Screening school-age children for developmental language disorder in primary care

A Review of Screeners to Identify Risk of Developmental Language Disorder

PURPOSE

This review aims to comprehensively summarize, compare, and evaluate screeners used to identify risk for developmental language disorder (DLD), a common learning disability that is underidentified. Screening for DLD is a cost-effective way to identify children in need of further assessment and, in turn, provides much needed supports.

METHOD

We identified 15 commercially available English language DLD screeners in North America. We then characterized each screener on 27 aspects in three domains, including (a) accessibility information (acronym, subtest, website, cost, materials included, publish year, examiner qualification, age range, administration time, and administration format), (b) usability features (dialect compatibility, progress monitoring function, actionable follow-up instruction, group assessment capability, and online administration availability), and (c) technical standards (the availability of a technical manual, conceptual definition, the sample size used in classification accuracy calculation, sample distribution, year of sample collection, outcome measure, sample base rate, cutoff score, sensitivity, specificity, positive predictive value, and negative predictive value).

RESULTS

We obtained sufficient accessibility information from 14 out of 15 (93%) screeners. In contrast, none of the screeners (0%) included comprehensive usability features. Ten screeners (67%) included a range of classification accuracy (70%-100% sensitivity and 68%-90% specificity). We provided areas of strength and weakness for each screener as a quick reference for users and generated screener recommendations for five practical scenarios.

CONCLUSIONS

Our findings presented some DLD screeners that meet most standards and highlight numerous areas for improvement, including improving classification accuracy and clarifying follow-up instructions for children who are identified with DLD risk. Screening for DLD is critical to provide timely early identification, intervention, and classroom support, which in turn facilitates student outcomes.

"Early detection of Spanish-speaking children with developmental language disorders: Concurrent validity of a short questionnaire and a screening test"

BACKGROUND

. Under-identification of Developmental Language Disorder (DLD) is a significant problem in monolingual Latin American Spanish-speaking children. We evaluated the identification utility of the sequential use of two screening tools, the "Parental Questionnaire (PQ)" and the "Screening for Language Problems (TPL)", to identify children who require confirmatory diagnosis of DLD.

METHODS

Parents of children (4 to 6 years) were contacted in schools and public health centers in Mexico. Monolingual Spanish-speaking children with no auditory and cognitive disorders were eligible. The reference diagnosis of DLD was established using BESA (Bilingual English-Spanish Assessment) or SCELF-4 (Spanish Clinical Evaluation of Language Fundamentals), combined with data from the narrative samples that yielded the percentage of ungrammaticality and the clinical judgment of two Speech-Language Pathologists (SLPs). Responses to the PQ were obtained as a parental report, and the TPL was applied by a trained SLPs.

RESULTS

. Both PQ and TPL presented a significant difference between the groups of children with DLD and typical language development (TLD). By combining the two instruments, a notable improvement in diagnostic utility was shown.

CONCLUSION

. The combination of these two procedures provides an efficient method for screening children having the risk of DLD and contributes to resolving the problem of under-identification.

Positive Predictive Values Associated With Adapting the Redmond Sentence Recall Measure Into a Kindergarten Screener for Developmental Language Disorder

PURPOSE

Researchers estimate the prevalence of developmental language disorder (DLD) in 5-year-olds to be between 7% and 12%. Current identification systems in public schools typically favor referral identification formats over targeted or universal screenings. Public schools face unique challenges when assessing the value of screening measures for DLD that include real-world considerations such as administration, time, and resource constraints. This study used the positive predictive value (PPV) of the Redmond Sentence Recall (RSR) to assess its fidelity when administered by special education paraprofessionals. Our obtained PPV was compared across three areas: (a) previous studies that have utilized the RSR, (b) rates extrapolated from the participating school district's preexisting referral system from a previous study, and (c) expectations based on DLD prevalence.

METHOD

Language screenings were conducted in two elementary schools using the RSR administered by school-based paraprofessionals trained on the screener protocol. One hundred sixty-four kindergarten students (age range: 5-6 years) were screened. Confirmatory testing was completed on all students who failed the screener.

RESULTS

Of the 164 students screened, 19 failed the RSR (11.5%), and 14 met criteria (8.5%) for DLD (PPV = .74). Our PPV was similar to previously published studies that utilized the RSR using research assistants and was higher than the PPV associated with teacher-based referrals from the participating school district.

CONCLUSION

The RSR represents a potentially useful screener for identifying children at risk for previously unidentified language disorders in public schools.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22044479.

Comparison of the Diagnostic Evaluation of Language Variation-Screening Test Risk Subtest to Two Other Screeners for Low-Income Prekindergartners Who Speak African American English and Live in the Urban South

Purpose We compared the Risk subtest of the Diagnostic Evaluation of Language Variation-Screening Test (DELV-Screening Test Risk) with two other screeners when administered to low-income prekindergartners (pre-K) who spoke African American English (AAE) in the urban South. Method Participants were 73 children (six with a communication disorder and 67 without) enrolled in Head Start or a publicly funded pre-K in an urban Southern city. All children completed the DELV-Screening Test Risk, the Fluharty Preschool Speech and Language Screening Test-Second Edition (FLUHARTY-2), and the Washington and Craig Language Screener (WCLS). Test order was counterbalanced across participants. Results DELV-Screening Test Risk error scores were higher than those reported for its standardization sample, and scores on the other screeners were lower than their respective standardization/testing samples. The 52% fail rate of the DELV-Screening Test Risk did not differ significantly from the 48% rate of the WCLS. Fail rates of the FLUHARTY-2 ranged from 34% to 75%, depending on the quotient considered and whether scoring was modified for dialect. Although items and subtests assumed to measure similar constructs were correlated to each other, the three screeners led to inconsistent pass/fail outcomes for 44% of the children. Conclusions Like other screeners, the DELV-Screening Test Risk subtest may lead to high fail rates for low-income pre-K children who speak AAE in the urban South. Inconsistent outcomes across screeners underscore the critical need for more study and development of screeners within the field.

Tense Marking in the Kindergarten Population: Testing the Bimodal Distribution Hypothesis

Purpose The purpose of this study was to explore whether evidence for a bimodal distribution of tense marking, previously documented in clinically referred samples, exists in a population-based sample of kindergarten children from a rural county in Tennessee. Method A measure of tense marking, the Test of Early Grammatical Impairment (TEGI) Screening Test, was individually administered to consented kindergarten students (N = 153) across three elementary schools in a single school district. The consented children constituted 73% of kindergartners in the district. Cluster analysis was used to evaluate the number and composition of latent classes that best fit the distribution of the TEGI Screening Test scores. Results Analysis of the scores revealed a distribution that deviated significantly from normality. Cluster analyses (Ward's, k-means, single linkage) revealed a two-cluster solution as the best fitting model. The very large effect-size difference in mean TEGI Screening Test score between the two clusters (d = 4.77) provides validation of an identifiable boundary delineating typical from atypical tense marking in this sample of kindergartners. The difference in tense marking across the two clusters was not attributable to child chronological age. The percentage of the sample comprising the low-performing cluster aligns with specific language impairment and developmental language disorder prevalence estimates. Conclusion Additional demonstrations of a bimodal distribution of tense marking in future studies with carefully defined samples could strengthen the clinical marker evidence and utility of this linguistic feature.

The Computerized Adaptable Test Battery (BMT-i) for Rapid Assessment of Children's Academic Skills and Cognitive Functions: A Validation Study

Background: Learning disabilities in children are a major public health concern worldwide, having a prevalence of 8%. They are associated with lost social, educational, and ultimately, professional opportunities for individuals. These disabilities are also very costly to governments and raise the issue of the appropriate means of screening. Unfortunately, validated tools for preliminary appraisal of learning and cognitive function in struggling children are presently restricted to specific age ranges and cognitive domains. This study sought to validate a first-line battery for assessment of academic skills and cognitive functions. Materials and Methods: The computerized Adaptable Test Battery, or BMT-i, includes a panel of tests for the first-line assessment of children's academic skills and cognitive functions. The tests reflect expected abilities for the age group in question, exploring academic skills (written language and mathematical cognition) and cognitive domains (verbal, non-verbal, and attentional/executive functions). The authors relied on the results of these tests for a sample of 1,074 Francophone children representative of the mainland French school-age population (522 boys and 552 girls, ages 4-13, from 39 classes at 7 public and 5 private schools). Thirteen speech-language pathologists and neuropsychologists individually administered the tests. Results: The psychometric characteristics of the empirical data obtained showed acceptable to good test homogeneity, internal consistency (Cronbach's alpha: > 0.70), test-retest reliability (intraclass correlation coefficients: ~0.80), and consistency with reference test batteries (r: 0.44-0.96). Conclusion: The BMT-i was validated in a large sample of children in mainstream French schools, paving the way for its use in first-line screening of learning disabilities among children with complaints, whether their learning difficulties have been flagged by their parents or by their teachers.

Diagnosis of Developmental Language Disorder in Research Studies

Purpose The aim of this study was to investigate the extent to which researchers in the field of developmental language disorder are utilizing validated methods to diagnose their research participants. Method We examined 90 research articles published from 2015 to 2019 that included English-speaking participants from the United States who were identified as having a developmental language disorder or specific language impairment. From these articles, we identified the tests and measures used to identify participants and classify them as healthy or impaired. We then consulted the test manuals and the literature to find information on sensitivity and specificity of the test and the evidence-based cut score that maximized identification accuracy. Results Of the 90 articles examined, 38 (42%) were found to reflect validated diagnostic methods, and 51 (58%) did not. Conclusion Our results illustrate that validated methods are used less than half of the time even by those who should have a high level of expertise and despite calls for increasing scientific rigor in research practices.