Abstract
This cohort study evaluates changes in pediatric speech delay diagnoses before and after the COVID-19 pandemic.
Approximately 8% of children have a communication or speech and language disorder.1 During the COVID-19 pandemic, lifestyle changes affected the way children live and communicate, including stay-at-home measures, decreases in preschool attendance, and in-person preschool options.2 A study3 in Uruguay found motor and cognitive losses for children during the pandemic compared to a control population. This study was conducted to assess whether there was a change in first-time speech delay diagnoses among US children before and after the pandemic.
Methods
We identified children younger than 5 years with encounters between January 1, 2018, and February 28, 2023, and no previous speech delay diagnosis in a subset of Truveta data. Truveta data consist of electronic health records provided by member US health care systems that were deidentified by expert determination in accordance with the HIPAA Privacy Rule and therefore exempt from institutional review board approval.4,5 The STROBE reporting guideline was followed in this study.
We identified encounters associated with first-time speech delay diagnosis defined using diagnostic codes (eTable in Supplement 1). We calculated the monthly rate of first-time speech delay diagnoses per children with an encounter within the last year and no previous speech delay diagnosis. We looked at the population younger than 5 years overall and stratified by age (0-1 year, 1-2 years, 2-3 years, 3-4 years, and 4-5 years).
We evaluated changes in monthly first-time diagnosis rates using interrupted time-series analysis with autoregressive integrated moving-average model models that accounted for both autocorrelation and seasonality. We modeled postpandemic changes in level (step) and slope (trend) of diagnoses, and allowed for an additional, short-term level change (pulse) between March 2020 and June 2020 due to variation in care seeking behavior during this period (not reported). P values less than .05 were considered significant.
Results
Of 2 463 511 included patients, 87 781 (3.6%) had a first-time diagnosis within this period (Table). Two-year-old patients had the highest rate of first-time diagnoses, followed by the 1-year-old patients (Figure).
Table. Demographic Characteristics of Population Based on the Year of Speech Delay Diagnosis.
| No. (%) | |||
|---|---|---|---|
| Overall | Speech delay diagnosis | No speech delay diagnosis | |
| No. | 2 463 511 | 87 781 | 2 375 730 |
| Sex | |||
| Female | 1 173 756 (47.6) | 28 846 (32.9) | 1 144 910 (48.2) |
| Male | 1 280 604 (52.0) | 58 743 (66.9) | 1 221 861 (51.4) |
| Unknown | 9151 (0.4) | 192 (0.2) | 8959 (0.4) |
| Racea | |||
| American Indian or Alaska Native | 18 518 (0.8) | 914 (1.0) | 17 604 (0.7) |
| Asian | 125 873 (5.1) | 5298 (6.0) | 120 575 (5.1) |
| Black | 247 261 (10.0) | 11 138 (12.7) | 236 123 (9.9) |
| Native Hawaiian or Other Pacific Islander | 14 735 (0.6) | 667 (0.8) | 14 068 (0.6) |
| White | 1 221 564 (49.6) | 44 872 (51.1) | 1 176 692 (49.5) |
| Otherb | 293 004 (11.9) | 11 297 (12.9) | 281 707 (11.9) |
| Unknown | 542 556 (22.0) | 13 595 (15.5) | 528 961 (22.3) |
| Ethnicitya | |||
| Hispanic or Latino | 434 272 (17.6) | 16 798 (19.1) | 417 474 (17.6) |
| Not Hispanic or Latino | 1 481 879 (60.2) | 59 381 (67.6) | 1 422 498 (59.9) |
| Unknown | 547 360 (22.2) | 11 602 (13.2) | 535 758 (22.6) |
| Age group | |||
| 0-1 y | 1340 (1.5) | 1340 (1.5) | NA |
| 1-2 y | 30 013 (34.2) | 30 013 (34.2) | NA |
| 2-3 y | 29 577 (33.7) | 29 577 (33.7) | NA |
| 3-4 y | 15 728 (17.9) | 15 728 (17.9) | NA |
| 4-5 y | 11 123 (12.7) | 11 123 (12.7) | NA |
| Year of diagnosis | |||
| 2018 | 15 063 (17.2) | 15 063 (17.2) | NA |
| 2019 | 15 937 (18.2) | 15 937 (18.2) | NA |
| 2020 | 14 377 (16.4) | 14 377 (16.4) | NA |
| 2021 | 18 771 (21.4) | 18 771 (21.4) | NA |
| 2022 | 20 080 (22.9) | 20 080 (22.9) | NA |
| 2023 | 3553 (4.0) | 3553 (4.0) | NA |
Abbreviation: NA, not applicable.
Race and ethnicity data were collected via electronic health report and reported because describe the representativeness of the population.
Other includes people identified as “other race” within their health system.
Figure. Actual and Predicted Rates of Speech Delays for the 4 Oldest Age Groups.
The shaded regions are 95% CIs. The vertical dotted line indicates the postpandemic period (July 2020).
We observed significant increases in both the level (0.48; 95% CI, 0.18-0.80; P = .002) and slope (0.02; 95% CI, 0.00-0.03; P = .02) of first-time speech delay diagnosis in the postpandemic period for the overall population. Significant increases in the level were observed in all age groups older than 1 year (1-2 years: 0.90; 95% CI, 0.27-1.54; P = .005; 2-3 years: 1.15; 95% CI, 0.12-2.18; P = .03; 3-4 years: 0.55; 95% CI, 0.11-0.99; P = .01; 4-5 years: 0.43; 95% CI, 0.13-0.73; P = .005) (Figure). There were also significant increases in the slope for the age groups younger than 2 (0-1 year: 0.00; 95% CI, 0.00.00; P = .004; 1-2 years: 0.04; 95% CI, 0.01-0.07; P = .005).
Discussion
In this cohort study, we found a significant increase in either the trend or step rate of first-time speech delay diagnosis for all age groups studied. Younger age groups experienced an increase in trend while older age groups exhibited increases in the step. Children aged 1 and 2 years experienced both an increase in step and trend, potentially due to regular screenings at these ages. Factors associated with these trends may include fewer social interactions, psychological distress, or changes in care routines which may have promoted parents to be more aware and seek care for potential speech delays.
This study did not analyze severity of speech delay, therapy initiation or effectiveness; however, the increases in diagnosis rates seen here are potentially amplified by reported decreases in therapy effectiveness during the pandemic.6 Only diagnoses within Truveta health systems were available; school or private practice–based diagnoses were not included. Age during months without an encounter was estimated using the age at previous encounters. Though data here did not include patients from all US states, this study still offers valuable insights with its substantial sample size. Despite these limitations, to our knowledge, these data are the first to show an increase in speech delay diagnoses in the years following the pandemic within the US.
eTable. Diagnostic codes used to define speech delay diagnosis
Data sharing statement
References
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Associated Data
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Supplementary Materials
eTable. Diagnostic codes used to define speech delay diagnosis
Data sharing statement
