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Early childhood services which seek to promote early language development are hampered by the absence of reliable methods to identify children who may develop persistent language difficulties. This is because of variability in preschool children's language development and that existing measures have limited diagnostic accuracy. In this study, we examined two approaches to identifying children at 12 months of age who are at risk of poor language skills at 4 years of age: (1) measurement of socio-cognitive and communicative foundations of language using the "Sure Steps to Talking" (SSTT) Questionnaire; (2) a "combined risk model" utilising child, family, and parenting characteristics. The study had three phases, and they are as follows: (1) evaluation of the predictive validity of SSTT through longitudinal follow-up of children in a matched cohort in the UK; (2) modelling application of SSTT as a population screener and assessing its validity in a longitudinal community cohort in Australia (Early Language in Victoria Study ELVS); and (3) evaluation of a list of risk factors through secondary data analysis of the ELVS cohort. Prediction using the SSTT measure was modest. A "risk model" that included seven factors (child communicative behaviours, family, and parenting characteristics) measured at 12 months reached "fair" levels of predictive validity and approached a similar level of prediction for language difficulties at age 4 years as found by measures of vocabulary at 24 months. This latter assessment approach potentially provides an additional 12-month window within which preventative interventions could be implemented.

Public health approaches to communication disability challenge the profession of speech-language pathology (SLP) to reconsider both frames of reference for practice and models of education. This paper reviews the impetus for public health approaches to communication disability and considers how public health is, and could be, incorporated into SLP education, both now and in the future. The paper describes tensions between clinical services, which have become increasingly specialized, and public health approaches that offer a broader view of communication disability and communication disability prevention. It presents a discussion of these tensions and asserts that public health approaches to communication are themselves a specialist field, requiring specific knowledge and skills. The authors suggest the use of the term 'communication disability public health' to refer to this type of work and offer a preliminary definition in order to advance discussion. Examples from three countries are provided of how some SLP degree programmes are integrating public health into the SLP curriculum. Alternative models of training for communication disability public health that may be relevant in the future in different contexts and countries are presented, prompting the SLP profession to consider whether communication disability public health is a field of practice for speech-language pathologists or whether it has broader workforce implications. The paper concludes with some suggestions for the future which may advance thinking, research and practice in communication disability public health. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: We have previously shown short-term benefits to phonology, letter knowledge, and possibly expressive language from systematically ascertaining language delay at age 4 years followed by the Language for Learning intervention. Here, we report the trial's definitive 6-year outcomes., Methods: Randomized trial nested in a population-based ascertainment. Children with language scores >1.25 SD below the mean at age 4 were randomized, with intervention children receiving 18 1-hour home-based therapy sessions. Primary outcome was receptive/expressive language. Secondary outcomes were phonological, receptive vocabulary, literacy, and narrative skills; parent-reported pragmatic language, behavior, and health-related quality of life; costs of intervention; and health service use. For intention-to-treat analyses, trial arms were compared using linear regression models., Results: Of 1464 children assessed at age 4, 266 were eligible and 200 randomized; 90% and 82% of intervention and control children were retained respectively. By age 6, mean language scores had normalized, but there was little evidence of a treatment effect for receptive (adjusted mean difference 2.3; 95% confidence interval [CI] -1.2 to 5.7; P = .20) or expressive (0.8; 95% CI -1.6 to 3.2; P = .49) language. Of the secondary outcomes, only phonological awareness skills (effect size 0.36; 95% CI 0.08-0.65; P = .01) showed benefit. Costs were higher for intervention families (mean difference AU$4276; 95% CI: $3424 to $5128)., Conclusions: Population-based intervention targeting 4-year-old language delay was feasible but did not have lasting impacts on language, possibly reflecting resolution in both groups. Long-term literacy benefits remain possible but must be weighed against its cost., (Copyright © 2015 by the American Academy of Pediatrics.)