Centre for Rural Health, Centre for Health Sciences, University of Aberdeen, Inverness, United Kingdom.
Farr Institute/Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, United Kingdom.
PLoS One. 2019 Feb 4;14(2):e0211409. doi: 10.1371/journal.pone.0211409. eCollection 2019.
Preschool screening for developmental difficulties is increasingly becoming part of routine health service provision and yet the scope and validity of tools used within these screening assessments is variable. The aim of this review is to report on the predictive validity of preschool screening tools for language and behaviour difficulties used in a community setting.
Studies reporting the predictive validity of language or behaviour screening tools in the preschool years were identified through literature searches of Ovid Medline, Embase, EBSCO CINAHL, PsycInfo and ERIC. We selected peer-reviewed journal articles reporting the use of a screening tool for language or behaviour in a population-based sample of children aged 2-6 years of age, including a validated comparison diagnostic assessment and follow-up assessment for calculation of predictive validity.
A total of eleven eligible studies was identified. Six studies reported language screening tools, two reported behaviour screening tools and three reported combined language & behaviour screening tools. The Language Development Survey (LDS) administered at age 2 years achieved the best predictive validity performance of the language screening tools (sens 67%, spec 94%, NPV 88% and PPV 80%). The Strengths and Difficulties Questionnaire (SDQ) administered at age 4 years achieved the best predictive validity compared to other behaviour screening tools (Sens 31%, spec 93%, NPV 84% and PPV 52%). The SDQ and Sure Start Language Measure (SSLM) administered at 2.5 years achieved the best predictive validity of the combined language & behaviour assessments (sens 87%, spec 64%, NPV 97% and PPV 31). Predictive validity data and diagnostic odds ratios identified language screening tools as more effective and achieving higher sensitivity and positive predictive value than either behaviour or combined screening tools. Screening tools with combined behaviour and language assessments were more specific and achieved higher negative predictive value than individual language or behaviour screening tools. Parent-report screening tools for language achieved higher sensitivity, specificity and negative predictive value than direct child assessment.
Universal screening tools for language and behaviour concerns in preschool aged children used in a community setting can demonstrate excellent predictive validity, particularly when they utilise a parent-report assessment. Incorporating these tools into routine child health surveillance could improve the rate of early identification of language and behavioural difficulties, enabling more informed referrals to specialist services and facilitating access to early intervention.
学龄前儿童发育困难的筛查越来越成为常规卫生服务的一部分，但这些筛查评估中使用的工具的范围和有效性各不相同。本研究的目的是报告在社区环境中使用的用于语言和行为困难的学龄前筛查工具的预测效度。
通过对 Ovid Medline、Embase、EBSCO CINAHL、PsycInfo 和 ERIC 进行文献检索，确定了报告语言或行为筛查工具预测效度的研究。我们选择了同行评议的期刊文章，这些文章报告了在年龄为 2-6 岁的基于人群的儿童样本中使用语言或行为筛查工具，包括用于计算预测效度的经过验证的比较诊断评估和随访评估。
确定了十一项符合条件的研究。六项研究报告了语言筛查工具，两项报告了行为筛查工具，三项报告了语言和行为联合筛查工具。在 2 岁时进行的语言发展调查 (LDS) 获得了语言筛查工具中最佳的预测效度表现（敏感度 67%，特异性 94%，NPV 88%和 PPV 80%）。在 4 岁时进行的长处与困难问卷 (SDQ) 与其他行为筛查工具相比具有最佳的预测效度（敏感度 31%，特异性 93%，NPV 84%和 PPV 52%）。在 2.5 岁时进行的 SDQ 和 Sure Start 语言测量 (SSLM) 获得了语言和行为联合评估中最佳的预测效度（敏感度 87%，特异性 64%，NPV 97%和 PPV 31%）。预测效度数据和诊断比值比确定语言筛查工具更有效，其敏感性和阳性预测值均高于行为或联合筛查工具。具有语言和行为联合评估的筛查工具比单独的语言或行为筛查工具更具特异性，且具有更高的阴性预测值。用于语言的家长报告筛查工具具有更高的敏感性、特异性和阴性预测值，而直接儿童评估则不然。
在社区环境中用于学龄前儿童语言和行为问题的通用筛查工具可以证明具有出色的预测效度，特别是当它们利用家长报告评估时。将这些工具纳入常规儿童健康监测中可以提高语言和行为困难的早期识别率，从而使更多人能够获得专业服务的转介，并促进早期干预的机会。
