Modifying a language screening tool for three-year-old children identified severe language disorders six months earlier.

AIM: We examined if routine Swedish language screening for developmental language disorder (DLD) carried out at three years of age could be performed as effectively six months earlier. METHODS: This study observed 105 monolingual Swedish-speaking children (53% boys) aged 29-31 months at three Swedish child health centres. We compared their ability to combine three words, as per the existing protocol, and two words. They also underwent a comprehension task. Speech and language pathologists clinically assessed the children for DLD and their results were compared with the nurse-led screening. RESULTS: The results for the three-word and two-word criterion were the following: sensitivity (100% versus 91%) specificity (81% versus 91%), positive predictive (38% versus 56%) and negative predictive value (100% versus 99%). The three-word criterion identified 29 children with possible DLD, including 11 cases later confirmed, and the two-word criterion identified 18 possible cases, including 10 confirmed cases. DLD was overrepresented in the 10% of children who did not cooperate with the nurse-led screening. CONCLUSION: Changing the required word combinations from three to two words worked well. The three-word test identified one extra confirmed case, but resulted in 10 more false positives. Lack of cooperation during screening constituted an increased risk for DLD.

Child healthcare nurses believe that bilingual children show slower language development, simplify screening procedures and delay referrals.

AIM: A significant number of children living in Sweden are bilingual, but how language screening is performed in this group is unknown. We investigated child healthcare nurses' perceptions of the language screening of bilingual children aged 30-36 months, together with their clinical practices. METHODS: An online questionnaire was completed by 863 nurses who performed language screening of bilingual children in Sweden at least once a month, corresponding to 89% of the target population. Cox regression identified predictors of the nurses' tendency to simplify the screening of bilingual children. RESULTS: The nurses reported a greater lack of confidence and more difficulties in interpreting screening outcomes for bilingual than monolingual children (p < 0.001). Half of the nurses simplified the screening processes for bilingual children and 74% postponed referrals to speech and language services, basing these adaptations on their perceptions of the children's Swedish language skills (p < 0.001). Most nurses (82%) believed that language development was slower in bilingual children, and this was the strongest predictor of simplified screening practices (RR=2.00, 95% CI 1.44-2.77). CONCLUSION: Child healthcare nurses need easily accessible information and clear guidelines on the language development of bilingual children to ensure that bilingual and monolingual children receive equitable language screening services.

Problems and limitations in studies on screening for language delay.

This study discusses six common methodological limitations in screening for language delay (LD) as illustrated in 11 recent studies. The limitations are (1) whether the studies define a target population, (2) whether the recruitment procedure is unbiased, (3) attrition, (4) verification bias, (5) small sample size and (6) inconsistencies in choice of "gold standard". It is suggested that failures to specify a target population, high attrition (both at screening and in succeeding validation), small sample sizes and verification bias in validations are often caused by a misguided focus on screen positives (SPs). Other limitations are results of conflicting methodological goals. We identified three such conflicts. One consists of a dilemma between unbiased recruitment and attrition, another between the comprehensiveness of the applied gold standard and sample size in validation and the third between the specificity of the gold standard and the risk of not identifying co-morbid conditions.

Narrative skills, cognitive profiles and neuropsychiatric disorders in 7-8-year-old children with late developing language.

BACKGROUND: A community-representative sample of screened and clinically examined children with language delay at 2.5 years of age was followed up at school age when their language development was again examined and the occurrence of neuropsychiatric/neurodevelopmental disorder (attention deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD)) was documented. AIMS: (1) To determine whether these 7-8-year-old children with a history of language delay have deficits in narrative skills compared with the age norms of standardized tests; and (2) to analyse if there is a relationship between narrative outcome, cognitive profile, and neuropsychiatric diagnosis. METHODS & PROCEDURES: Twenty-one children recruited from a community sample and with a history of language delay underwent an in-depth multidisciplinary examination at 7-8 years of age. Their narrative and cognitive skills were examined using the Bus Story Test, the Narrative Memory Subtest from the Developmental Neuropsychological Assessment (NEPSY), and The Wechsler Intelligence Scale for Children III (WISC-III). OUTCOMES & RESULTS: The three measures of the Bus Story Test (information, sentence length, and subordinate clauses) were below age norms for all 21 children, of whom 13 also had a neuropsychiatric diagnosis, i.e. ADHD and/or ASD. Half of the children with language delay had problems on Bus Story Test Information and on the Narrative Memory subtest independently of co-occurrence of neuropsychiatric disorder. The only difference across the children with language delay pure and those who had language delay plus ADHD or language delay plus ASD was on Freedom from Distractibility, where children with ADHD and ASD scored low. In addition, children with ASD had a much lower overall cognitive level (FSIQ) and poorer results on Processing Speed. CONCLUSIONS: Swedish children with late developing language at 2.5 years of age have persisting difficulties with oral narrative skills at age 7-8 years. However, almost none of the children with language delay had problems when responding to story-related questions--irrespective of whether or not they had an additional diagnosis of ADHD or ASD. Thus, asking story-related questions may be a good intervention strategy when working with these children. Because narrative difficulties are a reflection of linguistic, cognitive and/or pragmatic/social difficulties, it is important for clinicians of different specialties to work in close collaboration in order to establish a reliable measure that can be used in clinical assessment. Poor results on the WISC-III Kaufman Freedom from Distractibility factor had a strong relationship with a neuropsychiatric diagnosis (not just ADHD), whereas poor results on Bus Story Test Information or NEPSY Narrative Memory (measured as Free Recall) did not. Narrative problems were present among the language delay children even in the presence of adequate speech and verbal comprehension. Thus, narrative assessment may be a useful tool for identifying children with more persistent subtle language and pragmatic problems who are at risk for academic failure.

Can severely language delayed 3-year-olds be identified at 18 months? Evaluation of a screening version of the MacArthur-Bates Communicative Development Inventories.

PURPOSE: To evaluate the effectiveness of a screening instrument (the Swedish Communication Screening at 18 months of age; SCS18), derived from the Swedish MacArthur-Bates Communicative Development Inventory, in identification of 18-month-old children who will be severely language disabled by 3 years of age, the authors (a) analyzed which SCS18's component yielded the best prediction, (b) compared the productivity figures of the SCS18 with those of the traditional method of identification, and (c) tried different cutoff criteria of the SCS18. METHOD: Half of the child health care (CHC) centers in a Swedish county were randomly selected to use the SCS18 (e.g., a checklist supporting parents in assessing their child's word production, word comprehension, and communicative gestures). Remaining CHC centers used an informal assessment. Expressive and receptive language was subsequently judged with an observation for 3-year-olds that is routine in the county. An unselected population of 2,080 children participated at 18 months of age and again at 3 years of age. RESULT: Number of spoken words yielded the best prediction, and SCS18 was superior to the traditional method. A sensitivity of 50%, however, was not enough, and a stricter criterion resulted in too many false positives to be acceptable as routine. CONCLUSION: Although the SCS18 has strength, the age of 18 months seems to be too early for identification of severe language disability.

Communicative skills in relation to gender, birth order, childcare and socioeconomic status in 18-month-old children.

Variation in communicative skills, defined as gestures, vocabulary comprehension and vocabulary production, was examined as a function of gender, birth order, childcare and socioeconomic status (SES) in 1,019 18-month-old children. The children were recruited at their regular check-up at a number of randomly selected Child Health Care centers in a Swedish county. The participation rate was 88%. The children were assessed by their mothers using a short version of the Swedish Early Communicative Development Inventories. The results demonstrate significant effects of gender and birth order on vocabulary comprehension and vocabulary production. Girls scored higher than boys and first-born children scored higher than later-born children. Type of childcare (family care, care at home and day-care centers) interacted with gender and birth order on vocabulary production and indicated that family care is not as advantageous as care at home or at day-care centers. SES had no effect on children's communicative skills at this age.

Language skills at age 6 years in Swedish children screened for language delay at 2(1/2) years of age.

UNLABELLED: This study concerns language outcome in 6-y-old children who participated in a longitudinal community-based study of 105 children screened for language delay (LD) at 2(1/2) y of age. The purpose was to investigate (1) whether results from the 2(1/2)-y screening were persistent at 6 y of age, and (2) what language domains at age 6 were difficult for (a) children with LD at age 2(1/2) y and (b) children with normal language (LN) at the same age. Significant differences between LD and LN at age 2(1/2) y were persistent at age 6. The vulnerability that was identified at 2(1/2) y of age, such as problems with going from single-word utterances to multi-word utterances, seems to persist as delayed development at different language levels and across language domains. CONCLUSION: This study has shown that children who failed the 2(1/2)-y screening are at high risk of having persistent language problems at age 6 y.

A screening version of the Swedish communicative development inventories designed for use with 18-month-old children.

An instrument designed to assess young children's communicative skills at 18 months is described. The instrument consists of a 103-item parental report checklist based on the Swedish version of the Communicative Development Inventories (SECDI). We present descriptive data from a study at the Swedish Community Health Care Centres, including parental reports of 1021 18-month-old children. The response rate was 88%. Performance at the 10th percentile consisted of 8 communicative gestures, 45 comprehended words, and 7 spoken words. The overall results indicate that the instrument is reliable and has validity approximating that of the SECDI. Furthermore, parents of the children with the poorest vocabulary indicated approval of the assessment procedure in interviews especially directed to this group.