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In an effort to update nearly decade-old guidance on the effectiveness of brief, formal screening in primary care for speech and language delays in young children, the U.S. Preventive Services Task Force (USPSTF) recently issued a new review on the topic. Its final recommendation: The current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children age 5 years and younger.

The task force’s recommendation is troubling for several reasons. Undoubtedly, more research in this area is needed. However, insufficient evidence for screening is not counter-evidence. I fear this may be easily interpreted as such based on the limited language put forth by the USPSTF. Especially concerning is the possibility that current screening practices will be scaled back in some way based upon this recommendation.

The good news is the speech and language disorders are treatable. The bad: They appear to be spiking among U.S. children.

A 2014 study published in Pediatrics (doi: 10.1542/peds.2014-0594) showed a 63% increase in disability associated with speech problems in children from 2001 to 2011. While some of that rise is probably attributable to cases of autism spectrum disorder, which were not tracked for this particular study, there is no doubt speech and language problems are trending upward.

Clearly, this is not the time to cut back on screening for conditions that stand to be debilitative and life-altering if left unchecked. Without general population screening, I fear many diagnoses will be missed during children’s most critical developmental window. This could be especially true for some of society’s most vulnerable – children who live in poverty. Doing away with screening could contribute to holding them down and back their whole lives.

Despite the USPSTF review panel’s ultimate recommendation, its recent article in Pediatrics (doi: 10.1542/peds.2014-3889) actually made a strong case for screening:

“Young children with speech and language delay in the preschool years may be at increased risk for learning disabilities once they reach school age.”

“Estimates of the increased risk for poor reading outcomes in grade school are 4 to 5 times greater for children with speech and language impairment than for children with appropriate development; risk persists into adulthood.”

“Adults who had speech and language disorders as children may hold lower-skilled jobs and are more likely to experience unemployment than other adults.”

“Behavior problems and impaired psychosocial adjustment associated with speech and language may also persist into adulthood.”

Moreover, building on the USPSTF’s 2006 review on the same topic, the new review did find evidence that supports the effectiveness of treating speech and language delays and disorders in children.

Beyond the substantial benefits of early intervention, a number of other factors argue for pediatrician involvement in screening. These include:

• Ease and appropriateness of screening at well-child visits. Screening has already been successfully incorporated into routine pediatrician visits at times when a variety of other developmental milestones also are being tracked. As pediatricians are the only health professionals that most children reliably see during their early years when intervention is key, another opportunity for screening would be difficult to identify.

• Lack of evidence of harm from screenings. There is inadequate evidence of any harm from screening in primary care settings. I struggle to find a downside that comes anywhere close to the potential benefit of identifying a child early.

• Evidence of effective screening tools. There is robust evidence that at least two parent-administered screenings have high sensitivity and specificity, and can accurately identify children for diagnostic evaluations and interventions. This is included in the USPSTF review, but it is not highlighted.

• Availability of specialized professionals. There are more than 148,000 certified speech-language pathologists nationwide who are extensively trained to identify and treat speech and language disorders. Pediatricians are encouraged to refer any patients with suspected problems to these certified professionals. A searchable directory is available at www.asha.org/profind. More information about certification and credentials is available at www.ASHACertified.org.

Current American Academy of Pediatrics clinical guidelines recommend surveillance at well-child visits. They specify ages 9, 18, and 24 or 30 months as appropriate for screening. While the USPSTF review raises the need for more research and other important points, I encourage pediatricians to continue the practice of general screening. Doing so will be to the benefit of our nation’s children, who are increasingly grappling with communication and other developmental disorders.

Dr. Page is the 2015 president of the American Speech-Language-Hearing Association and an associate professor in the division of communication sciences and disorders at the University of Kentucky, Lexington.

In an effort to update nearly decade-old guidance on the effectiveness of brief, formal screening in primary care for speech and language delays in young children, the U.S. Preventive Services Task Force (USPSTF) recently issued a new review on the topic. Its final recommendation: The current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children age 5 years and younger.

The task force’s recommendation is troubling for several reasons. Undoubtedly, more research in this area is needed. However, insufficient evidence for screening is not counter-evidence. I fear this may be easily interpreted as such based on the limited language put forth by the USPSTF. Especially concerning is the possibility that current screening practices will be scaled back in some way based upon this recommendation.

The good news is the speech and language disorders are treatable. The bad: They appear to be spiking among U.S. children.

A 2014 study published in Pediatrics (doi: 10.1542/peds.2014-0594) showed a 63% increase in disability associated with speech problems in children from 2001 to 2011. While some of that rise is probably attributable to cases of autism spectrum disorder, which were not tracked for this particular study, there is no doubt speech and language problems are trending upward.

Clearly, this is not the time to cut back on screening for conditions that stand to be debilitative and life-altering if left unchecked. Without general population screening, I fear many diagnoses will be missed during children’s most critical developmental window. This could be especially true for some of society’s most vulnerable – children who live in poverty. Doing away with screening could contribute to holding them down and back their whole lives.

Despite the USPSTF review panel’s ultimate recommendation, its recent article in Pediatrics (doi: 10.1542/peds.2014-3889) actually made a strong case for screening:

“Young children with speech and language delay in the preschool years may be at increased risk for learning disabilities once they reach school age.”

“Estimates of the increased risk for poor reading outcomes in grade school are 4 to 5 times greater for children with speech and language impairment than for children with appropriate development; risk persists into adulthood.”

“Adults who had speech and language disorders as children may hold lower-skilled jobs and are more likely to experience unemployment than other adults.”

“Behavior problems and impaired psychosocial adjustment associated with speech and language may also persist into adulthood.”

Moreover, building on the USPSTF’s 2006 review on the same topic, the new review did find evidence that supports the effectiveness of treating speech and language delays and disorders in children.

Beyond the substantial benefits of early intervention, a number of other factors argue for pediatrician involvement in screening. These include:

• Ease and appropriateness of screening at well-child visits. Screening has already been successfully incorporated into routine pediatrician visits at times when a variety of other developmental milestones also are being tracked. As pediatricians are the only health professionals that most children reliably see during their early years when intervention is key, another opportunity for screening would be difficult to identify.

• Lack of evidence of harm from screenings. There is inadequate evidence of any harm from screening in primary care settings. I struggle to find a downside that comes anywhere close to the potential benefit of identifying a child early.

• Evidence of effective screening tools. There is robust evidence that at least two parent-administered screenings have high sensitivity and specificity, and can accurately identify children for diagnostic evaluations and interventions. This is included in the USPSTF review, but it is not highlighted.

• Availability of specialized professionals. There are more than 148,000 certified speech-language pathologists nationwide who are extensively trained to identify and treat speech and language disorders. Pediatricians are encouraged to refer any patients with suspected problems to these certified professionals. A searchable directory is available at www.asha.org/profind. More information about certification and credentials is available at www.ASHACertified.org.

Current American Academy of Pediatrics clinical guidelines recommend surveillance at well-child visits. They specify ages 9, 18, and 24 or 30 months as appropriate for screening. While the USPSTF review raises the need for more research and other important points, I encourage pediatricians to continue the practice of general screening. Doing so will be to the benefit of our nation’s children, who are increasingly grappling with communication and other developmental disorders.

Dr. Page is the 2015 president of the American Speech-Language-Hearing Association and an associate professor in the division of communication sciences and disorders at the University of Kentucky, Lexington.

In an effort to update nearly decade-old guidance on the effectiveness of brief, formal screening in primary care for speech and language delays in young children, the U.S. Preventive Services Task Force (USPSTF) recently issued a new review on the topic. Its final recommendation: The current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children age 5 years and younger.

The task force’s recommendation is troubling for several reasons. Undoubtedly, more research in this area is needed. However, insufficient evidence for screening is not counter-evidence. I fear this may be easily interpreted as such based on the limited language put forth by the USPSTF. Especially concerning is the possibility that current screening practices will be scaled back in some way based upon this recommendation.

The good news is the speech and language disorders are treatable. The bad: They appear to be spiking among U.S. children.

A 2014 study published in Pediatrics (doi: 10.1542/peds.2014-0594) showed a 63% increase in disability associated with speech problems in children from 2001 to 2011. While some of that rise is probably attributable to cases of autism spectrum disorder, which were not tracked for this particular study, there is no doubt speech and language problems are trending upward.

Clearly, this is not the time to cut back on screening for conditions that stand to be debilitative and life-altering if left unchecked. Without general population screening, I fear many diagnoses will be missed during children’s most critical developmental window. This could be especially true for some of society’s most vulnerable – children who live in poverty. Doing away with screening could contribute to holding them down and back their whole lives.

Despite the USPSTF review panel’s ultimate recommendation, its recent article in Pediatrics (doi: 10.1542/peds.2014-3889) actually made a strong case for screening:

“Young children with speech and language delay in the preschool years may be at increased risk for learning disabilities once they reach school age.”

“Estimates of the increased risk for poor reading outcomes in grade school are 4 to 5 times greater for children with speech and language impairment than for children with appropriate development; risk persists into adulthood.”

“Adults who had speech and language disorders as children may hold lower-skilled jobs and are more likely to experience unemployment than other adults.”

“Behavior problems and impaired psychosocial adjustment associated with speech and language may also persist into adulthood.”

Moreover, building on the USPSTF’s 2006 review on the same topic, the new review did find evidence that supports the effectiveness of treating speech and language delays and disorders in children.

Beyond the substantial benefits of early intervention, a number of other factors argue for pediatrician involvement in screening. These include:

• Ease and appropriateness of screening at well-child visits. Screening has already been successfully incorporated into routine pediatrician visits at times when a variety of other developmental milestones also are being tracked. As pediatricians are the only health professionals that most children reliably see during their early years when intervention is key, another opportunity for screening would be difficult to identify.

• Lack of evidence of harm from screenings. There is inadequate evidence of any harm from screening in primary care settings. I struggle to find a downside that comes anywhere close to the potential benefit of identifying a child early.

• Evidence of effective screening tools. There is robust evidence that at least two parent-administered screenings have high sensitivity and specificity, and can accurately identify children for diagnostic evaluations and interventions. This is included in the USPSTF review, but it is not highlighted.

• Availability of specialized professionals. There are more than 148,000 certified speech-language pathologists nationwide who are extensively trained to identify and treat speech and language disorders. Pediatricians are encouraged to refer any patients with suspected problems to these certified professionals. A searchable directory is available at www.asha.org/profind. More information about certification and credentials is available at www.ASHACertified.org.

Current American Academy of Pediatrics clinical guidelines recommend surveillance at well-child visits. They specify ages 9, 18, and 24 or 30 months as appropriate for screening. While the USPSTF review raises the need for more research and other important points, I encourage pediatricians to continue the practice of general screening. Doing so will be to the benefit of our nation’s children, who are increasingly grappling with communication and other developmental disorders.

Dr. Page is the 2015 president of the American Speech-Language-Hearing Association and an associate professor in the division of communication sciences and disorders at the University of Kentucky, Lexington.

We often hear parents express concern that misuse of technology may be harming their children’s communication health. Despite this concern, significant numbers of parents are handing off smart phones to children as young as age 2 years and are allowing considerable use of technology at the dinner table, sacrificing what should be a prime time to provide the human interaction so vital to their children’s development of strong communication skills.

These are some of the leading findings from a national survey of parents of children aged 0-8 years that the American Speech-Language-Hearing Association (ASHA) commissioned for release during Better Hearing and Speech Month May 2015.

Is technology bad? Are smart phones, tablets, MP3 players, and other devices overtaking and quite possibly harming young children? Not exactly. The devices themselves aren’t the problem, the problem is how they are used. Our survey showed that very young children are using devices such as tablets and smart phones – and that, unfortunately, parents are often not heeding pediatrician screen time recommendations. According to survey respondents, a majority of 2-year-olds use a tablet. The survey also suggests that as children grow older, they prefer to spend more time with technology, where they are free to stare at screens or blast music into ear buds as they wish – potentially damaging their hearing and losing out on important human interaction.

While children are developing their vocabulary and communication skills, it is vital that they not be preoccupied by activities involving use of tablets, smart phones, and other personal technology. This is especially the case for young children, who experience the vast majority of their brain development in their first few years of life. We know that early verbal communication is a strong predictor of a child’s future reading ability and overall academic success. It is critical that we make parents aware of the convincing benefits of reducing screen time and increasing time spent talking, reading, and interacting verbally with children.

We applaud you addressing this subject via the American Academy of Pediatrics’ literacy toolkit and other avenues for reducing screen time (Pediatrics 2013;132:958-61).Unfortunately, according to our poll, well-meaning parents haven’t completely gotten the message – and many rely on technology for a variety of purposes. About half of them say they use technology to keep kids aged 0-3 years entertained, and many report using it to prevent behavior problems and tantrums.

Let’s join forces in raising awareness about the importance of communication health and how parents can foster it through simple, free steps like regularly engaging their kids in conversation, talking to them about the importance of keeping volume levels down, and modeling safe listening behavior themselves.

The need for action is great. A study in Pediatrics reported significant increases between 2001-2002 and 2010-2011 in disabilities associated with speech and hearing among U.S. children (Pediatrics 2014;134:530-8).

Unlike most other conditions, many communication disorders are reversible or even preventable with early treatment. Parents may delay an assessment by a speech-language pathologist or audiologist in hopes that a child will “outgrow” a problem, or they may not recognize potentially problematic signs. We want to see kids before age 3 years if the early signs are there, when it is more likely they will qualify for early intervention services. Early intervention often results in a shorter, more effective, and less expensive course of treatment for these disorders. Ideally, early intervention will assure that any issue will be resolved or significantly improved by the time a child enters school.

ASHA has a current campaign, Identify the Signs (IdentifytheSigns.org), which offers resources about identifying communication disorders for parents and professionals alike. We invite you and your patients to use these materials to help assure that children receive early intervention for communication disorders. We look forward to working together for the communication health of children.

Dr. Page is director of the division of communication sciences and disorders at the University of Kentucky, Lexington, and 2015 ASHA President. E-mail her at [email protected].

We often hear parents express concern that misuse of technology may be harming their children’s communication health. Despite this concern, significant numbers of parents are handing off smart phones to children as young as age 2 years and are allowing considerable use of technology at the dinner table, sacrificing what should be a prime time to provide the human interaction so vital to their children’s development of strong communication skills.

These are some of the leading findings from a national survey of parents of children aged 0-8 years that the American Speech-Language-Hearing Association (ASHA) commissioned for release during Better Hearing and Speech Month May 2015.

Is technology bad? Are smart phones, tablets, MP3 players, and other devices overtaking and quite possibly harming young children? Not exactly. The devices themselves aren’t the problem, the problem is how they are used. Our survey showed that very young children are using devices such as tablets and smart phones – and that, unfortunately, parents are often not heeding pediatrician screen time recommendations. According to survey respondents, a majority of 2-year-olds use a tablet. The survey also suggests that as children grow older, they prefer to spend more time with technology, where they are free to stare at screens or blast music into ear buds as they wish – potentially damaging their hearing and losing out on important human interaction.

While children are developing their vocabulary and communication skills, it is vital that they not be preoccupied by activities involving use of tablets, smart phones, and other personal technology. This is especially the case for young children, who experience the vast majority of their brain development in their first few years of life. We know that early verbal communication is a strong predictor of a child’s future reading ability and overall academic success. It is critical that we make parents aware of the convincing benefits of reducing screen time and increasing time spent talking, reading, and interacting verbally with children.

We applaud you addressing this subject via the American Academy of Pediatrics’ literacy toolkit and other avenues for reducing screen time (Pediatrics 2013;132:958-61).Unfortunately, according to our poll, well-meaning parents haven’t completely gotten the message – and many rely on technology for a variety of purposes. About half of them say they use technology to keep kids aged 0-3 years entertained, and many report using it to prevent behavior problems and tantrums.

Let’s join forces in raising awareness about the importance of communication health and how parents can foster it through simple, free steps like regularly engaging their kids in conversation, talking to them about the importance of keeping volume levels down, and modeling safe listening behavior themselves.

The need for action is great. A study in Pediatrics reported significant increases between 2001-2002 and 2010-2011 in disabilities associated with speech and hearing among U.S. children (Pediatrics 2014;134:530-8).

Unlike most other conditions, many communication disorders are reversible or even preventable with early treatment. Parents may delay an assessment by a speech-language pathologist or audiologist in hopes that a child will “outgrow” a problem, or they may not recognize potentially problematic signs. We want to see kids before age 3 years if the early signs are there, when it is more likely they will qualify for early intervention services. Early intervention often results in a shorter, more effective, and less expensive course of treatment for these disorders. Ideally, early intervention will assure that any issue will be resolved or significantly improved by the time a child enters school.

ASHA has a current campaign, Identify the Signs (IdentifytheSigns.org), which offers resources about identifying communication disorders for parents and professionals alike. We invite you and your patients to use these materials to help assure that children receive early intervention for communication disorders. We look forward to working together for the communication health of children.

Dr. Page is director of the division of communication sciences and disorders at the University of Kentucky, Lexington, and 2015 ASHA President. E-mail her at [email protected].

We often hear parents express concern that misuse of technology may be harming their children’s communication health. Despite this concern, significant numbers of parents are handing off smart phones to children as young as age 2 years and are allowing considerable use of technology at the dinner table, sacrificing what should be a prime time to provide the human interaction so vital to their children’s development of strong communication skills.

These are some of the leading findings from a national survey of parents of children aged 0-8 years that the American Speech-Language-Hearing Association (ASHA) commissioned for release during Better Hearing and Speech Month May 2015.

Is technology bad? Are smart phones, tablets, MP3 players, and other devices overtaking and quite possibly harming young children? Not exactly. The devices themselves aren’t the problem, the problem is how they are used. Our survey showed that very young children are using devices such as tablets and smart phones – and that, unfortunately, parents are often not heeding pediatrician screen time recommendations. According to survey respondents, a majority of 2-year-olds use a tablet. The survey also suggests that as children grow older, they prefer to spend more time with technology, where they are free to stare at screens or blast music into ear buds as they wish – potentially damaging their hearing and losing out on important human interaction.

While children are developing their vocabulary and communication skills, it is vital that they not be preoccupied by activities involving use of tablets, smart phones, and other personal technology. This is especially the case for young children, who experience the vast majority of their brain development in their first few years of life. We know that early verbal communication is a strong predictor of a child’s future reading ability and overall academic success. It is critical that we make parents aware of the convincing benefits of reducing screen time and increasing time spent talking, reading, and interacting verbally with children.

We applaud you addressing this subject via the American Academy of Pediatrics’ literacy toolkit and other avenues for reducing screen time (Pediatrics 2013;132:958-61).Unfortunately, according to our poll, well-meaning parents haven’t completely gotten the message – and many rely on technology for a variety of purposes. About half of them say they use technology to keep kids aged 0-3 years entertained, and many report using it to prevent behavior problems and tantrums.

Let’s join forces in raising awareness about the importance of communication health and how parents can foster it through simple, free steps like regularly engaging their kids in conversation, talking to them about the importance of keeping volume levels down, and modeling safe listening behavior themselves.

The need for action is great. A study in Pediatrics reported significant increases between 2001-2002 and 2010-2011 in disabilities associated with speech and hearing among U.S. children (Pediatrics 2014;134:530-8).

Unlike most other conditions, many communication disorders are reversible or even preventable with early treatment. Parents may delay an assessment by a speech-language pathologist or audiologist in hopes that a child will “outgrow” a problem, or they may not recognize potentially problematic signs. We want to see kids before age 3 years if the early signs are there, when it is more likely they will qualify for early intervention services. Early intervention often results in a shorter, more effective, and less expensive course of treatment for these disorders. Ideally, early intervention will assure that any issue will be resolved or significantly improved by the time a child enters school.

ASHA has a current campaign, Identify the Signs (IdentifytheSigns.org), which offers resources about identifying communication disorders for parents and professionals alike. We invite you and your patients to use these materials to help assure that children receive early intervention for communication disorders. We look forward to working together for the communication health of children.

Dr. Page is director of the division of communication sciences and disorders at the University of Kentucky, Lexington, and 2015 ASHA President. E-mail her at [email protected].