Speech and language therapies for 4-year-old children in Hesse: an overview

Abstract

Background: A delayed identification of language impairments and missing interventions affect academic success and professional career. Due to various unfavorable sociodemographic conditions (e.g. parents’ limited German language skills, low family income), a growing number of children runs a considerable risk of delays in language learning. In Germany, at the age of 4 years only 1 or 2 years remain until the school enrolment examination. Therefore, most language screening programs in Germany were introduced for children of this age. However, in many regions participation in such programs is either not obligatory or not available. Therefore, decisions regarding children’s educational or medical needs are often made by kindergarten teachers on the basis of not validated language tests. Especially in cases of children with an immigration background it bears the risk that those with language-related medical issues participate in language courses instead of medical therapies or vice versa. Objective: Data of a Hessian language assessment study were utilized to examine differences in the provision of language therapies to 4‑year-old children with (KMM) and without immigration background (KOM), including motivation of these therapies. Material and methods: Kindergarten children (n = 1384, age 4.0–4.11 years) were examined using the validated language screening test “Kindersprachscreening” (KiSS.2). The KMM (n = 786) and KOM (n = 598) were compared regarding their known language-related disorders and participation in language therapies. The KiSS.2 contains subtests on speech comprehension, vocabulary, articulation, grammar and phonological short-term memory. The KiSS.2 can differentiate between children needing additional educational and medical assistance in learning German. Sociodemographic characteristics of children and their families were assessed by questionnaires for parents and kindergarten teachers. Results: In total, 8% of all children underwent language therapies. According to KiSS.2 the KMM were classified as needing medical assistance in learning German almost twice as often as KOM (21% vs. 11%); however, more language-related disorders (e.g. frequent otitis media) had already been diagnosed in the KOM subgroup prior to their inclusion in the study. Therefore, KOM with the KiSS.2 result “need for medical assistance” participated more frequently in language therapies in comparison to KMM (37% vs. 23%). Participation in language therapies was associated with children’s and their parents’ medical issues; however, most children classified as needing medical assistance in learning German, both KMM and KOM, did not undergo language therapies at the time of the language test or earlier. Also, approximately one half of children who underwent a language therapy did not need any medical assistance in acquiring German according to KiSS.2. Conclusion: In certain subgroups of 4‑year-olds, evidence was found for discrepancies between children’s therapeutic needs and their participation in language therapies. The KOM’s language-related medical issues were diagnosed and treated earlier than those of KMM. Therefore, KMM with medical needs underwent language therapies less often and later than KOM. In many cases, the motivation for language therapies remained unclear. Evidence-based, all-state language screening programs can contribute to the reduction of false positive and false negative results in the identification of children with educational and medical needs.