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Development and Validation of Nomogram-Based Prediction Models for Developmental Language Disorder in Bilingual

Joseph Hin Yan Lam¹, Michelle N Ramos², Jiali Wang³

¹School of Education, University of California, Irvine.

Journal of Speech, Language, and Hearing Research : JSLHR

|August 18, 2025

Summary

This study developed a nomogram to improve language assessment for bilingual children, finding specific subtest weightings crucial for diagnosing developmental language disorder (DLD). Bilingual language exposure was key for single-language assessments, particularly in Spanish.

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Universal Screening for Prevention of Reading, Writing, and Math Disabilities in Spanish

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Published on: July 18, 2020

Area of Science:

Speech and Language Pathology
Bilingualism Research
Diagnostic Accuracy

Background:

Bilingual language assessment faces challenges due to limited tools and services.
Optimal weighting of subtests in standardized assessments for bilingual children remains underexplored.
Language exposure information is critical for diagnosing developmental language disorder (DLD) in bilingual populations.

Purpose of the Study:

To explore subtest weighting in bilingual language tasks using a nomogram for improved diagnostic accuracy.
To assess the feasibility of single-language assessments for bilingual children with DLD.
To investigate the role of language exposure in the diagnostic process.

Main Methods:

A standardized bilingual language assessment was administered to 409 Spanish-English bilingual children (aged 4-7).
Caregivers reported on language exposure, and nomogram-based prediction models were used to evaluate DLD probability.
Classification accuracy, calibration curves, and decision curve analysis were employed.

Main Results:

The nomogram demonstrated generalizability with varying subtest weightings.
Bilingual language exposure did not enhance overall bilingual assessment accuracy but was vital for single-language assessments.
Spanish-only assessment combined with bilingual exposure met acceptable sensitivity and specificity thresholds.

Conclusions:

Subtest weighting ratios derived from nomograms can aid in classifying Spanish-English bilingual children with DLD.
The study discusses the practical application of nomograms and the viability of single-language assessments in clinical settings.
Optimized assessment strategies are essential for accurate DLD diagnosis in bilingual children.