Predictive validity of preschool screening tools for language and behavioural difficulties: A PRISMA systematic review

Abstract

BackgroundPreschool 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.MethodsStudies 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.ResultsA 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.ConclusionsUniversal 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.

Implementation of the norwegian ‘Starting right’ child health service innovation: implementation adjustments, adoption, and acceptability

“…For instance, population-based screening of general mental health using the Strength and Difficulties Questionnaire (SDQ) has been implemented successfully in Scotland, and is reported to add valuable decision support and to identify more cases for interventions [ 20 ]. This has also been confirmed at a global level [ 21 ]. Universal screening and routine outcome monitoring can in addition improve earlier identification of child problems [ 16 ], create opportunities for evaluation of early interventions and preventive services [ 17 ], enhance user involvement and communication with families as well as interdisciplinary collaboration [ 18 ], and help services improve [ 19 ].…”

Effects of improved complementary feeding and improved water, sanitation and hygiene on early child development among HIV-exposed children: substudy of a cluster randomised trial in rural Zimbabwe

“…However, among the HIV-exposed children, we found consistent, statistically significant improvements across multiple tests of global child development. These included specific motor, social and language scores, which exhibited substantial magnitudes of effect between IYCF +WASH and SOC of 0.4–0.5 SD 18 19. These effect sizes effects are considerable for child development at this age.…”

The Dutch well child language screening protocol for 2‐year‐old children was valid for detecting current and later language problems

“…Additionally, follow‐up was not evaluated for any of the screening protocols. Evidence on the concurrent validity of such screening protocols is frequently reported and expressed in sensitivity and specificity in a research setting 9,10 . Sensitivity is the percentage of individuals with a health condition, in this case children, who experience speech and language problems and are correctly identified as having the condition 11 .…”

“…Concurrent validity regards the degree to which the results of the screening test are parallel with a reference standard that is administered at the same time. However, evidence is scarce for the performance of a screening instrument regarding health outcomes in the long term, the so called predictive validity 10 . This lack of evidence implies that the efficacy of protocols to monitor the development of a child over time is not known.…”