Developmental Language Disorder: Early Predictors, Age for the Diagnosis, and Diagnostic Tools. A Scoping Review.

BACKGROUND: Developmental Language Disorder (DLD) is frequent in childhood and may have long-term sequelae. By employing an evidence-based approach, this scoping review aims at identifying (a) early predictors of DLD; (b) the optimal age range for the use of screening and diagnostic tools; (c) effective diagnostic tools in preschool children. METHODS: We considered systematic reviews, meta-analyses, and primary observational studies with control groups on predictive, sensitivity and specificity values of screening and diagnostic tools and psycholinguistic measures for the assessment of DLD in preschool children. We identified 37 studies, consisting of 10 systematic reviews and 27 primary studies. RESULTS: Delay in gesture production, receptive and/or expressive vocabulary, syntactic comprehension, or word combination up to 30 months emerged as early predictors of DLD, a family history of DLD appeared to be a major risk factor, and low socioeconomic status and environmental input were reported as risk factors with lower predictive power. Optimal time for screening is suggested between age 2 and 3, for diagnosis around age 4. Because of the high variability of sensitivity and specificity values, joint use of standardized and psycholinguistic measures is suggested to increase diagnostic accuracy. CONCLUSIONS: Monitoring risk situations and employing caregivers' reports, clinical assessment and multiple linguistic measures are fundamental for an early identification of DLD and timely interventions.

Can You Understand Your Child? Reliability and Validity of a Parent Questionnaire: The Intelligibility in Context Scale: Italian.

INTRODUCTION: The Intelligibility in Context Scale (ICS) is a parent-report scale by which parents can rate their child's functional speech intelligibility according to seven different communicative partners. Translations, linguistic adaptations, and psychometric and norming data for ICS have been achieved in different languages. OBJECTIVE: To evaluate the psychometric properties of the Italian version of the ICS (ICS-I) in terms of internal consistency, test-retest reliability, criterion validity (correlation with speech measures), and construct validity, and to investigate potential differences between mothers' and fathers' subjective ratings in ICS-I. METHODS: Italian-speaking children aged 3.0-5.11 years (n = 364), without major developmental impairment, were recruited in kindergartens. All children were independently rated by their mothers (ICS-Im) and fathers (ICS-If). A subsample of parents (n = 127) rated ICS-I twice after 3 weeks (test-retest reliability). Children were administered a naming and a word repetition task, by which speech measures were calculated: percentage of phonemes correct (PPC), percentage of consonants correct (PCC), and percentage of vowels correct (PVC). RESULTS: High internal consistency (α = 0.92) and good test-retest reliability (rs = 0.78) were found. A high (r > 0.67) correlation between the ICS-I total scores and single-item scores was found (construct validity), except for parental perception in ICS-Im and ICS-If. Moderate correlations (rs > 0.38) between the ICS-I and the PPC and PCC tasks suggested adequate criterion validity. Mothers' and fathers' ratings showed an appropriate agreement in the items acquaintances and teachers, but overall parent ratings were significantly different, with higher mean scores in ICS-Im (median = 4.57) than in ICS-If (median = 4.46), Z = -2.852, p < 0.01. CONCLUSIONS: As for other previous international studies, ICS-I presents good psychometric properties, but some differences in mothers' and fathers' scores suggest a potential parental influence in rating a child's intelligibility. Findings support cross-linguistic research, and further investigation could promote the application of ICS-I as an outcome measure in children with speech sound disorders.

Normative data and construct validity of a cross-linguistic functional speech outcome, the Intelligibility in Context Scale: Italian (ICS-I).

OBJECTIVES: The Intelligibility in Context Scale (ICS) is a parent-report scale, world-wide translated and widely validated, by which parents can rate their child's functional speech intelligibility according to seven different communicative partners. The study aimed to report and discuss the normative data of the Italian version of ICS (ICS-I) in Italian-speaking preschool children, and to investigate whether the age influences the ICS-I scores (construct validity). Socio-economic status (SES) of the family were investigated and compared to parents' ratings on child's speech intelligibility. METHODS: A cross-sectional observational study was conducted. Italian-speaking children aged 3-6 years (n = 355; mean age = 56.06 months; SD = 9.8 months), without major developmental impairment, were recruited in kindergartens throughout a convenience sampling. Parents completed a self-report form on their family SES (educational level and employment status of fathers and mothers). Children were independently rated by their mothers (ICS-Im) and fathers (ICS-If). RESULTS: Results show that ICS normative data for the Italian preschool population (ICS-Im = 4.52; SD = 0.46; ICS-If = 4.47; SD = 0.49) are consistent with previous evidence found in other languages, suggesting that ICS could be a potential cross-linguistic tool to assess functional intelligibility. A statistically significant (p < 0.001) improvement in ICS-I score was found with increase of age (construct validity). No evidence of association (p > 0.05) with ICS-I was found for SES family. CONCLUSION: The study provides normative data of the functional intelligibility assessed by a subjective parental scale. As for other previous international studies, ICS-I normative data suggest that a preschool child without major impairment shows a high degree of speech intelligibility, even if minimal differences of intelligibility are reported for different communicative partners. The current findings support clinicians and researchers in implementing ICS-I in typical and also in atypical population with different SES background and promoting its application as a potential outcome measure in children with Speech Sound Disorders.

An articulatory-based disyllabic and trisyllabic Non-Word Repetition test: reliability and validity in Italian 3- to 7-year-old children.

The contribution of the phonological working memory to the Non-Word Repetition (NWR) task is well established, but growing evidence also suggests a valuable underlying role of oro-motor abilities. Assuming that NWR involves output implementation mediated by the speech motor system, the study aimed to develop a novel Italian NWR task of disyllabic and trisyllabic items. The task, for the first time, was composed using each Italian speech sound. The study also aimed to investigate the reliability proprieties of the task (test-retest, intra-rater, inter-rater), internal consistency, concurrent and construct validity, and to collect normative data for pre-school children. An observational cross-sectional study was conducted and 375 Italian-speaking typically developing children aged 3.0-6.11 years were assessed with the novel test. Two raters assessed inter-rater reliability in a random sub-sample; test-retest reliability was examined through a repeated administration of the task two weeks apart; intra-rater reliability was investigated by two evaluations of the same audio-recordings. To evaluate concurrent validity children were also assessed through a pre-existing NWR test, and to estimate construct validity, scores from children of different age groups were compared. Results indicated excellent test-retest, intra-rater, inter-rater reliability agreement, high internal consistency and good concurrent validity. Normative data suggested that successful performance on NWR increases with age and declines with an increase in stimuli length. Despite the low working memory load in the disyllabic and trisyllabic items, a saturation of the task was not observed for any age group. The novel NWR test is a reliable and valid instrument, and it can be applied in clinical practice to assess how the child retains, plans and articulates a phonological and motor programme of unknown verbal material.