Prevalence of speech and language difficulties at ages 3 and 5 in - PowerPoint PPT Presentation

Prevalence of speech and language difficulties at ages 3 and 5 in the ROI, & attendance at Speech & Language Therapy services Dr. Aileen Wright & Michelle O’Donoghue 10 th Annual Research Conference 2018

What and Who? • Who are children with receptive language speech and language • understanding, difficulties (SLD)? interpreting • a small proportion due to some other condition e.g. hearing impairment, ASD, speech & Down Syndrome language • the vast majority appear to difficulties be developing as expected expressive in all respects except speech language speech and/or language, • pronouncing • getting their words message which is not developing at across the normal rate

Why does it matter? Research shows that persistent speech and language difficulties (SLD) are associated with negative long-term consequences : difficulty with lower poorer academic peer relations impaired literacy occupational achievement (St Clair et al 2011; skills status (Durkin et al 2009; Durkin and Conti- (Catts et al 2002) ( Johnson et al Johnson et al 2010) Ramsden 2010; Mok 2010) et al 2014) • provides a strong impetus for the early identification of speech and language difficulties to alter the child’s developmental trajectory and prevent secondary complications (Guralnick 2005)

Are we fulfilling the needs? Rooke et al. (2013) – teachers reported 2.2% of all children aged 9 have speech impairment severe enough BUT to limit activity Children's charity Barnardos said that there are widespread regional inconsistencies in the time children are left to wait for speech and language services, child and adolescent mental health Call to recruit 100 speech and language services and disability assessments. therapists to address 37,0000-person waiting list HSE reveals thousands of children left waiting for assessment, despite 3 month Over 15,000 people waiting for speech assessment… legal deadline

Why do we need to know the prevalence? • allows for planning of service delivery Planning • gap between prevalence and number presenting for services allows calculation of under-identification Identification • identification is imperative to allow for effective intervention • allows calculation at an epidemiological level of the impact of intervention • successful intervention should result in a decline in prevalence (Law Intervention 2000)

Prevalence internationally • Law et al (2000) systematic review of 21 prevalence studies: • median prevalence of 5.95%, range 5%-19% in 2 to 5 year olds rates similar for parent • More recent studies: report and direct Ax Study Age Sample Condition Measure Prevalence Okalidou & 4-5 Greece Speech & Pre-school teacher 14.4 – 18.7% Kampanaros (2001) n=1113 language check list Campbell et al. (2003) 3 USA cohort, n=639 Speech SDSC (Shriberg 1993, 15.6% direct) Reilly et al. (2010) 4 ELVS cohort Australia Language CELF P2 >-1.25 SD 20.6% n=1919 McLeod and Harrison 4-5 LSAC cohort Speech & parent report 25.5% (2009) Australia n=4983 language teacher report 22.3% Hughes et al (2016) 4-5 Australia Speech & Parent report 15% n= 53,256 Language McKean et al. (2017) 7 ELVS cohort Australia Language CELF 4 (Aus) >-1.25 18.9% n=1204 SD would expect ~13% on a normed test Zambrana (2014) 3 Norway cohort, Language ASQ parent checklist 8% 5 n=108,000 >1.5 SD 9.5% expect 6.68%

Aims of this study establish the prevalence of SLD in an Irish cohort at ages 3 and 5 describe the nature/prevalence of difficulties reported establish persistence of SLD from age 3 to 5 report number who have accessed SLT services

Data collection 9 mths • Presence and type of SLD established by questionnaires administered to Primary Care Giver in own home by a trained interviewer 3 years 5 years

Validity of caregiver report as a measure of speech & language difficulties (SLD) advantages of parent report accuracy of parent report • can identify functional deficiencies • Massa et al. (2008) that may remain undetected by significant relationships between direct assessment (Bishop and parent ratings of SLD and McDonald 2009; Thomas-Stonell et al. children’s scores on standardised 2010, 2013) tests of language • non-compliant/underperforming • Bishop et al. (2006) children • Children’s Communication • large sample, representative of the Checklist ratings were as population can be included effective as standardized tests at (Zambrana et al. 2014) identifying children with language impairment • Harrison et al (2017), • 86%-90% level of agreement between parent report and direct assessment of SSD.

Prevalence at 3 years: 19.2% C17:“Do you have concerns about how your child talks and makes speech sounds?” • PEDS scale (Glascoe, 2000) 9793 respondents • prevalence of (SLD) at Yes, a Don't Refusal, lot, 370 age 3: Know, 2 27 • 19.2%* overall Yes, a • 4%: “a lot” little, No, 1460 • 15.2%: “a little” 7934 • 64% male • no difference by household social class χ 2 (12) = 13.2, p *all percentage figures in this presentation are weighted = .354 to compensate for any imbalances in the recruited sample as compared with the population of interest

Prevalence at 5 years: 16.5% C21:“Do you have concerns about how your child talks and makes speech sounds?” • PEDS scale (Glascoe, 2000) • prevalence of (SLD) Yes, a Don t Yes, a little, know, 9 lot, 275 at age 5 (weighted): 1234 • 16.5% overall, down from 19.2% • 3.1% “a lot”) No, 7481 • 13.4 % “a little” • 65% male

Prevalence of SLD by SES at age 5 Concern at 5 Never worked Unskilled Semi-skilled Skilled manual Non-manual Managerial and technical Professional workers 0% 20% 40% 60% 80% 100% No Yes, a little Yes, a lot Don t know • no significant difference in prevalence by SES, χ 2 (18) = 26.9, p = .080

Were difficulties transient or persistent? DO YOU HAVE CONCERNS ABOUT HOW YOUR CHILD TALKS AND MAKES SPEECH SOUNDS? No at age 5 Yes, a little at 5 Yes, a lot at 5 122 (37%) (35%) YES, A LOT AT 3 115 92 (28%) (6%) 84 (32%) YES, A LITTLE AT 3 419 (61%) 799 (0.8%) 57 NO AT AGE 3 634 (9%) (90%) 6329

How many with SLD at age 5 were identified at age 3? 78 children not surveyed at 90% age 3 10% • 55% of children with No SLD ever (691) SLD at 3 resolved by No SLD at 3 age 5 • 51% of children with 45% (740) SLD at age 5 had not SLD at 5 been identified as having SLD at age 3 55% • although prevalence at SLD at 3 3 and 5 is similar, they No SLD at 5 are not the same children speech and language status very unstable

When can we identify SLD reliably? 10.3% of 3- • transient SLD year olds 8.6% of 3 • persistent SLD year olds 8% of 5-year • late onset SLD olds

Nature of difficulties identified Parents could choose more than 1 area: Child's area of difficulty at age 3 Other Lisp or difficulty with certain letter combinations Stutters, stammers Voice sounds unusual Difficulty putting words together Difficulty finding words Speech is developing slowly Speech not clear to others Speech not clear to family Reluctant to speak 0 200 400 600 800 1000 1200 • Survey not well designed for this purpose: • Difficult to tell the exact nature of difficulties • Do parents fail to identify language difficulties, speech easier to identify?

Change in difficulties between 3 and 5 Comparison of Nature of Difficulties at age 3 and 5 Lisps/distortions Other increasing Lisp/difficulty with certain letter… Stutters, stammers Voice sounds unusual Difficulty putting words together Difficulty finding words Intelligibility Speech is developing slowly improving Speech not clear to others Speech not clear to family Reluctant to speak 0 200 400 600 800 1000 1200 N at age 3 N at age 5 • Some conditions appear stable, but they are not the same children, e.g. : • 51% of those stammering at 3 were no longer stammering at 5 • only 41% of those with word-finding difficulties at 5 had shown them at 3

Treatment for those with SLD at age 3* C19. Has <child> received any treatment for his/her speech 68% of those with a lot of concern, 24% of those with a little or language problem? yes 36% of males with SLD 33% 27% of females no 67% Received Therapy at age 3 by social class 100% 80% 60% 40% significant difference by social 20% 0% class : χ 2 (7) = 17.3, p = .015 *Percentages weighted for population yes no

Treatment for those with SLD at age 5* C23. Has child (EVER) received any treatment for his/her speech or language problem? 53% of those with a little concern, 29% of these 82% of those with a lot had SLD at 3 No 42% Yes 61% of males with SLD 52% of females with SLD 58% no effect of social class • Limitation: parents were not asked whether they had looked for SLT services *Percentages weighted for population