Predictive validity of preschool screening tools for language and behavioural difficulties: A PRISMA systematic review
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BACKGROUND: Preschool screening for developmental difficulties is increasingly becoming part of routine health service provision and yet the scope and validity of tools used within these screening assessments is variable. The aim of this review is to report on the predictive validity of preschool screening tools for language and behaviour difficulties used in a community setting. METHODS: Studies reporting the predictive validity of language or behaviour screening tools in the preschool years were identified through literature searches of Ovid Medline, Embase, EBSCO CINAHL, PsycInfo and ERIC. We selected peer-reviewed journal articles reporting the use of a screening tool for language or behaviour in a population-based sample of children aged 2-6 years of age, including a validated comparison diagnostic assessment and follow-up assessment for calculation of predictive validity. RESULTS: A total of eleven eligible studies was identified. Six studies reported language screening tools, two reported behaviour screening tools and three reported combined language & behaviour screening tools. The Language Development Survey (LDS) administered at age 2 years achieved the best predictive validity performance of the language screening tools (sens 67%, spec 94%, NPV 88% and PPV 80%). The Strengths and Difficulties Questionnaire (SDQ) administered at age 4 years achieved the best predictive validity compared to other behaviour screening tools (Sens 31%, spec 93%, NPV 84% and PPV 52%). The SDQ and Sure Start Language Measure (SSLM) administered at 2.5 years achieved the best predictive validity of the combined language & behaviour assessments (sens 87%, spec 64%, NPV 97% and PPV 31). Predictive validity data and diagnostic odds ratios identified language screening tools as more effective and achieving higher sensitivity and positive predictive value than either behaviour or combined screening tools. Screening tools with combined behaviour and language assessments were more specific and achieved higher negative predictive value than individual language or behaviour screening tools. Parent-report screening tools for language achieved higher sensitivity, specificity and negative predictive value than direct child assessment. CONCLUSIONS: Universal screening tools for language and behaviour concerns in preschool aged children used in a community setting can demonstrate excellent predictive validity, particularly when they utilise a parent-report assessment. Incorporating these tools into routine child health surveillance could improve the rate of early identification of language and behavioural difficulties, enabling more informed referrals to specialist services and facilitating access to early intervention.
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According to Sim et al., universal screening tools for language and behavior concerns in preschool-aged children used in a community setting can demonstrate excellent predictive validity, particularly when based on parent-reported assessment.
“Indeed, according to the review by Sim et al. [69], universal screening tools for language and behavior concerns in preschool-aged children used in a community setting can demonstrate excellent predictive validity, particularly when based on parent-reported assessment.”
From Developmental Language Disorder: Early Predictors, Age for the Diagnosis, and Diagnostic Tools. A Scoping Review (2021) · cites this paper as [69]
The second strongest predictive validity data were achieved by the MacArthur Communicative Development Inventory Toddler form (ELFRA-2) at 24 months followed up by the Sprachentwicklungstest für zweijährige Kinder (SETK-3/5) at age 37 months.
“The second strongest predictive validity data were achieved by the MacArthur Communicative Development Inventory (MB-CDI) Toddler form (ELFRA-2) [115], measuring productive vocabulary, syntax and morphology, administered at an age of 24 months and followed up by the Sprachentwicklungstest für zweijährige Kinder (SETK-3/5) [135], administered at age 37 months.”
From Developmental Language Disorder: Early Predictors, Age for the Diagnosis, and Diagnostic Tools. A Scoping Review (2021) · cites this paper as [69]
The age at which children were first assessed does not appear to have a significant effect on the overall predictive performance of the language screening tool used.
“The authors concluded that the age at which children were first assessed does not appear to have a significant effect on the overall predictive performance of the language screening tool used.”
From Developmental Language Disorder: Early Predictors, Age for the Diagnosis, and Diagnostic Tools. A Scoping Review (2021) · cites this paper as [69]
Among language screening tools examined by Sim et al., the best predictive validity performance and diagnostic odds ratio was achieved by the Language Development Survey administered at a mean age of 24.7 months and the Reynell Developmental Language Scales at a mean age of 25.2 months.
“Among the language screening tools examined in the studies reviewed by Sim et al. [69], the best predictive validity performance and diagnostic odds ratio was achieved by the Language Development Survey (LDS) [106,107,108,109], a parent report of vocabulary and word combinations, administered at a mean age of 24.7 months, and the Reynell Developmental Language Scales—RDLS and NRDLS [133,134]—at a”
From Developmental Language Disorder: Early Predictors, Age for the Diagnosis, and Diagnostic Tools. A Scoping Review (2021) · cites this paper as [69]
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- Authors
- Sim, F., Thompson, L., Marryat, L., Ramparsad, N., & Wilson, P.
- Affiliations
- University of Aberdeen (GB)
- Scottish Collaboration for Public Health Research and Policy (GB)
- University of Glasgow (GB)
- Corresponding author
- Marryat, Louise
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2019-02-04
- Volume
- 14
- Issue
- 2
- Pages
- e0211409
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6361441
- OpenAlex
- W2911860711
- Cited by
- 81
- References
- 60
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 10 · 2023: 11 · 2022: 11 · 2021: 18 · 2020: 8 · 2019: 3
- FWCI
- 2.13
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (publishedVersion, cc-by)
- RePEc: Research Papers in Economics (acceptedVersion)
- Discovery Research Portal (University of Dundee) (acceptedVersion, cc-by)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- University of Aberdeen
- Topics
- Social Sciences › Psychology › Developmental and Educational Psychology › Language Development and Disorders
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Education › Early Childhood Education and Development
- Keywords
- preschool screening, predictive validity, language difficulties, behavioral problems, developmental screening, Strengths and Difficulties Questionnaire, parent report, early detection, child health monitoring, early intervention
- MeSH terms
- Behavior, Child, Preschool, Humans, Language Development, Mass Screening, Reproducibility of Results
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