Additionally, if a parent discloses concerns regarding their child’s language development, waiting to act on this concern likely has significant consequences for parental well-being, parental efficacy, and the parent-clinician relationship. 9 Underreferrals are especially concerning in minoritized communities because children with limited access to comprehensive health care and early childhood development services face a higher risk of academic difficulties. The intersection of poverty and race compounds the risk of misidentifying speech and language delays/disorders as behavioral problems, potentially leading to adverse downstream social and societal consequences (labeled by Dr Marian Wright Edelman as the “cradle to prison pipeline”). 7, 8 When concerns are raised, signs of speech and language delays are frequently misinterpreted as behavioral issues. 6 Minoritized children, especially Black children, are less likely to be referred to early intervention even after concerns are first raised. There are significant disadvantages and potential harms of waiting for such an evaluation if there is concern about speech and language delays, because waiting to refer these children may result in a loss of services during a critical period of development. For those children whose parents or pediatric primary care clinicians are concerned about speech and/or language, referral for a formal evaluation with a speech-language pathologist through early intervention or early childhood special education may be warranted. However, the USPSTF recommendation does not apply to children whose parents or pediatric primary care clinicians are concerned about a child’s speech and language development. The USPSTF finding of insufficient evidence applies to “Asymptomatic children 5 years or younger whose parents or clinicians do not have specific concerns about their speech, language, hearing, or development.” 3 In other words, there is not sufficient evidence to recommend universal screening for all children, particularly those not showing any signs of speech or language delay. 5 Children and families cannot wait, and it is necessary to consider the potential harm caused by the misinterpretation of USPSTF findings and discuss the steps that pediatric primary care clinicians can take in the interim. Notably, in the 8 years since the previous recommendation in 2015, there has been no new evidence to evaluate the utility of universal screening. Robust research is essential to endorsing universal screening, but resources and time are needed to establish this evidence base. 4 As speech-language pathologists, we are concerned about the number of children and families that could benefit from speech and language interventions. Given the rigorous data-driven approach of the USPSTF to evaluate the current evidence base, we as speech-language pathologists agree with the conclusions.Ĭontained within the USPSTF Recommendation Statement is the acknowledgment, shared by the American Speech-Language-Hearing Association (ASHA), that speech and language delays/disorders can have adverse effects on educational, social, and mental health outcomes. In the accompanying Recommendation Statement, 3 the task force concludes that the “evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children 5 years or younger without signs or symptoms (I statement).” The USPSTF recommendation was determined based on the general lack of evidence for screening rather than the absence of sound findings on the topic of speech and language delays, which underscores the importance of prioritizing research in this area to fill the current knowledge gaps.
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