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Outcomes of population based language promotion for slow to talk toddlers at ages 2 and 3 years: Let’s Learn Language cluster randomised controlled trial

BMJ 2011; 343 doi: (Published 18 August 2011) Cite this as: BMJ 2011;343:d4741
  1. Melissa Wake, professor and paediatrician1,
  2. Sherryn Tobin, research officer1,
  3. Luigi Girolametto, professor of speech-language pathology2,
  4. Obioha C Ukoumunne, statistician3,
  5. Lisa Gold, health economist4,
  6. Penny Levickis, research assistant1,
  7. Jane Sheehan, research assistant1,
  8. Sharon Goldfeld, paediatrician1,
  9. Sheena Reilly, professor of speech pathology1
  1. 1Royal Children’s Hospital, Murdoch Childrens Research Institute and University of Melbourne, Parkville, VIC 3052, Australia
  2. 2Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada, M5G 1V7
  3. 3PenCLAHRC, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK
  4. 4Deakin Health Economics, Deakin University, Burwood, VIC 3125, Australia
  1. Correspondence to: M Wake, Centre for Community Child Health, Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052, Australia melissa.wake{at}
  • Accepted 27 June 2011


Objective To determine the benefits of a low intensity parent-toddler language promotion programme delivered to toddlers identified as slow to talk on screening in universal services.

Design Cluster randomised trial nested in a population based survey.

Setting Three local government areas in Melbourne, Australia.

Participants Parents attending 12 month well child checks over a six month period completed a baseline questionnaire. At 18 months, children at or below the 20th centile on an expressive vocabulary checklist entered the trial.

Intervention Maternal and child health centres (clusters) were randomly allocated to intervention (modified “You Make the Difference” programme over six weekly sessions) or control (“usual care”) arms.

Main outcome measures The primary outcome was expressive language (Preschool Language Scale-4) at 2 and 3 years; secondary outcomes were receptive language at 2 and 3 years, vocabulary checklist raw score at 2 and 3 years, Expressive Vocabulary Test at 3 years, and Child Behavior Checklist/1.5-5 raw score at 2 and 3 years.

Results 1217 parents completed the baseline survey; 1138 (93.5%) completed the 18 month checklist, when 301 (26.4%) children had vocabulary scores at or below the 20th centile and were randomised (158 intervention, 143 control). 115 (73%) intervention parents attended at least one session (mean 4.5 sessions), and most reported high satisfaction with the programme. Interim outcomes at age 2 years were similar in the two groups. Similarly, at age 3 years, adjusted mean differences (intervention−control) were −2.4 (95% confidence interval −6.2 to 1.4; P=0.21) for expressive language; −0.3 (−4.2 to 3.7; P=0.90) for receptive language; 4.1 (−2.3 to 10.6; P=0.21) for vocabulary checklist; −0.5 (−4.4 to 3.4; P=0.80) for Expressive Vocabulary Test; −0.1 (−1.6 to 1.4; P=0.86) for externalising behaviour problems; and −0.1 (−1.3 to 1.2; P=0. 92) for internalising behaviour problems.

Conclusion This community based programme targeting slow to talk toddlers was feasible and acceptable, but little evidence was found that it improved language or behaviour either immediately or at age 3 years.

Trial registration Current Controlled Trials ISRCTN20953675.


  • We thank the participating maternal and child health nurses and families, the members of the project’s advisory group for their interest and support throughout, and all the research assistants who delivered the programme and did the follow-up assessments.

  • Contributors: As the chief investigators, MW, LGirolametto, OU, LGold, SG, and SR were all closely involved with the trial. MW was the lead chief investigator, obtained the funding, and led the writing of the manuscript. LGirolametto and SR provided expertise on speech pathology. ST was the project manager, and PL and JS were senior research assistants. OU did the statistical analyses, and LGold did the economic analyses. All the authors read, edited, and contributed to the manuscript. MW is the guarantor.

  • Funding: The trial was funded by the Australian National Health and Medical Research Council (NHMRC) strategic award 384491. The following authors were supported by the NHMRC during the trial: MW (population health career development grant 546405); LGold (population health capacity building grant 425855), SG and OU (population health capacity building grant 436914), and SR (practitioner research fellowship 491210). Murdoch Childrens Research Institute’s research is supported by the Victorian government’s Operational Infrastructure Support Program. The researchers were independent of the funders.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: that MW, ST, LGirolametto, OU, LGold, PL, JS, SG, and SR have support from the NHMRC for the submitted work; the authors have no relationships with any companies that might have an interest in the submitted work in the previous three years; and the authors have no non-financial interests that may be relevant to the submitted work.

  • Ethical approval: The project was approved by the Royal Children’s Hospital Ethics in Human Research Committee (EHRC 26028). All participating parents gave written informed consent.

  • Data sharing: No additional data available.

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