title: Randomized trial of a population-based, home-delivered intervention for preschool language delay.
abstract: OBJECTIVE
  Population approaches to lessen the adverse impacts of preschool language delay remain elusive. We aimed to determine whether systematic ascertainment of language delay at age 4 years, followed by a 10-month, 1-on-1 intervention, improves language and related outcomes at age 5 years.
  
  
  METHODS
  A randomized trial nested within a cross-sectional ascertainment of language delay. Children with expressive and/or receptive language scores more than 1.25 SD below the mean at age 4 years entered the trial. Children randomly allocated to the intervention received 18 1-hour home-based therapy sessions. The primary outcomes were receptive and expressive language (Clinical Evaluation of Language Fundamentals - Preschool, 2(nd) Edition) and secondary outcomes were child phonological skills, letter awareness, pragmatic skills, behavior, and quality of life.
  
  
  RESULTS
  A total of 1464 children were assessed for language delay at age 4 years. Of 266 eligible children, 200 (13.6%) entered the trial, with 91 intervention (92% of 99) and 88 control (87% of 101) children retained at age 5 years. At age 5 years, there was weak evidence of benefit to expressive (adjusted mean difference, intervention - control, 2.0; 95% confidence interval [CI] -0.5 to 4.4; P = .12) but not receptive (0.6; 95% CI -2.5 to 3.8; P = .69) language. The intervention improved phonological awareness skills (5.0; 95% CI 2.2 to 7.8; P < .001) and letter knowledge (2.4; 95% CI 0.3 to 4.5; P = .03), but not other secondary outcomes.
  
  
  CONCLUSIONS
  A standardized yet flexible 18-session language intervention was successfully delivered by non-specialist staff, found to be acceptable and feasible, and has the potential to improve long-term consequences of early language delay within a public health framework.
authors.affiliation: MBChB, FRACP, GDip, Epi Biostats, Centre for Community Child Health, Royal Children's Hospital, Flemington Rd, Parkville, VIC 3052, Australia. melissa.wake@rch.org.au.
authors.forename: Melissa
authors.initials: M
authors.lastname: Wake
authors.forename: Sherryn
authors.initials: S
authors.lastname: Tobin
authors.forename: Penny
authors.initials: P
authors.lastname: Levickis
authors.forename: Lisa
authors.initials: L
authors.lastname: Gold
authors.forename: Obioha C
authors.initials: OC
authors.lastname: Ukoumunne
authors.forename: Naomi
authors.initials: N
authors.lastname: Zens
authors.forename: Sharon
authors.initials: S
authors.lastname: Goldfeld
authors.forename: Ha
authors.initials: H
authors.lastname: Le
authors.forename: James
authors.initials: J
authors.lastname: Law
authors.forename: Sheena
authors.initials: S
authors.lastname: Reilly
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018479:Early Intervention, Educational / Q000379:methods*; D005260:Female; D006801:Humans; D007805:Language Development Disorders / Q000175:diagnosis / Q000628:therapy*; D007808:Language Therapy / Q000379:methods*; D008297:Male; D011159:Population Surveillance / Q000379:methods*
keywords: child development; early intervention; health services; language; randomized controlled trial