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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.
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.
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