Predictive validity of preschool screening tools for language and behavioural difficulties: A PRISMA systematic review

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Abstract

Background

Preschool screening for developmental difficulties is increasingly becoming part of routine health service provision and yet the scope and validity of tools used within these screening assessments is variable. The aim of this review is to report on the predictive validity of preschool screening tools for language and behaviour difficulties used in a community setting.

Methods

Studies reporting the predictive validity of language or behaviour screening tools in the preschool years were identified through literature searches of Ovid Medline, Embase, EBSCO CINAHL, PsycInfo and ERIC. We selected peer-reviewed journal articles reporting the use of a screening tool for language or behaviour in a population-based sample of children aged 2–6 years of age, including a validated comparison diagnostic assessment and follow-up assessment for calculation of predictive validity.

Results

A total of eleven eligible studies was identified. Six studies reported language screening tools, two reported behaviour screening tools and three reported combined language & behaviour screening tools. The Language Development Survey (LDS) administered at age 2 years achieved the best predictive validity performance of the language screening tools (sens 67%, spec 94%, NPV 88% and PPV 80%). The Strengths and Difficulties Questionnaire (SDQ) administered at age 4 years achieved the best predictive validity compared to other behaviour screening tools (Sens 31%, spec 93%, NPV 84% and PPV 52%). The SDQ and Sure Start Language Measure (SSLM) administered at 2.5 years achieved the best predictive validity of the combined language & behaviour assessments (sens 87%, spec 64%, NPV 97% and PPV 31). Predictive validity data and diagnostic odds ratios identified language screening tools as more effective and achieving higher sensitivity and positive predictive value than either behaviour or combined screening tools. Screening tools with combined behaviour and language assessments were more specific and achieved higher negative predictive value than individual language or behaviour screening tools. Parent-report screening tools for language achieved higher sensitivity, specificity and negative predictive value than direct child assessment.

Conclusions

Universal screening tools for language and behaviour concerns in preschool aged children used in a community setting can demonstrate excellent predictive validity, particularly when they utilise a parent-report assessment. Incorporating these tools into routine child health surveillance could improve the rate of early identification of language and behavioural difficulties, enabling more informed referrals to specialist services and facilitating access to early intervention.

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Most cited references 44

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Developmental language disorders--a follow-up in later adult life. Cognitive, language and psychosocial outcomes.

J. Clegg, C. Hollis, L Mawhood … (2005)

Little is known on the adult outcome and longitudinal trajectory of childhood developmental language disorders (DLD) and on the prognostic predictors. Seventeen men with a severe receptive DLD in childhood, reassessed in middle childhood and early adult life, were studied again in their mid-thirties with tests of intelligence (IQ), language, literacy, theory of mind and memory together with assessments of psychosocial outcome. They were compared with the non language disordered siblings of the DLD cohort to control for shared family background, adults matched to the DLD cohort on age and performance IQ (IQM group) and a cohort from the National Child Development Study (NCDS) matched to the DLD cohort on childhood IQ and social class. The DLD men had normal intelligence with higher performance IQ than verbal IQ, a severe and persisting language disorder, severe literacy impairments and significant deficits in theory of mind and phonological processing. Within the DLD cohort higher childhood intelligence and language were associated with superior cognitive and language ability at final adult outcome. In their mid-thirties, the DLD cohort had significantly worse social adaptation (with prolonged unemployment and a paucity of close friendships and love relationships) compared with both their siblings and NCDS controls. Self-reports showed a higher rate of schizotypal features but not affective disorder. Four DLD adults had serious mental health problems (two had developed schizophrenia). A receptive developmental language disorder involves significant deficits in theory of mind, verbal short-term memory and phonological processing, together with substantial social adaptation difficulties and increased risk of psychiatric disorder in adult life. The theoretical and clinical implications of the findings are discussed.

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Modeling developmental language difficulties from school entry into adulthood: literacy, mental health, and employment outcomes.

James Law, Robert W Rush, Ingrid Schoon … (2009)

Understanding the long-term outcomes of developmental language difficulties is key to knowing what significance to attach to them. To date, most prognostic studies have tended to be clinical rather than population-based, which necessarily affects the interpretation. This study sought to address this issue using data from a U.K. birth cohort of 17,196 children, following them from school entry to adulthood, examining literacy, mental health, and employment at 34 years of age. The study compared groups with specific language impairment (SLI), nonspecific language impairment (N-SLI), and typically developing language (TL). Secondary data analysis of the imputed 5-year and 34-year data was carried using multivariate logistic regressions. The results show strong associations for demographic and biological risk for both impairment groups. The associations are consistent for the N-SLI group but rather more mixed for the SLI group. The data indicate that both SLI and N-SLI represent significant risk factors for all the outcomes identified. There is a strong case for the identification of these children and the development of appropriate interventions. The results are discussed in terms of the measures used and the implications for practice.

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Screening for speech and language delay in preschool children: systematic evidence review for the US Preventive Services Task Force.

Heidi D Nelson, Peggy Nygren, Miranda Walker … (2006)

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Published in the public domain by the American Academy of Pediatrics. Speech and language development is a useful indicator of a child's overall development and cognitive ability and is related to school success. Identification of children at risk for developmental delay or related problems may lead to intervention services and family assistance at a young age, when the chances for improvement are best. However, optimal methods for screening for speech and language delay have not been identified, and screening is practiced inconsistently in primary care. We sought to evaluate the strengths and limits of evidence about the effectiveness of screening and interventions for speech and language delay in preschool-aged children to determine the balance of benefits and adverse effects of routine screening in primary care for the development of guidelines by the US Preventive Services Task Force. The target population includes all children up to 5 years old without previously known conditions associated with speech and language delay, such as hearing and neurologic impairments. Studies were identified from Medline, PsycINFO, and CINAHL databases (1966 to November 19, 2004), systematic reviews, reference lists, and experts. The evidence review included only English-language, published articles that are available through libraries. Only randomized, controlled trials were considered for examining the effectiveness of interventions. Outcome measures were considered if they were obtained at any time or age after screening and/or intervention as long as the initial assessment occurred while the child was or =2 screening techniques in 1 population, and comparisons of a single screening technique across different populations are lacking. Fourteen good- and fair-quality randomized, controlled trials of interventions reported significantly improved speech and language outcomes compared with control groups. Improvement was demonstrated in several domains including articulation, phonology, expressive language, receptive language, lexical acquisition, and syntax among children in all age groups studied and across multiple therapeutic settings. Improvement in other functional outcomes such as socialization skills, self-esteem, and improved play themes were demonstrated in some, but not all, of the 4 studies that measured them. In general, studies of interventions were small and heterogeneous, may be subject to plateau effects, and reported short-term outcomes based on various instruments and measures. As a result, long-term outcomes are not known, interventions could not be compared directly, and generalizability is questionable. Use of risk factors to guide selective screening is not supported by studies. Several aspects of screening have been inadequately studied to determine optimal methods, including which instrument to use, the age at which to screen, and which interval is most useful. Trials of interventions demonstrate improvement in some outcome measures, but conclusions and generalizability are limited. Data are not available addressing other key issues including the effectiveness of screening in primary care settings, role of enhanced surveillance by primary care physicians before referral for diagnostic evaluation, non-speech and language and long-term benefits of interventions, and adverse effects of screening and interventions.

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Author and article information

Contributors

Fiona Sim:

ORCID: http://orcid.org/0000-0003-4564-4451

Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing

Lucy Thompson: Role: SupervisionRole: Writing – review & editing

Louise Marryat:

ORCID: http://orcid.org/0000-0002-6093-4679

Role: SupervisionRole: Writing – review & editing

Nitish Ramparsad: Role: Formal analysisRole: Writing – review & editing

Philip Wilson:

ORCID: http://orcid.org/0000-0002-4123-8248

Role: Funding acquisitionRole: SupervisionRole: Writing – review & editing

Ronald B. Gillam: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 4 February 2019

Publication date Collection: 2019

Volume: 14

Issue: 2

Electronic Location Identifier: e0211409

Affiliations

[1 ] Centre for Rural Health, Centre for Health Sciences, University of Aberdeen, Inverness, United Kingdom

[2 ] Farr Institute/Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, United Kingdom

[3 ] Salvesen Mindroom Centre Research Centre for Learning Difficulties, University of Edinburgh, Edinburgh, United Kingdom

[4 ] Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom

Utah State University, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist

* E-mail: louise.marryat@ 123456ed.ac.uk

Author information

Fiona Sim http://orcid.org/0000-0003-4564-4451

Louise Marryat http://orcid.org/0000-0002-6093-4679

Philip Wilson http://orcid.org/0000-0002-4123-8248

Article

Publisher ID: PONE-D-18-13807

DOI: 10.1371/journal.pone.0211409

PMC ID: 6361441

PubMed ID: 30716083

SO-VID: a57e165f-b334-46db-8bed-c3f59125c713

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 8 May 2018

Date accepted : 14 January 2019

Page count

Figures: 5, Tables: 4, Pages: 31

Funding

Funded by: funder-id http://dx.doi.org/10.13039/501100000882, University of Aberdeen;

Award Recipient :

ORCID: http://orcid.org/0000-0003-4564-4451

Fiona Sim

FS received funding to complete this review from a University of Aberdeen PhD stipend. At the time of this work being carried out, LM was supported by the Farr Institute @ Scotland, which is supported by a 10-funder consortium: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute of Health Research, the National Institute for Social Care and Health Research (Welsh Assembly Government), the Chief Scientist Office (Scottish Government Health Directorates), (MRC Grant No: MR/K007017/1). At the time, LM sat within SCPHRP, the core grant to SCPHRP was from the MRC, with half that support from the Scottish Chief Scientist Office (MR/K023209/1). LM currently holds a funded research fellowship from the Slavesen Mindroom Centre Research Centre for Learning Difficulties.

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Data Availability All relevant data are within the paper and its Supporting Information files.