Population-based screening of children for specific speech and language impairment in Germany: a systematic review.

OBJECTIVE: The study was aimed at evaluating the effectiveness of a systematic population-based screening programme for specific language impairment (SLI) in preschool children in Germany. METHODS: The study question was divided into a review of (1) evidence from studies evaluating screening programmes, (2) diagnostic instruments in the German language, and (3) studies evaluating speech and language interventions. A systematic database search was conducted between June and October 2007 and was updated in January and again in May 2008. Relevant studies were identified by 2 independent reviewers based on screened titles/abstracts and full texts. RESULTS: 4,806 studies were screened. The only existing controlled screening study did not provide data for SLI. No diagnostic study met the inclusion criteria. Sixteen randomized intervention studies were included, 3 studies contributed to the appraisal of earlier against later initiation of treatment. Most studies were of limited quality. We found indications of short-term positive effects from language therapies in children with SLI. Long-term outcomes were not investigated. No evidence supporting the advantage of earlier treatment initiation was identified. CONCLUSIONS: The benefit of population-based language screening of preschool children with SLI is not proven. Controlled screening studies are therefore necessary. For Germany, the accuracy of existing diagnostic instruments has not yet been sufficiently examined.

[Implementation and evaluation of a parent training for language delayed children]. / Durchführung und Evaluation eines Elterntrainings bei Sprachentwicklungsverzögerung.

Two-year old children speaking fewer than 50 words are language delayed and at a 50 % risk for a persistent language impairment (Grimm, 2000). The present study pioneers as it presents for the first time an evaluation of the parent program "It Takes Two to Talk" (from the Hanen Early Language Parent Program, Girolametto et al., 1986) in this country. A nonrandomized controlled pre-post study design was implemented with the experimental treatment group of 9 mothers of language delayed toddlers and the matched waiting-control group of 8 mothers of language delayed toddlers. The Hanen Parent Program was carried out in the treatment group. The main outcome measures included (a) expressive language (measured with ELFRA-2, Grimm u. Doil, 2000); (b) ratings of outcome and process quality by mothers and therapist (measured with FBB, Mattejat u. Remschmidt, 1998). The central findings were as follows: (a) In the two-factor ANOVA with repeated measures on one factor no significant interaction was demonstrated between group factor and pre-post factor for the expressive language scale "vocabulary" (p = 0.18); the average gain in the treatment group (increase from M(-pre) = 13,6 to M(-post) = 62,3 words) was numerically larger than the average gain in the control group (M(-pre) = 15,5, M(-post) = 44,1), while the pre-post differences were significant in both groups (t-test: p = 0.001 in EG; p = 0.03 in CG); (b) process and outcome qualities of the parent intervention were rated "positive" or "very positive" by parents and therapist. The conclusions drawn from this study are as follows: The experimental validity of the present clinical pilot study was influenced by several methodological limitations. The overall findings at least support the assumption that the early intervention parent program examined indicates some social validity. In order to evaluate the effectiveness of this program more conclusively, further research is urgently needed.