Phoniatrics Late Language Emergence / Language Delay Language Disorders / Autism Spectrum Disorder

- Methods of development

➡️Stakeholder Involvement: Individuals who were involved in the development process. Included the above-mentioned Phoniatrics Chief Manager, Phoniatrics Executive Manager, Assembly Board, Grading Board and Reviewing Board.

Information about target population experiences were not applicable for this topic.

➡️Search Method

Electronic database searched:‎

Pubmed, Google, Medline, Egyptian Knowledge Bank, Medscape, WebMD, Google Scholar

➡️Keywords

Late language emergence, autism spectrum disorder, delayed language development, autism, late talkers, language delay, language disorders.

The adaptation cycle passed over: set-up phase, adaptation phase (Search and screen, assessment: currency, content, quality & /decision/selection) and finalization phase that included revision and external reviewing.

➡️Time period searched: from 2005 to 2020.

➡️Results

Four national phoniatricians reviewed the guidelines available. The American Speech-Language-Hearing Association (ASHA) Practice Portal (3) had the highest scores as regards to the currency, content and quality. Some of the statements were also obtained from the Royal College of Speech & Language Therapists Clinical Guidelines (RCSLT) (4)

It was graded GRADE by eighteen experts and reviewed by seven expert reviewers to improve quality, gather feedback on draft recommendations.

The external review was done through a rating scale as well as open-ended questions.

Most of the statements were taken from The American Speech-Language-Hearing Association (ASHA) Practice Portal. Some were based on ASHA evidence maps and others were taken from the Royal College of Speech and Language Therapists Guidelines.

➡️Setting: Primary, secondary and tertiary care centers & hospitals, and related specialties.

Interpretation of strong and conditional recommendations for an intervention (5)

Audience	Strong recommendation	Conditional recommendation
Patients	Most individuals in this situation would want the recommended course of action; only a small proportion would not. Formal decision aides are not likely to be needed to help individuals make decisions consistent with their values and preferences.	Most individuals in this situation would want the suggested course of action, but many would not
Clinicians	Most individuals should receive the intervention. Adherence to the recommendation could be used as a quality criterion or performance indicator.	Different choices will be appropriate for individual patients, who will require assistance in arriving at a management decision consistent with his or her values and preferences. Decision aides may be useful in helping individuals make decisions consistent with their values and preferences.
Policymakers	The recommendation can be adopted as policy in most situations.	Policy-making will require substantial debate and involvement of various stakeholders.

WHO handbook for guideline development – 2nd ed.

Chapter 10, page 129

The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to Decision frameworks                            (GRADE Working Group 2013)

Grade	Definition
High	We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate	We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low	Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very Low	We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.