Can early intervention help children with speech and language difficulties?
Law J, Garrett Z, Nye C
The Bottom Line:
Interventions targeted at some of the problems children have with speech have been found to be effective, while others have shown only mixed results. Those children with expressive language difficulties (producing speech sounds and words) did better than those with receptive language difficulties (understanding speech sounds and words.) The evidence for the effectiveness of interventions for children who have problems understanding grammar and sentences is lacking and more research is needed in this area. |
What problem is being addressed?
About 6% of children have speech and language difficulties. Some of these problems are related to other primary conditions such as hearing impairment, general developmental difficulties, behavioural or emotional difficulties, autism or other neurological impairment. The majority, however, are not associated with any significant developmental difficulty, and are referred to as primary speech and language delay/disorder.
Most primary speech and language problems resolve themselves over time. However, for some children they can persist into primary school and cause difficulties in learning and socialization that can last into adolescence and beyond with adverse effects on school achievement and social and emotional well-being.
What intervention is being tested?
Any type of intervention designed to improve any area of speech or language functioning, including:
- The ability to produce or understand speech sounds (phonology)
- The ability to produce or understand words(vocabulary)
- The ability to produce or understand sentences and grammar (syntax)
Some interventions were didactic (i.e., direct training), some were naturalistic (i.e., teaching children to use language in their usual environment), and others used a combination of the two.
What is the real scientific evidence?
The authors of this review conducted a search of the literature to identify randomized controlled trials of speech and language therapy interventions for children or adolescents with speech and language delay or disorder. They identified 36 papers (reporting on 33 different trials) that met the inclusion/exclusion criteria. Of the 33 trials, 25 included sufficient data to be used in a meta-analysis.
The results of the meta-analysis showed some support for the effectiveness of speech and language therapy for children with expressive phonology problems (producing speech sounds) and for expressive vocabulary problems (producing words). The findings for interventions for syntax problems (producing and understanding sentences and grammar) were mixed; children who have trouble producing sentences and grammar (expressive syntax) may benefit from therapy if they do not also have difficulty understanding speech (receptive phonology). There was little evidence that therapy for children with receptive language difficulties is effective.
There was no difference in the effectiveness of interventions administered by clinicians as compared to trained parents, and no difference in the effectiveness of interventions delivered to groups as compared to those delivered individually. However, interventions that incorporated play sessions with peers who were not language impaired had a positive effect on outcome. There is some indication that interventions lasting longer than 8 weeks may be more effective than those lasting less than 8 weeks.
The preceding is a summary of:
Law J, Garrett Z, Nye C. Speech and language therapy interventions for children with primary speech and language delay or disorder. The Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD004110. DOI: 10.1002/14651858.CD004110.
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