The impact of childhood language difficulties on healthcare costs from 4 to 13 years: Australian longitudinal study.

PURPOSE: This study investigated the relationship between children's language difficulties and health care costs using the 2004-2012 Longitudinal Study of Australian Children (LSAC). METHOD: Language difficulties were defined as scores ≤1.25SD below the standardised mean on measures of directly assessed receptive vocabulary (4-9 years) and teacher-reported language and literacy (10-13 years). Participant data were individually linked to administrative data, which were sourced from Australia's universal subsidised healthcare scheme (Medicare). RESULT: It was found that healthcare costs over each 2-year age band were higher for children with language difficulties than without in the 4-5-year-age bracket (mean difference = AU$357, 95%CI $59, $659), in the 6-7-year-age bracket (mean difference = AU$602, 95%CI $136, $1068) and in the 10-11-year-age bracket (mean difference = AU$504, 95%CI $153, $854). Out-of-pocket costs, that is the portion of healthcare costs paid for by the family, were also higher for children with than without language difficulties in the 4-5-year-age bracket (mean difference = AU$123, 95%CI $46, $199), in the 6-7-year-age bracket (mean difference = AU$176, 95%CI $74,278) and in the 10-11-year-age bracket (mean difference = AU$79, 95%CI $6, $152). Medical services accounted for 97% of total healthcare cost differences. CONCLUSION: Overall the findings from this study suggest that language difficulties are associated with increased healthcare costs at key developmental milestones, notably early childhood and as a child approaches the teenage years.

Service utilisation and costs of language impairment in children: The early language in Victoria Australian population-based study.

PURPOSE: To examine (1) the patterns of service use and costs associated with language impairment in a community cohort of children from ages 4-9 years and (2) the relationship between language impairment and health service utilisation. METHOD: Participants were children and caregivers of six local government areas in Melbourne participating in the community-based Early Language in Victoria Study (ELVS). Health service use was reported by parents. Costs were valued in Australian dollars in 2014, from the government and family perspectives. Depending on age, the Australian adapted Clinical Evaluation of Language Fundamentals - Pre-school, 2nd Edition (CELF-P2) or the CELF, 4th Edition (CELF4) was used to assess expressive and receptive language. RESULT: At 5, 7 and 9 years respectively 21%, 11% and 8% of families reported using services for speech and/or language concerns. The annual costs associated with using services averaged A$612 (A$255 to government, A$357 to family) at 5 years and A$992 (A$317 to government, A$675 to family) at 7 years. Children with persistent language impairment had significantly higher service costs than those with typical language. CONCLUSION: Language impairment in 4-9-year-old children is associated with higher use of services and costs to both families and government compared to typical language.

Association of postpartum maternal morbidities with children's mental, psychomotor and language development in rural Bangladesh.

Little is known from developing countries about the effects of maternal morbidities diagnosed in the postpartum period on children's development. The study aimed to document the relationships of such morbidities with care-giving practices by mothers, children's developmental milestones and their language, mental and psychomotor development. Maternal morbidities were identified through physical examination at 6-9 weeks postpartum (n=488). Maternal care-giving practices and postnatal depression were assessed also at 6-9 weeks postpartum. Children's milestones of development were measured at six months, and their mental (MDI) and psychomotor (PDI) development, language comprehension and expression, and quality of psychosocial stimulation at home were assessed at 12 months. Several approaches were used for identifying the relationships among different maternal morbidities, diagnosed by physicians, with children's development. After controlling for the potential confounders, maternal anaemia diagnosed postpartum showed a small but significantly negative effect on children's language expression while the effects on language comprehension did not reach the significance level (p=0.085). Children's development at 12 months was related to psychosocial stimulation at home, nutritional status, education of parents, socioeconomic status, and care-giving practices of mothers at six weeks of age. Only a few mothers experienced each specific morbidity, and with the exception of anaemia, the sample-size was insufficient to make a conclusion regarding each specific morbidity. Further research with a sufficient sample-size of individual morbidities is required to determine the association of postpartum maternal morbidities with children's development.

Estimated net saving to society from cochlear implantation in infants: a preliminary analysis.

OBJECTIVES/HYPOTHESIS: Although it is clear that cochlear implants (CIs) are highly cost-effective in adults and children, the possible additional economic benefit of implantation at younger ages has to be fully established to verify whether the costs and outcomes of CIs differ between infants and older children. STUDY DESIGN: Retrospective cohort study. METHODS: Comprehensive data of CI costs were obtained in four groups of children (age 2-11, 12-23, 24-35, and 72-83 months) from parent questionnaires, national healthcare and educational systems, and retail prices for materials used. Outcomes are compared in terms of receptive language level (Peabody Picture Vocabulary Test-Revised [PPVT-R]), with follow-up to the chronological age of 10 years. RESULTS: Implantation in infants was associated with a lower total cost for the first 10 years of life. The net savings to society ranged from around 21,000€ in the two younger classes to more than 35,000€ when comparing infants against children in the oldest group. When implantation was delayed, family costs played an important role in the increase in expenses. Children in the 2- to 11-month group scored significantly better at the PPVT-R than those in the other age groups (P < .05, P < .01, and P < .001, respectively; Dunn's test) at 10 years of age. The cost per 1-year gain in vocabulary age at the PPVT-R showed a substantial difference between the youngest and oldest age groups (13,266€/year, 17,719€/year, 20,029€/year, and 28,042€/year, respectively). CONCLUSIONS: CIs for patients under 1 year of age afford significantly improved performance and a net savings to society.

[Genetic causes in mild speech acquisition delay with/without mild developmental delay: significance for ENT physicians]. / Genetische Ursachen bei Störungen der Sprachentwicklung mit/ohne allgemeine Entwicklungsstörung : Bedeutung für HNO-Arzte.

Mental retardation (MR) has a prevalence of about 2%, and developmental speech disorders with unknown cause about 7%. Very often, developmental delay represents an early warning sign of later developmental problems, such as mental retardation and other developmental disorders (DD). Prognosis depends on many factors, most notably the limiting factor provided by the severity of the underlying brain dysfunction and its consequences for communication, cognition and other behaviour. Chromosomal aberrations are the major cause of MR and also play a role in mild forms of DD and speech acquisition delay. ENT specialists are confronted with children with DD or language acquisition disorders. If the suspicion of hearing impairment as the cause of problems in daily life is not confirmed in a patient, ENT specialists should also consider genetic causes in the differential diagnosis.

Parent based language intervention for 2-year-old children with specific expressive language delay: a randomised controlled trial.

OBJECTIVE: The aim of this randomised controlled trial was to evaluate the effectiveness of a short, highly structured parent based language intervention group programme for 2-year-old children with specific expressive language delay (SELD, without deficits in receptive language). METHODS: 61 children with SELD (mean age 24.7 months, SD 0.9) were selected between October 2003 and February 2006 during routine developmental check-ups in general paediatric practices, using a German parent-report screening questionnaire (adapted from the MacArthur Communicative Development Inventories). Standardised instruments were used to assess the language and non-verbal cognitive abilities of these children and of 36 other children with normal language development (reference group; mean age 24.6 months, SD 0.8). 58 children with SELD were sequentially randomly assigned to an intervention group (n = 29) or a 12-month waiting group (n = 29). In the intervention group, mothers participated in the 3-month Heidelberg Parent-based Language Intervention (HPLI). All children were reassessed 6 and 12 months after pretest. Assessors were blind to allocation and previous results. RESULTS: 47 children were included in the analysis. At the age of 3 years, 75% of the children in the intervention group showed normal expressive language abilities in contrast to 44% in the waiting group. Only 8% of the children in the intervention group versus 26% in the waiting group met the criteria for specific language impairment (t score < or =35). CONCLUSIONS: By applying the short, highly structured HPLI in children with SELD, the rate of treatment for language impairment at the age of 3 years can be significantly reduced.

Early Years Centres for pre-school children with primary language difficulties: what do they cost, and are they cost-effective?

BACKGROUND: High levels of early language difficulties raise practical issues about the efficient and effective means of meeting children's needs. Persistent language difficulties place significant financial pressures on health and education services. This has led to large investment in intervention in the early years; yet, little is known about the actual and relative costs of early years provision. AIMS: To profile the different costs incurred by two Early Years Centres (EYCs) partially funded by the charity I CAN and children receiving what might be termed 'routine' NHS speech therapy to provide an analysis of cost efficiency and equity. METHODS & PROCEDURES: Costings for service provision for 91 children (mean age 2;9) were collected. The activity of staff at each site and the cost of staff allocated to services were computed. Data on other resources were also collected. OUTCOMES & RESULTS: The cost per child per session was on average 12 pounds. Despite the longer course of intervention in the first centre (10 compared with 6 weeks), the cost of the course per child was of the same order (245 pounds compared with 253 pounds). The annual cost of the early years provision per child was higher relative to the costs of the NHS provision, 645 pounds compared with 181 pounds in one EYC (A) and 462 pounds compared with 173 pounds in the other (B). When the cost of standard nursery provision was factored in, the difference in annual costs was rather less, with 5298 pounds for the early years provision (EYC A) relative to 4276 pounds in the comparison group. By contrast, the annual cost of early provision rises to 5926 pounds relative to 8861 pounds in the comparison group (EYC B). CONCLUSIONS: The cost of the EYCs is relatively low and given the positive outcomes reported in the study of which this economic evaluation is a part, there is a good case for saying that they represent an efficient use of resources. The strengths and limitations of the economic evaluation are considered and the need for long-term evaluations is highlighted.

Cost-effectiveness analysis of current practice and parent intervention for children under 3 years presenting with expressive language delay.

BACKGROUND: Parents and professionals can both play a role in improving children's expressive language development and a number of alternative models of delivery exist that involve different levels of input by these two groups. However, these alternative treatments have not been subject to rigorous comparative analysis in terms of both cost and clinical effectiveness. AIMS: To compare, from the viewpoint of the healthcare provider, parent-based intervention (PBI) for preschool children presenting with expressive language delay with current practice observed in an actual healthcare setting where parents of the child follow a professional's advice on a review basis. METHODS & PROCEDURES: Two groups of children were compared on a variety of expressive and receptive language assessment measures. One group (n=10) received standard individual general care. The comparison group (n=12) received PBI. OUTCOMES & RESULTS: After the 6-month study, the results indicated that children who received PBI made significantly greater language gains that children who received current practice. In addition, a cost-effective analysis was conducted. This showed that although the language gains delivered by PBI did incur some additional costs for the healthcare provider, there was no significant increase in cost per outcome gain over general care. CONCLUSIONS: Options in the implementation of PBI are discussed that could potentially save costs for the healthcare providers and increase the value of a PBI-based approach.

[Telemedicine in phoniatrics and pediatric audiology--possible applications, technical implementation, economic aspects]. / Telemedizin in der Phoniatrie und Pädaudiologie--Anwendungsmöglichkeiten, technische Realisierung, ökonomische Aspekte.

BACKGROUND: Phoniatrics and Paedaudiology investigate and treat disorders of communication more than other medical specialties and are indicated by a distinctive interdisciplinary character. The methods of diagnosis and therapy are concentrated on a few specialists and produce a large quantity of multi-media data from daily clinical practice and research. For the cooperation between the specialists of these and neighboring branches and to reduce the costs for a second opinion these data must be available anywhere and any time using modern telecommunication and information technologies. METHODS: Following applications for a bi- or multidirectional data transmission are possible: Teleconsulting (second opinion of a far located specialist). Teleteaching (use of different data sources for education) and Teleroboting (remote control of medical equipment). Data sources can be: speaking and singing voice, sound, pictures (X-ray, CT, MR, ultrasound, voice range profile, audiogramm), video signals (stroboscopy, cinematography, intraoperative pictures) and written information (computer presentations) in all combinations. The transmission can be carried out synchronously or asynchronously, i.e. at the time for their generation or independent of this. This paper discusses the basics and the advantages and disadvantages of the available technologies and compares it for phoniatric/paedaudiologic applications in an experimental transmission. RESULTS: Use of the different technologies should be carried out depending upon the required quality, the availability and the costs considering medico-legal aspects. Relatively cheap and always available technologies are suitable for many applications in Phoniatrics and Paedaudiology. High costs for acquisition of the equipments could lowered by a common use of different medical branches. Expensive procedures with excellent communication quality are confined to special applications at the moment. CONCLUSION: Telemedicine can optimize quality and extend of the medical care and education in Phoniatrics and Paedaudiology with a simultaneous cost reduction and should increasingly be used in this branch.