Authors' objectives:

Four domains (prevalence, natural history, intervention and screening) were identified as being key to a review of screening issues, with the following objectives being stated:

to undertake a systematic review of research into the value of screening and intervention for speech and language delays in children up to the age of 7 years

to identify priority areas in need of further investigation

to provide evidence-based direction for the future provision of services.

Authors' results and conclusions: The screening evidence indicates that, although a considerable number of assessments have been shown to perform adequately in terms of their productivity, few studies compare the performance of two or more screening tests when applied to one population, nor do they compare single screening measures across different populations. It is difficult, therefore, to make judgements about the relative value of different procedures. In general, specificity is higher than sensitivity, suggesting that it is easier to determine who is not a case than to establish who is. Parent-focused measures appear to be as useful as specific tests of child behaviour. Interpretation is further complicated by the considerable variation in the cut-offs adopted on the range of reference 'gold-standard' measures, suggesting that there remains considerable disagreement as to what proportion of the population should be considered cases. There have been no explicit attempts to benchmark the target population in terms of prevalence estimates, the prediction of case status or the impact of the intervention.

Authors' recommendations: It is clear that early speech and language delay should be a cause for concern to those involved with child health surveillance because of the problems for the individual child, because it may indicate other comorbid conditions such as hearing loss, developmental and behavioural difficulties, and because of the implications it may have for literacy and socialisation in school. The fact that there is not sufficient evidence to merit the introduction of universal screening does not imply that speech and language delay should not be identified, for example, by less formal methods.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.hta.ac.uk/953

Year Published: 1998

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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