本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2023.24647

摘要内容如下：

重要性

有言语和语言障碍的儿童有学习和行为问题的风险。

目的

回顾关于筛查5岁及以下儿童言语和语言发育迟缓或障碍的证据，以告知美国预防服务工作组。

数据源

PubMed/MEDLINE、Cochrane Library、PsycInfo、Eric、语言学和语言行为文摘（ProQuest）和试验注册（至2023年1月17日）；监视到2023年11月24日。

研究选择

筛查试验准确性的英文研究，比较筛查与不筛查的试验或队列研究；干预的随机临床试验（RCT）。

数据提取与合成

摘要、全文、研究质量和数据提取的双重审查；对结果进行了叙述性总结。

主要成果和措施

筛选测试准确性、言语和语言结果、学校表现、功能、生活质量和危害。

结果

纳入41篇文章中的38项研究（n=9006）。没有研究评估筛查与不筛查的直接益处。21项研究（n=7489）评估了23种不同筛查工具的准确性，这些工具的设计是否由父母或受过培训的检查者完成，以及是否用于筛查整体（任何）语言问题或特定技能（如表达性语言）。三项评估父母报告的表达性语言技能工具的研究发现，敏感性（范围，88%-93%）和特异性（范围，88%-85%）始终很高。其他筛查工具的准确性差异很大。17项随机对照试验（n=1517）评估了言语和语言发育迟缓或障碍的干预措施，但没有一项纳入了通过初级保健常规筛查确定的儿童。两项评估相对密集的父母团体训练干预（11个疗程）的随机对照试验发现，不同的表达性语言技能测量方法都有益处，而一项评估较低强度干预（6个疗程）的随机对照试验发现，两组之间的任何结果都没有差异。两项随机对照试验（n=76）评估了Lidcombe早期口吃干预计划，该计划由言语-语言病理学家提供，以父母培训为特色。研究发现，在9个月时，与在诊所和通过远程医疗提供的对照组相比，口吃的音节比例分别降低了2.3%至3.0%。关于其他干预措施的证据有限。没有关于干预危害的随机对照试验报告。

结论和相关性

没有研究直接评估筛查的益处和危害。一些父母报告的表达性语言技能筛查工具在检测表达性语言延迟方面具有合理的准确性。提供至少11次父母培训课程的言语延迟团体父母培训计划提高了表达性语言技能，由言语-语言病理学家提供的口吃干预降低了口吃频率。

英文原文如下：

Abstracts

Importance  Children with speech and language difficulties are at risk for learning and behavioral problems.

Objective  To review the evidence on screening for speech and language delay or disorders in children 5 years or younger to inform the US Preventive Services Task Force.

Data Sources  PubMed/MEDLINE, Cochrane Library, PsycInfo, ERIC, Linguistic and Language Behavior Abstracts (ProQuest), and trial registries through January 17, 2023; surveillance through November 24, 2023.

Study Selection  English-language studies of screening test accuracy, trials or cohort studies comparing screening vs no screening; randomized clinical trials (RCTs) of interventions.

Data Extraction and Synthesis  Dual review of abstracts, full-text articles, study quality, and data extraction; results were narratively summarized.

Main Outcomes and Measures  Screening test accuracy, speech and language outcomes, school performance, function, quality of life, and harms.

Results  Thirty-eight studies in 41 articles were included (N = 9006). No study evaluated the direct benefits of screening vs no screening. Twenty-one studies (n = 7489) assessed the accuracy of 23 different screening tools that varied with regard to whether they were designed to be completed by parents vs trained examiners, and to screen for global (any) language problems vs specific skills (eg, expressive language). Three studies assessing parent-reported tools for expressive language skills found consistently high sensitivity (range, 88%-93%) and specificity (range, 88%-85%). The accuracy of other screening tools varied widely. Seventeen RCTs (n = 1517) evaluated interventions for speech and language delay or disorders, although none enrolled children identified by routine screening in primary care. Two RCTs evaluating relatively intensive parental group training interventions (11 sessions) found benefit for different measures of expressive language skills, and 1 evaluating a less intensive intervention (6 sessions) found no difference between groups for any outcome. Two RCTs (n = 76) evaluating the Lidcombe Program of Early Stuttering Intervention delivered by speech-language pathologists featuring parent training found a 2.3% to 3.0% lower proportion of syllables stuttered at 9 months compared with the control group when delivered in clinic and via telehealth, respectively. Evidence on other interventions was limited. No RCTs reported on the harms of interventions.

Conclusions and Relevance  No studies directly assessed the benefits and harms of screening. Some parent-reported screening tools for expressive language skills had reasonable accuracy for detecting expressive language delay. Group parent training programs for speech delay that provided at least 11 parental training sessions improved expressive language skills, and a stuttering intervention delivered by speech-language pathologists reduced stuttering frequency.

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