Universal language development screening: comparative performance of two questionnaires

Area of Science:

• Child Development
• Linguistics
• Psychopathology

Background:

• Early childhood language ability predicts later life outcomes, including psychopathology and educational attainment.
• Despite universal language development assessments, few tools have been rigorously evaluated.
• Accurate screening is crucial for early intervention and support.

Purpose of the Study:

• To compare the screening performance of two widely used early language assessment instruments.
• To evaluate the diagnostic accuracy of the Ages and Stages Questionnaire (ASQ) Communication Scale and the Sure Start Language Measure (SSLM).
• To inform the selection of effective tools for early language screening.

Main Methods:

• A pragmatic diagnostic accuracy study was conducted in five English regions.
• Compared the ASQ Communication Scale and SSLM against the Preschool Language Scale, 5th edition (PLS-5) as a reference standard.
• Included 357 children aged 23–30 months.

Main Results:

• The SSLM demonstrated higher sensitivity (0.83) and negative predictive value (0.98) compared to the ASQ Communication Scale (sensitivity 0.55, NPV 0.95).
• The ASQ Communication Scale exhibited higher specificity (0.95) than the SSLM (0.81).
• Both tools performed less effectively in multilingual households where English was not exclusively spoken.

Conclusions:

• The widely used ASQ Communication Scale is not optimal for language screening, missing over a third of children with low language ability.
• The SSLM demonstrated superior performance as a language screening tool in this cohort.
• Consideration of the home language environment is important when interpreting screening results.