Speech and language therapy interventions for children with primary speech and language delay or disorder

James Law; Zoe Garrett; Chad Nye

doi:10.1002/14651858.CD004110

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Analysis 1.1

Comparison 1 Speech and language intervention vesus delayed or no treatment, Outcome 1 Expressive phonology outcomes.

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Analysis 1.2

Comparison 1 Speech and language intervention vesus delayed or no treatment, Outcome 2 Receptive phonology outcomes.

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Analysis 1.3

Comparison 1 Speech and language intervention vesus delayed or no treatment, Outcome 3 Expressive syntax outcomes.

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Analysis 1.4

Comparison 1 Speech and language intervention vesus delayed or no treatment, Outcome 4 Receptive syntax outcomes.

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Analysis 1.5

Comparison 1 Speech and language intervention vesus delayed or no treatment, Outcome 5 Expressive vocabulary outcomes.

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Analysis 1.7

Comparison 1 Speech and language intervention vesus delayed or no treatment, Outcome 7 Composite language measures.

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Analysis 1.8

Comparison 1 Speech and language intervention vesus delayed or no treatment, Outcome 8 Subgroup analysis (clinician only data).

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Analysis 1.9

Comparison 1 Speech and language intervention vesus delayed or no treatment, Outcome 9 Subgroup analysis (trials of longer than eight weeks).

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Analysis 1.10

Comparison 1 Speech and language intervention vesus delayed or no treatment, Outcome 10 Subgroup Analysis (excluding data from children with receptive and expressive difficulties).

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Analysis 1.11

Comparison 1 Speech and language intervention vesus delayed or no treatment, Outcome 11 Sensitivity analysis (excluding studies not reporting attrition).

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Analysis 1.12

Comparison 1 Speech and language intervention vesus delayed or no treatment, Outcome 12 Sensitivity analysis (excluding studies not reporting blinding).

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Analysis 2.3

Comparison 2 Speech and language intervention versus general stimulation programmes, Outcome 3 Expressive syntax outcomes.

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Analysis 2.5

Comparison 2 Speech and language intervention versus general stimulation programmes, Outcome 5 Expressive vocabulary outcomes.

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Analysis 3.1

Comparison 3 Speech and language interventions versus traditional speech and language programmes, Outcome 1 Expressive phonology outcomes.

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Analysis 3.2

Comparison 3 Speech and language interventions versus traditional speech and language programmes, Outcome 2 Receptive phonology outcomes.

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Analysis 3.3

Comparison 3 Speech and language interventions versus traditional speech and language programmes, Outcome 3 Expressive syntax outcomes.

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Analysis 3.4

Comparison 3 Speech and language interventions versus traditional speech and language programmes, Outcome 4 Receptive syntax outcomes.

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Analysis 3.5

Comparison 3 Speech and language interventions versus traditional speech and language programmes, Outcome 5 Expressive vocabulary outcomes.

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Analysis 3.6

Comparison 3 Speech and language interventions versus traditional speech and language programmes, Outcome 6 Receptive vocabulary outcomes.

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Analysis 3.8

Comparison 3 Speech and language interventions versus traditional speech and language programmes, Outcome 8 Subgroup analysis (clinician versus parent).

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Analysis 3.9

Comparison 3 Speech and language interventions versus traditional speech and language programmes, Outcome 9 Subgroup analysis (excluding data from children with expressive and receptive difficulties).

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Table 1. Methodological Quality (A‐L)


Study	Randomisation	Blinding of Assessors	Similarities at Baseline	Explanation of Withdrawals	Discounting in analysis of Missing Values	Degree of Attrition	Intention to Treat Analysis	Power	Description of Eligibility Criteria
Almost (1998)	A	A	A	A	A (last known scores used)	C (.15)	A (I to T)	A	A
Barratt (1992)	B	B	B	A	C	A (.07)	B	A	A
Cole (1986)	B	B	A	B	B	B	B	B	A
Courtwright (1979)	B	A	B	B	B	B	B	B	B
Dixon (2001)	B	B	B	A (none)	A (none)	A (none)	B	B	A
Evans (Forthcoming)	B	A	B	A	C	C (.10)	B	B	A
Fey (1993)	B	A	C (mothers education)	A	C	A (.03)	B	B	A
Fey (1994)	B	C	A	A	A (none)	A (none)	B	B	A
Fey (1997)	B	A	A	A	C	A (.06)	B	B	A
Fudala (1972)	B	B	A	B	B	B	B	B	B
Gibbard (1994a)	B	B	A	A (none)	A (none)	A (none)	B	B	A
Gibbard (1994b)	B	B	A	A (none)	A (none)	A (none)	B	B	A
Girolametto (1996a)	B	A	C (behaviour)	A (none)	A (none)	A (none)	B	B	A
Girolametto (1996b)	B	A	A	A (none)	A (none)	A (none)	B	B	A
Girolametto (1997)	B	A	A	A (none)	A (none)	A (none)	B	B	A
Glogowska (2000)	A	A	A	A	C	A (.03)	A (I to T)	C	A
Head (1975)	B	B	B	A	C	C (.11)	B	B	C
Lancaster (1991)	B	B	B	A	A (included in end analysis)	A (none)	A (I to T)	B	A
Law (1999)	A	A	C (esteem, behaviour)	A	C	C (.12)	B	C	A
Key:	A: randomisation methods explained	A: assessors blind at pre and post test	A: baseline characteristics reported	A: withdrawals accounted for	A: missing values accounted for in analysis	A: attrition <.10	A: intention to treat analysis	A: power calculation and sufficient participants recruited	A: characteristics provided in main areas of language
	B: randomisation methods not explained	B: blinding not reported	B: baseine characteristics not reported	B: withdrawals not reported	B: no missing values shown	B: attrition not reported	B: intention to treat analysis not used	B: power claculation not reported	B: characteristics reported in area of investigation
	C: randomisation methods not adequate	C: blinding at pre‐test only	C: baseline characteristics reported to be different	C: withdrawals not accounted for	C: missing values discounted from analysis	C: attrition >.10		C: power calculation completed but insufficient participants recruited	C: characteristics unclear

Table 1. Methodological Quality (A‐L)

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Table 2. Methodological Quality (M‐Z)

Study	Randomisation	Blinding of Assessor	Baseline	Withdrawals	Missing Values	Attrition	Analysis	Power	Eligibility
Matheny (1978)	B	B	A	B	B	B	B	B	A
Mulac (1977)	B	A	B	B	B	B	B	B	B
Munro (1999)	B	A	B	A	C	C (.15)	B	B	A
Reid (1996)	B	B	C (medians)	A (subgroup)	A (subgroup)	A (subgroup)	B	B	A
Robertson (1997)	B	C	A	B	B	B	B	B	A
Robertson (1999)	B	B	A	A	C	C (.13)	B	B	A
Ruscello (1993)	B	B	A	B	B	B	B	B	A
Rvachew (1994)	B	A	A	B	C	C (.13)	B	B	A
Rvachew (2001)	B	A	A	A	B	B	B	B	A
Schwartz (1985)	B	C	B	B	B	B	B	B	A
Shelton (1978)	B	B	A	A	C	A (.08)	B	B	A
Sommers (1962)	B	B	A	B	B	B	B	B	B
Sommers (1964)	B	B	B	B	B	B	B	B	B
Sommers (1966)	B	A	B	C	C	C (.10)	B	B	B
Sutton (1999)	B	B	B	B	B	B	B	B	A
Tufts (1959)	B	A	A	B	B	B	B	B	B
Wilcox (1991)	B	B	A	B	B	B	B	B	A
Key	A: methods of randomisation explained	A: assessors blind to group allocation at pre and post test	A: baseline characteristics reported	A: withdrawals accounted for	A: missing values taken into account in analysis	A: <.10 attrition	A: intention to treat analysis used	A: power calculation completed and sufficient participants recruited	A: characteristics in main linguistic areas
	B: methods fo randomisation not explained	B: blinding not reported	B: baseline characteristics not reported	B: withdrawals not reported	B: no missing values shown	B: attrition not reported	B: intention to treat analysis not reported	B: power claculation not reported	B: characteristics in main area of study
	C: methods of randomisation inadequate	C: assessors blind at pre‐test only	C: baseline characteristics reported to be different	C: withdrawals not accounted for	C: missing values discounted in analysis	C: >.10 attrition		C: power calculation completed but insufficient participants recruited	C: characteristics unclear

Table 2. Methodological Quality (M‐Z)

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Comparison 1. Speech and language intervention vesus delayed or no treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Expressive phonology outcomes Show forest plot	6		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 Production of target sound	1	11	Std. Mean Difference (IV, Random, 95% CI)	0.98 [‐0.35, 2.31]
1.2 Variability in production of target sound	1	11	Std. Mean Difference (IV, Random, 95% CI)	0.91 [‐0.41, 2.23]
1.3 Measures of overall phonological development	6	264	Std. Mean Difference (IV, Random, 95% CI)	0.44 [0.01, 0.86]
1.4 Percentage of consonants correct in conversation	1	26	Std. Mean Difference (IV, Random, 95% CI)	1.91 [0.96, 2.86]
1.5 Re‐telling a story with target sound	1	11	Std. Mean Difference (IV, Random, 95% CI)	1.29 [‐0.11, 2.69]
2 Receptive phonology outcomes Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Auditory association test	1	45	Std. Mean Difference (IV, Random, 95% CI)	0.53 [‐0.10, 1.16]
3 Expressive syntax outcomes Show forest plot	7		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

3.1 Measures of overall expressive syntax development	5	271	Std. Mean Difference (IV, Random, 95% CI)	0.70 [‐0.14, 1.55]
3.2 Total number of utterances in a language sample	3	99	Std. Mean Difference (IV, Random, 95% CI)	0.68 [‐0.45, 1.82]
3.3 Mean length of utterance from language sample	3	95	Std. Mean Difference (IV, Random, 95% CI)	0.74 [‐0.33, 1.81]
3.4 Parent report of phrase complexity	3	99	Std. Mean Difference (IV, Random, 95% CI)	1.02 [‐0.17, 2.22]
4 Receptive syntax outcomes Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

4.1 measures of overall receptive syntax development	2	193	Std. Mean Difference (IV, Random, 95% CI)	‐0.04 [‐0.64, 0.56]
5 Expressive vocabulary outcomes Show forest plot	5		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

5.1 Number of different target words learnt	2	41	Std. Mean Difference (IV, Random, 95% CI)	0.93 [0.27, 1.58]
5.2 Measures of overall expressive vocabulary development	2	74	Std. Mean Difference (IV, Random, 95% CI)	0.98 [‐0.59, 2.56]
5.3 Different words in language sample	3	82	Std. Mean Difference (IV, Random, 95% CI)	1.08 [0.61, 1.55]
5.4 Parent report of vocabulary	5	136	Std. Mean Difference (IV, Random, 95% CI)	0.89 [0.21, 1.56]
6 Receptive vocabulary outcomes	0		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only
7 Composite language measures Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

7.1 REEL Language quotients	1	55	Std. Mean Difference (IV, Random, 95% CI)	0.22 [‐0.32, 0.76]
8 Subgroup analysis (clinician only data) Show forest plot	7		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

8.1 measures of overall expressive phonology development	5	214	Std. Mean Difference (IV, Random, 95% CI)	0.67 [0.19, 1.16]
8.2 measures of overall expressive syntax development	4	214	Std. Mean Difference (IV, Random, 95% CI)	0.28 [‐0.19, 0.75]
8.3 measures of overall expressive vocabulary development	1	27	Std. Mean Difference (IV, Random, 95% CI)	0.13 [‐0.65, 0.91]
8.4 measures of overall receptive syntax development	2	182	Std. Mean Difference (IV, Random, 95% CI)	0.01 [‐0.53, 0.55]
9 Subgroup analysis (trials of longer than eight weeks) Show forest plot	5		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

9.1 measures of overall phonological development	4	203	Std. Mean Difference (IV, Random, 95% CI)	0.74 [0.14, 1.33]
9.2 measures of overall expressive syntax development	3	187	Std. Mean Difference (IV, Random, 95% CI)	0.43 [‐0.06, 0.93]
9.3 measures of overall expressive vocabulary development	0	0	Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
9.4 measures of overall receptive syntax development	1	155	Std. Mean Difference (IV, Random, 95% CI)	0.19 [‐0.12, 0.51]
10 Subgroup Analysis (excluding data from children with receptive and expressive difficulties) Show forest plot	7		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

10.1 Measures of overall expressive syntax development	4	233	Std. Mean Difference (IV, Random, 95% CI)	1.02 [0.04, 2.01]
10.2 Total number of utterances in language sample	2	61	Std. Mean Difference (IV, Random, 95% CI)	1.20 [0.33, 2.07]
10.3 Mean langth of utterance based on language sample	2	57	Std. Mean Difference (IV, Random, 95% CI)	1.28 [0.66, 1.89]
10.4 Parent report of phrase complexity	2	61	Std. Mean Difference (IV, Random, 95% CI)	1.54 [0.42, 2.65]
10.5 Measures of overall vocabulary development	1	36	Std. Mean Difference (IV, Random, 95% CI)	1.79 [1.01, 2.58]
10.6 Parent report of vocabulary size	4	98	Std. Mean Difference (IV, Random, 95% CI)	1.00 [0.16, 1.84]
11 Sensitivity analysis (excluding studies not reporting attrition) Show forest plot	9		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

11.1 Measures of overall expressive phonology development	5	248	Std. Mean Difference (IV, Random, 95% CI)	0.40 [‐0.08, 0.89]
11.2 Measures of overall receptive phonology development	1	45	Std. Mean Difference (IV, Random, 95% CI)	0.53 [‐0.10, 1.16]
11.3 Measures of overall expressive syntax development	4	255	Std. Mean Difference (IV, Random, 95% CI)	0.67 [‐0.33, 1.66]
11.4 Measures of overall receptive syntax development	2	193	Std. Mean Difference (IV, Random, 95% CI)	‐0.04 [‐0.64, 0.56]
11.5 Measures of overall expressive vocabulary development	2	74	Std. Mean Difference (IV, Random, 95% CI)	0.98 [‐0.59, 2.56]
11.6 Measures of overall receptive vocabulary development	0	0	Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
11.7 Composite language measures	1	55	Std. Mean Difference (IV, Random, 95% CI)	0.22 [‐0.32, 0.76]
12 Sensitivity analysis (excluding studies not reporting blinding) Show forest plot	6		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

12.1 Measures of overall expressive phonology	3	188	Std. Mean Difference (IV, Random, 95% CI)	0.66 [‐0.07, 1.40]
12.2 Measures of overall receptive phonology	0	0	Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
12.3 Measures of overall expressive syntax	3	219	Std. Mean Difference (IV, Random, 95% CI)	0.14 [‐0.47, 0.75]
12.4 Measures of overall receptive syntax	2	193	Std. Mean Difference (IV, Random, 95% CI)	‐0.04 [‐0.64, 0.56]
12.5 Measures of overall expressive vocabulary	1	38	Std. Mean Difference (IV, Random, 95% CI)	0.19 [‐0.54, 0.91]
12.6 Measures of overall receptive vocabulary	0	0	Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
12.7 Composite language measures	1	55	Std. Mean Difference (IV, Random, 95% CI)	0.22 [‐0.32, 0.76]

Comparison 1. Speech and language intervention vesus delayed or no treatment

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Comparison 2. Speech and language intervention versus general stimulation programmes

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Expressive phonology outcomes	0		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only
2 Receptive phonology outcomes	0		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only
3 Expressive syntax outcomes Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

3.1 Multi‐word utterances using target stimuli	1	10	Std. Mean Difference (IV, Random, 95% CI)	0.74 [‐0.87, 2.34]
3.2 Measures of overall expressive syntax development	1	25	Std. Mean Difference (IV, Random, 95% CI)	0.93 [0.05, 1.82]
3.3 Number of play related speech acts during play	1	20	Std. Mean Difference (IV, Random, 95% CI)	3.20 [1.79, 4.62]
3.4 Total number of utterances in language sample	1	25	Std. Mean Difference (IV, Random, 95% CI)	0.88 [‐0.00, 1.76]
3.5 Mother description of phrase complexity	1	25	Std. Mean Difference (IV, Random, 95% CI)	0.78 [‐0.09, 1.65]
3.6 Mean length of utterance based on language sample	1	25	Std. Mean Difference (IV, Random, 95% CI)	1.36 [0.42, 2.29]
4 Receptive syntax outcomes	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Expressive vocabulary outcomes Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

5.1 Number of words in play scripts	1	20	Std. Mean Difference (IV, Random, 95% CI)	2.29 [1.11, 3.48]
5.2 Measures of overall expressive vocabulary development	1	25	Std. Mean Difference (IV, Random, 95% CI)	0.76 [‐0.11, 1.63]
5.3 Number of words in language sample	2	45	Std. Mean Difference (IV, Random, 95% CI)	1.25 [‐0.07, 2.58]
6 Receptive vocabulary outcomes	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. Speech and language intervention versus general stimulation programmes

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Comparison 3. Speech and language interventions versus traditional speech and language programmes

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Expressive phonology outcomes Show forest plot	7		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

1.1 Production of target sound	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.2 Measures of overall expressive phonology development	7		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.3 Percentage of consonants correct in conversation	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2 Receptive phonology outcomes Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Test of Auditory Association	1	30	Std. Mean Difference (IV, Random, 95% CI)	0.0 [‐0.72, 0.72]
3 Expressive syntax outcomes Show forest plot	6		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

3.1 Correct utterance of 20 unusual sentences	1	24	Std. Mean Difference (IV, Random, 95% CI)	0.57 [‐0.25, 1.39]
3.2 Measures of overall expressive syntax development	5	138	Std. Mean Difference (IV, Random, 95% CI)	‐0.13 [‐0.47, 0.21]
3.3 Total utterances from a language sample	2	45	Std. Mean Difference (IV, Random, 95% CI)	0.15 [‐0.45, 0.74]
3.4 Mean length of utterance from a language sample	3	89	Std. Mean Difference (IV, Random, 95% CI)	0.09 [‐0.75, 0.93]
3.5 Parent report of complexity of phrases	2	45	Std. Mean Difference (IV, Random, 95% CI)	0.01 [‐0.63, 0.66]
4 Receptive syntax outcomes Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

4.1 Measures of overall receptove syntax development	3		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
5 Expressive vocabulary outcomes Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

5.1 Overall use of target words in clinic interaction	1	20	Std. Mean Difference (IV, Random, 95% CI)	0.35 [‐0.53, 1.24]
5.2 Measures of overall expressive vocabulary development	2	45	Std. Mean Difference (IV, Random, 95% CI)	0.20 [‐0.40, 0.79]
5.3 Different words in language sample	1	17	Std. Mean Difference (IV, Random, 95% CI)	‐0.50 [‐1.48, 0.47]
5.4 Parent report of vocabulary size	2	45	Std. Mean Difference (IV, Random, 95% CI)	‐0.16 [‐0.76, 0.44]
6 Receptive vocabulary outcomes Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

6.1 Measures of overall vocabulary understanding	1	44	Std. Mean Difference (IV, Random, 95% CI)	‐0.22 [‐0.82, 0.38]
7 Composite language outcomes	0		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only
8 Subgroup analysis (clinician versus parent) Show forest plot	6		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

8.1 Measures of overall expressive phonology development	3	130	Std. Mean Difference (IV, Random, 95% CI)	0.66 [‐0.47, 1.80]
8.2 Measures of overall expressive syntax development	3	66	Std. Mean Difference (IV, Random, 95% CI)	‐0.04 [‐0.56, 0.48]
8.3 Measures of overall expressive vocabulary development	2	45	Std. Mean Difference (IV, Random, 95% CI)	0.20 [‐0.40, 0.79]
8.4 Measures of overall receptive syntax development	1	28	Std. Mean Difference (IV, Random, 95% CI)	‐0.11 [‐0.87, 0.65]
9 Subgroup analysis (excluding data from children with expressive and receptive difficulties) Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

9.1 Measures of overall syntax development	2	38	Std. Mean Difference (IV, Random, 95% CI)	0.27 [‐0.37, 0.91]
9.2 Total number of utterances in a language sample	1	17	Std. Mean Difference (IV, Random, 95% CI)	0.43 [‐0.54, 1.39]
9.3 Mean length of utterance derived from a language sample	1	17	Std. Mean Difference (IV, Random, 95% CI)	1.17 [0.12, 2.23]
9.4 Parent report of phrase complexity	1	17	Std. Mean Difference (IV, Random, 95% CI)	0.42 [‐0.54, 1.39]
9.5 Measures of overall vocabulary development	1	17	Std. Mean Difference (IV, Random, 95% CI)	0.33 [‐0.63, 1.29]
9.6 Parental report of vocabulary size	1	17	Std. Mean Difference (IV, Random, 95% CI)	0.13 [‐0.82, 1.08]

Comparison 3. Speech and language interventions versus traditional speech and language programmes

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