Validity of the language development survey in infants born preterm

Comparison of parent or caregiver-completed development screening tools with Bayley Scales of Infant Development: a systematic review and meta-analysis

BACKGROUND

Parent/caregiver-completed developmental testing (PCDT) is integral to developmental care in children; however, there is limited information on its accuracy. In this systematic review, we compared the diagnostic accuracy of PCDT with concurrently administered Bayley Scales of Infant Development for detection of developmental delay (DD) in children below 4 years of age.

METHODS

We searched databases PubMed, Embase, CINAHL, PsycINFO and Google Scholar until November 2023. Bivariate and multiple thresholds summary receiver operating characteristics were used to obtain the summary sensitivity and specificity with 95% CIs. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used for risk of bias assessment.

RESULTS

A total of 38 studies (31 in the meta-analysis) were included. Ages and Stages Questionnaire (ASQ) and Parent Report of Children's Abilities-Revised (PARCA-R) were the most commonly evaluated PCDTs. ASQ score >2 SD below the mean had an overall sensitivity of 0.72 (0.6, 0.82) and 0.63 (0.50, 0.75) at a median specificity of 0.89 (0.82, 0.94) and 0.81 (0.76, 0.86) for diagnosing moderate to severe DD and severe DD, respectively. PARCA- R had an overall sensitivity of 0.69 (0.51, 0.83) at median specificity of 0.75 (0.64, 0.83) for predicting severe DD. Participant selection bias and partial verification bias were found in over 50% of the studies. The certainty of evidence was low for the studied outcomes.

CONCLUSIONS

The most commonly studied parental tools, ASQ and PARCA-R, have moderate to low sensitivity and moderate specificity for detecting DD in young children. High risk of bias and heterogeneity in the available data can potentially impact the interpretation of our results.

PROSPERO REGISTRATION NUMBER

CRD42021268629.

Insufficient evidence for the validity of the Language Development Survey and the MacArthur-Bates Communicative Development Inventories as screening tools: A critical review

BACKGROUND

The Language Development Survey (LDS) and the MacArthur-Bates Communicative Development Inventories (MB-CDI) are two parental report forms that have been productive in providing data on early child language during the past 30 years. The instruments have been used both in studies relating to typical developing children and in screening for language difficulties.

AIM

To review the evidence for the LDS and the MB-CDI utility as screening instruments.

METHODS

A literature search in PubMed and PsychInfo identified 16 articles based on LDS or MB-CDI that reported statistics pertinent to early screening for language difficulties.

MAIN CONTRIBUTION

It was found that most reviewed studies were explorative in nature and tried out different versions of the screening test, including different cut-off values, multiple reference tests, small sample sizes and rarely reported confidence intervals. Spectrum, verification and review biases were common. Moreover, no study could convincingly show that the actual diagnostic accuracy was sufficient for clinical use.

CONCLUSIONS

There is insufficient evidence that the LDS or any version of the MB-CDI is a valid tool for screening for language difficulties. Of course, this is not to say that sufficient evidence will not be achieved in future studies, or that the instruments do not work well for purposes other than screening.

WHAT THIS PAPER ADDS

What is already known on this subject The LDS and the MB-CDI are two often-used instruments assessing various aspects of early child language by parental reports. Both instruments have also been used in screening for early language difficulties. What this study adds This study reveals that most published studies in which the classification accuracy of LDS and the MB-CDI has been investigated contain serious methodological shortcomings limiting conclusions about their validity. Currently, there is no good evidence about the usefulness of the LDS and the MB-CDI as general screening tools for language difficulties. What are the potential or actual clinical implications of this work? The LDS and MB-CDI should not be used as screening tools for language difficulties until better evidence of their effectiveness has been demonstrated.

Language Impairment in Children of Mothers with Gestational Diabetes, Preeclampsia, and Preterm Delivery: Current Hypothesis and Potential Underlying Mechanisms : Language Impartment and Pregnancy Complications

Many conditions may impair or delay language development, including socioeconomic status, parent's education, or intrauterine environment. Accordingly, increasing evidence has described that pregnancy complications, including gestational diabetes mellitus (GDM), preeclampsia, and preterm delivery, are associated with the offspring's impaired neurodevelopment. Since language is one of the high brain functions, alterations in this function are another sign of neurodevelopment impairment. How these maternal conditions may generate language impairment has yet to be entirely understood. However, since language development requires adequate structural formation and function/connectivity of the brain, these processes must be affected by alterations in maternal conditions. However, the underlying mechanisms of these structural alterations are largely unknown. This manuscript critically analyzes the literature focused on the risk of developing language impairment in children of mothers with GDM, preeclampsia, and preterm delivery. Furthermore, we highlight potential underlying molecular mechanisms associated with these alterations, such as neuroinflammatory and metabolic and cerebrovascular alterations.

Validity of an early parent-report questionnaire for language disorder in very preterm children from 2 to 10 years of age

BACKGROUND

Language problems at an early age in very preterm (VP) children can have a detrimental effect on other developmental domains and often persist throughout childhood. The aim of this study was to examine the concurrent and predictive validity of an early language parent-report questionnaire for language disorder in VP children from 2 to 10 years of age.

MATERIALS AND METHODS

In 80 VP children (<32 weeks' gestation) without major disabilities, a parent-questionnaire and formal language assessment, both normed for the general population, were administered at 2 years corrected age (CA). Of these infants, 62 were seen for follow-up formal language assessment at age 4 and 61 were seen at age 10. Sensitivity and specificity values were calculated.

RESULTS

The Lexi-list showed acceptable concurrent validity for word production scores obtained at age 2 CA. The predictive validity was good for sentence production and acceptable for word production scores obtained at age 4, and low for language production scores obtained at age 10. A Lexi-list cut-off score of <85 (i.e., <-1 SD) was found optimal.

INTERPRETATION

A norm-referenced parent-report questionnaire is a useful, first screening tool in a neonatal follow-up. It not only detected early language disorder at age 2 CA but also proved to be a good predictor for language disorder at age 4. However, it did not predict language disorder at age 10. Formal language assessment at age 4 would therefore be recommended for children with an abnormal parent-report language score at age 2 CA.

Validation of the Early Language Scale

The aim of this study was to assess the criterion validity of a new screening instrument, the Early Language Scale (ELS), for the identification of young children at risk for developmental language disorder (DLD), and to determine optimal age-adjusted cut-off scores. We recruited a community-based sample of 265 children aged 1 to 6 years of age. Parents of these children responded on the ELS, a 26-item "yes-no" questionnaire. The children were assessed with extended language tests (language comprehension, word production, sentence production, communication). A composite score out of these tests (two tests below - 1 SD or one below - 1.5 SD) was used as reference standard. We assessed the validity of the ELS, measured by sensitivity, specificity, predictive values, and AUC. The optimal sensitivity/specificity age-dependent cut-off ELS score was at 15th percentile. Sensitivity and specificity were 0.62 and 0.93, respectively. Positive predictive value was moderate (0.53), negative predictive value was high (0.95), the positive likelihood ratio was 9.16, and negative likelihood ratio was 0.41. The area under the ROC curve was 0.88. The items covered the increasing language development for the ages from 1 to 6.Conclusion: The ELS is a valid instrument to identify children with DLD covering an age range of 1 to 6 years in community-based settings. What is Known: • Early identification and treatment of developmental language disorders can reduce negative effects on children's emotional functioning, academic success, and social relationships. • Short, validated language screening instruments that cover the full age range of early childhood language development lack. What is New: • The 26-item Early Language Scale (ELS) is a valid instrument to identify children at risk for developmental language disorder in well-child care and early educational settings among Dutch children aged 1-6 years.

Does gender affect Bayley-III scores and test-taking behavior?

The developmental test Bayley-III is widely used in clinical and research settings, but there are no published gender-specific norms. The purpose of the present study was to investigate gender differences in Bayley-III scores in a sample of 55 typically developing children assessed repeatedly at ages 4, 7, 10, 13, 24 and 36 months, and to investigate gender differences in the test-taking behavior of the children as measured with the BRS at 36 months. The results of the study demonstrated gender differences at 24 and 36 months for the Cognitive Scale, at 10, 13, 24 and 36 months for the Language Scale and at 36 months for the Motor Scale. On a subtest level, gender differences were found for the Receptive Communication subtest at 13, 24 and 36 months and for the Fine Motor subtest at 7 and 36 months. In all cases where significant gender differences were found, girls achieved higher mean scores than boys. No gender differences were found in the children's test-taking behavior at 36 months on any of the BRS scales, but independently of gender, higher Bayley-III Cognitive and Motor Scale scores were associated with more compliant test-taking behavior.

Association of Language Skills with Other Developmental Domains in Extremely, Very, and Moderately Preterm Children: EPIPAGE 2 Cohort Study

OBJECTIVE

To analyze language skills in children born at 24-34 weeks of gestation at 2 years of corrected age and the association between language and other developmental domains.

STUDY DESIGN

We included 2424 children (64% of the eligible population) from the French population-based EPIPAGE 2 cohort study. At 2 years' corrected age, children were screened with the French short version of the MacArthur-Bates Communication Developmental Inventories and the Ages and Stages Questionnaire completed by parents.

RESULTS

Small lexicon size, <10th percentile of the calibration sample (ie, 28 words in a list of 100) was observed in 135 of 300 children (45%) born at 23-26 weeks, 484 of 1513 (32%) born at 27-31 weeks, and 165 of 611 (27%) born at 32-34 weeks of gestation. Small lexicon size was associated with 2 other language measures: word combination use and the Ages and Stages Questionnaire communication domain score. It was also significantly associated with the Ages and Stages Questionnaire score below the threshold in the other developmental domains (gross motor function, fine motor function, problem solving skills, and personal social skills) for all gestational age groups, after adjustment for potential confounders. Overall, 46% of children with a small lexicon size had ≥1 of these domains below the threshold, as compared with only 22% of children without a small lexicon size.

CONCLUSIONS

These results highlight the usefulness of the MacArthur-Bates Communication Developmental Inventories in preterm children, especially those who do not participate in specialized follow-up. A small lexicon size points to developmental difficulties in language and increased risk for other developmental and neurobehavioral functions.