A cluster-randomised trial of screening for language disorders in toddlers

Abstract

Objective: To assess the screening performance of a specific language-screening instrument at 18 and 24 months of age and to assess its effect on the early detection and prognosis of language delay. Design: Child health care physicians were randomised to the intervention group, in which specific language screening was conducted twice (at age 18 months and 24 months), or to the control group (usual care). The specific screening instrument consisted of a uniform set of questions for the parents and test elements for the child, with scaled scores to assess responses. Setting: Child health care in the Netherlands and referral of screen-positive children. Subjects: 5734 children in the intervention group and 4621 in the control group. Main outcome measures: Test characteristics and disorders at 24 months, and confirmed diagnoses of a language disorder before 36 months in both groups. Gold standard based on reports of parents, specialists and expert panel. Prognosis estimated from two diagnostic language development performance scores at 36 months (in questionnaire). Results: In the intervention group, 3147 of the 5734 children (55%) were screened with the specific screening instrument and 73 of the screened children (2.3%) were screen-positive. Of the screen-positive children, 41 (55%) had confirmed language delay (diagnostic assessment and/or reported treatment). The estimated sensitivity of the test ranged between 24–52% depending on the severity of language disorders. The prevalence of language disorders in three-year olds was estimated to be 2.4–5.3%. In the intervention group, 1.25–2 times more children with language delay had been diagnosed before 36 months. The assessment of language development at 36 months showed no statistically significant differences between the intervention and the control groups. Conclusions: The inclusion of a specific language-screening instrument in child health centre activities resulted in the earlier detection of children with language delay. Short-term health benefits could not be demonstrated. Large-scale introduction cannot be recommended on the basis of this information alone.

Screening for Speech and Language Delay in Children 5 Years Old and Younger: A Systematic Review

“…One randomized controlled trial (RCT) met our inclusion criteria by randomizing a large national sample of children who received regularly scheduled care at child health centers to early screening and measuring outcomes at 8 years of age. 25,26 We did not include evidence from this trial owing to a rating of poor quality caused by very high attrition.…”

Detecting language problems: accuracy of five language screening instruments in preschool children

“…Children in six regions in the Netherlands (a large city in the west and rural and urban areas in the south) who routinely visited child health-care centres around the age of 2 years were included in a prospective cohort study (de Koning et al 2004). To assess the children's language development the parents of 11 423 children were sent a questionnaire around the time of their child's third birthday, including four validated language screening instruments, parents' own evaluation of their child's language development on a VAS, and questions about current or past language problems.…”

“…A large variety of instruments to detect language delays, often based on parent report, have been developed (Rescorla 1989, Ward 1992, Clark et al 1995, Stott et al 2002, de Koning et al 2004. Evaluation of such screening instruments consists of comparing the result of the screen that is the assignment of cases into 'normal' or 'not normal', with the result on a reference test or 'criterion standard', which should ideally be a standardized clinical diagnostic test.…”

“…To identify a simple and effective screening instrument to detect language delays in 3-year-old children, we assessed the reliability, validity, and accuracy of the Dutch version of the GLS, three other screening instruments, and parents' own judgement as measured on a visual analogue scale (VAS) in a large cohort study in the Netherlands of 10 000 preschool children (de Koning et al 2004). We calculated the sensitivity and specificity for different cut-off points of the screening instruments.…”

Screening 3-year-olds for language delay using selected parent-report measures: The jury is still out1

“…To their credit, this same research team recently published a trial examining the outcome at 36 months of children who had been screened for language delay at 18 and 24 months, involving essentially the same cohort of children who participated in the study reviewed here (de Koning et al, 2004).…”