Health-related quality of life, service utilization and costs of low language: A systematic review

Evaluating a targeted selective speech, language, and communication intervention at scale - Protocol for the Happy Talk cluster randomised controlled trial

Background

In areas of social disadvantage up to 40-50% of children enter preschool with speech and language skills significantly poorer than would be expected for their age. The Happy Talk trial tests if a community embedded, targeted selective speech and language programme that simultaneously engages with parents and early childhood educators, (1) improves language outcomes in children aged between 2 years 10 months and 6 years and (2) is cost effective for the health care system.

Method

The Happy Talk trial is a large scale cluster randomised trial of a 12-week manualised intervention delivered in pre/school settings serving socially disadvantaged communities, in Ireland. Seventy-two clusters will receive the intervention (12 participants per cluster). Parents and pre/school staff engage in group training and coaching in the form of 12 1-hour sessions for parents and four staff workshops, over the course of the pre/school year. Training/coaching includes core interaction skills (modelling, expanding, balancing questions and comments), early literacy and phonological awareness. Blinded assessments pre- and immediately post-intervention and at 6 months follow up, will measure the primary outcomes of children's receptive and expressive language and functional impact, and secondary outcomes of quality of life. Parental responsiveness and educator-child interactions will also be evaluated.

Discussion

This robust study evaluates a public health approach to the delivery of speech language and communication intervention in the 'real world' in the community, which focuses on prevention and equity of access. Pilot work indicates that the programme is feasible, acceptable to parents and staff, cost effective, and suitable for implementation at scale. The trial includes a process evaluation, a well-developed economic evaluation and the outcomes are directly relevant to children, families and educators. This work has the potential to improve the long-term outcomes and life chances of people living in social disadvantage.

Trial registration

clinicaltrials.gov NCT06460090.

Trial Management

There is a formal governance structure to oversee the conduct and running of the trial, consisting of a trial management group and a steering committee. More details on the composition, roles and responsibilities of each committee can be found in the supplemental material.

Health-Related Quality of Life and Behavioral Difficulties in Greek Preschool Children with Developmental Language Disorder

Developmental language disorder (DLD) has a great impact on language skills as well as on a wide range of functioning areas, such as social and school functioning. In the present study, we aim to explore the Health-Related Quality of Life (HRQoL) of preschool children with DLD, compared to children with no language difficulties, using a self and proxy report method. A total of 230 parents of preschool children with DLD and 146 parents of children without language difficulties completed the Pediatric Quality of Life Inventory (PedsQLTM) 4.0 Generic Core Module and the Strengths and Difficulties Questionnaire (SDQ). Additionally, 71 children with DLD and 55 peers without DLD completed the self-reported PedsQLTM module. The parents of kindergarten children (5-6 years old) with DLD reported that their kids experience worse social and school functioning compared to the control group. In addition, the children with DLD self-reported lower physical and social functioning. The parents of children with DLD reported that their children experience higher hyperactivity/inattention problems than the parents of the control group. Kindergarten children with DLD have a poorer HRQoL compared to their peers, as perceived by themselves and their parents. Moreover, children with DLD present with higher hyperactivity and inattention symptoms. Health professionals working with children who have DLD need to consider not only the language difficulties but also the children's wellbeing and symptoms of hyperactivity and inattention.

Ameliorating poverty-related communication and swallowing disabilities: Sustainable Development Goal 1

PURPOSE

More than 700 million people globally are still living in extreme poverty. No poverty (Sustainable Development Goal 1, SDG 1), is considered to be the greatest global challenge. This paper aims to outline the effects of poverty on communication and swallowing disabilities across the lifespan and steps to take for its amelioration.

RESULT

Poverty and disability are in a vicious cycle with each being a cause for and a consequence of the other. Poverty has incontrovertible and significant ramifications for communication and swallowing disabilities across the lifetime from pregnancy to old age. The individual, family and social burden and costs of these disabilities have lifelong economic and social consequences.

CONCLUSION

Considering poverty is a known and important determinant of communication and swallowing disabilities, the most potent weapon is to focus on preventing and ameliorating poverty-related communication and swallowing disabilities in children. A call to action is issued to speech-language pathologists to take steps towards this goal. This commentary paper focusses on Sustainable Development Goal of no poverty (SDG 1) and also addresses zero hunger (SDG 2), reduced inequalities (SDG 10), and climate action (SDG 13).

Health-related quality of life of caregivers of children with low language: Results from two Australian population-based studies

Purpose: To examine (1) the association between low language (LL) and caregiver's health-related quality of life (HRQoL), (2) whether persistent LL affects caregiver's HRQoL and (3) whether child social-emotional-behavioural (SEB) difficulties attenuates the association between LL and caregiver's HRQoL.Method: Data were from the Early Language in Victoria Study (ELVS) and the Longitudinal Study of Australian Children (LSAC). Caregiver's HRQoL was measured using the EuroQoL-5 dimensions and the Assessment of Quality of Life-8 dimensions. Language ability was determined using the Clinical Evaluation of Language Fundamentals (CELF)-Preschool-2nd or 4th edition (ELVS) and the Peabody Picture Vocabulary Test-3^rd edition or CELF-4 recalling sentences subscale (LSAC). Child SEB difficulties were measured using the Strengths and Difficulties Questionnaire. Multivariable linear regression was used for the analysis.Result: At 11-12 years, an association between LL and reduced caregiver's HRQoL was found in LSAC, but not in ELVS. Persistent LL from 4-11 years seemed to not affect caregivers' HRQoL in either cohort. Child SEB difficulties attenuated the association between caregiver's HRQoL and LL.Conclusion: Both LL and SEB difficulties contributed to reduced caregiver's HRQoL at children age 11-12 years. Interventions supporting children with LL should consider caregiver's well-being in provision of care that meets families' needs.

Luck, our journey, doing the best we could: The experiences of speech-language pathologists, parents, and teachers in service delivery for school-aged children

Purpose: Speech-language pathology intervention is effective in supporting the needs of school-aged children with speech and language difficulties, particularly when implemented collaboratively among speech-language pathologists (SLPs), parents, and teachers. However, such intervention is not always accessible, affordable, or timely. The present study explored the experiences of SLPs, parents, and teachers with regard to service delivery for school-aged children as recorded in submissions to the Senate Inquiry into speech-language pathology services in Australia almost 10 years ago and related those experiences to current service provision.Method: In 2013, the Australian Government Senate formed a committee for inquiry and report into the prevalence of speech, language, and communication disorders and speech-language pathology services in Australia. The current study used a phenomenological approach to analyse submissions from SLPs (n = 9), parents (n = 8), and teachers (n = 3) of primary school-aged children who had submitted their experiences of speech-language pathology intervention.Result: Themes that emerged from the submissions showed that participants' experiences of service delivery were associated with "luck", "our journey", and "doing the best we could". Participants described their experiences as "luck" when they were able to access services that they knew others could not; they described their experiences as a "journey" when they reflected on the process of seeking, accessing, and obtaining services which was often quite circuitous; and they described their experience as "doing the best we could" when they persisted in seeking or providing services, despite frustration in not fulfilling their perceived duty of care.Conclusion: The experiences of SLPs, parents and teachers highlight the importance of listening to the stories of these groups to understand the strengths and challenges of service delivery for school-aged children and the need for timely, targeted, and evidence-based care. The experiences of service delivery described by participants in the Senate Inquiry are still common today and thus the need to address the issues they raised remains.

Economic evaluation of the Happy Talk pilot effectiveness trial: A targeted selective speech, language and communication intervention for children from areas of social disadvantage

Purpose: This study presents a cost-effectiveness analysis of a targeted selective pre-school intervention programme, "Happy Talk", which focuses on language development, by simultaneously enhancing parental interaction and the pre-school environment.Method: Happy Talk (delivered to 77 children) is an add on intervention, and is compared to usual care, adopting a healthcare perspective. Cost-effectiveness analyses were carried out using the Pre-school Language Scale 5- Total (PLS-5) for baseline analysis and the Child Health Utility Instrument (CHU9D) in a secondary analysis.Result: Baseline cost-effectiveness analysis showed Happy Talk was more effective (6.3 point change in total PLS-5 standard score - effect size 0.463SD and more expensive (€82.06) than usual care (cost-effectiveness ratio is €13.02 per unit change). Employing a proxy to estimate monetary net benefit, the benefits outweigh the costs, showing that it is cost-effective. However, results do not persist when health-related quality of life outcome measures are considered.Conclusion: Findings suggest a targeted selective public health approach, could be considered value for money to reduce the societal burden of children with low levels of speech, language and communication. However, measurement of longer term outcomes and a larger trial are required, to definitively inform policy changes.

Neurodevelopmental problems and quality of life in 6-year-olds with a history of developmental language disorder

AIM

To explore family-reported neurodevelopmental functioning and quality of life in 6-year-olds who had screened positive for developmental language disorder at age 2.5 years.

METHODS

Parents of 85 6-year-old children completed questionnaires about child neurodevelopmental difficulties and quality of life. The children were interviewed regarding quality of life, and their language was assessed by speech and language pathologists. Test results at 6 years identified three subgroups: children with developmental language disorder (n = 68) or speech sound disorder (n = 6) and children with no current language disorder (n = 11).

RESULTS

Out of the 68 children with developmental language disorder, 33 (48%) had significant parent-rated problems with language, executive functions 17 (25%), perception 15 (22%) and/or motor skills 15 (22%). Four (67%) of the children with speech sound disorder had significant problems with language. Significant problems were reported with language in five (45%) and with perception in four (36%) children with no current language disorder. The parents reported no impaired quality of life, whereas the children themselves reported impairment mainly with school functioning.

CONCLUSIONS

Overlap between language difficulties and other neurodevelopmental problems was higher in 6-year-olds who had screened positive for developmental language disorder about 3 years earlier, than in the general population. The parent and child reports of quality of life were not consistent.

Moving towards accurate and early prediction of language delay with network science and machine learning approaches

Due to wide variability of typical language development, it has been historically difficult to distinguish typical and delayed trajectories of early language growth. Improving our understanding of factors that signal language disorder and delay has the potential to improve the lives of the millions with developmental language disorder (DLD). We develop predictive models of low language (LL) outcomes by analyzing parental report measures of early language skill using machine learning and network science approaches. We harmonized two longitudinal datasets including demographic and standardized measures of early language skills (the MacArthur-Bates Communicative Developmental Inventories; MBCDI) as well as a later measure of LL. MBCDI data was used to calculate several graph-theoretic measures of lexico-semantic structure in toddlers' expressive vocabularies. We use machine-learning techniques to construct predictive models with these datasets to identify toddlers who will have later LL outcomes at preschool and school-age. This approach yielded robust and reliable predictions of later LL outcome with classification accuracies in single datasets exceeding 90%. Generalization performance between different datasets was modest due to differences in outcome ages and diagnostic measures. Grammatical and lexico-semantic measures ranked highly in predictive classification, highlighting promising avenues for early screening and delineating the roots of language disorders.

Health-related quality of life of children with low language from early childhood to adolescence: results from an Australian longitudinal population-based study

BACKGROUND

Low language abilities are known to be associated with significant adverse long-term outcomes. However, associations between low language and health-related quality of life (HRQoL) are unclear. We aimed to (a) examine the association between low language and HRQoL from 4 to 13 years and (b) classify the children's trajectories of HRQoL and language and examine the association between language and HRQoL trajectories.

METHODS

Data were from an Australian community-based cohort of children. HRQoL was measured at ages 4-13 years using the parent-reported Pediatric Quality of Life Inventory 4.0. Language was assessed using the Clinical Evaluation of Language Fundamentals (CELF)-Preschool 2nd edition at 4 years and the CELF-4th edition at 5, 7 and 11 years. Multivariable linear regression and mixed effect modelling were used to estimate cross-sectional and longitudinal associations between low language and HRQoL from 4 to 13 years. A joint group-based trajectory model was used to characterize associations between HRQoL and language trajectories over childhood.

RESULTS

Children with low language had substantially lower HRQoL than children with typical language from 4 to 13 years. Higher language scores were associated with better HRQoL, particularly in social and school functioning. Three HRQoL trajectories were identified: stable-high (51% of children), reduced with slow decline (40%) and low with rapid decline (9%). Children with low language were less likely to follow a stable-high HRQoL trajectory (40%) while 26% and 34% followed the reduced with slow decline and low with rapid decline trajectories, respectively.

CONCLUSIONS

Children with low language experienced reduced HRQoL from 4 to 13 years. More than half had declining trajectories in HRQoL highlighting the need to monitor these children over time. Interventions should not only aim to improve children's language ability but also address the wider functional impacts of low language.

Academic achievement and productivity losses associated with speech, language and communication needs

BACKGROUND

Childhood speech, language and communication needs (SLCN) impose a significant burden on individuals, families and society. There are explicit costs related to increased health utilization and expenditure. Additionally, there may be indirect costs associated with a child's employment prospects in the long term because of the child's low literacy and numeracy, which in turn affects adult labour force participation (LFP). Several reviews have identified that there is paucity of published evidence on the costs of SLCN. Motivated by broad policy implications, and the lack of prior research in this area, this paper calculates the indirect costs and workplace productivity losses of children with SLCN.

AIMS

To estimate the indirect costs of SLCN associated with a child's reduced long-term productivity.

METHODS & PROCEDURES

Using 12 years of data from a longitudinal study of Australian children, we employed a panel fixed-effects model to estimate academic achievement at 14-15 years of age. Using these estimates, we employed a human capital approach (HCA) to estimate the projected LFP for children with SLCN, measured by workforce participation and foregone wages. LFP is estimated by extrapolating a child's academic achievement at 14-15 years of age to adulthood outcomes.

OUTCOMES & RESULTS

The results showed that a 1 SD (standard deviation) decrease in SLCN is equivalent to 0.19 (95% confidence interval (CI) = 0.09, 0.30) SD decrease in academic achievement at 14-15 years, 0.79% (95% CI = 0.37, 1.21) decrease in work participation and A$453 (95% CI = A$207, A$674) per annum in lost wages. The average work participation penalty across all level of SLCN (-3, -2, -1) is A$628 (95% CI = A$236, A$894) per person per year. Based on the prevalence of 8.3% from our sample, this equates to lifetime costs of A$21.677 billion (US$14.28 billion, €13.08 billion, £11.66 billion) for children with SLCN in Australia. Speech pathology treatment appears to have a positive impact on work participation and wages. On average A$355 (95% CI = A$346, A$355) per person per year could be saved through treatment or identification (the difference in lost wages for children with and without speech pathology treatment at each SLCN level (-1, -2 ,-3) calculated as a weighted average). This equates to lifetime savings of A$5.22 billion (US$3.44 billion, €3.15 billion, £2.81 billion) for children with SLCN in Australia.

CONCLUSIONS & IMPLICATIONS

Overall, the findings showed that SLCN are associated with increased indirect costs through reduced workforce participation. The evidence from this study can be used to inform policies on the societal costs of SLCN. What this paper adds What is already known on this subject Childhood SLCN impose significant burden on individuals, families and society. There are explicit costs related to increased health utilization and expenditure. Additionally, there may be indirect costs associated with a child's employment prospects in the long term because of the child's low literacy and numeracy, which in turn affects adult LFP. Several reviews have identified that there is paucity of published evidence on the costs of SLCN. Motivated by broad policy implications, and the lack of prior research in this area, this paper calculates the indirect costs and workplace productivity losses of children with SLCN. What this paper adds to existing knowledge This study estimates the academic achievement and indirect costs of SLCN associated with a child's reduced long-term productivity. Using 12 years of data from a longitudinal study of Australian children, we employed a panel fixed-effects model to estimate academic achievement at 14-15 years of age. Using these estimates, we used a human capital approach to estimate the projected LFP for children with SLCN, measured by workforce participation and foregone wages. LFP is estimated by extrapolating a child's academic achievement at 14-15 years of age to adulthood outcomes. What are the potential or actual clinical implications of this work? SLCN are associated with increased indirect costs through reduced workforce participation. The evidence from this study provides one of the first indirect cost estimates of how SLCN impacts LFP through educational achievement. Early identification, intervention and screening for SLCN may be useful offsets to reduce the economic effects identified here.