Spannenkrebs M, Crispin A, Krämer D
MPH-HAM, Landratsamt Biberach, Kreisgesundheitsamt.
MPH, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie der Ludwig-Maximilians-Universität München.
Gesundheitswesen. 2013 Dec;75(12):838-47. doi: 10.1055/s-0033-1345197. Epub 2013 Jun 18.
The new examination before primary school enrollment in Baden-Wuerttemberg aims at detecting problems in infant development with regard to later school success in time to initiate supporting measures, especially to improve the language skills of children with other native languages. By a 2-level process composed of a screening of language skills (HASE and KVS) and an additional test (SETK 3-5) of children who did not pass the screening, the school physicians attested special needs for language promotion in the kindergarten. This study looked for associated risks of children with special needs for language promotion. The degree of test quality of the 2-level process for identifying special needs for language promotion was determined.
This cross-sectional analysis explored findings of n=80,781 children in the new examination before primary school enrollment of the data-set of Baden-Wuerttemberg (children with school enrollment 2011). 56,352 children (69.8%) were speaking German, 24,429 children (30.2%) had other family languages. 20,461 children (25.3%) had special needs for language promotion in the kindergarten. A logistic regression model to determine main risks of special needs for language promotion was developed. Main effects were other native languages (OR 5.1 [4.8; 5.2]), problems in subitising (OR 2.8 [2.7; 3.0]) and language development lags in the questionnaire of the nursery school teachers (OR 3.5 [3.3; 3.7]). Protective effects were an elevated graduation of the mother (OR 0.7 [0.7; 0.7]) or the father (OR 0.8 [0.7; 0.8]). Risk scores of the effects were defined. The corresponding predictive probability to different levels of risk scores was calculated. The true positive rate of the screening of language skills (HASE/KVS) in regard to special needs for language promotion was 0.95, the true negative rate was 0.72 and the -positive predictive value was 0.53. The school physician's findings of special needs for language promotion acted as gold standard. With the additional test (SETK 3-5) the positive predictive value improved to 0.9, if at least one of the subtests of the SETK 3-5 was not passed. The risk score-level corresponded with the pretest-probability and the consecutive positive predictive value of the screening of language skills.
This study showed an adequate degree of test quality of the 2-level process in the new examination before primary school enrollment in Baden-Wuerttemberg (screening of language skills and additional test, if the screening is not passed). In addition children with special needs for language promotion had associated risks. Risk scores, that have been defined, offer an information tool to the school physicians concerning the positive predictive value of the screening of language skills without additional testing.
巴登 - 符腾堡州小学入学前的新检查旨在及时发现幼儿发育中与日后学业成就相关的问题，以便启动支持措施，特别是提高母语非德语儿童的语言技能。通过一个由语言技能筛查（HASE和KVS）以及对未通过筛查的儿童进行的额外测试（SETK 3 - 5）组成的两级流程，学校医生证实幼儿园中存在语言促进方面的特殊需求。本研究探寻了有语言促进特殊需求儿童的相关风险。确定了用于识别语言促进特殊需求的两级流程的测试质量程度。
这项横断面分析探讨了巴登 - 符腾堡州数据集（2011年入学儿童）中80,781名小学入学前新检查儿童的结果。56,352名儿童（69.8%）说德语，24,429名儿童（30.2%）有其他家庭语言。20,461名儿童（25.3%）在幼儿园有语言促进方面的特殊需求。建立了一个逻辑回归模型来确定语言促进特殊需求的主要风险。主要影响因素为其他母语（比值比5.1 [4.8; 5.2]）、点数识别困难（比值比2.8 [2.7; 3.0]）以及幼儿园教师问卷中的语言发育迟缓（比值比3.5 [3.3; 3.7]）。保护因素为母亲（比值比0.7 [0.7; 0.7]）或父亲（比值比0.8 [0.7; 0.8]）的较高教育程度。定义了各影响因素的风险评分。计算了不同风险评分水平对应的预测概率。语言技能筛查（HASE/KVS）针对语言促进特殊需求的真阳性率为0.95，真阴性率为0.72，阳性预测值为0.53。学校医生对语言促进特殊需求的诊断结果作为金标准。通过额外测试（SETK 3 - 5），如果SETK 3 - 5的至少一个子测试未通过，阳性预测值提高到0.9。风险评分水平与语言技能筛查的预测试概率及后续阳性预测值相对应。
本研究表明，巴登 - 符腾堡州小学入学前新检查中的两级流程（语言技能筛查及筛查未通过时的额外测试）具有足够的测试质量。此外，有语言促进特殊需求的儿童存在相关风险。已定义的风险评分为学校医生提供了一个关于无需额外测试的语言技能筛查阳性预测值的信息工具。
