Objective: The Survey of Well-being of Young Children (SWYC) supports developmental screening at well-child visits. However, a US Preventive Services Task Force report suggests insufficient evidence for this approach for speech-language delay identification. The objective of this study was to determine associations between SWYC use and score at 24-month visits and timing of speech-language delay diagnoses and whether timing differed by sociodemographic characteristics.
Methods: Using electronic health records of 7,198 children born January 2016-December 2020 in a mid-sized health care system, we fit Kaplan-Meier survival curves for time to speech-language delay diagnosis based on SWYC use and score. Cox proportional hazards time-to-event analyses were run, and interactions between SWYC use and score and sociodemographics were assessed.
Results: Fifty percent received the SWYC, with use increasing during the study period with no sociodemographic differences detected. While SWYC use had no association with diagnosis (hazard ratio: 0.986, 95% confidence interval: 0.856-1.1136), lower SWYC scores (indicating greater developmental concern) were associated with higher likelihood of diagnosis (hazard ratio: 0.114, 95% confidence interval: 0.095-0.137). Interactions between scores and diagnostic timing by payer type and race/ethnicity were detected. Boys, publicly insured children, and those with lower SWYC scores were more likely to receive a speech-language delay diagnosis at their 24-month visit.
Conclusion: While clinicians likely rely on clinical judgement to identify delays, results suggest the SWYC is associated with speech-language delay identification. The ability of the SWYC to identify speech-language delay was moderated by insurance and race/ethnicity, warranting further study of factors shaping diagnostic decision-making.
Keywords: developmental screening; electronic health records; language delay; pediatric primary care.
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