Background:
Early language delay is a high-prevalence condition of concern to parents and professionals.It may result in lifelong deficits not only in language function, but also in social,emotional/behavioural, academic and economic well-being. Such delays can lead toconsiderable costs to the individual, the family and to society more widely. The Language forLearning trial tests a population-based intervention in 4 year olds with measured languagedelay, to determine (1) if it improves language and associated outcomes at ages 5 and 6 yearsand (2) its cost-effectiveness for families and the health care system.
Methods:
A large-scale randomised trial of a year-long intervention targeting preschoolers withlanguage delay, nested within a well-documented, prospective, population-based cohort of1464 children in Melbourne, Australia.All children received a 1.25-1.5 hour formal languageassessment at their 4th birthday. The 200 children with expressive and/or receptive languagescores more than 1.25 standard deviations below the mean were randomised into interventionor ‘usual care’ control arms. The 20-session intervention program comprises 18 one-hourhome-based therapeutic sessions in three 6-week blocks, an outcome assessment, and a finalfeed-back/forward planning session. The therapy utilises a ‘step up-step down’ therapeuticapproach depending on the child’s language profile, severity and progress, with standardised,manualised activities covering the four language development domains of: vocabulary andgrammar; narrative skills; comprehension monitoring; and phonological awareness/preliteracyskills. Blinded follow-up assessments at ages 5 and 6 years measure the primaryoutcome of receptive and expressive language, and secondary outcomes of vocabulary,narrative, and phonological skills.DiscussionA key strength of this robust study is the implementation of a therapeutic framework thatprovides a standardised yet tailored approach for each child, with a focus on specificlanguage domains known be associated with later language and literacy. The trial responds toidentified evidence gaps, has outcomes of direct relevance to families and the community,includes a well-developed economic analysis, and has the potential to improve long-termconsequences of early language delay within a public health framework.Trial registrationCurrent Controlled Trials ISRCTN03981121