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Evaluation of a structured test and a parent led method for screening for speech and language problems: prospective
Gabrielle J Laing1, James Law, Abigail Levin
1Child Health Department, St Leonard's Hospital, City and Hackney Primary Care Trust, London N1 5LZ, UK.
Insights
Evaluating screening methods for preschool speech and language problems revealed significant limitations. Both structured screening tests and parent-led methods failed to identify many children needing intervention, suggesting screening
Area of Science:
- Pediatric Speech-Language Pathology
- Early Childhood Development
- Public Health Screening
Background:
- Early identification of speech and language problems in preschool children is crucial for timely intervention.
- Existing screening methods require evaluation for effectiveness and efficiency in identifying at-risk populations.
Purpose of the Study:
- To compare the effectiveness of a structured screening test versus a parent-led method in identifying speech and language problems in 30-36 month old children.
- To assess the sensitivity and specificity of each screening method for detecting severe language problems and the need for therapy.
Main Methods:
- A prospective, population-based study conducted in Inner London.
- 37 health visitors were randomized to use either a structured screening test or a parent-led approach.
- 582 children aged 30-36 months participated; assessments were conducted by blinded speech and language therapists using the Reynell developmental language scales.
Main Results:
- Of 474 screened children, 21% had severe language problems and 29% needed therapy.
- The structured screening test had a sensitivity of 66% for severe problems and 54% for needing therapy.
- The parent-led method showed similar performance, with a sensitivity of 56% for severe problems and 58% for needing therapy; both methods had high specificity but low sensitivity.
Conclusions:
- Both the structured screening test and the parent-led method failed to detect a significant proportion of preschool children with speech and language issues.
- These screening approaches resulted in over-referral for diagnostic assessments, indicating inefficiency.
- Screening may be an ineffective strategy for managing speech and language problems in this preschool population.
Objective:
To evaluate two methods for identifying speech and language problems in preschool children.
Design:
Prospective population based study.
Setting:
Inner London.
Participants And Methods:
37 health visitors were randomly assigned to use a structured screening test (18) or a parent led method (19). Of 623 eligible children aged 30-36 months, the parents of 582 agreed to participate (353 using the structured test and 229 the parent led method).
Main Outcome Measures:
Children were assessed by a speech and language therapist blinded to the test result, using the Reynell developmental language scales. Children were classified as having "severe language problems" if the Reynell score was below the third centile for receptive language and as "needing therapy" if the Reynell score was below the seventh centile for receptive or expressive language and clinical opinion.
Results:
Reference assessments and usable scores were obtained for 458 (97%) of the 474 children screened. 98 (21%) children had severe language problems and 131 (29%) needed therapy. The sensitivity and specificity for the structured screening test were 66% (95% confidence interval 53% to 76%) and 89% (85% to 93%) respectively for severe language problems and 54% (43% to 65%) and 90% (85% to 93%) for those needing therapy. The sensitivity and specificity for referral by the parent led method were 56% (40% to 71%) and 85% (78% to 90%) for severe language problems and 58% (44% to 71%) and 90% (83% to 94%) for those needing speech and language therapy.
Conclusions:
Both approaches failed to detect a substantial proportion of children with severe language problems and led to over-referral for diagnostic assessments. Screening is likely to be an ineffective approach to the management of speech and language problems in preschool children in this population.
