Parents helpful in assessing speech skills

Physicians should attempt to elicit and address parental concerns about a child's emerging ability to speak and use language. There is not, however, enough evidence to answer the question over whether any of the currently available screening tools should be used to assess all children on this issue, according to a position statement and study by the U.S. Preventive Services Task Force. Both documents were published in Pediatrics last month.

"Parents are really good at picking this up, and probably better than anyone else when it comes to their child," said Virginia Moyer, MD, MPH, a member of the task force and professor of pediatrics at the University of Texas Medical School at Houston.

Experts praised this statement for giving more weight to the concerns of parents. Many acknowledge that such difficulties might not be apparent in a 10-minute office visit when a doctor feels rushed to address the many other issues that come up. Children also could be hesitant to talk to someone perceived to be a stranger.

"We kind of know how many words a child should be saying at various ages, but I may not be able to get more than one word out of them," said Karole Lakota, MD, a family physician with PCC Community Wellness Center in Oak Park, Ill. "Anecdotally, if a parent has a concern, that probably tells you more than any tool is going to tell you."

The task force statement also was praised for highlighting just how little evidence there is in this area and outlining exactly the kind of research that needs to be done.

"People who do research can show this statement to people who fund [such projects] and say that this is clearly a missing link and you should give us the money," said Donna Halloran, MD, MSPH, assistant professor of pediatrics at Saint Louis University School of Medicine.

The hope is that, because of this statement, the evidence the task force needs to endorse screening may not be far behind. The tools exist, but it's a matter of proving they work on a large scale.

But some who work on childhood developmental issues say that what might be needed is more global screening rather than just that for speech and language. For example, the American Medical Association endorsed policy last year calling for ways to help physicians identify children with all kinds of developmental delays. The American Academy of Pediatrics recommends that all infants and young children receive periodic screenings for developmental delays related to language, behavioral issues and autism.

"We really need to be looking at development in general, at problem solving, fine motor skills, and language," said Marian Earls, MD, lead physician for the Assuring Better Child Health and Development program in North Carolina, which seeks to increase the availability of developmental services in primary care.

But the bigger concern is not just detecting delays but getting children access to some kind of intervention. Those who authored the task force statement expressed particular frustration over this issue because, although evidence that screening works is lacking, the evidence backing intervening in some way is fairly strong.

"It's not clear that screening is beneficial or harmful, and that's terribly unfortunate because it's clear that treatment can help," Dr. Moyer said. "If only we had a way to catch them that worked -- there's the dilemma."

AMA policy urges physicians to assist parents in obtaining access to these services, and experts said they are available in most communities, even if they aren't easy to find.

"Most states have early intervention services," Dr. Halloran said. "The trick is to find out how to get access, but they're there."