Two-Year Outcomes of a Population-Based Intervention for Preschool Language Delay: An RCT.
OBJECTIVE
We have previously shown short-term benefits to phonology, letter knowledge, and possibly expressive language from systematically ascertaining language delay at age 4 years followed by the Language for Learning intervention. Here, we report the trial's definitive 6-year outcomes.


METHODS
Randomized trial nested in a population-based ascertainment. Children with language scores >1.25 SD below the mean at age 4 were randomized, with intervention children receiving 18 1-hour home-based therapy sessions. Primary outcome was receptive/expressive language. Secondary outcomes were phonological, receptive vocabulary, literacy, and narrative skills; parent-reported pragmatic language, behavior, and health-related quality of life; costs of intervention; and health service use. For intention-to-treat analyses, trial arms were compared using linear regression models.


RESULTS
Of 1464 children assessed at age 4, 266 were eligible and 200 randomized; 90% and 82% of intervention and control children were retained respectively. By age 6, mean language scores had normalized, but there was little evidence of a treatment effect for receptive (adjusted mean difference 2.3; 95% confidence interval [CI] -1.2 to 5.7; P = .20) or expressive (0.8; 95% CI -1.6 to 3.2; P = .49) language. Of the secondary outcomes, only phonological awareness skills (effect size 0.36; 95% CI 0.08-0.65; P = .01) showed benefit. Costs were higher for intervention families (mean difference AU$4276; 95% CI: $3424 to $5128).


CONCLUSIONS
Population-based intervention targeting 4-year-old language delay was feasible but did not have lasting impacts on language, possibly reflecting resolution in both groups. Long-term literacy benefits remain possible but must be weighed against its cost.
Centre for Community Child Health, Royal Children's Hospital, Parkville, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, Australia; melissa.wake@rch.org.au.
Melissa
M
Wake
Centre for Community Child Health, Royal Children's Hospital, Parkville, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Melbourne, Australia;
Penny
P
Levickis
Centre for Community Child Health, Royal Children's Hospital, Parkville, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Melbourne, Australia;
Sherryn
S
Tobin
Deakin Health Economics, Deakin University, Burwood, Australia;
Lisa
L
Gold
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, Exeter, United Kingdom; and.
Obioha C
OC
Ukoumunne
Centre for Community Child Health, Royal Children's Hospital, Parkville, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, Australia;
Sharon
S
Goldfeld
Centre for Community Child Health, Royal Children's Hospital, Parkville, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Melbourne, Australia;
Naomi
N
Zens
Deakin Health Economics, Deakin University, Burwood, Australia;
Ha N D
HN
Le
Institute of Health and Society, School of Education, Communication and Language Sciences, University of Newcastle, United Kingdom.
James
J
Law
Murdoch Childrens Research Institute, Parkville, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, Australia;
Sheena
S
Reilly
D001315:Australia; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006699:Home Care Services; D006801:Humans; D007802:Language; D007805:Language Development Disorders / Q000628:therapy*; D007808:Language Therapy / Q000191:economics / Q000379:methods*; D008297:Male; D010342:Patient Acceptance of Health Care; D011788:Quality of Life; D016896:Treatment Outcome; D014825:Vocabulary