The influence of peer models on the play scripts of children with specific language impairment

Screening for Speech and Language Delay and Disorders in Children 5 Years or Younger: Evidence Report and Systematic Review for the US Preventive Services Task Force

Importance

Children with speech and language difficulties are at risk for learning and behavioral problems.

Objective

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.

Data Sources

PubMed/MEDLINE, Cochrane Library, PsycInfo, ERIC, Linguistic and Language Behavior Abstracts (ProQuest), and trial registries through January 17, 2023; surveillance through November 24, 2023.

Study Selection

English-language studies of screening test accuracy, trials or cohort studies comparing screening vs no screening; randomized clinical trials (RCTs) of interventions.

Data Extraction and Synthesis

Dual review of abstracts, full-text articles, study quality, and data extraction; results were narratively summarized.

Main Outcomes and Measures

Screening test accuracy, speech and language outcomes, school performance, function, quality of life, and harms.

Results

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.

Conclusions and Relevance

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.

Peer Effects in Language Therapy for Preschoolers With Developmental Language Disorder: A Pilot Study

PURPOSE

The purpose of this pilot study was to determine the impact of including peers with typically developing language (TDL) in language intervention sessions for preschool children with diagnosed developmental language disorder (DLD).

METHOD

To measure peer effects, participants received 8 weeks of group language intervention in their neighborhood head start. Twenty children with DLD were randomly assigned to one of two conditions. Children in the experimental condition received language intervention with a peer with TDL; children in the control condition received language intervention with another peer with DLD. Pre- and posttest measures of language (semantics, syntax, morphology, and narrative) were collected. Teachers, speech-language pathologists, and assessors were blind to study condition.

RESULTS

All children in the study showed gains from pre- to posttest; there were no statistically significant differences between conditions. However, effect size estimates (Cohen's d) indicated that the children in the experimental condition showed an advantage over the control condition in syntax, morphology, and narrative.

CONCLUSIONS

This study provides preliminary evidence that children with DLD show increased gains in language when paired with peers with TDL. This finding supports previous research in educational literature, suggesting that children's development is influenced by the skills of their peers. Additional research is warranted to further explore and understand the role of peers for children with DLD.

Reviewing the link between language abilities and peer relations in children with developmental language disorder: The importance of children's own perspectives

BACKGROUND AND AIMS

Children with developmental language disorder (DLD) are at risk of difficulties in their friendships and peer relations. The present review explores how research directly involving children with DLD can inform our understanding of peer relations in this group, and how research insights may change according to the nature of their involvement in the studies. We further examine how these findings might shape current theoretical understandings of the links between language impairment and peer relations.

METHODS

An integrative review methodology was used in order to identify relevant studies and synthesise the findings. A structured database search was carried out using the qualitative PICo framework; Population = 4-12-year-old children with DLD, phenomenon of Interest = peer relations, Context = research studies directly including children. After screening, 52 studies were included in a narrative research synthesis.Main contribution: We identified six main types of study that directly included children with DLD; interview, sociometric, self-report, task-based, naturalistic observation and staged observation. Interview-based studies were the most likely to use a meaningful participatory approach. Indications of good practices for participation included reporting on involvement practices, seeking child assent, adapting materials and language used, using visual supports, using child-preferred communication methods and using art-based approaches. Findings from the narrative synthesis of studies highlight the importance of friendships to quality of life, and the role of pragmatic language skills and self-perceptions in building friendships.

CONCLUSIONS

Research on the peer relations of children with DLD is in the early stages when it comes to taking a participatory approach, however there are some examples of inclusive practice from which the whole field can learn. The findings show that research that directly includes children with language disorders and takes account of their communication challenges can help build a more comprehensive knowledge of their world and leads to interesting avenues for interventions targeting social adjustment.Implications: Clinical implications are discussed with reference to the highlighted pragmatic language and social needs of children with DLD, which are typically not addressed unless disproportionately affected in comparison to structural language impairments.

Effect of Group Setting on Gross Motor Performance in Children 3-5 Years Old with Motor Delays

AIMS

The purpose of this study was to evaluate differences in gross motor performance of children 3-5 years of age with motor delays when assessed individually compared to assessment in a group setting among peers with typical development (TD).

METHODS

Twenty children with motor delays and 42 children with TD were recruited from a preschool program. A within-subject repeated measures design was used; each child with delay was tested both in an individual setting and in a group setting with two to four peers with TD. Testing sessions were completed 4-8 days apart. Ten different motor skills from the Peabody Developmental Motor Scales-2 were administered. Performance of each item was videotaped and scored by a blinded researcher.

RESULTS

Overall gross motor performance was significantly different (p < .05) between the two settings, with 14 of 20 children demonstrating better performance in the group setting. In particular, children performed better on locomotion items (p < .05).

CONCLUSIONS

The higher scores for locomotion in the group setting may be due to the influence of competition, motivation, or modeling. Assessing a child in a group setting is recommended as part of the evaluation process.

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

BACKGROUND AND OBJECTIVES

No recommendation exists for or against routine use of brief, formal screening instruments in primary care to detect speech and language delay in children through 5 years of age. This review aimed to update the evidence on screening and treating children for speech and language since the 2006 US Preventive Services Task Force systematic review.

METHODS

Medline, the Cochrane Library, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and reference lists. We included studies reporting diagnostic accuracy of screening tools and randomized controlled trials reporting benefits and harms of treatment of speech and language. Two independent reviewers extracted data, checked accuracy, and assigned quality ratings using predefined criteria.

RESULTS

We found no evidence for the impact of screening on speech and language outcomes. In 23 studies evaluating the accuracy of screening tools, sensitivity ranged between 50% and 94%, and specificity ranged between 45% and 96%. Twelve treatment studies improved various outcomes in language, articulation, and stuttering; little evidence emerged for interventions improving other outcomes or for adverse effects of treatment. Risk factors associated with speech and language delay were male gender, family history, and low parental education. A limitation of this review is the lack of well-designed, well-conducted studies addressing whether screening for speech and language delay or disorders improves outcomes.

CONCLUSIONS

Several screening tools can accurately identify children for diagnostic evaluations and interventions, but evidence is inadequate regarding applicability in primary care settings. Some treatments for young children identified with speech and language delays and disorders may be effective.

Cost of speech-language interventions for children and youth with foetal alcohol spectrum disorder in Canada

This study, which is part of a large economic project on the overall burden and cost associated with Foetal Alcohol Spectrum Disorder (FASD) in Canada, estimated the cost of 1:1 speech-language interventions among children and youth with FASD for Canada in 2011. The number of children and youth with FASD and speech-language disorder(s) (SLD), the distribution of the level of severity, and the number of hours needed to treat were estimated using data from the available literature. 1:1 speech-language interventions were computed using the average cost per hour for speech-language pathologists. It was estimated that ˜ 37,928 children and youth with FASD had SLD in Canada in 2011. Using the most conservative approach, the annual cost of 1:1 speech-language interventions among children and youth with FASD is substantial, ranging from $72.5 million to $144.1 million Canadian dollars. Speech-language pathologists should be aware of the disproportionate number of children and youth with FASD who have SLD and the need for early identification to improve access to early intervention. Early identification and access to high quality services may have a role in decreasing the risk of developing the secondary disabilities and in reducing the economic burden of FASD on society.

Systematic Review of Occupational Therapy and Mental Health Promotion, Prevention, and Intervention for Children and Youth

We describe the results of a systematic review of the literature on children’s mental health using a public health model consisting of three levels of mental health service: universal, targeted, and intensive. At the universal level, strong evidence exists for the effectiveness of occupation- and activity-based interventions in many areas, including programs that focus on social–emotional learning; schoolwide bullying prevention; and after-school, performing arts, and stress management activities. At the targeted level, strong evidence indicates that social and life skills programs are effective for children who are aggressive, have been rejected, and are teenage mothers. The evidence also is strong that children with intellectual impairments, developmental delays, and learning disabilities benefit from social skills programming and play, leisure, and recreational activities. Additionally, evidence of the effectiveness of social skills programs is strong for children requiring services at the intensive level (e.g., those with autism spectrum disorder, diagnosed mental illness, serious behavior disorders) to improve social behavior and self-management.

Characterizing optimal intervention intensity: the relationship between dosage and effect size in interventions for children with developmental speech and language difficulties

Although Warren, Fey and Yoder (2007) have described the key components of "dosage", one needs to go beyond description if one is to understand "optimal" dosage, specifically one needs to relate the characteristics of the intervention to the size of the intervention effect. This study examines the association between dose, intensity, and effect size in 20 randomized controlled studies taken from a few systematic reviews focusing on interventions aiming to ameliorate vocabulary, phonology, and syntax. Reporting of dosage characteristics is an important issue. Our analysis shows that "teaching episodes" and "dose form" are rarely reported in the included studies. The other dosage characteristics are present but not always reported in a transparent fashion. Session length and cumulative intervention intensity is lower for phonology interventions than it is for vocabulary intervention. Dosage, however defined, is not directly associated with outcome, although the level of association varies across the three interventions, for example appearing stronger for vocabulary and phonology than syntax. Taking the three interventions together the dosage components are related to the intervention effects size, but the sample is small and the association is not statistically significant. This study concludes that, while the framework suggested by Baker (2012) and adapted from Warren et al. (2007) is useful but without reference to the effect size of a study, it can only ever tell half the story. One needs to be able to relate dosage to outcome, asking questions about the relationship between the different dosage characteristics and the intervention effect size. Given the available data, it is not, at this stage, possible to make recommendations about optimal dosage.

Population-based screening of children for specific speech and language impairment in Germany: a systematic review

OBJECTIVE

The study was aimed at evaluating the effectiveness of a systematic population-based screening programme for specific language impairment (SLI) in preschool children in Germany.

METHODS

The study question was divided into a review of (1) evidence from studies evaluating screening programmes, (2) diagnostic instruments in the German language, and (3) studies evaluating speech and language interventions. A systematic database search was conducted between June and October 2007 and was updated in January and again in May 2008. Relevant studies were identified by 2 independent reviewers based on screened titles/abstracts and full texts.

RESULTS

4,806 studies were screened. The only existing controlled screening study did not provide data for SLI. No diagnostic study met the inclusion criteria. Sixteen randomized intervention studies were included, 3 studies contributed to the appraisal of earlier against later initiation of treatment. Most studies were of limited quality. We found indications of short-term positive effects from language therapies in children with SLI. Long-term outcomes were not investigated. No evidence supporting the advantage of earlier treatment initiation was identified.

CONCLUSIONS

The benefit of population-based language screening of preschool children with SLI is not proven. Controlled screening studies are therefore necessary. For Germany, the accuracy of existing diagnostic instruments has not yet been sufficiently examined.

Language intervention practices for school-age children with spoken language disorders: a systematic review

PURPOSE

This systematic review focuses on peer-reviewed articles published since 1985 that assess the outcomes of language intervention practices for school-age students with spoken language disorders.

METHOD

We conducted computer searches of electronic databases and hand searches of other sources for studies that used experimental designs that were considered to be reliable and valid: randomized clinical trials, nonrandomized comparison studies, and multiple-baseline single-subject design studies.

RESULTS

The review yielded 21 studies concerning the efficacy or effectiveness of language intervention practices with school-age children since 1985. Eleven of the studies limited participants to children in kindergarten and first grade, and no studies were located that focused on students in middle grades or high school. The relatively high quality of the studies that met our criteria, and the moderate-to-high effect sizes we calculated for the majority of studies, suggests that clinicians can have some confidence in the specific language intervention practices examined.

CONCLUSION

The fact that only 21 studies met our criteria means that there is relatively little evidence supporting the language intervention practices that are currently being used with school-age children with language disorders. We outline significant gaps in the evidence and discuss the implications for clinical practice in schools.

Screening for speech and language delay in preschool children: systematic evidence review for the US Preventive Services Task Force

BACKGROUND

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Published in the public domain by the American Academy of Pediatrics. Speech and language development is a useful indicator of a child's overall development and cognitive ability and is related to school success. Identification of children at risk for developmental delay or related problems may lead to intervention services and family assistance at a young age, when the chances for improvement are best. However, optimal methods for screening for speech and language delay have not been identified, and screening is practiced inconsistently in primary care.

PURPOSE

We sought to evaluate the strengths and limits of evidence about the effectiveness of screening and interventions for speech and language delay in preschool-aged children to determine the balance of benefits and adverse effects of routine screening in primary care for the development of guidelines by the US Preventive Services Task Force. The target population includes all children up to 5 years old without previously known conditions associated with speech and language delay, such as hearing and neurologic impairments.

METHODS

Studies were identified from Medline, PsycINFO, and CINAHL databases (1966 to November 19, 2004), systematic reviews, reference lists, and experts. The evidence review included only English-language, published articles that are available through libraries. Only randomized, controlled trials were considered for examining the effectiveness of interventions. Outcome measures were considered if they were obtained at any time or age after screening and/or intervention as long as the initial assessment occurred while the child was < or =5 years old. Outcomes included speech and language measures and other functional and health outcomes such as social behavior. A total of 745 full-text articles met our eligibility criteria and were reviewed. Data were extracted from each included study, summarized descriptively, and rated for quality by using criteria specific to different study designs developed by the US Preventive Services Task Force.

RESULTS

The use of risk factors for selective screening has not been evaluated, and a list of specific risk factors to guide primary care physicians has not been developed or tested. Sixteen studies about potential risk factors for speech and language delay in children enrolled heterogeneous populations, had dissimilar inclusion and exclusion criteria, and measured different risk factors and outcomes. The most consistently reported risk factors included a family history of speech and language delay, male gender, and perinatal factors. Other risk factors reported less consistently included educational levels of the mother and father, childhood illnesses, birth order, and family size. The performance characteristics of evaluation techniques that take < or =10 minutes to administer were described in 24 studies relevant to screening. Studies that were rated good to fair quality reported wide ranges of sensitivity and specificity when compared with reference standards (sensitivity: 17-100%; specificity: 45-100%). Most of the evaluations, however, were not designed for screening purposes, the instruments measured different domains, and the study populations and settings were often outside of primary care. No "gold standard" has been developed and tested for screening, reference standards varied across studies, few studies compared the performance of > or =2 screening techniques in 1 population, and comparisons of a single screening technique across different populations are lacking. Fourteen good- and fair-quality randomized, controlled trials of interventions reported significantly improved speech and language outcomes compared with control groups. Improvement was demonstrated in several domains including articulation, phonology, expressive language, receptive language, lexical acquisition, and syntax among children in all age groups studied and across multiple therapeutic settings. Improvement in other functional outcomes such as socialization skills, self-esteem, and improved play themes were demonstrated in some, but not all, of the 4 studies that measured them. In general, studies of interventions were small and heterogeneous, may be subject to plateau effects, and reported short-term outcomes based on various instruments and measures. As a result, long-term outcomes are not known, interventions could not be compared directly, and generalizability is questionable.

CONCLUSIONS

Use of risk factors to guide selective screening is not supported by studies. Several aspects of screening have been inadequately studied to determine optimal methods, including which instrument to use, the age at which to screen, and which interval is most useful. Trials of interventions demonstrate improvement in some outcome measures, but conclusions and generalizability are limited. Data are not available addressing other key issues including the effectiveness of screening in primary care settings, role of enhanced surveillance by primary care physicians before referral for diagnostic evaluation, non-speech and language and long-term benefits of interventions, and adverse effects of screening and interventions.

Intervention With Linguistically Diverse Preschool Children

Purpose: This article addresses a series of questions that are critical to planning and implementing effective intervention programs for young linguistically diverse learners with primary language impairment (LI). Linguistically diverse learners in the United States include children whose families speak languages such as Spanish, Korean, Cantonese, Hmong, Vietnamese, or any language other than, or in addition to, English.

Method: A narrative review of the relevant literature addresses clinical questions including (a) Why support the home language when it is not the language used in school or the majority community? (b) Does continued support for the home language undermine attainment in a second language? (c) Should we support the home language when it includes the code switching or mixing of two traditionally separate languages? and (d) What are some strategies that can be used to support the home language when it is a language that the speech-language pathologist (SLP) does not speak?

Conclusion: SLPs should provide services to linguistically diverse preschool-age children with LI in a manner that effectively supports the development of the home language. Parent and paraprofessional training along with peer-mediated models of intervention are presented as two possible methods for facilitating the home language in children with LI.

Speech and language therapy interventions for children with primary speech and language delay or disorder

BACKGROUND

It is thought that approximately 6% of children have speech and language difficulties of which the majority will not have any other significant developmental difficulties. Whilst most children's difficulties resolve, children whose difficulties persist into primary school may have long-term problems concerning literacy, socialisation, behaviour and school attainment.

OBJECTIVES

To examine the effectiveness of speech and language interventions for children with primary speech and language delay/disorder.

SEARCH STRATEGY

The following databases were searched: The Cochrane Controlled Trials Register (Cochrane Library, CENTRAL: 2002/3), CINAHL (1982 - July 2002), EMBASE (1980 - Sept Week 4 2002), ERIC (1965 - 2002), MEDLINE (1966 - Sept Week 3 2002), PsycINFO (1872 - 2002/10 Week 2), The National Research Register (2002/3). In addition to this references were taken from reviews of the literature and reference lists from articles.

SELECTION CRITERIA

The review considered randomised controlled trials of speech and language therapy interventions for children or adolescents with primary speech and language delay/disorder.

DATA COLLECTION AND ANALYSIS

Titles and abstracts were identified and assessed for relevance, before the full text version was obtained of all potentially relevant articles. The data were categorised depending on the nature of the control group and considered in terms of the effects of intervention on expressive and receptive phonology, syntax and vocabulary. The outcomes used in the analysis were dependent on the focus of the study with only the primary effects of therapy being considered in this review.

MAIN RESULTS

The results of twenty-five studies were used in the meta-analysis. The results suggest that speech and language therapy is effective for children with phonological (SMD=0.44, 95%CI: 0.01,0.86) or vocabulary difficulties (SMD=0.89, 95%CI: 0.21,1.56), but that there is less evidence that interventions are effective for children with receptive difficulties (SMD=-0.04, 95%CI: -0.64,0.56). Mixed findings were found concerning the effectiveness of expressive syntax interventions (n=233; SMD=1.02, 95%CI: 0.04-2.01). No significant differences were shown between clinician administered intervention and intervention implemented by trained parents, and studies did not show a difference between the effects of group and individual interventions (SMD=0.01, 95%CI: -0.26,1.17). The use of normal language peers in therapy was shown to have a positive effect on therapy outcome (SMD=2.29, 95%CI: 1.11,3.48).

REVIEWER'S CONCLUSIONS

The review shows that overall there is a positive effect of speech and language therapy interventions for children with expressive phonological and expressive vocabulary difficulties. The evidence for expressive syntax difficulties is more mixed, and there is a need for further research to investigate intervention for receptive language difficulties. There is a large degree of heterogeneity in the results, and the sources of this need to be investigated.

Partner Influences on the Social Pretend Play of Children With Language Impairments

Purpose: This study examined the social pretend play and conversational behaviors of children with language impairment (LI) in dyadic interactions with peers.

Method: The participants (aged 4;3 [years;months] to 6;2) were 3 boys with LI and 4 with typical language development (LN). In this multiple embedded case study, hypotheses regarding the sophistication of verbal interaction and social pretend play were developed and tested with respect to two cases. Each case consisted of five interactions—four involving a child with LI in dyadic play with peers (2 LI, 2 LN), and the last involving the 2 LN peers. The dyad types for each case were LI, mixed, and LN. Within each case, LI dyads were expected to perform less well than mixed dyads, who were, in turn, expected to perform less well than the LN dyad on measures of verbal interaction and social pretend play. Also, greater conversational success was expected in social pretend play than in other forms of play for all dyads.

Results: For both cases, the results for verbal sophistication generally conformed to expectations for the dyad types. In contrast, social pretend play behaviors were inconsistent with expectations across dyads and cases. In all dyads, social pretend play yielded greater conversational success than other forms of play. The quality of play varied as a function of partner characteristics, such as responsiveness, theme knowledge, verbal skill, and adaptability.

Clinical Implications: Clinicians are cautioned to ensure that evaluations of play in children with LI encompass multiple aspects of both play and conversation, as well as observation of children with multiple partners. Likewise, in planning interventions, it may be important to address both play and verbal behaviors and to incorporate opportunities for interaction with multiple partners.

Supporting communication in young children with developmental disabilities

The behavior of parents, adult caregivers, and peers comprises the critical features of community support for the development of communication in young children with developmental disabilities. In a bio-ecological model of development, communication development is the result of the interactions of individuals with specific characteristics, in particular contexts over time. From the perspective of this model, foundational findings of intervention research to current views of communication development in children with developmental disabilities are summarized. The contributions of individual child characteristics to child-caregiver interactions that support language development are illustrated based on research with children who have autism, Williams syndrome, Down syndrome, and children who use augmentative communication systems. Parent-child interaction and the quality and quantity of parent talk are discussed as factors in children's language development. The effects of young children's delayed language on their interactions with peers, the contributions of peers to children's language learning and use, and the critical features of classroom settings that support child language development are reviewed. MRDD Research Reviews 7:143-150, 2001.