Identifying language impairment in children: combining language test scores with parental report

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Children who meet language test criteria for specific language impairment (SLI) are not necessarily the same as those who are referred to a speech and language therapist. To consider how far this discrepancy reflects insensitivity of traditional language tests to clinically important features of language impairment. A total of 245 twin children, 52 of whom had been referred to a speech and language therapist for assessment or intervention, were studied. They were given a battery of language tests and their parents completed the Children's Communication Checklist - 2 (CCC-2). Language tests that stressed verbal short-term memory were best at distinguishing clinically referred from other cases; narrative and vocabulary tasks were less effective. A discriminant function analysis identified a combination of language test and parental report measures as giving the best discrimination between referred and non-referred cases. Nevertheless, of 82 children classified as language impaired by the discriminant function, 44 had never been referred to a speech and language therapist. These did not appear to be false-positives; they scored at least as poorly as referred cases on literacy tests. They had significantly lower socio-economic backgrounds than referred cases. Language test scores provide important information about which children are at risk of academic failure, though this varies from test to test. Reliance on language tests alone, however, is insufficient; a parental report provides important complementary information in the diagnostic process. Children of low socio-economic status with language problems are particularly likely to have no contact with speech and language therapist services.