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1.
Pediatrics ; 136(4): e838-47, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26347428

RESUMO

OBJECTIVE: We have previously shown short-term benefits to phonology, letter knowledge, and possibly expressive language from systematically ascertaining language delay at age 4 years followed by the Language for Learning intervention. Here, we report the trial's definitive 6-year outcomes. METHODS: Randomized trial nested in a population-based ascertainment. Children with language scores >1.25 SD below the mean at age 4 were randomized, with intervention children receiving 18 1-hour home-based therapy sessions. Primary outcome was receptive/expressive language. Secondary outcomes were phonological, receptive vocabulary, literacy, and narrative skills; parent-reported pragmatic language, behavior, and health-related quality of life; costs of intervention; and health service use. For intention-to-treat analyses, trial arms were compared using linear regression models. RESULTS: Of 1464 children assessed at age 4, 266 were eligible and 200 randomized; 90% and 82% of intervention and control children were retained respectively. By age 6, mean language scores had normalized, but there was little evidence of a treatment effect for receptive (adjusted mean difference 2.3; 95% confidence interval [CI] -1.2 to 5.7; P = .20) or expressive (0.8; 95% CI -1.6 to 3.2; P = .49) language. Of the secondary outcomes, only phonological awareness skills (effect size 0.36; 95% CI 0.08-0.65; P = .01) showed benefit. Costs were higher for intervention families (mean difference AU$4276; 95% CI: $3424 to $5128). CONCLUSIONS: Population-based intervention targeting 4-year-old language delay was feasible but did not have lasting impacts on language, possibly reflecting resolution in both groups. Long-term literacy benefits remain possible but must be weighed against its cost.


Assuntos
Transtornos do Desenvolvimento da Linguagem/terapia , Terapia da Linguagem/métodos , Austrália , Criança , Pré-Escolar , Estudos Transversais , Feminino , Serviços de Assistência Domiciliar , Humanos , Idioma , Terapia da Linguagem/economia , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Qualidade de Vida , Resultado do Tratamento , Vocabulário
2.
Pediatrics ; 132(4): e895-904, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24043276

RESUMO

OBJECTIVE: Population approaches to lessen the adverse impacts of preschool language delay remain elusive. We aimed to determine whether systematic ascertainment of language delay at age 4 years, followed by a 10-month, 1-on-1 intervention, improves language and related outcomes at age 5 years. METHODS: A randomized trial nested within a cross-sectional ascertainment of language delay. Children with expressive and/or receptive language scores more than 1.25 SD below the mean at age 4 years entered the trial. Children randomly allocated to the intervention received 18 1-hour home-based therapy sessions. The primary outcomes were receptive and expressive language (Clinical Evaluation of Language Fundamentals - Preschool, 2(nd) Edition) and secondary outcomes were child phonological skills, letter awareness, pragmatic skills, behavior, and quality of life. RESULTS: A total of 1464 children were assessed for language delay at age 4 years. Of 266 eligible children, 200 (13.6%) entered the trial, with 91 intervention (92% of 99) and 88 control (87% of 101) children retained at age 5 years. At age 5 years, there was weak evidence of benefit to expressive (adjusted mean difference, intervention - control, 2.0; 95% confidence interval [CI] -0.5 to 4.4; P = .12) but not receptive (0.6; 95% CI -2.5 to 3.8; P = .69) language. The intervention improved phonological awareness skills (5.0; 95% CI 2.2 to 7.8; P < .001) and letter knowledge (2.4; 95% CI 0.3 to 4.5; P = .03), but not other secondary outcomes. CONCLUSIONS: A standardized yet flexible 18-session language intervention was successfully delivered by non-specialist staff, found to be acceptable and feasible, and has the potential to improve long-term consequences of early language delay within a public health framework.


Assuntos
Intervenção Educacional Precoce/métodos , Transtornos do Desenvolvimento da Linguagem/terapia , Terapia da Linguagem/métodos , Vigilância da População/métodos , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Masculino
3.
BMC Pediatr ; 12: 96, 2012 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-22776103

RESUMO

BACKGROUND: Early language delay is a high-prevalence condition of concern to parents and professionals. It may result in lifelong deficits not only in language function, but also in social, emotional/behavioural, academic and economic well-being. Such delays can lead to considerable costs to the individual, the family and to society more widely. The Language for Learning trial tests a population-based intervention in 4 year olds with measured language delay, to determine (1) if it improves language and associated outcomes at ages 5 and 6 years and (2) its cost-effectiveness for families and the health care system. METHODS/DESIGN: A large-scale randomised trial of a year-long intervention targeting preschoolers with language delay, nested within a well-documented, prospective, population-based cohort of 1464 children in Melbourne, Australia. All children received a 1.25-1.5 hour formal language assessment at their 4th birthday. The 200 children with expressive and/or receptive language scores more than 1.25 standard deviations below the mean were randomised into intervention or 'usual care' control arms. The 20-session intervention program comprises 18 one-hour home-based therapeutic sessions in three 6-week blocks, an outcome assessment, and a final feed-back/forward planning session. The therapy utilises a 'step up-step down' therapeutic approach depending on the child's language profile, severity and progress, with standardised, manualised activities covering the four language development domains of: vocabulary and grammar; narrative skills; comprehension monitoring; and phonological awareness/pre-literacy skills. Blinded follow-up assessments at ages 5 and 6 years measure the primary outcome of receptive and expressive language, and secondary outcomes of vocabulary, narrative, and phonological skills. DISCUSSION: A key strength of this robust study is the implementation of a therapeutic framework that provides a standardised yet tailored approach for each child, with a focus on specific language domains known to be associated with later language and literacy. The trial responds to identified evidence gaps, has outcomes of direct relevance to families and the community, includes a well-developed economic analysis, and has the potential to improve long-term consequences of early language delay within a public health framework. TRIAL REGISTRATION: Current Controlled Trials ISRCTN03981121.


Assuntos
Transtornos do Desenvolvimento da Linguagem/terapia , Criança , Pré-Escolar , Humanos , Estudos Prospectivos , Características de Residência , Método Simples-Cego , Resultado do Tratamento
4.
Int J Speech Lang Pathol ; 11(6): 509-24, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-21271927

RESUMO

This study examined the effects of phonological awareness and semantic intervention on word-learning abilities in children with Specific Language Impairment (SLI) and whether treatment order influenced outcomes. An alternating treatment design was implemented to evaluate whether phonological awareness, semantic awareness, or a combination of both interventions positively influenced children's word-learning ability and whether the order of the treatments influenced outcomes. Nineteen children with SLI, aged between 6;3 and 8;2 years, and 19 age-matched children with typical language development participated in this study. The children with SLI were randomly assigned either to treatment condition A (phonological awareness intervention followed by semantic intervention) or treatment condition B (same interventions in reverse order). A word-learning paradigm was applied at pre-, mid-, and post-testing to evaluate which condition accelerated the receptive and expressive learning of novel words. Positive treatment effects on producing new words were found for the children who received phonological awareness intervention followed by semantic intervention. There was no improvement on the comprehension of new words for either group. The findings suggest that phonological awareness intervention may not only improve children's phonological skills, but may help to facilitate some aspects of word-learning when followed by an additional semantic based intervention.

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