USPSTF: Speech, Language Delay Screening Lacks Evidence in Young Children

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Despite a discernible risk of social and behavioral issues in affected individuals, there is currently an insufficient amount of evidence to determine the benefits versus harms of speech and language delay screening among asymptomatic children ≤5 years old, according to a new recommendation statement from the US Preventive Services Task Force (USPSTF).¹

In a new clinical review from the USPSTF, a committee of pediatric experts identified a trio of clinical research needs and gaps remaining in the subject of screening for speech and language delays and disorders in children, based on their report:

• Treatment studies over both short and long durations seeking outcomes in improved academic performance, social and emotional health, or child and family wellbeing, based on screen-detected populations—particularly among the most impacted populations including children from Black and Hispanic ethnicity and those in households with low incomes.
• Standardized outcome measurements across such studies, to help reduce heterogeneity in speech and language outcome reporting.
• Studies on the potential harms of factors including labeling, stigma, parental/guardian anxiety, psychosocial harm, and overdiagnosis.

Compounding the matter, experts noted that this latest USPSTF recommendation statement follows a 2015 report on the same subject—in which the task force additionally stressed the need for improved evidence regarding benefits and risks of screening for speech and language delay in young children. Insufficient progress has been made in the last 9 years to alter that outcome.

“Robust research is essential to endorsing universal screening, but resources and time are needed to establish this evidence base,” Megan Y. Roberts, PhD, CCC-SLP, et al. wrote in an accompanying editorial. “Children and families cannot wait, and it is necessary to consider the potential harm caused by the misinterpretation of USPSTF findings and discuss the steps that pediatric primary care clinicians can take in the interim.”²

Speech and language disorders current affected an estimated 3 – 16% of US children and adolescents aged 3 – 21 years old, with a significant majority being male individuals (approximately two-fold). Black and Hispanic children, as well as those from low-income households, are disparately affected compared to White peers. Though many children with identified delays or disorders in their speech or language may recover without intervention, observational data previously suggest impacted school-aged children may be at risk of learning and literacy disabilities, as well as social and behavioral problems.¹

“Screening for speech and language delay is distinct from overall developmental screening recommended by the American Academy of Pediatrics at 18 and 30 months,” the task force wrote. “Children who screen positive require referral for a diagnostic evaluation to confirm the suspected delay or disorder.”

A pair of investigators identified 38 total studies included in the systematic review—a majority (n = 21) regarding the key question of, “What is the accuracy of screening tools to detect speech and language delay or disorders in children aged 5 years or younger?” Another 17 addressed the key question, “Do interventions for speech and language delay or disorders in children aged 6 years or younger improve speech and language outcomes?” And 8 addressed the question, “Do interventions for speech and language delay or disorders in children aged 6 years or younger improve school performance, function, or quality-of-life outcomes?”

Regarding the key question for accuracy of screening tools, the USPSTF team concluded data suggested moderate strength of evidence supporting utility of parent-reported specific language skills; all other strategies were supported by low or insufficient evidence.

Regarding the key question of speech and language outcomes due to intervention, the task force reported that fluency disorders including Lidcombe Program of Early Stuttering Intervention were benefitted by early speech and language intervention, supported by moderate-strength evidence; all other outcomes had low to insufficient evidence.

Regarding the key question as to whether early intervention improve school performance, function, or quality-of-life outcomes, they reported insufficient data to distinguish strength of evidence in favor or against the notion—despite the available trial data.

The task force had no clinical trial evidence to distinguish validity of 3 key questions:

1. Does screening for speech and language delay or disorders in children aged 5 years or younger improve speech and language outcomes, school performance, function, or quality-of-life outcomes?
2. What are the harms of screening for speech and language delay or disorders in children aged 5 years or younger?
3. What are the harms of interventions for speech and language delay or disorders?

Despite the inconclusive outcomes, Roberts and colleagues stressed that the USPSTF recommendation does not apply to children whose parents or primary care provider are concerned about their speech and language development, and that a referral to a speech-language pathologist may be recommended in relevant cases. However, this may be a time-inefficient process at a crucial point of intervention opportunity.²

“Minoritized children, especially Black children, are less likely to be referred to early intervention even after concerns are first raised,” they wrote. “When concerns are raised, signs of speech and language delays are frequently misinterpreted as behavioral issues. The intersection of poverty and race compounds the risk of misidentifying speech and language delays/disorders as behavioral problems, potentially leading to adverse downstream social and societal consequences.”

Moving forward, Roberts et al echoed the task force’s sentiment that benefit and harm-related outcomes research on universal speech and language screening is urgently needed.

“Achieving this goal requires large, diverse study populations and robust partnerships between pediatric primary care clinicians, speech-language pathologists, and researchers, all of which require substantial funding and time,” they wrote. “This research is not just a matter of academic interest but a crucial step toward informing policy and practice that can genuinely make a difference in the lives of countless children and families struggling with speech and language delays/disorders.”

Reference

1. ^{US Preventive Services Task Force. Screening for Speech and Language Delay and Disorders in Children: US Preventive Services Task Force Recommendation Statement. JAMA. 2024;331(4):329–334. doi:10.1001/jama.2023.26952}
2. ^{Speights ML, Jones MK, Roberts MY. Recommendations for Speech and Language Screenings: Lack of Evidence Should Not Endorse Lack of Action. JAMA. 2024;331(4):292–293. doi:10.1001/jama.2023.26817}