Diagnostic Accuracy and Concurrent Validity of the Diagnostic Receptive and Expressive Assessment of
Jinzhu Zhao1, Lina Tang1, Jinhui Li1
1Division of Child Healthcare, Department of Pediatrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
Background:
Standardised Mandarin assessment tools for examining difficulties in language comprehension and expression at different developmental stages are limited in China. The first comprehensive standardised Mandarin assessment tool is the Diagnostic Receptive and Expressive Assessment of Mandarin-Comprehensive (DREAM-C), which is normed for children aged 2.5-8 years in Mainland China.
Aims:
This study aimed to explore the evidence-based validity of DREAM-C in children with Developmental Language Disorder (DLD) to make it clinically useful in Hubei Province, China. To evaluate the diagnostic performance of three commonly used assessment tools in identifying DLD among Mandarin-speaking children in China, using multidisciplinary clinical diagnosis as the reference standard, with particular focus on the diagnostic accuracy and concurrent validity of the DREAM-C.
Methods And Procedures:
The detailed medical history of children with speech, language and communication needs in child healthcare paediatric outpatient clinics was taken by clinicians and speech-language therapists and assessed using the DREAM-C, Gesell Developmental Schedules (GDS), and Wechsler Preschool and Primary Intelligence Scale (WPPSI-IV) in Tongji Hospital in Hubei Province, China, from December 2018 to January 2020. The sensitivity, specificity, percent agreement and correlation coefficient for the three assessments were compared for 320 children with DLD and 101 typical children.
Outcomes & Results:
The mean age of participants was 3.81 years (range: 2.5-5.7) for the DLD group and 4.08 years (range: 2.5-6.0) for the TD group. Results showed that the sensitivity and specificity of DREAM-C were as high as that of the GDS (>0.80) in children with DLD, and the Verbal Comprehension Index (VCI) in WPPSI-IV had a low sensitivity (0.58) in the DLD group. The percent agreement between the DREAM-C subscales and language developmental quotient (DQ) of GDS was also high (70.63%-88.75%). The scores of each subscale of DREAM-C had a moderate and significant positive correlation with the language DQ of GDS (r = 0.35-0.56, p < 0.05). The scores of each subtest of DREAM-C had significantly low correlation with the verbal comprehension index in WPPSI-IV (r = 0.27-0.39, p < 0.05) in the DLD group.
Conclusions And Implications:
The findings indicate that DREAM-C demonstrates good diagnostic accuracy and concurrent validity for identifying language difficulties in children with DLD. It may represent a valuable assessment option for Mandarin-speaking children with suspected DLD. Further research is warranted to examine its longitudinal applicability, cross-regional generalizability, and use in diverse clinical practice settings.
What This Paper Adds:
What is already known on the subject In English-speaking countries, well-established comprehensive language scales with robust validity and reliability standards have been extensively developed and utilised. Conversely, the profession of speech-language pathology is still emerging in mainland China. This situation has resulted in a significant shortage of standard, norm-referenced language assessments for children with language impairments. Among the limited tools available, the Diagnostic Receptive and Expressive Assessment of Mandarin-Comprehensive (DREAM-C) has stood out in recent years. What this paper adds to the existing knowledge In China, developmental-behavioural paediatricians often rely on comprehensive developmental scales to identify children at risk for developmental delay and to evaluate if a child's language development aligns with age expectations. Specialised language assessments, however, are not as commonly employed. This study investigates the evidence-based validity of the DREAM-C in comparison to traditional developmental scales for diagnosing children with DLD. What are the potential or actual clinical implications for this work? DREAM-C demonstrates diagnostic accuracy in identifying language impairments, which may support developmental-behavioural paediatricians and speech-language therapists establish an appropriate individual intervention plan for children in clinical practice.
