Population-based screening of children for specific speech and language impairment in Germany: a systematic review

Validity and feasibility of a predictive language screening tool in 2-year-old children in primary pediatric care

OBJECTIVE

To assess the predictive validity and feasibility of the newly developed language screening tool, SPES-2 (Sprachentwicklungsscreening), for 2-year-old children in pediatric primary care.

METHODS

A prospective cohort study recruited 2,044 non-selected German-speaking children undergoing a regular well-baby check-up at the age of 2 years. Thirty primary care pediatricians spread over urban and rural areas screened the children using a short parent-reported questionnaire and direct assessment of word comprehension. To validate the screening tool, language skills were assessed using a standardized language screening tool in the complete sample 1 year later. Data of a random sample of 621 children were analyzed. Feasibility of the screening tool was evaluated using questionnaires completed by the participating pediatricians.

RESULTS

The new screening tool, SPES-2, demonstrated good diagnostic accuracy with AUC (Area under the Roc Curve) of 0.885, a sensitivity of 0.74, and specificity of 0.86, using a parent-reported questionnaire (expressive vocabulary, two-word combinations, parental concerns) as stage 1, followed by a stage 2 direct assessment of word comprehension by the pediatrician. The second stage was restricted to children who failed the parental screening. The screening identified children with high, moderate, and low risk of significant language deficits (SLD) at the age of 3 years, permitting tailored follow-up assessment and parental counseling. Practicality and acceptability of the screening were mostly rated as high. Pediatricians regarded the availability of follow-up diagnostic services and parent guidance as most important for a general implementation of the new instrument.

CONCLUSION

The language screening tool, SPES-2, was valid for the identification of significant language deficits 1 year later, and considered as feasible within primary pediatric care.

Language Screening in 3-Year-Olds: Development and Validation of a Feasible and Effective Instrument for Pediatric Primary Care

Objective: The study was aimed at evaluating the validity and feasibility of SPES-3 (Sprachentwicklungsscreening), a language screening in 3-year-old children within the constraints of regular preventive medical check-ups. Methods: A four-component screening measure including parental reports on the child's expressive vocabulary and grammar based on the MacArthur Communicative Development Inventory and pediatrician-administered standardized assessments of noun plurals and sentence comprehension was used in a sample of 2,044 consecutively seen children in 30 pediatric offices. One-hundred forty-four children (70 who failed and 74 who passed the screener) comprised the validation sample and also underwent follow-up gold standard assessment. To avoid verification and spectrum bias multiple imputation of missing diagnosis for children who did not undergo gold standard assessment was used. Independent diagnoses by two experts blinded to the screening results were considered gold standard for diagnosing language disorder. Screening accuracy of each of the four subscales was analyzed using receiver operator characteristic (ROC) curves. Feasibility was assessed by use of a questionnaire completed by the pediatricians. Results: The two parental screening subscales demonstrated excellent accuracy with area under the curve (AUC) scores of 0.910 and 0.908 whereas AUC scores were significantly lower for the subscales directly administered by the pediatricians (0.816 and 0.705). A composite score based on both parental screening scales (AUC = 0.946) outperformed single subscales. A cut off of 41.69 on a T-scale resulted in about 20% positive screens and showed good sensitivity (0.878) and specificity (0.876). Practicability, acceptability and sustainability of the screening measure were mostly rated as high. Conclusion: The parent-reported subscales of the SPES-3 language screener are a promising screening tool for use in primary pediatric care settings.

Screening for language and speech delay in children under five years

We looked at existing recommendations and supporting evidence on the effectiveness of universal screening for language and speech delay in children under 5 years of age for short- and long-term outcomes.

We conducted a literature search up to the 20th of November 2019 by using key terms and manual search in selected sources. We summarized the recommendations and the strength of the recommendation when and as reported by the authors. We summarized the main findings of systematic reviews with the certainty of the evidence as reported on the accuracy of the screening tests for detecting language and speech delay, the efficacy of existing interventions for children with language and speech delay, and the potential harms associated with screening and the associated interventions.

Several screening tools are used to assess language and speech delay with a wide variation in their accuracy. Targeted interventions improve some measures of speech and language delay and disorders. However, there is no evidence on the effectiveness of such interventions in children detected by screening with no specific concerns about their speech or language before screening. There is no evidence assessing whether universal screening for language and speech delay in a primary care setting improves short and long-term outcomes (including speech and language outcomes and other outcomes). Finally, there is no evidence on the harms of screening for language and speech delay in primary care settings, and there is limited evidence assessing the potential harms of interventions.

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.

The German Music@Home: Validation of a questionnaire measuring at home musical exposure and interaction of young children

The present study introduces the German version of the original version of the Music@Home questionnaire developed in the UK, which systematically evaluates musical engagement in the home environment of young children. Two versions are available, an Infant version for children aged three to 23 months and a Preschool version for children aged two to five and a half years. For the present study, the original Music@Home questionnaire was translated from English into German and 656 caregivers completed the questionnaire online. A confirmatory factor analysis showed moderate to high fit indices for both versions, confirming the factor structure of the original questionnaire. Also, the reliability coefficients for the subscales (Parental beliefs, Child engagement with music, Parent initiation of singing, Parent initiation of music-making for the Infant version and Parental beliefs, Child engagement with music, Parent initiation of music behavior and Breadth of musical exposure for the Preschool version) ranged from moderate to high fits. Furthermore, the test-retest analysis (N = 392) revealed high correlations for the general factor and all subscales confirming their internal reliability. Additionally, we included language questionnaires for children of two and three years of age. Results showed that higher scores on the Music@Home questionnaire were moderately associated with better language skills in two-year-olds (N = 118). In sum, the study presents the validated German Music@Home questionnaire, which shows good psychometric properties. The two versions of the questionnaire are available for use in order to assess home musical engagement of young children, which could be of interest in many areas of developmental research.

Sensitivity and specificity of a low-cost screening protocol for identifying children at risk for language disorders

OBJECTIVES

To compare the diagnostic accuracy of a low-cost screening test for identifying children at risk for language disorders with that of a specific language assessment.

METHODS

The study was conducted during a polio vaccination campaign in basic health units in western São Paulo, Brazil. The parents/guardians of 1000 children aged between 0 and 5 years were asked to answer questions of a specific screening test. The instrument consisted of a uniform set of questions about the main milestones in language development (from 0 to 5 years of age) with scaled scores to assess responses. There were no exclusion criteria. After the screening test, the children were referred to a specific language assessment by ABFW, following a determined flow of referrals. The results obtained in the screening were compared to those obtained in the specific language assessment; then, the sensitivity, specificity, accuracy, and positive and negative predictive values were determined for the screening test. Children who failed the screening test also underwent an audiological evaluation. The statistical significance was set at 5%.

RESULTS

The majority of the participants were aged between 4 and 5 years (21.82%) and were male (51.6%). The sensitivity and specificity values were 82.5% and 98.93%, respectively. The area under the curve was 0.907 (0.887-0.925), and the screening test showed 96% accuracy.

CONCLUSIONS

The screening test showed high diagnostic efficiency in determining the risk of language disorders in children aged between 0 and 5 years.

Management of developmental speech and language disorders: Part 1

The identification of developmental problems in a child's acquisition of speech, language and/or communication is a core activity in child surveillance. These are common difficulties with up to 15% of toddlers being 'late talkers' and 7% of children entering school with persisting impairments of their language development. These delays can confer disadvantages in the long term, adversely affecting language, cognition, academic attainment, behaviour and mental health. All children presenting with significant speech and language delay should be investigated with a comprehensive hearing assessment and be considered for speech and language therapy assessment. Socioeconomic adversity correlates with delayed language development. Clinical assessment should confirm that the presentation is definitely not acquired (see part 2) and will also guide whether the difficulty is primary, in which there are often familial patterns, or secondary, from a very wide range of aetiologies. Symptoms may be salient, such as the regression of communication in <3-year-olds which 'flags up' autism spectrum disorder. Further investigation will be informed from this clinical assessment, for example, genetic investigation for sex aneuploidies in enduring primary difficulties. Management of the speech and language difficulty itself is the realm of the speech and language therapist, who has an ever-increasing evidence-based choice of interventions. This should take place within a multidisciplinary team, particularly for children with more severe conditions who may benefit from individualised parental and educational supports.