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

Fiona Sim; Lucy Thompson; Louise Marryat; Nitish Ramparsad; Philip Wilson

doi:10.1371/journal.pone.0211409

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

Fiona Sim, Lucy Thompson, Louise Marryat (Corresponding Author), Nitish Ramparsad, Philip Wilson

Research output: Contribution to journal › Article › peer-review

53 Citations (Scopus)

10 Downloads (Pure)

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Original language	English
Article number	e0211409
Number of pages	31
Journal	PloS ONE
Volume	14
Issue number	2
DOIs	https://doi.org/10.1371/journal.pone.0211409
Publication status	Published - 4 Feb 2019

Bibliographical note

Acknowledgments
We are grateful to Dr Alex McConnachie for his guidance on the quantitative analysis of the data in this systematic review.

Funding: FS received funding to complete this review from a University of Aberdeen PhD stipend. At the time of this work being carried out, LM was supported by the Farr Institute @ Scotland, which is supported by a 10-funder consortium: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute of Health Research, the National Institute for Social Care and Health Research (Welsh Assembly Government), the Chief Scientist Office (Scottish Government Health Directorates), (MRC Grant No: MR/K007017/1). At the time, LM sat within SCPHRP, the core grant to SCPHRP was from the MRC, with half that support from the Scottish Chief Scientist Office (MR/K023209/1). LM currently holds a funded research fellowship from the Slavesen Mindroom Centre Research Centre for Learning Difficulties.

All relevant data are within the paper and its Supporting Information files.

Keywords

CHILDREN
CONCURRENT
DELAY
DISORDERS
IDENTIFICATION
ISSUES
MENTAL-HEALTH
RISK
SPEECH
SURVEILLANCE

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1371/journal.pone.0211409Licence: CC BY

Predictive validity of preschool screening tools for language and behavioural difficulties: A PRISMA systematic review
© 2019 Sim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. https://creativecommons.org/licenses/by/4.0/
Final published version, 3.09 MBLicence: CC BY

Cite this

@article{ba07dabfdef84ccfbd2c19115936f1be,

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

abstract = "Background 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. Methods 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. Results 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. Conclusions 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.",

keywords = "CHILDREN, CONCURRENT, DELAY, DISORDERS, IDENTIFICATION, ISSUES, MENTAL-HEALTH, RISK, SPEECH, SURVEILLANCE",

author = "Fiona Sim and Lucy Thompson and Louise Marryat and Nitish Ramparsad and Philip Wilson",

note = "Acknowledgments We are grateful to Dr Alex McConnachie for his guidance on the quantitative analysis of the data in this systematic review. Funding: FS received funding to complete this review from a University of Aberdeen PhD stipend. At the time of this work being carried out, LM was supported by the Farr Institute @ Scotland, which is supported by a 10-funder consortium: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute of Health Research, the National Institute for Social Care and Health Research (Welsh Assembly Government), the Chief Scientist Office (Scottish Government Health Directorates), (MRC Grant No: MR/K007017/1). At the time, LM sat within SCPHRP, the core grant to SCPHRP was from the MRC, with half that support from the Scottish Chief Scientist Office (MR/K023209/1). LM currently holds a funded research fellowship from the Slavesen Mindroom Centre Research Centre for Learning Difficulties. All relevant data are within the paper and its Supporting Information files.",

year = "2019",

month = feb,

day = "4",

doi = "10.1371/journal.pone.0211409",

language = "English",

volume = "14",

journal = "PloS ONE",

issn = "1932-6203",

publisher = "PUBLIC LIBRARY SCIENCE",

number = "2",

}

TY - JOUR

T1 - Predictive validity of preschool screening tools for language and behavioural difficulties

T2 - A PRISMA systematic review

AU - Sim, Fiona

AU - Thompson, Lucy

AU - Marryat, Louise

AU - Ramparsad, Nitish

AU - Wilson, Philip

N1 - Acknowledgments We are grateful to Dr Alex McConnachie for his guidance on the quantitative analysis of the data in this systematic review. Funding: FS received funding to complete this review from a University of Aberdeen PhD stipend. At the time of this work being carried out, LM was supported by the Farr Institute @ Scotland, which is supported by a 10-funder consortium: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute of Health Research, the National Institute for Social Care and Health Research (Welsh Assembly Government), the Chief Scientist Office (Scottish Government Health Directorates), (MRC Grant No: MR/K007017/1). At the time, LM sat within SCPHRP, the core grant to SCPHRP was from the MRC, with half that support from the Scottish Chief Scientist Office (MR/K023209/1). LM currently holds a funded research fellowship from the Slavesen Mindroom Centre Research Centre for Learning Difficulties. All relevant data are within the paper and its Supporting Information files.

PY - 2019/2/4

Y1 - 2019/2/4

N2 - Background 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. Methods 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. Results 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. Conclusions 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.

AB - Background 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. Methods 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. Results 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. Conclusions 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.

KW - CHILDREN

KW - CONCURRENT

KW - DELAY

KW - DISORDERS

KW - IDENTIFICATION

KW - ISSUES

KW - MENTAL-HEALTH

KW - RISK

KW - SPEECH

KW - SURVEILLANCE

UR - http://www.scopus.com/inward/record.url?scp=85061056145&partnerID=8YFLogxK

UR - http://www.mendeley.com/research/predictive-validity-preschool-screening-tools-language-behavioural-difficulties-prisma-systematic-re

U2 - 10.1371/journal.pone.0211409

DO - 10.1371/journal.pone.0211409

M3 - Article

SN - 1932-6203

VL - 14

JO - PloS ONE

JF - PloS ONE

IS - 2

M1 - e0211409

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this