The Relationship Between the Survey of Well-being of Young Children and Speech-language Delay Diagnosis.

objectiveThe 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.

methodsUsing 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.

resultsFifty 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.

conclusionWhile 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.