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

Sim, F., Thompson, L. , Marryat, L., Ramparsad, N. and Wilson, P. (2019) Predictive validity of preschool screening tools for language and behavioural difficulties: a PRISMA systematic review. PLoS ONE, 14(2), e0211409. (doi: 10.1371/journal.pone.0211409) (PMID:30716083) (PMCID:PMC6361441)

178631.pdf - Published Version
Available under License Creative Commons Attribution.



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.

Item Type:Articles
Additional Information: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.
Glasgow Author(s) Enlighten ID:Thompson, Dr Lucy and Sim, Dr Fiona and Wilson, Prof Philip and Marryat, Dr Louise and Ramparsad, Mr Nitish
Creator Roles:
Sim, F.Conceptualization, Data curation, Investigation, Methodology, Project administration, Writing – original draft, Writing – review and editing
Thompson, L.Supervision, Writing – review and editing
Marryat, L.Supervision, Writing – review and editing
Ramparsad, N.Formal analysis, Writing – review and editing
Wilson, P.Funding acquisition, Supervision, Writing – review and editing
Authors: Sim, F., Thompson, L., Marryat, L., Ramparsad, N., and Wilson, P.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:PLoS ONE
Publisher:Public Library of Science
ISSN (Online):1932-6203
Copyright Holders:Copyright © 2019 Sim et al.
First Published:First published in PLoS ONE 14(2):e0211409
Publisher Policy:Reproduced under a Creative Commons License

University Staff: Request a correction | Enlighten Editors: Update this record

Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
603761The Scottish eHealth Informatics Research Centre (E-HIRCs)Jill PellMedical Research Council (MRC)MR/K007017/1IHW - PUBLIC HEALTH