Who to refer for speech therapy at 4 years of age versus who to "Watch and Wait"?

Objective: To examine predictors of speech disorder resolution versus persistence at age 7 years in children with speech errors at age 4 years. Study design: Participants were drawn from a longitudinal, community cohort. Assessment at age 4 years (N = 1494) identified children with speech errors. Reassessment at age 7 years allowed categorization into resolved or persistent categories. Logistic regression examined predictors of speech outcome, including family history, sex, socioeconomic status, nonverbal intelligence, and speech error type (delay vs disorder). Results: At age 7 years, persistent errors were seen in over 40% of children who had errors at age 4 years. Speech symptomatology was the only significant predictor of outcome (P = .02). Children with disordered errors at age 4 years were twice as likely to have poor speech outcomes at age 7 years compared with those with delayed errors. Conclusions: Children with speech delay at age 4 years seem more likely to resolve, and this might justify a “watch and wait” approach. In contrast, those with speech disorder at age 4 years appear to be at greater risk for persistent difficulties, and could be prioritized for therapy to offset long-term impacts.