a potential speech or language problem, with Hispanic/Latino and Black children less likely to receive services.

“Our recommendation is not a recommendation for or against screening, but rather a call for more research,” Task Force member Li Li, MD, PhD, MPH, of the University of Virginia School of Medicine in Charlottesville, said in a statement. “It is essential that the gaps in the evidence be addressed, particularly for those who are more likely to experience speech and language delays and disorders, such as Black, Hispanic/Latino, and Native American children, as well as children in households with low incomes.”

The draft evidence review found median sensitivity and specificity of instruments for detecting speech and language delay and disorders of 87% for sensitivity (range 43-100%) and 88% for specificity (range 32-98%) across 21 studies. Accuracy varied in terms of whether tests were completed by parents or trained examiners and whether instruments focused on global language, specific language skills, or articulation.

The Task Force found no studies addressing the direct benefits of screening on health outcomes, such as school performance, function, or quality of life.

Of eight trials assessing interventions among kids diagnosed with language delay but no fluency or speech-sound impairment, two studies that evaluated more intensive parent-delivered group training interventions found benefits for expressive language outcomes measures.

In general, the results were inconsistent for other interventions and settings, with only some studies showing improvement in some measures of receptive or expressive language.

Both trials that assessed speech-language pathologist treatment for young children with fluency disorder found benefit in reducing stuttering frequency at 9 months post-intervention.

Four studies reported on measures of early literacy, with one finding benefit for improving letter knowledge. Two studies assessing interventions for speech sound disorders found no statistically significant difference between intervention and control groups on measures of functional communication. And no study reported benefit when it came to improving function or quality of life among kids.

The Task Force did not identify any studies on the potential harms of screening or interventions for speech and language delay and disorders in children.

The draft recommendation statement and draft evidence review were posted for public comment on the USPSTF website. Comments can be submitted until August 21.