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The evidence is still insufficient to recommend either for or against screening children aged 5 years and younger for speech and language problems in the primary care setting, according to a U.S. Preventive Services Task Force recommendation statement published online July 7 in Pediatrics.
The USPSTF last issued recommendations regarding this issue in 2006, when it concluded that the evidence was insufficient to assess the balance of benefits and harms of primary caregivers screening this patient population for speech and language delay and disorders. After reviewing the literature published since then, including 5 good-quality and 19 fair-quality randomized controlled trials, other systematic reviews, and cohort studies assessing 20 different screening tools, the current task force came to the same conclusion, said Dr. Albert L. Siu, chair of the task force and professor of population health science and policy at Mount Sinai Medical Center, New York.
As with the earlier recommendation statement, this one addresses only asymptomatic children aged 5 years and younger whose parents or clinicians do not have specific concerns about their speech, language, hearing, or overall development. Although some interventions can improve some measures of speech and language for some of these children, the evidence does not show whether primary care physicians’ use of the Ages and Stages Questionnaire, the Language Development Survey, the MacArthur-Bates Communicative Development Inventory, or other screening instruments ultimately improves speech or language disorders, academic achievement, behavioral competence, socioemotional development, or quality of life, Dr. Siu and his associates said (Pediatrics 2015 July 7 [doi:10.1542/peds.2015-1711]).
In contrast, the American Academy of Pediatrics recommends that developmental surveillance be incorporated at every well-child visit from birth through age 3 years, and that screening tests be administered at well-child visits at ages 9, 18, and 24 or 30 months.
*Correction, 7/13/2015: An earlier version of this story misstated Dr. Robert G. Voight's institution.
The USPSTF continues to find no evidence to suggest that speech-language screening at routine well-child visits improves speech or language outcomes.
This persistent lack of evidence accumulated during close to a decade of inquiry shows that unlike simple laboratory screening for problems such as lead toxicity or dyslipidemia, screening for developmental problems is drastically more complex. It may be that such disorders present insurmountable obstacles to the process of simple screening.
Given the status of child development as the basic science of pediatrics, the high prevalence of developmental disorders in general pediatric practice, and the scarcity of subspecialists to whom to refer, the ability to evaluate development clinically and make developmental diagnoses – rather than simple screening – needs to become a line item of competence for which every graduating pediatric resident is certified.
Unfortunately, the Accreditation Council of Graduate Medical Education Program Requirements for Graduate Medical Education in Pediatrics currently mandate only a 4-week subspecialty experience in developmental-behavioral pediatrics. A substantial expansion of required subspecialty exposure to developmental evaluation and diagnosis during pediatric residency training should lead to increased confidence in using clinical judgment to address developmental concerns just like any other commonly presenting concern in daily pediatric practice. Such enhanced pediatrician competence in evaluation and diagnosis of the basic science of pediatrics might ultimately provide evidence for improved outcomes, which has so far been lacking in the USPSTF studies of screening.
Robert G. Voigt, M.D., is in the department of pediatrics at Baylor College of Medicine, Houston.* Pasquale J. Accardo, M.D., is in the department of pediatrics at Virginia Commonwealth University, Richmond. Dr. Voigt and Dr. Accardo reported receiving no external funding for this work and having no potential conflicts of interest. These remarks were excerpted from a commentary accompanying the USPSTF recommendation statement (Pediatrics 2015 July 7 [doi:10.1542/peds.2015-0211]).
The USPSTF continues to find no evidence to suggest that speech-language screening at routine well-child visits improves speech or language outcomes.
This persistent lack of evidence accumulated during close to a decade of inquiry shows that unlike simple laboratory screening for problems such as lead toxicity or dyslipidemia, screening for developmental problems is drastically more complex. It may be that such disorders present insurmountable obstacles to the process of simple screening.
Given the status of child development as the basic science of pediatrics, the high prevalence of developmental disorders in general pediatric practice, and the scarcity of subspecialists to whom to refer, the ability to evaluate development clinically and make developmental diagnoses – rather than simple screening – needs to become a line item of competence for which every graduating pediatric resident is certified.
Unfortunately, the Accreditation Council of Graduate Medical Education Program Requirements for Graduate Medical Education in Pediatrics currently mandate only a 4-week subspecialty experience in developmental-behavioral pediatrics. A substantial expansion of required subspecialty exposure to developmental evaluation and diagnosis during pediatric residency training should lead to increased confidence in using clinical judgment to address developmental concerns just like any other commonly presenting concern in daily pediatric practice. Such enhanced pediatrician competence in evaluation and diagnosis of the basic science of pediatrics might ultimately provide evidence for improved outcomes, which has so far been lacking in the USPSTF studies of screening.
Robert G. Voigt, M.D., is in the department of pediatrics at Baylor College of Medicine, Houston.* Pasquale J. Accardo, M.D., is in the department of pediatrics at Virginia Commonwealth University, Richmond. Dr. Voigt and Dr. Accardo reported receiving no external funding for this work and having no potential conflicts of interest. These remarks were excerpted from a commentary accompanying the USPSTF recommendation statement (Pediatrics 2015 July 7 [doi:10.1542/peds.2015-0211]).
The USPSTF continues to find no evidence to suggest that speech-language screening at routine well-child visits improves speech or language outcomes.
This persistent lack of evidence accumulated during close to a decade of inquiry shows that unlike simple laboratory screening for problems such as lead toxicity or dyslipidemia, screening for developmental problems is drastically more complex. It may be that such disorders present insurmountable obstacles to the process of simple screening.
Given the status of child development as the basic science of pediatrics, the high prevalence of developmental disorders in general pediatric practice, and the scarcity of subspecialists to whom to refer, the ability to evaluate development clinically and make developmental diagnoses – rather than simple screening – needs to become a line item of competence for which every graduating pediatric resident is certified.
Unfortunately, the Accreditation Council of Graduate Medical Education Program Requirements for Graduate Medical Education in Pediatrics currently mandate only a 4-week subspecialty experience in developmental-behavioral pediatrics. A substantial expansion of required subspecialty exposure to developmental evaluation and diagnosis during pediatric residency training should lead to increased confidence in using clinical judgment to address developmental concerns just like any other commonly presenting concern in daily pediatric practice. Such enhanced pediatrician competence in evaluation and diagnosis of the basic science of pediatrics might ultimately provide evidence for improved outcomes, which has so far been lacking in the USPSTF studies of screening.
Robert G. Voigt, M.D., is in the department of pediatrics at Baylor College of Medicine, Houston.* Pasquale J. Accardo, M.D., is in the department of pediatrics at Virginia Commonwealth University, Richmond. Dr. Voigt and Dr. Accardo reported receiving no external funding for this work and having no potential conflicts of interest. These remarks were excerpted from a commentary accompanying the USPSTF recommendation statement (Pediatrics 2015 July 7 [doi:10.1542/peds.2015-0211]).
The evidence is still insufficient to recommend either for or against screening children aged 5 years and younger for speech and language problems in the primary care setting, according to a U.S. Preventive Services Task Force recommendation statement published online July 7 in Pediatrics.
The USPSTF last issued recommendations regarding this issue in 2006, when it concluded that the evidence was insufficient to assess the balance of benefits and harms of primary caregivers screening this patient population for speech and language delay and disorders. After reviewing the literature published since then, including 5 good-quality and 19 fair-quality randomized controlled trials, other systematic reviews, and cohort studies assessing 20 different screening tools, the current task force came to the same conclusion, said Dr. Albert L. Siu, chair of the task force and professor of population health science and policy at Mount Sinai Medical Center, New York.
As with the earlier recommendation statement, this one addresses only asymptomatic children aged 5 years and younger whose parents or clinicians do not have specific concerns about their speech, language, hearing, or overall development. Although some interventions can improve some measures of speech and language for some of these children, the evidence does not show whether primary care physicians’ use of the Ages and Stages Questionnaire, the Language Development Survey, the MacArthur-Bates Communicative Development Inventory, or other screening instruments ultimately improves speech or language disorders, academic achievement, behavioral competence, socioemotional development, or quality of life, Dr. Siu and his associates said (Pediatrics 2015 July 7 [doi:10.1542/peds.2015-1711]).
In contrast, the American Academy of Pediatrics recommends that developmental surveillance be incorporated at every well-child visit from birth through age 3 years, and that screening tests be administered at well-child visits at ages 9, 18, and 24 or 30 months.
*Correction, 7/13/2015: An earlier version of this story misstated Dr. Robert G. Voight's institution.
The evidence is still insufficient to recommend either for or against screening children aged 5 years and younger for speech and language problems in the primary care setting, according to a U.S. Preventive Services Task Force recommendation statement published online July 7 in Pediatrics.
The USPSTF last issued recommendations regarding this issue in 2006, when it concluded that the evidence was insufficient to assess the balance of benefits and harms of primary caregivers screening this patient population for speech and language delay and disorders. After reviewing the literature published since then, including 5 good-quality and 19 fair-quality randomized controlled trials, other systematic reviews, and cohort studies assessing 20 different screening tools, the current task force came to the same conclusion, said Dr. Albert L. Siu, chair of the task force and professor of population health science and policy at Mount Sinai Medical Center, New York.
As with the earlier recommendation statement, this one addresses only asymptomatic children aged 5 years and younger whose parents or clinicians do not have specific concerns about their speech, language, hearing, or overall development. Although some interventions can improve some measures of speech and language for some of these children, the evidence does not show whether primary care physicians’ use of the Ages and Stages Questionnaire, the Language Development Survey, the MacArthur-Bates Communicative Development Inventory, or other screening instruments ultimately improves speech or language disorders, academic achievement, behavioral competence, socioemotional development, or quality of life, Dr. Siu and his associates said (Pediatrics 2015 July 7 [doi:10.1542/peds.2015-1711]).
In contrast, the American Academy of Pediatrics recommends that developmental surveillance be incorporated at every well-child visit from birth through age 3 years, and that screening tests be administered at well-child visits at ages 9, 18, and 24 or 30 months.
*Correction, 7/13/2015: An earlier version of this story misstated Dr. Robert G. Voight's institution.
FROM PEDIATRICS
Key clinical point: The evidence is still insufficient to recommend for or against speech and language screening of children aged 5 years and younger in the primary care setting.
Major finding: Evidence from 5 good-quality and 19 fair-quality studies does not show whether primary care physicians’ use of the Ages and Stages Questionnaire, the Language Development Survey, the MacArthur-Bates Communicative Development Inventory, or other screening instruments ultimately improves patients’ speech or language disorders, academic achievement, behavioral competence, socioemotional development, or quality of life.
Data source: A systematic review of 24 randomized controlled trials, meta-analyses, and cohort studies in the literature assessing 20 different screening tools, published since the last USPSTF recommendation statement in 2006.
Disclosures: The USPSTF is funded by the federal government, but is an independent, voluntary group that makes recommendations about the effectiveness of specific preventive care services for patients without related signs or symptoms. Dr. Siu reported having no conflicts of interest.