USPSTF: Data insufficient for speech-language screening recommendations

The USPSTF continues to find no evidence to suggest that speech-language screening at routine well-child visits improves speech or language outcomes.

This persistent lack of evidence accumulated during close to a decade of inquiry shows that unlike simple laboratory screening for problems such as lead toxicity or dyslipidemia, screening for developmental problems is drastically more complex. It may be that such disorders present insurmountable obstacles to the process of simple screening.

Given the status of child development as the basic science of pediatrics, the high prevalence of developmental disorders in general pediatric practice, and the scarcity of subspecialists to whom to refer, the ability to evaluate development clinically and make developmental diagnoses – rather than simple screening – needs to become a line item of competence for which every graduating pediatric resident is certified.

Unfortunately, the Accreditation Council of Graduate Medical Education Program Requirements for Graduate Medical Education in Pediatrics currently mandate only a 4-week subspecialty experience in developmental-behavioral pediatrics. A substantial expansion of required subspecialty exposure to developmental evaluation and diagnosis during pediatric residency training should lead to increased confidence in using clinical judgment to address developmental concerns just like any other commonly presenting concern in daily pediatric practice. Such enhanced pediatrician competence in evaluation and diagnosis of the basic science of pediatrics might ultimately provide evidence for improved outcomes, which has so far been lacking in the USPSTF studies of screening.

Robert G. Voigt, M.D., is in the department of pediatrics at Baylor College of Medicine, Houston.* Pasquale J. Accardo, M.D., is in the department of pediatrics at Virginia Commonwealth University, Richmond. Dr. Voigt and Dr. Accardo reported receiving no external funding for this work and having no potential conflicts of interest. These remarks were excerpted from a commentary accompanying the USPSTF recommendation statement (Pediatrics 2015 July 7 [doi:10.1542/peds.2015-0211]).