Universal language development screening: comparative performance of two questionnaires

Low language ability in early childhood is a strong predictor of later psychopathology as well as reduced school readiness, lower educational attainment, employment problems and involvement with the criminal justice system. Assessment of early language development is universally offered in many countries, but there has been little evaluation of assessment tools. We planned to compare the screening performance of two commonly used language assessment instruments.

A pragmatic diagnostic accuracy study was carried out in five areas of England comparing the performance of two screening tools (Ages and Stages Questionnaire (ASQ) and Sure Start Language Measure (SSLM)) against a reference test (Preschool Language Scale, 5th edition).

Results were available for 357 children aged 23-30 months. The ASQ Communication Scale using optimal cut-off values had a sensitivity of 0.55, a specificity of 0.95 and positive and negative predictive values of 0.53 and 0.95, respectively. The SSLM had corresponding values of 0.83, 0.81, 0.33 and 0.98, respectively. Both screening tools performed relatively poorly in families not using English exclusively in the home.

The very widely used ASQ Communication Scale performs poorly as a language screening tool, missing over one-third of cases of low language ability. The SSLM performed better as a screening tool.