■有言语和语言障碍的儿童有学习和行为问题的风险。
■审查5岁或以下儿童的言语和语言延迟或障碍筛查证据,以通知美国预防服务工作组。
■PubMed/MEDLINE,科克伦图书馆,PsycInfo,ERIC,语言和语言行为文摘(ProQuest),和试验登记处至2023年1月17日;监测至2023年11月24日。
■筛选测试准确性的英语研究,比较筛查与未筛查的试验或队列研究;干预措施的随机临床试验(RCT)。
■摘要的双重审查,全文文章,学习质量,和数据提取;对结果进行了叙述性总结。
■筛选测试准确性,言语和语言结果,学校表现,函数,生活质量,和伤害。
■纳入41篇文章中的38项研究(N=9006)。没有研究评估筛查与不筛查的直接益处。21项研究(n=7489)评估了23种不同的筛查工具的准确性,这些工具在设计是否由父母与训练有素的审查员完成方面有所不同。并筛选全球(任何)语言问题与特定技能(例如,表现性语言)。三项评估父母报告的表达性语言技能工具的研究发现,始终具有很高的敏感性(范围,88%-93%)和特异性(范围,88%-85%)。其他筛选工具的准确性差异很大。17项RCT(n=1517)评估了言语和语言延迟或障碍的干预措施。尽管没有纳入初级保健常规筛查确定的儿童。两个RCT评估了相对密集的父母团体培训干预措施(11个课程),发现对表达语言技能的不同措施有益,1评估强度较低的干预措施(6个疗程),发现两组间的任何结局均无差异.两个RCT(n=76)评估了由语言病理学家进行的以父母培训为特征的Lidcombe早期口吃干预计划,发现在临床和通过远程医疗,与对照组相比,在9个月时口吃的音节比例降低了2.3%至3.0%。分别。其他干预措施的证据有限。没有RCT报告干预的危害。
■没有研究直接评估筛查的益处和危害。一些家长报告的表达性语言技能筛选工具对于检测表达性语言延迟具有合理的准确性。针对言语延迟的小组家长培训计划,提供至少11次家长培训课程,提高了表达语言技能,语言病理学家提供的口吃干预减少了口吃的频率。
Children with speech and language difficulties are at risk for learning and behavioral problems.
To
review the evidence on screening for speech and language delay or disorders in children 5 years or younger to inform the US Preventive Services Task Force.
PubMed/MEDLINE, Cochrane Library, PsycInfo, ERIC, Linguistic and Language Behavior Abstracts (ProQuest), and trial registries through January 17, 2023; surveillance through November 24, 2023.
English-language studies of screening test accuracy, trials or cohort studies comparing screening vs no screening; randomized clinical trials (RCTs) of interventions.
Dual
review of abstracts, full-text articles, study quality, and data extraction; results were narratively summarized.
Screening test accuracy, speech and language outcomes, school performance, function, quality of life, and harms.
Thirty-eight studies in 41 articles were included (N = 9006). No study evaluated the direct benefits of screening vs no screening. Twenty-one studies (n = 7489) assessed the accuracy of 23 different screening tools that varied with regard to whether they were designed to be completed by parents vs trained examiners, and to screen for global (any) language problems vs specific skills (eg, expressive language). Three studies assessing parent-reported tools for expressive language skills found consistently high sensitivity (range, 88%-93%) and specificity (range, 88%-85%). The accuracy of other screening tools varied widely. Seventeen RCTs (n = 1517) evaluated interventions for speech and language delay or disorders, although none enrolled children identified by routine screening in primary care. Two RCTs evaluating relatively intensive parental group training interventions (11 sessions) found benefit for different measures of expressive language skills, and 1 evaluating a less intensive intervention (6 sessions) found no difference between groups for any outcome. Two RCTs (n = 76) evaluating the Lidcombe Program of Early Stuttering Intervention delivered by speech-language pathologists featuring parent training found a 2.3% to 3.0% lower proportion of syllables stuttered at 9 months compared with the control group when delivered in clinic and via telehealth, respectively. Evidence on other interventions was limited. No RCTs reported on the harms of interventions.
No studies directly assessed the benefits and harms of screening. Some parent-reported screening tools for expressive language skills had reasonable accuracy for detecting expressive language delay. Group parent training programs for speech delay that provided at least 11 parental training sessions improved expressive language skills, and a stuttering intervention delivered by speech-language pathologists reduced stuttering frequency.