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General principles of screening tests

1. It is important to recognize that even screening instruments that are easy to administer usually require the experience of a qualified professional (knowledgeable about communication disorders in young children) to interpret results and counsel parents. [D2]

2. It is recommended that screening for communication disorders include use of:

• open-ended questions
• informal checklists
• formal checklists
• formal screening instruments
• observation of parent child communicative interactions in a naturalistic setting [D1]

3. If screening for communication disorders is done with a

• Ages and Stages Questionnaire (ASQ)
• Language Development Survey (LDS)
• MacArthur Communicative Development Inventories (CDIs) [D1]

4. If there is heightened concern about a possible communication disorder in a young child, it may be useful for professionals to use a

• Clinical Linguistic Auditory Milestone Scale (CLAMS)
• Early Language Milestone Scale (ELM-2)
• Receptive-Expressive Emergent Language Scale (REEL) [B]

Interpretation of screening test results

5. If a screening instrument suggests a possible communication disorder, further assessment is needed to determine whether a disorder exists and to establish a diagnosis. [D2]

6. If a screening instrument suggests that a communication disorder is not likely, it is still important to assess the child for other developmental or medical problems that may have caused the initial concern. [D2]

7. It is important to remember that not all children with communication disorders can be identified early. Because the time of onset and severity of symptoms vary, it is recommended that screenings be repeated at various age levels when concerns for communication disorders persist or become apparent. [D1]

8. It is recommended that parents be advised of the limitations of screening tests for communication disorders. Some children who have a communication disorder will pass a screening test whereas some children who fail the screening test do not necessarily have a communication disorder. [D2]

9. In interpreting results of screening tests for communication disorders, it is recommended that:

• if a child scores below the standard cut-off, that this alert the examiner to the need for further assessment. A standard cut-off is a clinically accepted set of criteria to separate passing or failing scores on the screening test

• if a child scores above the standard cut-off and there are other indications of a possible communication disorder, then the child's progress continue to be monitored and periodic follow-up be scheduled [D2]

The Clinical Linguistic Auditory Milestone Scale (CLAMS) was developed to screen for language delays in young children between birth and 3 years of age. The test uses standardized methods for obtaining information from parent report and from direct interaction between the examiner and the child. The CLAMS is designed to be administered by a physician in an office setting.

The CLAMS includes both parent report and activities to elicit specific responses from the child. The test determines if a child has specific language skills or abilities that have been found to be present in most typically developing children at set chronological ages.

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1. The CLAMS may be useful as a screening test that can be used in physicians' offices to identify communication disorders in young children. [B]

2. Because of its high specificity, the CLAMS is most useful for confirming normal language development in children from 14 to 36 months of age. [B]

3. The CLAMS may be useful as a screening test to identify expressive language delays in children age 25-36 months, but is less useful for this purpose in children younger than 25 months old because of its decreased sensitivity. [B]

4. The CLAMS may have limited usefulness in identifying children 14 to 36 months of age with receptive language delays. [B]

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. Responses are obtained from a combination of parental report, examiner observation, and direct testing. There is a revised version available, the ELM-2.

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1. The ELM Scale may be useful for identifying 24 month-old children who have normal expressive language development because of its high specificity. [B]

2. The ELM Scale may be less useful for identifying children with the possibility of expressive language delays at 24 months because of its decreased sensitivity. [B]

The Language Development Survey (LDS) was originally designed to be completed by parents in a clinical setting, but it can also be mailed to parents. It is a test of expressive language designed to identify language delay in 2 year-old children. The LDS consists of a one-page vocabulary checklist of about 300 words, plus a question asking about combining two or more words into phrases. If a 2 year-old child has fewer than 50 words or no word combinations, the child is considered to have a language delay.

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1. The LDS may be useful in identifying children 24 months of age who have a possible communication disorder. [B]

2. If a child at 24 months has less than a 50 word vocabulary or has no word combinations, further assessment is needed. [B]

The MacArthur Communicative Developmental Inventories (CDIs) are norm-referenced tests of language development in children and are based on parent reports on a standardized questionnaire. They are intended to describe typical language development in children from 8 to 30 months of age. There are two formats, one for children age 8 to 16 months old and another for children age 16 to 30 months. Parents complete a standardized questionnaire asking about various aspects of nonverbal and verbal communication.

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1. The CDIs are useful to aid in the recognition of children with possible communication disorders who would benefit from further assessment from 8 to 30 months of age. [B]

2. If the child is from a family where Spanish is the primary language, the Spanish version of the CDIs may be particularly useful. [B]

3. It is important to remember that the CDIs are intended as screening instruments and not as tools to make a formal diagnosis. [B]

The Vineland Adaptive Behavior Scales (VABS) is a norm- referenced instrument that assesses a child's adaptive behavior by means of an interview with the child's primary caregiver. The VABS assesses adaptive behavior in the domains of receptive and expressive communication, daily living, socialization, and motor skills.

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1. A low score on the Vineland Adaptive Behavior Scales may be useful in identifying children under the age of 3 who have a possible communication disorder. [B]

2. If a child has a low score on the Socialization Domain scale on the Vineland Adaptive Behavior Scales or similar general developmental test, it may be reflective of an underlying communication disorder. [B]

The following recommendations are based on a review of the scientific literature evaluating the efficacy of three assessment instruments that are not readily available to U.S. clinicians.

The assessment instruments evaluated include an auditory processing test, an interactive test, and the Preschool Language Checklist. These are all research tests developed for screening young children in community language studies in Great Britain.

The results of the British studies are useful for supporting some general recommendations about the use of language screening instruments.