Two-Year Outcomes of a Population-Based Intervention for Preschool Language Delay: An RCT

Abstract

OBJECTIVE: We have previously shown short-term benefits to phonology, letter knowledge, and possibly expressive language from systematically ascertaining language delay at age 4 years followed by the Language for Learning intervention. Here, we report the trial's definitive 6-year outcomes.METHODS: Randomized trial nested in a population-based ascertainment. Children with language scores .1.25 SD below the mean at age 4 were randomized, with intervention children receiving 18 1-hour home-based therapy sessions. Primary outcome was receptive/expressive language. Secondary outcomes were phonological, receptive vocabulary, literacy, and narrative skills; parent-reported pragmatic language, behavior, and health-related quality of life; costs of intervention; and health service use. For intention-to-treat analyses, trial arms were compared using linear regression models.RESULTS: Of 1464 children assessed at age 4, 266 were eligible and 200 randomized; 90% and 82% of intervention and control children were retained respectively. By age 6, mean language scores had normalized, but there was little evidence of a treatment effect for receptive (adjusted mean difference 2.3; 95% confidence interval [CI] -1.2 to 5.7; P = .20) or expressive (0.8; 95% CI -1.6 to 3.2; P = .49) language. Of the secondary outcomes, only phonological awareness skills (effect size 0.36; 95% CI 0.08-0.65; P = .01) showed benefit. Costs were higher for intervention families (mean difference AU $4276; 95% CI: $3424 to $5128).CONCLUSIONS: Population-based intervention targeting 4-year-old language delay was feasible but did not have lasting impacts on language, possibly reflecting resolution in both groups. Long-term literacy benefits remain possible but must be weighed against its cost.

Parent‐implemented early language intervention programme for late talkers: parental communicative behaviour change and child language outcomes at 3 and 4 years of age

“…Wake et al . ). Considering this, we argue that treatment should be offered at different language stages and the type of treatment needs to change over time.…”

“…Predictive screening tools are needed that will quantify a child's absolute risk for developmental language disorder (Wake et al . ). Since these are not yet available, we agree with Reilly et al .…”

“…However, it is also known that late language emergence is a risk indicator for developmental language disorder (Taylor et al 2013, Bishop et al 2012, Prathanee et al 2009). Deciding if and when LTs should receive treatment is particularly difficult because it is hard to predict which children will catch up and which will not (Bishop et al 2016, Wake et al 2015, Reilly et al 2010. Some researchers advocate the 'watch and see' approach (Bishop et al 2016, Paul 1996.…”

Evidence based pathways to intervention for children with language disorders

“…However, the concept has utility when couched in terms of avoiding functional impairments or secondary sequelae (such as poor mental health) and enhancing skill development in individuals with long term conditions, even if the condition itself cannot be prevented. When making any assumptions about preventative intervention, the research on the variability in language trajectories in pre-school children and the spontaneous progress many pre-school children make should be borne in mind (see Wake et al, 2015).…”

Should We Use Sentence- or Text-Level Tasks to Measure Oral Language Proficiency in Year-One Students following Whole-Class Intervention?

“…The current study will investigate this issue in relation to Australian students who attended schools in an area known to be home to a high percentage of children from culturally and linguistically diverse (CALD) backgrounds. Of these students, it is estimated that only 1 in 5 have sufficient language skills to efficiently access and successfully participate in education [4]. The results from this study will assist SLPs and educators to make informed decisions regarding the use of assessment tasks for measuring oral language progress of Australian students from low socioeconomic backgrounds during their first year of formal schooling.…”