Abstract
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.
Highlights
Depending on the definition used, 2–10% of pre-schoolage children experience delayed language acquisition, which makes language disorder (LD) one of the most prevalent developmental disorders [1, 2]
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)
The screening subscales administered by the pediatricians were compiled from pre-existing subtests of a German standardized language test (Sprachentwicklungstest SETK 3-5; [36], The first subscale includes 20 items that assess the production of noun plurals: The pediatrician presents and names a pictured item in the singular and asks the child to produce the respective plural form supported by a picture that shows several identical items
Summary
Depending on the definition used, 2–10% of pre-schoolage children experience delayed language acquisition, which makes language disorder (LD) one of the most prevalent developmental disorders [1, 2]. A recent consensus statement on terminology and criteria for language problems in children [3] has resulted in the endorsement of the term Developmental Language Disorder (DLD) for language difficulties that are associated with functional impairment and poor prognosis but have no known biomedical etiology. In an English population study, Norbury et al [2] found a prevalence of DLD (of unknown origin) of 7.58%, while 2.34% of LDs were associated with intellectual disability and/or a medical diagnosis (total approximately 10% of LDs from all causes). They defined DLD as scores of −1.5 standard deviations (SD) and below on at least two of five language domains. In the absence of a generally accepted measurable gold standard for the definition of LDs, we based our definition on the previously mentioned classifications, which are commonly used in research, with an expected prevalence rate of about 10%
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