Report of the Recommendations, Communication Disorders, Assessment and Intervention for Young Children (Age 0-3 years)
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Clinical Practice Guideline: Report of the Recommendations, Communication Disorders, Assessment and Intervention for Young Children (Age 0-3 years) |
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RISK FACTORS AND CLINICAL CLUES FOR POSSIBLE COMMUNICATION DISORDERS
LISTENING TO PARENT CONCERNS
CLINICAL LINGUISTIC AUDITORY MILESTONE SCALE (CLAMS)
EARLY LANGUAGE MILESTONE (ELM) SCALE
LANGUAGE DEVELOPMENT SURVEY (LDS)
MACARTHUR COMMUNICATIVE DEVELOPMENTAL INVENTORIES (CDIs)
VINELAND ADAPTIVE BEHAVIOR SCALES (VABS)
AUDITORY PROCESSING QUESTIONNAIRE
SCREENING TESTS USING A SAMPLE OF LANGUAGE
PRESCHOOL LANGUAGE CHECKLIST (PLC)
SPECIFIC TECHNIQUES FOR IN-DEPTH ASSESSMENT
ASSESSMENT METHODS
SUMMARY CONCLUSIONS
The presence of risk factors or certain "clinical clues" for communication disorders may be useful in identifying children under the age of three who have a possible communication disorder.
Articles screened for this topic: 489
Articles meeting criteria for evidence: 2
Taking a history of risk factors can easily be incorporated into routine health exams. Parents as well as professionals can be educated to be alert to risk factors for communication disorders including hearing loss.
Clinical clues of possible communication disorders can also be easily identified during healthcare visits as part of developmental surveillance and by professionals caring for the child in childcare settings. Parents as well as professionals can be educated to be alert to clinical clues for communication disorders. Some of the clinical clues listed in Table III-5 have been evaluated for their ability to identify children with communication disorders.
Some children with risk factors will not develop communication disorders and some children who have communication disorders will have no known risk factors. In a similar fashion, the presence of a clinical clue may not in itself be sufficient to establish a diagnosis of a communication disorder. However, while the presence of risk factors and clinical clues may have a limited sensitivity and specificity for identifying communication disorders, they are useful for identifying the need for appropriate surveillance or further assessment of the child.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
Risk factors may be present before a communication disorder becomes apparent, and can alert professionals to the need for appropriate surveillance or further assessment.
Taking a history of risk factors is not a formal test to screen for communication disorders, but can easily be incorporated into routine health exams and other professional interactions with the child.
Clinical clues of possible communication disorders can be easily identified during healthcare visits as part of developmental surveillance and by professionals caring for the child in childcare settings.
Parents as well as professionals can be educated to be alert to risk factors and clinical clues for communication disorders.
Some of the clinical clues listed in Table III-5 have been evaluated in studies reviewed for their ability to identify children with communication disorders.
Limitations
The presence of a particular risk factor is not sufficient to diagnose a communication disorder because of its limited sensitivity and specificity for identifying children with language problems.
For many of the clinical clues listed, the sensitivities and specificities for identifying children with communication disorders have not been determined.
SUMMARY CONCLUSIONS
Parent's concerns about their child's development can be very useful in helping to identify young children with possible communication problems.
Articles screened for this topic: 489
Articles meeting criteria for evidence: 1
Parents' concerns about their child's development can be very useful in helping to identify young children with possible communication disorders including hearing loss. Listening to unsolicited expressions of concern and specifically asking about the child's developmental status appear to be useful. A standardized method for eliciting and documenting parent concerns, such as the PEDS, may have some benefit in some situations.
Paying attention to parents' concerns is only one of several methods for identifying children with communication problems. It is important for the professional to recognize that even if a parent does not express a specific concern, the child may have a communication disorder. Also, parents sometimes express concerns about their child's development when the child is developing typically.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
The PEDS brings some degree of objectivity, standardization, and consistency to the clinical decision-making process.
The PEDS provides a structured format for gathering and recording information about a parent's concerns.
The PEDS is very easy to administer and score.
Limitations
As with all diagnostic tests, there may be false positive and false negative test results.
SUMMARY CONCLUSIONS
CLAMS was developed to screen for language delays in young children between birth and three years of age.
Articles screened for this topic: 489
Articles meeting criteria for evidence: 1
The CLAMS may be useful for identifying children age 14-36 months who have normal language development. The CLAMS may also be useful to identify expressive language delays in children age 25-36 months, but it is less useful for identifying these problems in children 14-24 months old. The CLAMS appears to have limited usefulness for identifying receptive language delays in children 14-35 months of age. However, even for speech language professionals, it is considered difficult to identify receptive language delays in children less than 24 months of age.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
The CLAMS provides a structured format for gathering and recording information about a child's language.
The CLAMS brings some degree of objectivity, standardization, and consistency to the clinical decision-making process.
The CLAMS is easy to learn and simple to administer; it can be used by a variety of professionals.
When a higher than standard cut-off level is used, the CLAMS has a good ability to identify:
Expressive language delay in children age 25-36 months, and
Normal expressive language in children age 14-36 months
Limitations
As with all screening tests, there may be false positive and false negative test results.
When a higher than standard cut-off level is used, the CLAMS has a poor ability to identify:
Expressive language delay in children age 14-24 months
Receptive language delays in children from 14-36 months
SUMMARY CONCLUSIONS
The Early Language Milestone (ELM) Scale was developed for use in the pediatrician's office for a brief screening of a child's language abilities. The test is easy to administer and can be given by a physician or allied personnel in about 1-10 minutes. There is a revised version available, the ELM-2.
Articles screened for this topic: 489
Articles meeting criteria for evidence: 1
The ELM may be useful for identifying 24-month-old children who have normal expressive language development. The ELM may be less useful for identifying children with expressive language delays at 24 months.
Based on the evidence reviewed, no conclusions could be drawn about the ability of the ELM to identify expressive language delay in 12-month-old children because there were too few subjects with language delay on the reference test. The panel noted that even speech language professionals find it difficult to identify receptive language delays in children less than 24 months of age. The panel had no confidence in the ability of either the reference standard or the ELM to identify children with receptive language delay.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
The ELM brings some degree of objectivity, standardization, and consistency to the clinical decision-making process.
The ELM provides a structured format for gathering and recording information about a child's language.
The ELM is easy and quick to administer.
The ELM has a moderately high specificity (a moderately good ability to identify normal expressive language in 24-month-old children).
Limitations
As with all screening tests, there may be false positive and false negative test results.
The ELM has a low sensitivity (a poor ability to identify expressive language delay in 24-month-old children).
SUMMARY CONCLUSIONS
LDS was originally developed to be administered to parents in a clinical setting, but can also be mailed to parents. It is a test of expressive language designed to identify language delay in two-year-old children.
Articles screened for this topic: 489
Articles meeting criteria for evidence: 2
Although the LDS is designed for children in a very restricted age range, it may be useful for identifying children 24 months of age who have a possible communication disorder.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
The LDS brings some degree of objectivity, standardization, and consistency to the clinical decision-making process.
The LDS provides a structured format for gathering and recording information about a child's language.
The LDS is designed for parents of two-year-old children.
The LDS can be mailed to parents or be administered in a clinical setting.
The LDS has a moderate-to-high sensitivity and specificity.
Limitations
As with all screening tests, there may be false positive and false negative test results.
The LDS is designed to measure expressive language only.
The LDS is designed for children who are in a very restricted age group.
SUMMARY CONCLUSIONS
CDIs are norm-referenced tests of language development based on parent responses to a standardized questionnaire.
Articles screened for this topic: 489
Articles meeting criteria for evidence: 0
The CDIs are designed to be used for children from eight to thirty months of age and are normed for age. Because they have been standardized in English and Spanish as well as across socioeconomic levels, they are very useful in identifying young children with possible communication disorder who need further assessment.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
The CDIs bring some degree of objectivity, standardization, and consistency to the clinical decision-making process.
The CDIs provide a structured format for gathering and recording information about a child's language.
The CDIs are designed for parents of children from 8-30 months.
The CDIs can be mailed to parents or be administered in a clinical setting. They are brief and easy to administer.
The CDIs have been normed for age.
The CDIs have been standardized in English and Spanish, as well as across socioeconomic levels.
Limitations
As with all screening tools, there may be false positive and false negative test results.
SUMMARY CONCLUSIONS
VABS assesses a child's adaptive behavior by means of an interview with the child's primary caregiver.
Articles screened for this topic: 489
Articles meeting criteria for evidence: 1
Although there is research evidence evaluating the VABS as a screening test for communication disorders, its primary use is for assessing children in multiple domains. Because it requires more training and more time to administer than tests designed particularly to screen for language impairments, it is not as useful for detecting communication disorders as some of the other tests evaluated in this section. However, the VABS may be useful when a child is being assessed in multiple areas.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
The VABS brings some degree of objectivity, standardization, and consistency to the clinical decision-making process.
The VABS provides a structured format for gathering and recording information about a child's language.
The VABS has been normed on children under the age of three.
The VABS covers multiple domains which are interconnected.
When administered by highly trained individuals, the expressive communication sub-domain of the VABS has a high sensitivity and specificity for detecting language delays as defined by the LDS.
Limitations
As with all screening tools, there may be false positive and false negative results.
The VABS requires more training and more time to administer than tests designed to screen for language impairments.
SUMMARY CONCLUSIONS
The Auditory Processing Questionnaire was developed to identify auditory problems and language delay in nine month old infants at a routine screening test for hearing in a community setting in Great Britain.
Articles screened for this topic: 489
Articles meeting criteria for evidence: 1
Because this questionnaire is not used in the United States, the panel chose not to make any specific recommendations about the test. However, the questions asked of parents about their child's responses to sounds and understanding of speech might be useful. Some of the questions (such as those which refer to the "hoover" and a "biscuit tin") may have to be adapted to terminology more understandable in the United States.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
The auditory processing questionnaire brings some degree of objectivity, standardization, and consistency to the clinical decision-making process.
The auditory processing questionnaire provides a structured format for gathering and recording information about an infant's language.
The questionnaire is brief and easy to administer.
The auditory processing questionnaire has a low-to-moderate sensitivity and high specificity for predicting communication problems.
Limitations
As with all screening tools, there may be false positive and false negative test results.
SUMMARY CONCLUSIONS
The interactive test was developed for a community study in Great Britain to screen the language of children between the ages of 30 and 34 months.
Articles screened for this topic: 489
Articles meeting criteria for evidence: 1
Because this questionnaire is not available in the United States, the panel chose not to make any specific recommendations about the test. However, the panel noted that, just as with other screening tests, using different pass/fail cut-off levels will yield different sensitivity and specificity.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
Using measures derived from spontaneous language samples brings some degree of objectivity, standardization, and consistency to the clinical decision-making process.
Using measures derived from spontaneous language samples provides a structured format for gathering and recording information about a child's language.
Developers of the measures derived from spontaneous language samples consider it useful for young children.
When administered by highly trained individuals, the measures derived from spontaneous language samples have at least a moderate sensitivity and specificity.
The measures derived from spontaneous language samples may more closely reflect the clinician's perception of impaired language development for some children than standardized discrepancy criteria.
Limitations
As with all diagnostic tests, there may be false positive and false negative results.
Both test batteries and the measures derived from spontaneous language samples take an extensive amount of time and require a highly trained person to administer and score.
These clinical assessment methods may be expensive because of the professional time involved.
SUMMARY CONCLUSIONS
PLC was developed as a postal questionnaire for use in a community research study in Great Britain to screen the language of three-year-old children.
Articles screened for this topic: 489
Articles meeting criteria for evidence: 1
Because this questionnaire is not available in the United States, the panel chose not to make any specific recommendations about the test. However, the research evidence evaluating the PLC can be used as additional support for parent questionnaires in general. Parent questionnaires, when interpreted by a professional with expertise in assessing children with communication disorders, may provide useful information.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
The PLC brings some degree of objectivity, standardization, and consistency to the clinical decision-making process.
The PLC provides a structured format for gathering and recording information about a child's language.
The PLC has demonstrated feasibility as a mail-in questionnaire.
The items on the PLC have content validity; they are good indicators of potential language problems.
Although the focus of the PLC is on 36-month-old children, the questionnaire may be applicable to younger children.
Limitations
As with all screening tests, there may be false positive and false negative test results.
SUMMARY CONCLUSIONS
This method involves systematically analyzing multiple aspects of spontaneous samples of language often gathered during standardized play sessions of other naturalistic settings.
Articles screened for this topic: 489
Articles meeting criteria for evidence: 3
A variety of specific methods and techniques are useful when performing an in-depth speech/language assessment. It is important to use both standardized tests of expressive and receptive language and alternative methods, such as analysis of spontaneous speech/ language samples.
In children with specific language impairment (SLI), analysis of spontaneous speech samples may be particularly useful. Identification of SLI through spontaneous language criteria may predict school-age outcome more accurately than psychometric discrepancy criteria.
SUMMARY ADVANTAGES AND LIMITATIONS
Advantages
Using measures derived from spontaneous language samples brings some degree of objectivity, standardization, and consistency to the clinical decision-making process.
Using measures derived from spontaneous language samples provides a structured format for gathering and recording information about a child's language.
Developers of the measures derived from spontaneous language samples consider it useful for young children.
When administered by highly trained individuals, the measures derived from spontaneous language samples have at least a moderate sensitivity and specificity.
Limitations
As with all diagnostic tests, there may be false positive and false negative results.
Both test batteries and the measures derived from spontaneous language samples take an extensive amount of time and require a highly trained person to administer and score.
These clinical assessment methods may be expensive because of the professional time involved.
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Send questions or comments to: bei@health.state.ny.us |
| Revised: June 2002 | |