Published online November 30, 2007
PEDIATRICS Vol. 120 No. 6 December 2007, pp. 1317-1325 (doi:10.1542/10.1542/peds.2006-3145)
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ARTICLE

A Cluster-Randomized Trial of Screening for Language Delay in Toddlers: Effects on School Performance and Language Development at Age 8

Heleen M.E. van Agt, MAa, Heleen A. van der Stege, PhDb, Hanneke de Ridder-Sluiter, PhDb, Ludo T. W. Verhoeven, PhDc and Harry J. de Koning, MD, PhDa

a Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
b Dutch Foundation for the Deaf and Hard of Hearing Child, Amsterdam, Netherlands
c Pedagogical and Educational Sciences, Faculty of Social Sciences, Radboud University Nijmegen, Nijmegen, Netherlands

OBJECTIVE. The goal of this study was to assess the effects of screening and early treatment of preschool children for language delay on language development and school performance at age 8.

METHODS. A cluster-randomized, controlled trial and follow-up study of 55 child health centers in 6 geographic regions were conducted from January 2002 to September 2005. A total of 9419 children who were from the general population and aged 15 months at entry were studied. School type end school progress was known for 5406 (57.4%) children. In the intervention group, a structured screening instrument was conducted twice (at ages 15/18 and 24 months), and usual care was applied in the control group. The screening instrument consisted of a uniform set of questions for the parents and test elements for the child. A positive screen result was followed by multidisciplinary assessments at speech and hearing centers and subsequent early treatment if needed. Percentages of children who attended a special school, repeated a class because of language problems, and scored low on standardized language tests, in intention-to-screen analyses, were measured.

RESULTS. At age 8, 2.7% in the intervention group and 3.7% in the control group attended a special school, 6.1% vs 4.9% had repeated a grade, 8.8% vs 9.7% had deficient oral language performance, 4.7% vs 4.7% had deficient reading, and 2.8% vs 4.2% had deficient spelling.

CONCLUSIONS. Screening toddlers for language delays reduces the number of children who require special education and leads to improved language performance at age 8. Nationwide implementation of the screening might be recommended.

Key Words: screening • language delay • preschool children • RCT

Abbreviations: RCT—randomized, controlled trial • VTO—VroegTijdige Onderkenning Ontwikkelingsstoornissen • RR—relative risk • CI—confidence interval

Accepted Jun 19, 2007.


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