Systematic Review and Meta-Analysis of Screening Tools for Language Disorder

Abstract

Language disorder is one of the most prevalent developmental disorders and is associated with long-term sequelae. However, routine screening is still controversial and is not universally part of early childhood health surveillance. Evidence concerning the detection accuracy, benefits, and harms of screening for language disorders remains inadequate, as shown in a previous review. In October 2020, a systematic review was conducted to investigate the accuracy of available screening tools and the potential sources of variability. A literature search was conducted using CINAHL Plus, ComDisCome, PsycInfo, PsycArticles, ERIC, PubMed, Web of Science, and Scopus. Studies describing, developing, or validating screening tools for language disorder under the age of 6 were included. QUADAS-2 was used to evaluate risk of bias in individual studies. Meta-analyses were performed on the reported accuracy of the screening tools examined. The performance of the screening tools was explored by plotting hierarchical summary receiver operating characteristic (HSROC) curves. The effects of the proxy used in defining language disorders, the test administrators, the screening-diagnosis interval and age of screening on screening accuracy were investigated by meta-regression. Of the 2,366 articles located, 47 studies involving 67 screening tools were included. About one-third of the tests (35.4%) achieved at least fair accuracy, while only a small proportion (13.8%) achieved good accuracy. HSROC curves revealed a remarkable variation in sensitivity and specificity for the three major types of screening, which used the child's actual language ability, clinical markers, and both as the proxy, respectively. None of these three types of screening tools achieved good accuracy. Meta-regression showed that tools using the child's actual language as the proxy demonstrated better sensitivity than that of clinical markers. Tools using long screening-diagnosis intervals had a lower sensitivity than those using short screening-diagnosis intervals. Parent report showed a level of accuracy comparable to that of those administered by trained examiners. Screening tools used under and above 4yo appeared to have similar sensitivity and specificity. In conclusion, there are still gaps between the available screening tools for language disorders and the adoption of these tools in population screening. Future tool development can focus on maximizing accuracy and identifying metrics that are sensitive to the dynamic nature of language development.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=210505, PROSPERO: CRD42020210505.

Testing the continuum/spectrum model in Russian-speaking children with and without developmental language disorder

“…The agreement to use a cutoff of 1.25 SD below average on two or more language levels to identify DLD may not be entirely accurate. There are debates about the acceptance of a stricter 2 SD cutoff instead of 1.25 SD cutoff (So & To, 2022). Still, in our present study, some children who struggled with the tasks on two or more language levels, may still need additional attention from a teacher or from RTI services for prevention the possible learning difficulties in the future.…”

Assessing pragmatics in early childhood with the Language Use Inventory across seven languages

“…It was found that for children assessed with the LUI between the ages of 24 and 47 months, LUI scores predicted their language and communication skills at ages 5–6 years ( M age 5;6) assessed via a protocol that included standardized language measures and clinical history. The values were 81% for sensitivity and 93% for specificity, despite a time interval of up to 3 years between the LUI and follow-up measures at ages 5–6, a factor known to lower these values ( So and To, 2022 ). Additionally, children who scored below an empirically derived cut-off on the LUI at ages 24–47 months were 27 times more likely to display language difficulties at ages 5–6 than children scoring above the cut-off.…”

“…While there is continued discussion of whether routine, universal screening of early language is advisable (see Sansavini et al, 2021 ; So and To, 2022 ), the discriminative and predictive validity studies of the LUI described above provide support for screening and monitoring children, particularly when a concern about pragmatic language use is present (see also Miller et al, 2015 ; Conti et al, 2020 ). Additionally, the LUI’s internal reliability and sensitivity to growth in children’s language use are each high; data relevant to these features are reported in later sections where they serve as a comparison point for findings from studies of the seven LUI translations.…”

“…The LUI asks parents about how their child is using language, including for what purposes, types of questions and comments, and how they adapt their communication to context ( O’Neill, 2007 , 2009 ). Its completion by parents is grounded on the premise that they are ideally suited to observe these early abilities in diverse contexts, and on evidence that parents are accurate reporters of children’s language production ( Fenson et al, 2007 ) and that their reports are comparable in accuracy to screenings for language disorder carried out by trained examiners ( So and To, 2022 ). Pragmatics is also referred to in the literature as social communication (e.g., Dillon et al, 2021 ) and implicated in the category of social (pragmatic) communication disorder (SPCD) introduced in the last edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013 ).…”

LanguageScreen: The development, validation and standardization of an automated language assessment App

“…Two recent systematic reviews have addressed this issue: Wallace et al, (2015) evaluated the use of screening for speech and language delays in pre-school children (5 years and younger) with a view to their use in primary care settings. The sensitivity of existing measures ranged from 50% and 94% with specificity 45% to 96% Similarly, So and To (2022) reported heterogeneity in outcomes following a review of 67 screening tools for children aged 6 years and under; these tools used either direct language assessment, clinical markers derived from parent observations or both.…”