Randomised controlled trial of community based speech and language therapy in preschool children

Abstract

Objective To compare routine speech and language therapy in preschool children with delayed speech and language against 12 months of "watchful waiting.'' Design Pragmatic randomised controlled trial. Setting 16 community clinics in Bristol. Participants 159 preschool children with appreciable speech or language difficulties who fulfilled criteria for admission to speech and language therapy. Main outcome measures Four quantitative measures of speech and language, assessed at 6 and 12 months; a binary variable indicating improvement, by 12 months, on the trial entry criterion. Results Improvement in auditory comprehension was significant in favour of therapy (adjusted difference in means 4.1, 95% confidence interval 0.5 to 7.6; P = 0.025). No significant differences were observed for expressive language (1.4, − 2.1 to 4.8; P = 0.44); phonology error rate ( − 4.4, − 12.0 to 3.3; P = 0.26); language development (0.1, − 0.4 to 0.6; P = 0.73); or improvement on entry criterion (odds ratio 1.3, 0.67 to 2.4; P = 0.46). At the end of the trial, 70% of all children still had substantial speech and language deficits. Conclusions This study provides little evidence for the effectiveness of speech and language therapy compared with watchful waiting over 12 months. Providers of speech and language therapy should reconsider the appropriateness, timing, nature, and intensity of such therapy in preschool children. Continued research into more specific provision to subgroups of children is also needed to identify better treatment methods. The lack of resolution of difficulties for most of the children suggests that further research is needed to identify effective ways of helping this population of children.

Screening for Speech and Language Delay in Preschool Children: Systematic Evidence Review for the US Preventive Services Task Force

“…Treatment for receptive auditory comprehension lead to significant improvement for the intervention group compared with the control group; however, results did not differ between groups for several expressive and phonology outcomes. 72 …”

“…One good 72 and 6 fair-quality [77][78][79][80]84,85 studies evaluated speech and language interventions for children who were 2 to 3 years old. The studies reported improvement on a variety of communication domains including clinician-directed treatment for expressive and receptive language, 80 parent-directed therapy for expressive delay, 77,78 and clinician-directed receptive auditory comprehension.…”

“…Twenty-five RCTs in 24 publications met inclusion criteria, including 1 rated good, 72 13 rated fair, [73][74][75][76][77][78][79][80][81][82][83][84][85] and 11 rated poor quality 77,[86][87][88][89][90][91][92][93][94][95] (Table 7). Studies were considered to be of poor quality if they reported important differences between intervention and comparison groups at baseline, did not use intention-to-treat analysis, no method of randomization was reported, or there were Ͻ10 subjects in the intervention or comparison groups.…”

“…Outcomes were measured by subjective reports from parents 77,78,80,85 and by scores on standardized instruments such as the Reynell Expressive and Receptive Scales, 74,77 the Preschool Language Scale, 72,75,85 and the MacArthur Communicative Development Inventories. 80,93 The most widely used outcome measure was mean-length utterances, used by 6 studies.…”

“…72 The clinician-directed, 12-month intervention consisted of 10-minute weekly sessions focusing on multiple language domains, expressive and receptive language, and phonology. Treatment for receptive auditory comprehension lead to significant improvement for the intervention group compared with the control group; however, results did not differ between groups for several expressive and phonology outcomes.…”