U.S. Preventive Services Task Force: Final Research Plan: Screening for Speech and Language Delay and Disorders in Children Age 5 Years or Younger

U.S. Preventive Services Task Force: Final Research Plan

U.S. Preventive Services Task Force

 

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Final Research Plan

Screening for Speech and Language Delay and Disorders in Children Age 5 Years or Younger

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The final Research Plan is used to guide a systematic review of the evidence by researchers at an Evidence-based Practice Center. The resulting Evidence Report forms the basis of the USPSTF Recommendation Statement on this topic.
The draft Research Plan was available for comment from July 25 until August 21, 2013 at 5:00 p.m., ET. To view the draft Research Plan, click here.

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I. Analytic Framework

^a Excluding children with diagnosed disorders including autism, mental retardation, Fragile X, hearing loss, degenerative and other neurologic conditions.
^b School performance, behavioral competence, socioemotional development, quality of life, and others.

[D] Select for Text Description.

II. Key Questions to Be Systematically Reviewed

1. Does screening for speech and language delay or disorders lead to improved speech and language outcomes, as well as improved outcomes in domains other than speech and language?
2. Do screening evaluations in the primary care setting accurately identify children for diagnostic evaluations and interventions?
   1. What is the accuracy of these screening techniques and does it vary by age, cultural/linguistic background, whether it is conducted in a child's native language, or by how the screening was administered (i.e., parent report, parent interview, direct assessment of child by professional)?
   2. What are the optimal ages and frequency for screening?
   3. Is selective screening based on risk factors more effective than unselected, general population screening?
   4. Does the accuracy of selective screening vary based on risk factors? Is the accuracy of screening different for children with an inherent language disorder compared with children whose language delay is due to environmental factors?
3. What are the adverse effects of screening for speech and language delay or disorders?
4. Does surveillance (active monitoring) by primary care clinicians play a role in accurately identifying children for diagnostic evaluations and interventions?
5. Do interventions for speech and language delay or disorders improve speech and language outcomes?
6. Do interventions for speech and language delay or disorders improve other outcomes, such as academic achievement, behavioral competence, and socioemotional development or health outcomes, such as quality of life?
7. What are the adverse effects of interventions for speech and language delay or disorders (e.g., time, stress, and stigma)?

III. Contextual Questions

Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.

1. What are the techniques for screening for speech and language delay or disorders and do they differ by age and cultural background?
2. What risk factors are associated with speech and language delay?
3. What is the role of primary care providers in screening in children age 5 years or younger that is performed in other venues (such as Head Start or preschool)?

IV. Research Approach

The Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Report. Criteria are overarching as well as specific to each of the key questions (KQs).

Category	Include	Exclude
Populations	Children age 5 years or younger (for screening) who speak any language	Children with previously known conditions associated with language delay (e.g., hearing impairment, developmental or neurological/neurogenetic impairment)
Setting	Studies conducted in countries listed as “high” on the Human Development Index	Studies conducted in countries not listed as “high” on the Human Development Index
Screening	All instruments and procedures that are applicable for use in children age 5 years or younger: ≤10 minutes to administer or to be interpreted in a primary care setting >10 minutes if completed by a parent or teacher and interpreted by the clinician Instruments specifically for speech and language General developmental instruments with a separate component for speech and/or language skills	Instruments not designed for use in children age 5 years or younger Tools that take >10 minutes to administer General developmental screening instruments that do not have a separate component for speech and/or language skills
Treatment/management interventions	All standardized and nonstandardized procedures to diagnose specific speech and/or language impairments that are appropriate for use in children younger than age 6 years All therapeutic interventions designed to improve speech or language in children, as long as diagnosis occurs when child is age 6 years or younger Therapists may be speech-language pathologists or other clinicians, parents, or teachers Therapeutic settings include group and individual sessions offered in a clinical locale, school, or home	Diagnostic procedures administered to children older than age 6 years Therapeutic interventions delivered to children who are diagnosed after age 6 years
Comparisons	KQs 1, 3: Screened vs. unscreened KQs 2, 4: Different subpopulations (e.g., by age, risk factors) KQ 4: Surveillance vs. referral for diagnosis KQs 5–7: Intervention vs. no intervention; length of time until outcome measurement	Single-group design with no comparator Treatment comparisons
Outcomes	Improvements in all aspects of speech and/or language functioning: Speech domains include stuttering, fluency, and articulation Language domains include expressive language, receptive language, phonology, vocabulary, syntax, and/or pragmatics Improvements in other types of functioning, such as emergent academic skills, academic achievement (e.g., reading, writing, spelling, arithmetic), behavior competence, socioemotional functioning, quality of life, and parental satisfaction
Study Design	KQs 1–4, 7: Cohort studies; randomized, controlled trials; systematic reviews KQs 5, 6: Randomized, controlled trials or systematic reviews of randomized, controlled trials	Letters to the editor that do not present primary data, commentaries, editorials, case reports, or case series Poor-quality studies (studies with poor internal or external validity)
Language	English	Languages other than English

IV. Response to Public Comment

The draft Research Plan was posted for public comment on the U.S. Preventive Services Task Force (USPSTF) Web site from July 25 to August 21, 2013. In response to comments, several key questions were expanded to include more detail; the USPSTF added several child and test characteristics that may affect screening, as well as several specific possible adverse effects of interventions. The USPSTF revised the analytic framework to reflect that referral and diagnostic evaluations for a speech and language delay or disorder could lead to the identification of nonspeech and language diagnostic concerns. This outcome acknowledges that speech and language screening and evaluation can be the gateway to the diagnosis of other conditions, such as autism spectrum disorder. As the framework shows, the review will not examine outcomes related to the diagnosis of other conditions. The USPSTF also added a loop in the analytic framework, from no disorder or delay detected during the diagnostic evaluation back to surveillance, to indicate that screening/surveillance can be a recurrent process.

AHRQ Publication No. 13-05197-EF-5
Current as of October 2013

CDC's Dr. Frank DeStefano Discusses Latest Data on Rotavirus Vaccine and Risk of Intussusception in CDC Expert Commentary on Medscape

CDC's Dr. Frank DeStefano Discusses Latest Data on Rotavirus Vaccine and Risk of Intussusception in CDC Expert Commentary on Medscape

CDC's Dr. Frank DeStefano Discusses Latest Data on Rotavirus Vaccine and Risk of Intussusception in CDC Expert Commentary on Medscape

Centers for Disease Control and Prevention (CDC) sent this bulletin at 10/31/2013 11:06 AM EDT

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In a recent CDC Expert Commentary on Medscape, CDC’s Director of the Immunization Safety Office Dr. Frank DeStefano takes a detailed look at the very latest data on rotavirus vaccine and the risk of intussusception, the most common cause of acute bowel obstruction in infants. Dr. DeStefano explains that providers should be ready to talk with parents about the benefits of rotavirus vaccine, as well as the small risk for intussusception associated with the vaccines. He reminds clinicians that parents need to know the signs and symptoms of intussusception. They also need to know that they should seek prompt care if they are concerned that their child may be ill.
To learn more about rotavirus, rotavirus vaccines, and the benefits and risks associated with vaccines, watch Dr. DeStefano’s commentary.
For additional information, visit these websites:

• CDC: Rotavirus
• CDC: Rotavirus Multimedia
• Rotavirus en Español
• FDA Safety Communication
• Rotavirus Fact Sheet for Parents

Viral Hepatitis Prevention Coordinators Convene in DC

Viral Hepatitis Prevention Coordinators Convene in DC

AIDS.gov Blog Update

U.S. Dept. of Health & Human Services sent this bulletin at 10/31/2013 10:12 AM EDT

AIDS.gov Blog for U.S. Dept. of Health & Human Services.
This information has recently been updated, and is now available.

Viral Hepatitis Prevention Coordinators Convene in DC

10/31/2013 10:00 AM EDT

Last week I had the opportunity to discuss the federal response to viral hepatitis with some of our key allies in the states: the CDC-funded Adult Viral Hepatitis Prevention Coordinators who had assembled in Washington, DC for the third National Hepatitis Technical Assistance meeting organized and hosted by the National Alliance of State and Territorial...

Media Availability: HIV Antibody Infusions Show Promise for Treating SHIV-Infected Monkeys

Media Availability: HIV Antibody Infusions Show Promise for Treating SHIV-Infected Monkeys

National Institute of Allergy and
Infectious Diseases (NIAID)
http://www.niaid.nih.gov

FOR IMMEDIATE RELEASE
Wednesday, Oct. 30, 2013

MEDIA AVAILABILITY
HIV Antibody Infusions Show Promise for Treating SHIV-Infected Monkeys

NIH-Supported Scientists Advocate Trying Similar Strategy in People

WHAT:Two teams are reporting results from experiments in which they infused powerful anti-HIV antibodies into monkeys infected with an HIV-like virus, rapidly reducing the amount of virus, or viral load, to undetectable levels, where it remained for extended periods. One study was led by government scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and the other was led by NIAID grantees at Beth Israel Deaconess Medical Center. Both teams worked with monkeys infected with simian human immunodeficiency virus, or SHIV, which can cause AIDS in monkeys. The researchers selected monoclonal antibodies that targeted two different sites on SHIV and gave the monkeys either one or two infusions of one or a combination of two or three of these antibodies. Then the scientists measured changes in the monkeys’ viral load and their immune responses to the virus.

In the study led by NIAID grantees, the antibody infusions reduced SHIV viral load to an undetectable level in 16 of 18 monkeys within just 7 days and kept it there for a median of 56 days, when the infused antibodies were gone. While the two monkeys with the highest viral loads at the outset of the study never achieved undetectable viral loads, the three monkeys with the lowest viral loads at the outset maintained stable, undetectable viral loads long after the infused antibodies were gone. The antibody infusions appeared both to improve the monkeys’ control of the virus and to reduce the presence of SHIV DNA in blood and tissues without generating SHIV resistance to the antibodies.

In the study led by NIAID scientists, infusion of a single antibody to 4 monkeys infected for 3 months quickly reduced SHIV viral load to undetectable levels for 4 to 7 days, but then virus reappeared and strains in two animals were antibody-resistant. Yet when two asymptomatic monkeys SHIV-infected for more than 3 years received an infusion of two antibodies, viral load fell to undetectable levels within 7 to 10 days and remained there for 18 to 36 days. A second infusion reduced viral load to undetectable levels for 4 to 28 days. When virus reappeared, strains in one monkey were antibody-resistant. Infusion of the same antibody pair into three monkeys SHIV-infected for more than 3 years and with AIDS symptoms provided modest or no benefit but did not generate resistance.

The studies’ authors now propose testing antibody-based immunotherapy in HIV-infected people and exploring the potential role of antibody infusions in curing people of HIV.

ARTICLES:DH Barouch et al. Therapeutic efficacy of potent neutralizing HIV-1 specific monoclonal antibodies in SHIV-infected rhesus monkeys. Nature DOI: 10.1038/nature12744 (2013).

M Shingai et al. Antibody-mediated immunotherapy of macaques chronically infected with SHIV suppresses viremia. Nature DOI: 10.1038/nature12746 (2013).

WHO:NIAID Director Anthony S. Fauci, M.D., and Distinguished NIH Senior Investigator Malcolm A. Martin, M.D., are available for comment.

CONTACT:To schedule interviews, please contact Laura S. Leifman, (301) 402-1663, laura.sivitz@nih.gov.

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NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at www.niaid.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH...Turning Discovery Into Health ^®

Data Brief No. 133. Hypertension Among Adults in the United States: National Health and Nutrition Examination Survey, 2011–2012

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NCHS Data Briefs from the National Center for Health Statistics, Centers for Disease Control and Prevention. The following reports have been added:

Data Brief No. 133. Hypertension Among Adults in the United States: National Health and Nutrition Examination Survey, 2011–2012Hypertension is an important risk factor for cardiovascular disease and affects almost one-third of the U.S. adult population. In 2009–2010, nearly 82% of adults with hypertension were aware of their status, and nearly 76% were taking medication. Despite considerable improvement in increasing the awareness, treatment, and control of hypertension, undiagnosed and uncontrolled hypertension among minority groups remains a challenge. This report presents survey results for 2011–2012 on the prevalence, awareness, treatment, and control of hypertension.

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No. 41. Population Aging and the Use of Office-based Physician Services. 8 pp. (PHS) 2010-1209. August 2010.   [PDF - 695 KB]
No. 40. Dental Insurance for Persons Under Age 65 Years with Private Health Insurance: United States, 2008. 8 pp. (PHS) 2010-1209. June 2010.   [PDF - 1.1 MB]
No. 39. Are Preterm Births on the Decline in the United States? Recent Data From the National Vital Statistics System. 8 pp. (PHS) 2010-1209. May 2010.   [PDF - 1.1 MB]
No. 38. Emergency Department Visitors and Visits: Who Used the Emergency Room in 2007?. 8 pp. (PHS) 2010-1209. May 2010.   [PDF - 555 KB]
No. 37. Mortality Among Teenagers Aged 12-19 Years: United States, 1999-2006. 8 pp. (PHS) 2010-1209. May 2010.   [PDF - 871 KB]
No. 36. Hypertension, High Serum Total Cholesterol, and Diabetes: Racial and Ethnic Prevalence Differences in U.S. Adults, 1999-2006. 8 pp. (PHS) 2010-1209. April 2010.   [PDF - 1.1 MB]
No. 35. Recent Trends in Cesarean Delivery in the United States. 8 pp. (PHS) 2010-1209. March 2010.   [PDF - 856 KB]
No. 34. Depression and Smoking in the U.S. Household Population Aged 20 and Over, 2005-2008. 8 pp. (PHS) 2010-1209. April 2010.   [PDF - 879 KB]
No. 33. Potentially Preventable Emergency Department Visits by Nursing Home Residents: United States, 2004. 8 pp. (PHS) 2010-1209. April 2010.   [PDF - 387 KB]
No. 32. Health Care Utilization Among Adults Aged 55-64 Years: How Has It Changed Over the Past 10 Years?. 8 pp. (PHS) 2010-1209. March 2010.   [PDF - 1.1 MB]
No. 31. Vision, Hearing, Balance, and Sensory Impairment in Americans Aged 70 Years and Over: United States, 1999-2006. 8 pp. (PHS) 2010-1209. April 2010.   [PDF - 540 KB]
No. 30. Prevalence and Management of Pain, by Race and Dementia Among Nursing Home Residents: United States, 2004. 8 pp. (PHS) 2010-1209. March 2010.   [PDF - 962 KB]
No. 29. Access to and Utilization of Medical Care for Young Adults Aged 20-29 Years: United States, 2008. 8 pp. (PHS) 2010-1209. February 2010.   [PDF - 1.1 MB]
No. 28. Impact of Type of Insurance Plan on Access and Utilization of Health Care Services for Adults Aged 18-64 Years With Private Health Insurance: United States, 2007-2008. 8 pp. (PHS) 2010-1209. February 2010.   [PDF - 987 KB]
No. 27. Viral Hepatitis. 8 pp. (PHS) 2010-1209. March 2010.   [PDF - 757 KB]
No. 26. Death in the United States, 2007. 8 pp. (PHS) 2010-1209. December 2009.   [PDF - 940 KB]
No. 25. Racial Differences in Functioning Among Elderly Nursing Home Residents, 2004. 8 pp. (PHS) 2010-1209. December 2009.   [PDF - 940 KB]
No. 24. Born a Bit Too Early: Recent Trends in Late Preterm Births. 8 pp. (PHS) 2010-1209. November 2009.   [PDF - 691 KB]
No. 23. Behind International Rankings of Infant Mortality: How the United States Compares with Europe. 8 pp. (PHS) 2010-1209. November 2009.   [PDF - 979 KB]
No. 22. Increase in Fatal Poisonings Involving Opioid Analgesics in the United States, 1999-2006. 8 pp. (PHS) 2010-1209. September 2009.   [PDF - 1.2 MB]
No. 21. Delayed Childbearing: More Women Are Having Their First Child Later in Life. 8 pp. (PHS) 2009-1209. August 2009.   [PDF - 701 KB] Statcasts
No. 20. Aging Differently: Physical Limitations Among Adults Aged 50 years and Over: United States, 2001-2007. 8 pp. (PHS) 2009-1209. July 2009.   [PDF - 985 KB]
No. 19. Who Marries and When? Age at first Marriage in the United States; 2002. 8 pp. (PHS) 2009-1209. June 2009.   [PDF - 498 KB]
No. 18. Changing Patterns of Nonmarital Childbearing in the United States. 8 pp. (PHS) 2009-1209. May 2009.   [PDF - 704 KB]
No. 17. One-Third of U.S. Adults Embraced Most Heart Healthy Behaviors in 1999-2002. 8 pp. (PHS) 2009-1209. May 2009.   [PDF - 1 MB]
No. 16. The Challenge of Fetal Mortality. 8 pp. (PHS) 2009-1209. April 2009.   [PDF - 528 KB]
No. 15. Consumer-Directed Health Care for Persons Under 65 Years of Age with Private Health Insurance: United States, 2007. 8 pp. (PHS) 2009-1209. March 2009.   [PDF - 999 KB]
No. 14. Pressure Ulcers Among Nursing Home Residents: United States, 2004. 8 pp. (PHS) 2009-1209. February 2009.   [PDF - 607 KB]
No. 13. Role of International Medical Graduates Providing Office-based Medical Care: United States, 2005-2006. 8 pp. (PHS) 2009-1209. February 2009.   [PDF - 403 KB]
No. 12. Who Adopts? Characteristics of Women and Men Who Have Adopted Children. 8 pp. (PHS) 2009-1209. January 2009.   [PDF - 484 KB]
No. 11. Marital Status is Associated With Health Insurance Coverage for Working-age Women at all Income Levels, 2007. 8 pp. (PHS) 2009-1209. December 2008.   [PDF - 453 KB]
No. 10. Food Allergy Among U.S. Children: Trends in Prevalence and Hospitalizations. 8 pp. (PHS) 2009-1209. October 2008.   [PDF - 484 KB]
No. 9. Recent Trends in Infant Mortality in the United States. 8 pp. (PHS) 2009-1209. October 2008.   [PDF - 1 MB]
No. 8. Use of Mental Health Services in the Past 12 Months by Children Aged 4-17 Years: United States, 2005-2006. 8 pp. (PHS) 2008-1209. September 2008.   [PDF - 806 KB]
No. 7. Depression in the United States Household Population, 2005-2006. 8 pp. (PHS) 2008-1209. September 2008.   [PDF - 944 KB]
No. 6. Blood Folate Levels: The Latest NHANES Results. 8 pp. (PHS) 2008-1209. May 2008.   [PDF - 467 KB]
No. 5. Breastfeeding in the United States: Findings from the National Health and Nutrition Examination Surveys, 1999-2006. 8 pp. (PHS) 2008-1209. April 2008.   [PDF - 500 KB]
No. 4. HIV Infection in the United States Household Population Aged 18-49 Years: Results from 1999-2006. 8 pp. (PHS) 2008-1209. January 2008.   [PDF - 614 KB]
No. 3. Hypertension Awareness, Treatment, and Control-Continued Disparities in Adults: United States, 2005-2006. 8 pp. (PHS) 2008-1209. January 2008.   [PDF - 1.2 MB]
No. 2. High Serum Total Cholesterol-An Indicator for Monitoring Cholesterol Lowering Efforts: U.S. Adults, 2005-2006. 8 pp. (PHS) 2008-1209. December 2007.   [PDF - 490 KB]
No. 1. Obesity Among Adults in the United States-No Statistically Significant Change Since 2003-2004. 8 pp. (PHS) 2008-1209. November 2007.   [PDF - 193 KB]