Validity and feasibility of a predictive language screening tool in 2-year-old children in primary pediatric care

Daniel Holzinger; Christoph Weber; Johannes Fellinger

doi:10.3389/fped.2022.865457

Validity and feasibility of a predictive language screening tool in 2-year-old children in primary pediatric care

Front Pediatr. 2022 Sep 6:10:865457. doi: 10.3389/fped.2022.865457. eCollection 2022.

Authors

Daniel Holzinger^{1

2

3}, Christoph Weber^{2

4}, Johannes Fellinger^{1

2

5}

Affiliations

¹ Institute of Neurology of Senses and Language, Hospital of St. John of God, Linz, Austria.
² Research Institute for Developmental Medicine, Johannes Kepler University Linz, Linz, Austria.
³ Institute of Linguistics, University of Graz, Graz, Austria.
⁴ Department for Inclusive Education, University of Education Upper Austria, Linz, Austria.
⁵ Division of Social Psychiatry, University Clinic for Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.

Abstract

Objective: To assess the predictive validity and feasibility of the newly developed language screening tool, SPES-2 (Sprachentwicklungsscreening), for 2-year-old children in pediatric primary care.

Methods: A prospective cohort study recruited 2,044 non-selected German-speaking children undergoing a regular well-baby check-up at the age of 2 years. Thirty primary care pediatricians spread over urban and rural areas screened the children using a short parent-reported questionnaire and direct assessment of word comprehension. To validate the screening tool, language skills were assessed using a standardized language screening tool in the complete sample 1 year later. Data of a random sample of 621 children were analyzed. Feasibility of the screening tool was evaluated using questionnaires completed by the participating pediatricians.

Results: The new screening tool, SPES-2, demonstrated good diagnostic accuracy with AUC (Area under the Roc Curve) of 0.885, a sensitivity of 0.74, and specificity of 0.86, using a parent-reported questionnaire (expressive vocabulary, two-word combinations, parental concerns) as stage 1, followed by a stage 2 direct assessment of word comprehension by the pediatrician. The second stage was restricted to children who failed the parental screening. The screening identified children with high, moderate, and low risk of significant language deficits (SLD) at the age of 3 years, permitting tailored follow-up assessment and parental counseling. Practicality and acceptability of the screening were mostly rated as high. Pediatricians regarded the availability of follow-up diagnostic services and parent guidance as most important for a general implementation of the new instrument.

Conclusion: The language screening tool, SPES-2, was valid for the identification of significant language deficits 1 year later, and considered as feasible within primary pediatric care.

Keywords: language screening; late language emergence; late talker; predictive; two-year olds.