Lavesson Ann, Lövdén Martin, Hansson Kristina
Department of Speech and Language Pathology, Skåne University Hospital, Malmö, Sweden.
Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.
Int J Lang Commun Disord. 2018 May;53(3):605-614. doi: 10.1111/1460-6984.12374. Epub 2018 Feb 7.
The Swedish Program for health surveillance of preschool children includes screening of language and communication abilities. One important language screening is carried out at age 4 years as part of a general screening conducted by health nurses at child health centres. The instruments presently in use for this screening mainly focus on expressive phonology. This may result in both over-referral of children with phonological difficulties and under-referral of children with language disorders (LDs), involving difficulties with vocabulary, grammar and/or language comprehension. Previous research has proposed non-word repetition as a clinical marker for LD. It has also been found that higher predictive power is achieved when non-word repetition is combined with the assessment of lexical/semantic skills. Taking these findings into account, the construction of a language screening instrument may yield more adequate referrals to speech-language therapists (SLTs).
To construct a new standardized language screening instrument for 4-year-olds and to test its properties.
METHODS & PROCEDURES: An instrument was developed and revised after piloting. A population of 352 children was screened at the regular 4-year check-up by 11 health nurses. The final sample consisted of 328 children aged 46-53 months (23% multilingual). Children performing below a preliminary cut-off were referred to an SLT (n = 52). Five SLTs carried out an assessment on average within 5 weeks using a gold standard language test battery. Children who screened negatively were followed up with a parent questionnaire at age 5;6.
OUTCOMES & RESULTS: Thirty-one true-positives and 11 false-positives were identified after SLT assessment. A further six children were identified as false-negatives (two through referral to an SLT and four through parent questionnaire at age 5;6). A receiver-operating characteristics curve with a C statistic of .94 was calculated. Based on optimal cut-off, the sensitivity of the screening instrument was found to be .84, and specificity was .96. Multilingual children performed similar to monolingual children; boys performed significantly lower than girls; and children with a family history of language-related problems performed lower than those without. Interrater reliability was high, as was Cronbach's alpha.
CONCLUSIONS & IMPLICATIONS: The screening instrument seems sufficiently valid for its purpose to identify children who need further assessment by an SLT. A follow-up study including SLT assessment for all children to check for false-negatives would be interesting in future, as would studies comparing results from the 4-year screening with those from earlier screens.
瑞典学前儿童健康监测项目包括对语言和沟通能力的筛查。一项重要的语言筛查在4岁时进行，作为儿童健康中心保健护士进行的全面筛查的一部分。目前用于该筛查的工具主要侧重于表达性语音学。这可能导致语音困难儿童被过度转诊，而语言障碍（LD）儿童（涉及词汇、语法和/或语言理解方面的困难）被转诊不足。先前的研究提出非词重复作为LD的临床标志物。还发现，当非词重复与词汇/语义技能评估相结合时，预测能力更强。考虑到这些发现，构建一种语言筛查工具可能会使转介给言语治疗师（SLT）的情况更加合适。
为4岁儿童构建一种新的标准化语言筛查工具并测试其性能。
开发了一种工具并在试点后进行了修订。11名保健护士在4岁常规检查时对352名儿童进行了筛查。最终样本包括328名年龄在46至53个月的儿童（23%为多语言儿童）。表现低于初步临界值的儿童被转介给SLT（n = 52）。5名SLT平均在5周内使用金标准语言测试组合进行了评估。筛查为阴性的儿童在5岁6个月时通过家长问卷进行随访。
SLT评估后确定了31例假阳性和11例假阴性。另外6名儿童被确定为假阴性（2名通过转介给SLT，4名通过5岁6个月时的家长问卷）。计算出C统计量为0.94的受试者工作特征曲线。基于最佳临界值，筛查工具的敏感性为0.84，特异性为0.96。多语言儿童的表现与单语言儿童相似；男孩的表现明显低于女孩；有语言相关问题家族史的儿童表现低于没有家族史的儿童。评分者间信度较高，克朗巴哈系数也较高。
该筛查工具似乎足以有效地识别需要SLT进一步评估的儿童。未来进行一项包括对所有儿童进行SLT评估以检查假阴性的随访研究将很有意义，比较4岁筛查结果与早期筛查结果的研究也将很有意义。
