BMJ 2000;321:923 ( 14 October )

Papers

Randomised controlled trial of community based speech and language therapy in preschool children

Editorial by Law and Conti-Ramsden

Margaret Glogowska, research assistant, ^a Sue Roulstone, clinical research director, ^a Pam Enderby, professor of community rehabilitation, ^b Tim J Peters, reader in medical statistics. ^c

^a Speech and Language Therapy Research Unit, Frenchay Hospital, Bristol BS16 1LE, ^b Centre for Ageing and Rehabilitation Studies, School of Health and Related Studies, University of Sheffield, Northern General Hospital, Sheffield S5 7AU, ^c Department of Social Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PR

Correspondence to: S Roulstone sue{at}speech-therapy.org.uk

Objective: To compare routine speech and language therapy in preschool children with delayed speech and language against 12 months of "watchful waiting."
Design: Pragmatic randomised controlled trial.
Setting: 16 community clinics in Bristol.
Participants: 159 preschool children with appreciable speech or language difficulties who fulfilled criteria for admission to speech and language therapy.
Main outcome measures: Four quantitative measures of speech and language, assessed at 6 and 12 months; a binary variable indicating improvement, by 12 months, on the trial entry criterion.
Results: Improvement in auditory comprehension was significant in favour of therapy (adjusted difference in means 4.1, 95% confidence interval 0.5 to 7.6; P=0.025). No significant differences were observed for expressive language (1.4, 2.1 to 4.8; P=0.44); phonology error rate (4.4, 12.0 to 3.3; P=0.26); language development (0.1, 0.4 to 0.6; P=0.73); or improvement on entry criterion (odds ratio 1.3, 0.67 to 2.4; P=0.46). At the end of the trial, 70% of all children still had substantial speech and language deficits.
Conclusions: This study provides little evidence for the effectiveness of speech and language therapy compared with watchful waiting over 12 months. Providers of speech and language therapy should reconsider the appropriateness, timing, nature, and intensity of such therapy in preschool children. Continued research into more specific provision to subgroups of children is also needed to identify better treatment methods. The lack of resolution of difficulties for most of the children suggests that further research is needed to identify effective ways of helping this population of children.

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