Language screening tools for children 0-5 years: a systematic scoping review
The purpose of this scoping review is to identify tools for detecting deviations from normal language development in children aged 0-5 years in Norwegian child health centres.
Language development in children is a complex and crucial part of their cognitive and social development. Language screening in preschool children takes place at child health centres in Norway, mainly when the child is 2 and 4 years old. The assessment includes observation, conversations with parents and often with the use of language screening tools. The aim is to detect deviations in language development at an early stage to provide the necessary follow-up. The recommendation on language in the national professional guideline will be updated in 2024, and there is a need for a review of relevant language screening tools and their evaluation.
The purpose of this scoping review is to identify tools for detecting deviations from normal language development in children aged 0-5 years in Norwegian child health centres. We identified 47 relevant studies:
- We identified a total of 46 tools for detecting deviations from normal language development in children 0-5 years, which are considered appropriate for use in Norwegian child health centres.
- We identified research that evaluated measurement properties for 24 of the 46 tools.
- There is little research on the tools recommended for use in Norwegian child health centres in the current guideline: We identified one study described in two publications that evaluated the tool SPRÅK 4.
- There is considerable variation in the number of measurement properties assessed for each tool.
- Several of the included studies emphasise the challenges of developing and using universal language screening tools, especially for multilingual children.
The reported results of the included studies emphasise the complexity of identifying universal language assessment tools for children 0-5 years of age.
Children's language development is a complex and crucial part of their cognitive and social development, as language is essential for communication and the transfer of meaningful information. Deviations from normal language development can affect the child's ability to actively participate in interaction with peers and adults, and delayed language development can have significant consequences for the child's experience and interaction with the outside world.
The use of language screening tools to identify deviations from normal language development at Norwegian child health centres is carried out at the 2- and 4-year consultations. This includes observation of the child and conversations with parents/carers. The purpose is early identification of children with deviations from normal language development. If delayed language development is suspected, the child should be referred for further language assessment. However, early assessment is controversial, as there are different parameters and methods for assessment, as well as variations in tool formats and who administers them. National guidelines recommend systematic observation of the child's communication, language comprehension and spoken language. This scoping review is necessary because the national recommendations on language mapping have not been updated since 2006, and an update is planned for 2024.
The objective of this scoping review is to identify tools for detecting deviations from normal language development in children 0-5 years that can be used in Norwegian child health centres, and to summarise the characteristics of these tools.
We conducted a systematic scoping review. A scoping review is a type of knowledge synthesis that maps and narratively describes the existing research base in a specific topic area. To identify relevant studies, a librarian conducted searches in literature databases such as MEDLINE and Embase. We included empirical primary studies from 2000-2023 that evaluated tools/measurement instruments to detect deviations from normal language development in children aged 0-5 years suitable for use in Norwegian child health centres. The project staff selected studies according to the inclusion criteria. For each of the included studies, we extracted descriptive information about the study, the tool and the measurement properties that were evaluated according to Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). The results are presented with simple narrative presentations of results and conclusions as reported in the studies.
In summary, we identified a total of 46 tools for detecting deviations from normal language development in children 0-5 years, which are considered appropriate for use in Norwegian child health centres. For 24 of these tools, we identified research that evaluated measurement properties.
For the tools that are recommended according to current guidelines for Norwegian child health centres (Screening of Two-Year-Old Language (SATS) and SPRÅK 4), we found only one study described in two publications. Both evaluated SPRÅK 4. The measurement properties of the tool that were assessed were internal consistency (how well all the items or questions within an instrument measure the same concept), construct validity (the extent to which the instrument measures the concept or phenomenon it is intended to measure) and criterion validity (the extent to which the results from the instrument are correlated with the results from a "gold standard" instrument or already established diagnoses).
The most evaluated tool - evaluated in terms of seven measurement properties - was C-BiLLT (Computer-Based Instrument for Low Motor Language Testing). For four tools four measurement properties were evaluated: BITS (Brigance Infant and Toddler Screen), GAPS (Grammar and Phonology Screening), NRT (Nonword Repetition Test), PSRep (Preschool repetition test). The remaining 19 tools were evaluated on three or fewer measurement properties, of which nine of the tools were evaluated on only one measurement property.
The measurement property that was most frequently evaluated in the studies - measured in 31 studies - was criterion validity (diagnostic accuracy): How well the tool distinguished between children with and without language difficulties. Furthermore, internal consistency was measured in 16 studies. Six studies examined cultural validity in the assessment of children's language skills. Two studies evaluating the PPVT (Peabody Picture Vocabulary Test) reported cultural bias in the assessment of children when the PPVT-IV was used, while three studies reported no cultural bias when the PPVT-III was used.
For bilingual children, one study concluded that screening in both languages spoken by the children was the most accurate method for identifying children with language difficulties.
Discussion and Conclusion
Many tools have been developed to identify children with deviations from normal expected language development. However, many of the tools have not been evaluated, or have been evaluated to a very limited extent, regarding their measurement properties. Overall, we found that 24 tools have been developed for which there is research on their measurement properties, and which are considered appropriate for use in a Norwegian child health centre setting. The results show a lack of studies on the measurement properties of many identified tools, especially for the youngest age groups.
Overall, the included publications provide a picture of the complexity of assessing language development among younger children, including challenges related to early identification, reliability and validity of tests, and transferability to different populations and ages. Our results also highlight the importance of considering cultural and linguistic factors in the development and administration of language tests and the need for a comprehensive approach to language assessment.
The results reported in the included studies are largely consistent with trends reported in other systematic reviews. Our review and other reviews emphasise the complexity of identifying universal tools that can be used for all children, the challenges of identifying appropriate tools for multilingual children, and the need to combine different tools for a more holistic understanding of the child's language development.
This scoping review does not provide a basis for making specific recommendations for practice. A full systematic review is needed to develop such a knowledge base. However, our work has raised important questions that this scoping review cannot answer. These include which tools are best suited for language screening in Norwegian child health centres, especially for multilingual children, and how language screening can best be adapted to their needs. Subject matter experts can use the findings in this scoping review to assess the measurement properties of a selection of tools in more detail.
The knowledge gaps identified in the review include a lack of evaluations for many tools, especially for the youngest age group (0-2 years), few Nordic studies, limited number of measurement properties evaluated for many tools, and a lack of suitable tools for multilingual children. These knowledge gaps provide direction for future research in this area