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Cited by 207Language Development and DisordersDevelopmental and Educational NeuropsychologyReading and Literacy Development

Developmental Language Disorder: Early Predictors, Age for the Diagnosis, and Diagnostic Tools. A Scoping Review

Open access
Sansavini, Alessandra, Favilla, Maria Elena, Guasti, Maria Teresa, Marini, Andrea, Millepiedi, Stefania, Di Martino, Maria Valeria, Vecchi, Simona, Battajon, Nadia +20 more·2021·Brain Sciences
DOI 10.3390/brainsci11050654PMC PMC8156743
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Abstract

Background. Developmental Language Disorder (DLD) is frequent in childhood and may have long-term sequelae. By employing an evidence-based approach, this scoping review aims at identifying (a) early predictors of DLD; (b) the optimal age range for the use of screening and diagnostic tools; (c) effective diagnostic tools in preschool children. Methods. We considered systematic reviews, meta-analyses, and primary observational studies with control groups on predictive, sensitivity and specificity values of screening and diagnostic tools and psycholinguistic measures for the assessment of DLD in preschool children. We identified 37 studies, consisting of 10 systematic reviews and 27 primary studies. Results. Delay in gesture production, receptive and/or expressive vocabulary, syntactic comprehension, or word combination up to 30 months emerged as early predictors of DLD, a family history of DLD appeared to be a major risk factor, and low socioeconomic status and environmental input were reported as risk factors with lower predictive power. Optimal time for screening is suggested between age 2 and 3, for diagnosis around age 4. Because of the high variability of sensitivity and specificity values, joint use of standardized and psycholinguistic measures is suggested to increase diagnostic accuracy. Conclusions. Monitoring risk situations and employing caregivers’ reports, clinical assessment and multiple linguistic measures are fundamental for an early identification of DLD and timely interventions.

AI snapshot

Written from the paper’s full text.

TL;DR

This scoping review synthesizes 37 studies on early predictors, optimal screening/diagnosis ages, and diagnostic tools for Developmental Language Disorder (DLD) in preschool children. It concludes that screening is best around age 2–3, diagnosis around age 4, and that no single diagnostic tool is sufficient, so joint standardized and psycholinguistic measures are recommended.

Key findings

  • Early predictors of DLD include delayed gesture production, limited receptive and/or expressive vocabulary, impaired syntactic comprehension, and absence of word combinations still observable at 30 months; family history of DLD was often significantly associated with DLD, while low socioeconomic status and environmental input had lower predictive power.
  • Fisher’s meta-analysis found medium correlations between expressive-vocabulary size and later expressive language outcome (r = 0.249, p < 0.01) and between receptive language and outcome (r = 0.340, p < 0.01), with a small significant effect for socioeconomic status (r = 0.111, p < 0.01); MLU and male gender showed no significant effects, and family history lacked predictive power.
  • Screening accuracy varied widely: the Language Development Survey at age 2 had sensitivity 67%, specificity 94%, NPV 88%, and PPV 80%; MB-CDI toddler forms ELFRA-2/SETK-2 had sensitivity 61%, specificity 94%, NPV 95%, PPV 56%; the British short form MB-CDI-UKSF had sensitivity 50%, specificity 67%, NPV 60.5%, PPV 58%.
  • In one primary study, two-word combinations at 2;5 years versus three-word combinations at 3 years showed sensitivity 100% vs 91%, specificity 81% vs 91%, PPV 38% vs 56%, and NPV 100% vs 99%; the TPL screening task showed sensitivity/specificity of 0.90/0.83 at 4 years, 0.90/0.84 at 5 years, and 0.94/0.92 at 6 years.

Methods

  • Scoping review following a four-stage model, conducted as part of an Italian Consensus Conference and updated through December 2020; databases searched included PubMed, Embase, Web of Science, CENTRAL, SpeechBITE, and PsycINFO.
  • Included systematic reviews, meta-analyses, health technology assessment reports, and primary observational studies with control groups on early predictors, screening/diagnostic accuracy, and psycholinguistic measures in preschoolers; studies on children with cognitive delay, deafness, autism spectrum disorders, genetic syndromes, neurological deficits, and bilingual children were excluded.
  • From 12,253 identified records, 7,927 remained after duplicate removal, 83 were retrieved in full text, and 37 papers were included (10 systematic reviews and 27 primary studies); results were summarized narratively, and no quality assessment of included studies was performed.

Limitations

  • The paper states limitations including limited generalizability and paucity of data on languages other than English, difficulty generalizing psycholinguistic measures across languages, difficulty translating results into clinical service recommendations, lack of clear evidence on the efficacy of early screening to reduce later DLD incidence, and limited evidence on diagnostic accuracy of tools used in clinical practice.
  • The paper also states that no assessment of study quality was performed, and it notes heterogeneity in nosographic labels, diagnostic criteria, and cut-offs across studies, as well as the difficulty of distinguishing predictors of general language development from predictors of DLD.
  • Evident from the text: none of the included studies directly addressed the optimal age range for screening/diagnostic tools (Q2), so age recommendations are indirect; many findings concern late talkers or children at risk rather than fully diagnosed DLD, and sensitivity/specificity values vary widely across tools and measures.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/brainsci11050654

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 195 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    One study reviewed by Bettio and colleagues reported a persistent gap in vocabulary equivalent to eight months of vocabulary growth between children with and without socioeconomic disadvantages.

    “One of the studies reviewed by Bettio and colleagues [73] reported a persistent gap in vocabulary equivalent to eight months of vocabulary growth between children with and without socioeconomic disadvantages.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] Bettio, 2019, Risk and protective factors for language development delay, Psicol. Estud.

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  • Findingcitation

    The predictive value of dynamic factors such as mother-child interaction is low.

    “However, the review also suggested that the predictive value of such factors is low”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [73] Bettio, 2019, Risk and protective factors for language development delay, Psicol. Estud.

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  • Findingcitation

    Belonging to a family with four or more children seemed to be a predictive factor only up to age four.

    “Belonging to a family with four or more children, by contrast, seemed to be a predictive factor (possibly linked to divided attention by parents) only up to the age of four.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] Bettio, 2019, Risk and protective factors for language development delay, Psicol. Estud.

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  • Findingcitation

    Overlap with other environmental factors may be a confounding factor.

    “as well as overlap with other environmental factors (e.g., different language spoken at home and at kindergarten) may be confounding factors.”
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    • cites [73] Bettio, 2019, Risk and protective factors for language development delay, Psicol. Estud.

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  • Findingcitation

    The effects of biological risk (low birth weight) on language development appeared to be contingent on environmental factors such as parental responsiveness.

    “For instance, the effects of biological risk (low birth weight) on language development appeared to be contingent on environmental factors such as parental responsiveness.”
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    • cites [73] Bettio, 2019, Risk and protective factors for language development delay, Psicol. Estud.

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  • Classified as probably not a substantial claim. 32
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    Findingcitation

    Gender may be a predictive factor of language development in children under age three, but after this age gender difference might become less evident.

    “By contrast, gender may be a predictive factor of language development in children under the age of three. After this age, gender difference might become less evident.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] Bettio, 2019, Risk and protective factors for language development delay, Psicol. Estud.

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    Findingcitation

    Wallace et al. confirmed the validity of some screening tools: MB-CDI and CSBS ITC for parents, and SKOLD for professionals.

    “The study by Wallace et al. [66] confirmed the validity of some screening tools, such as, for parents, the MacArthur–Bates Communicative Development Inventory (MB-CDI; [113]), and the Infant Toddler Checklist of the Communication and Symbolic Behavior Scales ([CSBS ITC; [114]), and, for professionals, the Screening Kit of Language Development ([SKOLD, [112]) questionnaires.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [66] Wallace, 2015, Screening for Speech and Language Delay in Children 5 Years Old and Younger: A Systematic Review, Pediatrics source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Measurement issues in assessing environmental factors may be confounding factors.

    “measurement issues (i.e., vocabulary measures through parental reports represented by the MacArthur–Bates Communicative Development Inventory (MB-CDI) for two of the included studies, by the Ages and Stages Questionnaires (ASQ) for two other studies and by non-standardized, ad hoc questions to the parents for an additional study)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] Bettio, 2019, Risk and protective factors for language development delay, Psicol. Estud.

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Two studies included in Bettio et al.'s review support the view that environmental factors exert a higher influence on language development compared to biological/genetic ones.

    “Notably, two of the studies included in their review [73] support the view that environmental factors exert a higher influence on language development compared to biological/genetic ones.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] Bettio, 2019, Risk and protective factors for language development delay, Psicol. Estud.

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    Findingcitation

    None of the selected studies directly focused on the most appropriate age range for the use of screening and diagnostic tools, but almost all provided indirect indications to answer this question.

    “Even if none of the selected studies directly focused on the problem of the most appropriate age range for the use of screening and diagnostic tools (Q2), almost all of them provided indirect indications to answer Q2 [74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100].”
    Quote in the paperSubstantial claim

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    Findingnone given

    Optimal time for screening is suggested between age 2 and 3, and for diagnosis around age 4.

    “Optimal time for screening is suggested between age 2 and 3, for diagnosis around age 4.”
    Quote in the paperSubstantial claim

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    Findingcitation

    MLU and male gender showed no significant effects on later expressive language outcomes in late talkers.

    “MLU and male gender showed no significant effects”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [72] Fisher, 2017, A systematic review and meta-analysis of predictors of expressive-language outcomes among late talkers, J. Speech Lang. Hear. Res. source

      Not checked in the free run.

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    Findingcitation

    Family history lacked predictive power for later expressive language outcomes in late talkers, possibly due to heterogeneity of the type of family history assessed.

    “family history also lacked predictive power, possibly due to the heterogeneity of the type of family history assessed in the various studies.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [72] Fisher, 2017, A systematic review and meta-analysis of predictors of expressive-language outcomes among late talkers, J. Speech Lang. Hear. Res. source

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    Findingcitation

    Mixed results were found for the SDQ, DDST, and GLS, with sensitivity values of 31%, 44%, and 67.4%, and PPV values of 31%, 41%, and 31.5%, respectively, which were unsatisfactory.

    “Mixed results were found also for the Strengths and Difficulties Questionnaire (SDQ) [118], the Denver Developmental Screening Test (DDST) [119,120], and the General Language Screen (GLS) [121] for which both sensitivity values (31%, 44%, and 67.4%, respectively) and PPV values (31%, 41%, and 31.5%, respectively) were particularly unsatisfactory”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [118] Muris, 2003, The Strengths and Difficulties Questionnaire (SDQ), Eur. Child Adolesc. Psychiatry source

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    • cites [119] Frankenburg, 1967, The Denver Developmental Screening Test, J. Pediatr. source

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    • cites [120] Cadman, 1984, The usefulness of the Denver Developmental Screening Test to predict kindergarten problems in a general community population, Am. J. Public Health source

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    • cites [121] Stott, 2002, Screening for speech and language disorders: The reliability, validity and accuracy of the General Language Screen, Int. J. Lang. Commun. Disord. source

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    Findingnone given

    ALL, CELF-5, and PLS-5 were not examined in the independent literature.

    “The ALL, CELF-5, and PLS-5 were not examined in the independent literature.”
    Quote in the paperNot a substantial claim

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    Findingown data

    ALL, CELF-5, and PLS-5 were rated as having "strong" or "moderate" evidence across two or more measurement properties, including content validity and hypothesis testing for all three, with CELF-5 also having positive ratings for reliability.

    “The ALL, CELF-5, and PLS-5 were all rated as having “strong” or “moderate” evidence across two or more measurement properties (content validity and hypothesis testing for the three of them, with CELF-5 also having positive ratings for reliability).”
    Quote in the paperSubstantial claim

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    Findingcitation

    Children who failed the Fluharty-2 scored significantly lower on each of the diagnostic measures (SPELT-P2, MLUm, finite verb morphology composite, IPSyn) than children who passed the Fluharty-2, but the effect size for MLUm was small.

    “Children who failed the Fluharty-2 scored significantly lower on each of the diagnostic measures than children who passed the Fluharty-2, but the effect size for MLUm was small.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [98] Eisenberg, 2019, Concurrent validity of the Fluharty preschool speech and language screening test–second edition at age 3: Comparison with four diagnostic measures, Lang. Speech Hear. Ser. source

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  • May combine two claims.

    Findingcitation

    Some investigations on predictors of persistent language delay were general population studies, while others referred to late talkers or children at risk of language delay.

    “Additionally, some of the investigations on the predictors of persistent language delay were general population studies (e.g., [75]), while others referred to late talkers (e.g., [72,86,88]) or children at risk of language delay (e.g., [79,80,81]).”
    Quote in the paperNot a substantial claim0 of 7 sources checked
    • cites [75] Hsu, 2016, Early gesture, early vocabulary, and risk of language impairment in preschoolers, Res. Dev. Disabil. source

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    • cites [72] Fisher, 2017, A systematic review and meta-analysis of predictors of expressive-language outcomes among late talkers, J. Speech Lang. Hear. Res. source

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    • cites [86] Bello, 2018, Prediction and persistence of late talking: A study of Italian toddlers at 29 and 34 months, Res. Dev. Disabil. source

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    • cites [88] Chilosi, 2019, Which linguistic measures distinguish transient from persistent language problems in Late Talkers from 2 to 4 years? A study on Italian speaking children, Res. Dev. Disabil. source

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    • cites [79] Grimminger, 2017, In infants’ hands: Identification of preverbal infants at risk for Primary Language Delay, Child Dev. source

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    • cites [80] Ritterfeld, 2020, Integrated communication system: Gesture and language acquisition in typically developing children and children with LD and DLD, Front. Psychol. source

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    • cites [81] Sansavini, 2019, Low rates of pointing in 18-month-olds at risk for autism spectrum disorder and extremely preterm infants: A common index of language delay?, Front. Psychol. source

      Not checked in the free run.

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    Findingcitation

    The SIOLD showed acceptable sensitivity (0.75-0.86) and good specificity (0.95) values.

    “The SIOLD showed acceptable sensitivity (ranging between 0.75 and 0.86) and good specificity (0.95) values.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [100] Puglisi, 2020, Screening for the identification of oral language difficulties in Brazilian preschoolers: A validation study, Lang. Speech Hear. Ser. source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Delayed gesture production, limited receptive and/or expressive vocabulary size, impaired syntactic comprehension, and the absence of two-word combinations up to 30 months of age emerged as potential early predictors of DLD.

    “Delayed gesture production, limited receptive and/or expressive vocabulary size, impaired syntactic comprehension, and the absence of two-word combinations up to 30 months of age emerged as potential early predictors of DLD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The TPL screening task showed good sensitivity and fair specificity for 4-year-olds (0.90 and 0.83) and 5-year-olds (0.90 and 0.84), and good sensitivity and specificity for 6-year-olds (0.94 and 0.92), with positive and negative likelihood ratios moderate to large.

    “The TPL screening task showed good sensitivity and fair specificity for 4- (0.90 and 0.83, respectively) and 5-year-olds (0.90 and 0.84, respectively) and good sensitivity and specificity for 6-year-olds (0.94 and 0.92, respectively), with positive and negative likelihood ratios being moderate to large.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [99] Benavides, 2018, Two Grammatical Tasks for Screening Language Abilities in Spanish-Speaking Children, Am. J. Speech-Lang. Pathol. source

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  • May combine two claims.

    Findingnone given

    The predictive power of some reported indicators changes over time, and some predictors reported in selected studies referred to late talkers while others referred to prediction of fully diagnosed DLD.

    “Noteworthy, we should also highlight that the predictive power of some of the reported indicators changes over time and that some of the predictors reported in the selected studies referred to late talkers, while others referred to the prediction of fully diagnosed DLD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Although the SIOLD overpredicted positive cases, it identified most children with true language disorders and passed most children without language disorders.

    “Although the SIOLD overpredicted positive cases, it identified most children with true language disorders and passed most children without language disorders.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [100] Puglisi, 2020, Screening for the identification of oral language difficulties in Brazilian preschoolers: A validation study, Lang. Speech Hear. Ser. source

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  • May combine two claims.

    Findingcitation

    All studies examined by the review were performed on samples composed of an equal number of TD and DLD subjects (prevalence 50%) and most on unselected populations.

    “(b) all the studies were performed on samples composed of an equal number of TD and DLD subjects (prevalence 50%) and most of them on unselected populations;”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [71] Maleki Shahmahmood, T., Jalaie, S.H., Soleymani, Z., Haresabadi, F., and Nemati, P. (2016). A systematic review on diagnostic procedures for specific language impairment: The sensitivity and specificity issues. J. Res. Med. Sci., 21–67. source

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  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    Such predictors have almost never been analyzed in terms of their specific, individual predictive and discriminating power, even in studies where such indicators have been provided for the whole screening tool.

    “Unfortunately, such predictors have almost never been analyzed in terms of their specific, individual predictive and discriminating power, even in studies where such indicators have been provided for the whole screening tool.”
    Quote in the paperNot a substantial claim

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    Findingnone given

    The different studies have not devoted the same attention to all kinds of risk factors; there is a prevalence of studies on biological factors while just a few studies have focused on environmental risk factors, dynamic risk factors, and protective factors.

    “Unfortunately, the different studies have not devoted the same attention to all kinds of risk factors. Indeed, there is a prevalence of studies on biological factors while just a few studies have focused on environmental risk factors, dynamic risk factors (such as family interactions) and protective factors.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Studies have focused on children aged 5 years and younger for timing of screening and assessment of DLD; however, unclear results have been reported about the optimal age, frequency and efficacy of screening.

    “As for the timing at which risk for DLD should be screened and DLD assessed, studies have focused on children aged 5 years and younger; however, unclear results have been reported about the optimal age, frequency and efficacy of screening.”
    Quote in the paperSubstantial claim

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    Findingreasoning

    The same cannot be said for psycholinguistic measures; they cannot be easily observed regardless of language.

    “Unfortunately, the same cannot be said for psycholinguistic measures.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Some studies providing data on languages other than English exist, but interesting studies on DLD screening and diagnostic tools in Romance languages are mainly published in national reviews or based on relatively small samples, so they did not satisfy selection criteria and were not included in the present review.

    “Indeed, some studies providing data on languages other than English do exist. For instance, there are interesting studies on DLD screening and diagnostic tools in Romance languages, but they are mainly published in national reviews or are based on relatively small samples; therefore, they did not satisfy selection criteria and have not been included in the present review.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Beyond general support for the validity of screening tools at an early age, little evidence was found for the usefulness of screening procedures in order to reduce the incidence of the disorders; even when screenings correctly identified children at risk, evidence regarding the efficacy of an intervention aimed at modifying the children's developmental trajectories is scarce.

    “Beyond general support for the validity of screening tools at an early age, little evidence was found for the usefulness of screening procedures in order to reduce the incidence of the disorders: even when the screenings correctly identified children at risk, evidence regarding the efficacy of an intervention aimed at modifying the children’s developmental trajectories is scarce.”
    Quote in the paperSubstantial claim

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    Premisecitation

    Early word comprehension and gesture production are tightly associated and predictive of expressive vocabulary at 24 months.

    “Early word comprehension and gesture production are tightly associated [4,6] and predictive of expressive vocabulary at 24 months [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Bavin, 2008, The early language in Victoria study: Predicting vocabulary at age one and two years from gesture and object use, J. Child Lang. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Two independent reviewers screened titles and abstracts to exclude irrelevant studies, potentially eligible studies were retrieved in full text and screened for eligibility, and disagreements were resolved through discussion.

    “Two independent reviewers screened titles and abstracts to exclude irrelevant studies. Potentially eligible studies were retrieved in full text and screened for eligibility. Disagreements were resolved through discussion.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Because of the high variability of sensitivity and specificity values, joint use of standardized and psycholinguistic measures is suggested to increase diagnostic accuracy.

    “Because of the high variability of sensitivity and specificity values, joint use of standardized and psycholinguistic measures is suggested to increase diagnostic accuracy.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    With very frequently occurring disorders such as DLD, it is better to have high specificity than high sensitivity.

    “with very frequently occurring disorders such as DLD, they argued that, even if high values of both sensitivity and specificity are desirable, it is better to have high specificity (accurate identification of children without speech or language delays, i.e., few false positives) than high sensitivity (accurate identification of children with speech or language delays, i.e., few false negatives).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [64] Law, 1998, Screening for speech and language delay: A systematic review of the literature, Health Technol. Assess. source

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  • May combine two claims.

    Premisecitation

    Potential risk factors for DLD include a family history of speech and language impairments, low parental education and/or socioeconomic status, male gender, and pre- or peri-natal factors such as being born preterm or with low birth weight.

    “Growing evidence suggests that potential risk factors include a family history of speech and language impairments, a low level of parental education and/or socioeconomic status (SES), male gender, and pre- or peri-natal factors such as being born preterm or with low birth weight [19,22,51].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [19] Snowling, 2016, Language profiles and literacy outcomes of children with resolving, emerging, or persisting language impairments, J. Child Psychol. Psychiatry source

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    • cites [22] Bishop, 2017, The Catalise-2 Consortium. Phase 2 of CATALISE: A multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology, J. Child Psychol. Psychiatry Allied Discip. source

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    • cites [51] Sansavini, 2010, Does preterm birth increase a child’s risk for language impairment?, Early Hum. Dev. source

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  • May combine two claims.

    Premisecitation

    Prompt inclusion into a rehabilitation program might help children with DLD improve their language skills by age 5 and reduce the risk of subsequent sequelae.

    “prompt inclusion into a rehabilitation program might help them improve their language skills by the age of 5 and reduce the risk of subsequent sequelae [50].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50] Spaulding, 2006, Eligibility criteria for language impairment: Is the low end of normal always appropriate?, Lang. Speech Hear. Serv. Sch. source

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    Premisecitation

    Some late talkers will not catch up with their peers and, after the age of three, will likely receive a diagnosis of Language Disorder, more recently labelled Developmental Language Disorder (DLD).

    “Some late talkers, however, will not catch up with their peers and, after the age of three, will likely receive a diagnosis of Language Disorder [21], more recently labelled Developmental Language Disorder (DLD, [22]).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [21] APA–American Psychiatric Association (2013). DSM-5 Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.]. source

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    • cites [22] Bishop, 2017, The Catalise-2 Consortium. Phase 2 of CATALISE: A multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology, J. Child Psychol. Psychiatry Allied Discip. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    For each included study, three independent reviewers extracted information on study design, population characteristics, type of test, type of comparison group, language domain assessed, and tool, setting and figures involved.

    “For each included study, three independent reviewers extracted information on the study design, population characteristics, type of test, type of comparison group, language domain assessed, and tool, setting and figures involved.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    An assessment of the quality of the included studies was not performed.

    “An assessment of the quality of the studies was not performed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The negative association between language scores and maternal directives attenuated after adjusting for co-occurring maternal responsive expansions and was strongest for children exposed to lower quality interactions.

    “The latter association attenuated after adjusting for co-occurring maternal responsive expansions and was strongest for children exposed to lower quality interactions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [78] Conway, 2018, Maternal communicative behaviours and interaction quality as predictors of language development: Findings from a community-based study of slow-to-talk toddlers, Int. J. Lang. Commun. Disord. source

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  • Classified as probably not a substantial claim.

    Premisecitation

    The combination of several measures provides better results for identifying language delay/disorder.

    “the review by Maleki Shahmahmood et al. [71] suggests that the combination of several measures provides better results.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [71] Maleki Shahmahmood, T., Jalaie, S.H., Soleymani, Z., Haresabadi, F., and Nemati, P. (2016). A systematic review on diagnostic procedures for specific language impairment: The sensitivity and specificity issues. J. Res. Med. Sci., 21–67. source

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  • The quote only partly states this claim.

    Premisecitation

    Participants' language scores at 24, 36, and 48 months are negatively associated with maternal directives in mother-child play interactions at 24 months.

    “At the same time, they were negatively associated with maternal directives in mother–child play interactions at 24 months.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [78] Conway, 2018, Maternal communicative behaviours and interaction quality as predictors of language development: Findings from a community-based study of slow-to-talk toddlers, Int. J. Lang. Commun. Disord. source

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  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationcitation

    The findings support an integrated speech-gesture communication system and the importance of early assessment of gesture production and comprehension to detect children with language delay.

    “Their findings support the view of an integrated speech–gesture communication system and the importance of an early assessment of gesture production and comprehension to detect children with LD.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [80] Ritterfeld, 2020, Integrated communication system: Gesture and language acquisition in typically developing children and children with LD and DLD, Front. Psychol. source

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  • May combine two claims.

    Premisecitation

    The longitudinal study by Hsu and Iyer showed a prevalence of DLD in males, children belonging to ethnic minorities, and children born to mothers with low levels of formal education and poor linguistic skills.

    “The longitudinal study by Hsu and Iyer [75] showed a prevalence of DLD in males, children belonging to ethnic minorities, and born to mothers with low levels of formal education and with poor linguistic skills.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] Hsu, 2016, Early gesture, early vocabulary, and risk of language impairment in preschoolers, Res. Dev. Disabil. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A second group, "Slow Learners," had mild expressive delay at 28 months that persisted up to 36 months and showed slow language recovery within 48 months.

    “A second group (i.e., “Slow Learners”) had mild expressive delay at 28 months that persisted up to 36 months and showed a slow language recovery within 48 months.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [88] Chilosi, 2019, Which linguistic measures distinguish transient from persistent language problems in Late Talkers from 2 to 4 years? A study on Italian speaking children, Res. Dev. Disabil. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The K-ASQ appears to be a good screening tool, but because its communication domain has six items exploring receptive and expressive linguistic skills, it is not possible to discriminate which item the sensitivity of the scale is related to.

    “The K-ASQ test appears to be a good screening tool but, since the communication domain is composed of six different items exploring the children’s receptive and expressive linguistic skills, it is not possible to discriminate to which item the sensitivity of the scale is related, thus failing to provide crucial information for the question under consideration.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [84] Kim, 2016, The Comparison of M-B CDI-K Short Form and K-ASQ as Screening Test for Language Development, Ann. Rehabil. Med. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Associations were also found for low socioeconomic conditions, linguistic input, and quality of communicative interactions, but with more limited predictive power.

    “Associations were also found for low socioeconomic conditions, linguistic input and quality of communicative interactions but with more limited predictive power.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Expressive but not receptive vocabulary at 15 months, assessed with the MB-CDI, contributed to DLD risk at 3 and 4;6 years and mediated the effects of gesture production at 15 months.

    “As for expressive vocabulary, in Hsu and Iyer [75], expressive (but not receptive) vocabulary at 15 months (assessed with the MB-CDI) contributed to DLD risk at 3 and at 4;6 years, also mediating the effects of gesture production at 15 months (again assessed with the MB-CDI).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] Hsu, 2016, Early gesture, early vocabulary, and risk of language impairment in preschoolers, Res. Dev. Disabil. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Delayed gesture production, limited receptive and/or expressive vocabulary size, impaired syntactic comprehension, and absence of two-word combinations still observable at 30 months of age appear as potential early predictors of DLD.

    “In sum, delayed gesture production, limited receptive and/or expressive vocabulary size, impaired syntactic comprehension, and absence of two-word combinations still observable at 30 months of age appear as potential early predictors of DLD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The Korean integral version of the Ages and Stages Questionnaire (K-ASQ) is valid as a screening tool for mixed developmental disorders and, to a lesser degree, for isolated DLD.

    “The study by Kim et al. [84], on a population of Korean children with a mean age of 29.7 months, highlighted the validity of the Korean integral version of the Ages and Stages Questionnaire (K-ASQ Questionnaire; [127]) as a screening tool for mixed developmental disorders and—to a lesser degree—for isolated DLD.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] Kim, 2016, The Comparison of M-B CDI-K Short Form and K-ASQ as Screening Test for Language Development, Ann. Rehabil. Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Both the three-word combination at 3 years and the two-word combination at 2;5 years are accurate measures for early identification of children with DLD, with sensitivity 100% versus 91%, specificity 81% versus 91%, positive predictive value 38% versus 56%, and negative predictive value 100% versus 99%.

    “Both the three-word combination at 3 years and the two-word combination at 2;5 years resulted as accurate measures for the early identification of children with DLD, with, respectively good sensitivity (100% versus 91%), specificity (81% versus 91%), positive predictive (38% versus 56%), and negative predictive value (100% versus 99%).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [89] Nayeb, 2019, Modifying a language screening tool for three-year-old children identified severe language disorders six months earlier, Acta Paediatr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    At t2, 33 children identified as late talkers at t1 performed more poorly than age-matched typically developing peers in articulatory and naming skills, lexical comprehension, and lexical knowledge, showing a persisting mild lexical deficit.

    “At t2, 33 children, identified as late talkers at t1, performed more poorly as compared with age-matched TD peers in articulatory and naming skills, lexical comprehension, and lexical knowledge, showing a persisting mild lexical deficit.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [76] Marini, 2017, The role of phonological working memory and environmental factors in lexical development in Italian-speaking late talkers: A one year follow up study, J. Speech Lang. Hear. Res. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The study by Kademann et al. has limitations because its sample is not representative of the population for socioeconomic status and educational level, and some children underwent speech therapy from 3 to 4 years.

    “However, the study by Kademann et al. [87] has some limitations because the sample, as stated by the authors, is not representative of the population for socioeconomic status and educational level (higher than the average, but lower than in other longitudinal studies); furthermore, some of the children underwent speech therapy from 3 to 4 years.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [87] Kademann, 2015, Spätsprecher im Kindergartenalter, Mon. Kinderheilkd source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Children (10%) who were unable to cooperate in screening at age 2;5 had an increased risk for DLD and should be carefully monitored.

    “Those children (10%), who were unable to cooperate in the screening at age 2;5, had an increased risk for DLD and should be carefully monitored.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [89] Nayeb, 2019, Modifying a language screening tool for three-year-old children identified severe language disorders six months earlier, Acta Paediatr. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    An early syntactic comprehension delay may predict a future diagnosis of DLD in late talkers, and measures of grammar comprehension should be included in late talkers.

    “These findings suggest that an early syntactic comprehension delay may predict a future diagnosis of DLD in late talkers and confirm the need to include measures of grammar comprehension in late talkers.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [88] Chilosi, 2019, Which linguistic measures distinguish transient from persistent language problems in Late Talkers from 2 to 4 years? A study on Italian speaking children, Res. Dev. Disabil. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A third group, "Children with DLD," had impaired syntactic comprehension and severe expressive delay at 28 months, difficulties in expressive grammar at 36 months, and was diagnosed as DLD at 48 months.

    “A third group (i.e., “Children with DLD”) had impaired syntactic comprehension and severe expressive delay at 28 months and difficulties in expressive grammar at 36 months and was diagnosed as DLD at 48 months.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [88] Chilosi, 2019, Which linguistic measures distinguish transient from persistent language problems in Late Talkers from 2 to 4 years? A study on Italian speaking children, Res. Dev. Disabil. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Not only expressive vocabulary but also gesture production and symbolic skills should be assessed in late talkers at 29 months.

    “This provided further evidence that not only expressive vocabulary, but also gesture production and symbolic skills should be assessed in late talkers at this age.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [86] Bello, 2018, Prediction and persistence of late talking: A study of Italian toddlers at 29 and 34 months, Res. Dev. Disabil. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The FinCDI-SF and FinCSBS screening tools have high specificity but only moderate sensitivity.

    “The two screening tools were shown to have high specificity but only moderate sensitivity.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [83] Vehkavuori, 2018, Screening language skills at 2;0, Infant Behav. Dev. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Because effect sizes were small overall, other variables such as a family history of DLD should also be considered for a stronger prediction of persisting language delay.

    “As effect sizes were small overall, the authors argued that other variables, such as a family history of DLD, should also be considered for a stronger prediction of persisting language delay.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [82] Morgan, 2020, Measures of early social communication and vocabulary production to predict language outcomes at two and three years in late-talking toddlers, Early Child. Res. Q. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationcitation

    Language screening at 2 years of age should assess both receptive and expressive communicative-linguistic skills.

    “In line with the findings by Morgan et al. [82], this study further highlights the need for the assessment of both receptive and expressive communicative–linguistic skills in language screening at 2 years of age.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [82] Morgan, 2020, Measures of early social communication and vocabulary production to predict language outcomes at two and three years in late-talking toddlers, Early Child. Res. Q. source

      Not checked in the free run.

    • cites [83] Vehkavuori, 2018, Screening language skills at 2;0, Infant Behav. Dev. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    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”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [69] Sim, F., Thompson, L., Marryat, L., Ramparsad, N., and Wilson, P. (2019). Predictive validity of preschool screening tools for language and behavioural difficulties: A PRISMA systematic review. PLoS ONE, 14. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Denman et al.'s review systematically examined and evaluated the psychometric quality of diagnostic spoken language assessment tools for children aged 4-12 years using the COSMIN checklist.

    “In order to collect information on the overall psychometric quality of assessment tools and identify those having the best evidence of psychometric quality, Denman et al.’s review [70] systematically examined and evaluated the psychometric quality of diagnostic spoken language assessment tools for children aged 4–12 years using the Consensus Based Standards for the Selection of Health Status”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [70] Denman, 2017, Psychometric properties of language assessments for children aged 4–12 years: A systematic review, Front. Psychol. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The age between 15 and 24 months is assumed as adequate for screenings, and some diagnostic tools for DLD are also used with toddlers for identifying those with weaker linguistic development.

    “The conclusion we can derive is that they assume the age between 15 and 24 months as adequate for screenings and that some diagnostic tools for DLD are also used with toddlers for identifying those with a weaker linguistic development.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [68] Kasper, 2011, Population-Based Screening of Children for Specific Speech and Language Impairment in Germany: A Systematic Review, Folia Phoniatr. Logop. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The decrease in specificity with time may mean that some children with language delays catch up and display more typical language skills as they grow older.

    “The authors suggested that the decrease in specificity with time may mean that some children with language delays catch up and display more typical language skills as they grow older [66].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [66] Wallace, 2015, Screening for Speech and Language Delay in Children 5 Years Old and Younger: A Systematic Review, Pediatrics source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Although some screening tools can accurately identify language delays or disorders, none appear more accurate than others, and no age is shown to be particularly adequate for screening.

    “Wallace et al. [66] confirmed that, although some screening tools can accurately identify language delays or disorders, none of them appear to be more accurate than others, and no age is shown to be particularly adequate for screening.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [66] Wallace, 2015, Screening for Speech and Language Delay in Children 5 Years Old and Younger: A Systematic Review, Pediatrics source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    By the age of 4, a diagnosis of DLD has already been made, and by then it is possible to use diagnostic tools to collect data about linguistic abilities as well as non-linguistic abilities that can reveal markers associated with DLD.

    “Thirdly, the studies on linguistic and communicative abilities in TD children and children already diagnosed with DLD showed that, by the age of 4, a diagnosis has already been made and that, by then, it is possible to use diagnostic tools to collect data about linguistic abilities as well as non-linguistic abilities that can reveal markers associated with DLD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The following age ranges have been identified for assessment of potential predictors of DLD: communicative gestures between 12 and 30 months; communication and receptive lexical skills between 15 and 30 months; expressive lexical skills between 15 and 32 months; syntactic comprehension from 28 months onward; word combination from 30 months onward; non-word repetition from 32 months onward; and Exp

    “The following age ranges have been identified: (a) use of communicative gestures between 12 and 30 months [75,79,80,81,86]; (b) communication and receptive lexical skills between 15 and 30 months [75,82,83,86]; (c) expressive lexical skills between 15 and 32 months [75,76,82,83,86,87]; (d) syntactic comprehension from 28 months onward [88]; (f) word combination from 30 months onward [89]; (g) non”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [75] Hsu, 2016, Early gesture, early vocabulary, and risk of language impairment in preschoolers, Res. Dev. Disabil. source

      Not checked in the free run.

    • cites [79] Grimminger, 2017, In infants’ hands: Identification of preverbal infants at risk for Primary Language Delay, Child Dev. source

      Not checked in the free run.

    • cites [80] Ritterfeld, 2020, Integrated communication system: Gesture and language acquisition in typically developing children and children with LD and DLD, Front. Psychol. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The relationship between the age at which a child is identified as a late talker and the actual outcome has not been adequately examined yet.

    “Moreover, Fisher [72] highlighted that the relationship between the age at which a child is identified as a late talker and the actual outcome has not been adequately examined yet.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [72] Fisher, 2017, A systematic review and meta-analysis of predictors of expressive-language outcomes among late talkers, J. Speech Lang. Hear. Res. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Maleki Shahmahmood et al. pointed at the preschool period, starting from 3 years, as the most important in the diagnostic process.

    “Maleki Shahmahmood et al. [71] pointed at the preschool period, starting from 3 years, as the most important in the diagnostic process.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [71] Maleki Shahmahmood, T., Jalaie, S.H., Soleymani, Z., Haresabadi, F., and Nemati, P. (2016). A systematic review on diagnostic procedures for specific language impairment: The sensitivity and specificity issues. J. Res. Med. Sci., 21–67. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Nelson et al. found no studies addressing the question of appropriate age range and highlighted the need to derive indications for optimal ages and intervals for screening from additional work about the effectiveness of school-based interventions.

    “The authors found no studies addressing the question and highlighted the need to derive indications for the identification of optimal ages and intervals for screening from additional work about the effectiveness of school-based interventions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [67] Nelson, 2006, Screening for Speech and Language Delay in Preschool Children: Systematic Evidence Review for the US Preventive Services Task Force, Pediatrics source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The TPL and SIOLD studies involved 4- to 6-year-old children, with diagnostic accuracy increasing toward 5 years of age.

    “The study concerning the Tamiz de Problemas de Lenguaje—TPL [99]—and the Screening for Identification of Oral—SIOLD [100]—involved 4- to 6-year-old children with diagnostic accuracy increasing toward 5 years of age.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [99] Benavides, 2018, Two Grammatical Tasks for Screening Language Abilities in Spanish-Speaking Children, Am. J. Speech-Lang. Pathol. source

      Not checked in the free run.

    • cites [100] Puglisi, 2020, Screening for the identification of oral language difficulties in Brazilian preschoolers: A validation study, Lang. Speech Hear. Ser. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    According to Fisher, a timely diagnosis can be performed when the child is between 4 and 5 years old, while children under age 3 can only be described as late talkers and therefore only at risk for DLD but not yet diagnosed with DLD, without detail on what happens between 3 and 4 years.

    “Therefore, according to Fisher [72], a timely diagnosis can be performed when the child is between 4 and 5 years old, while children under the age of 3 can only be described as late talkers and, therefore, only at risk for DLD but not yet diagnosed with DLD, without any detail on what happens between 3 and 4 years.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [72] Fisher, 2017, A systematic review and meta-analysis of predictors of expressive-language outcomes among late talkers, J. Speech Lang. Hear. Res. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The issue of early identification requires the previous solution of other issues, namely the need to distinguish between children with speech and language disorders and late talkers in a pre-symptomatic phase, likely in the 1 to 4-year-old age range.

    “As the authors explicitly pointed out, the issue of early identification requires the previous solution of other issues, namely the need to distinguish between children with speech and language disorders and late talkers in a pre-symptomatic phase (likely in the 1 to 4-year-old age range).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [65] Law, 2000, Prevalence and natural history of primary speech and language delay: Findings from a systematic review of the literature, Int. J. Lang. Commun. Disord. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Maleki Shahmahmood et al. [71] analyzed literature published in English-language journals between 2000 and 2015, including 23 studies concerning diagnosis of DLD (SLI) in monolingual preschool children over age 3.

    “Another review by Maleki Shahmahmood et al. [71] analyzed the literature published in English-language journals between 2000 and 2015, including 23 studies concerning the diagnosis of DLD (in the paper, SLI) in monolingual children of preschool age over the age of 3 years.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [71] Maleki Shahmahmood, T., Jalaie, S.H., Soleymani, Z., Haresabadi, F., and Nemati, P. (2016). A systematic review on diagnostic procedures for specific language impairment: The sensitivity and specificity issues. J. Res. Med. Sci., 21–67. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Fluharty-2 test included 3-year-old children, but the findings did not confirm its accuracy for this age range.

    “The study [98] concerning the Fluharty-2 test included 3-year-old children but the findings did not confirm its accuracy for this age range.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [98] Eisenberg, 2019, Concurrent validity of the Fluharty preschool speech and language screening test–second edition at age 3: Comparison with four diagnostic measures, Lang. Speech Hear. Ser. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Denman et al. took into account tests assessing language skills across at least two of the three domains of semantics, morphosyntax, and discourse.

    “Denman et al. [70] took into account tests assessing language skills across at least two of the three domains of semantics, morphosyntax, and discourse.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [70] Denman, 2017, Psychometric properties of language assessments for children aged 4–12 years: A systematic review, Front. Psychol. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Studies were included if they concerned standardized norm-referenced spoken language assessments, from any English-speaking country with normative data for use with mono-lingual English-speaking children aged 4-12 years.

    “Studies were included if they concerned standardized norm-referenced spoken language assessments, from any English-speaking country with normative data for use with mono-lingual English-speaking children aged 4–12 years.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [70] Denman, 2017, Psychometric properties of language assessments for children aged 4–12 years: A systematic review, Front. Psychol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Denman et al. did not consider responsiveness, cross-cultural validity, and criterion validity.

    “Denman et al. did not consider responsiveness, cross-cultural validity (as all the tools were originally published in English) and criterion validity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [70] Denman, 2017, Psychometric properties of language assessments for children aged 4–12 years: A systematic review, Front. Psychol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The accuracy of some screening tools seems to drop over time, as observed in two studies on a parent report screening tool administered at 2 and 3 years of age, which showed lower sensitivity in one study and lower specificity in the other.

    “The accuracy of some screening tools seems to drop over time, as observed in two studies on a parent report screening tool administered at 2 and at 3 years of age, which showed lower sensitivity in one study and lower specificity in the other.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [66] Wallace, 2015, Screening for Speech and Language Delay in Children 5 Years Old and Younger: A Systematic Review, Pediatrics source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The indirect indications that can be derived suggest an optimal time for screening between age 2 and 3, whereas diagnosis is optimal around age 4.

    “The indirect indications that can be derived are a suggested optimal time for screening between age 2 and 3, whereas diagnosis is optimal around age 4.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premiseown data

    Non-word repetition results were not sufficiently consistent across different studies, so it cannot be considered as an accurate diagnostic tool if used individually.

    “as for non-word repetition, the results were not sufficiently consistent across different studies, so it cannot be considered as an accurate diagnostic tool if used individually”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [156] Hesketh, 2003, Risk markers for SLI: A study of young language-learning children, Int. J. Lang. Commum. Disord. source

      Not checked in the free run.

    • cites [157] Archibald, 2009, On the sensitivity and specificity of non-word repetition and sentence recall to language and memory impairments in children, J. Speech Lang. Hear. Res. source

      Not checked in the free run.

    • cites [158] Dollaghan, 1998, Nonword repetition and child language impairment, J. Speech Lang. Hear. Res. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The observed difficulty in distinguishing predictors may be at least in part related to the heterogeneity of nosographic categories and labels used in the literature, and may stem from the heterogeneity of diagnostic criteria and cut-offs across different studies.

    “The observed difficulty may be, at least in part, related to the heterogeneity of nosographic categories and labels used in the literature. It may stem from the heterogeneity of diagnostic criteria and cut-offs across different studies as well.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    Different screening tools exist, including or not including testing of children along with parental (or clinicians') questionnaires.

    “It should also be considered that different screening tools exist, including or not including testing of children along with parental (or clinicians’) questionnaires.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Among risk factors, biological ones are generally more predictive in the very first years of life, whereas psychosocial risk factors become increasingly more important during development.

    “Among risk factors, biological ones are generally more predictive in the very first years of life, whereas psychosocial risk factors become increasingly more important during development [73,159].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [73] Bettio, 2019, Risk and protective factors for language development delay, Psicol. Estud.

      Not checked in the free run.

    • cites [159] To, 2004, Risk markers for poor developmental attainment in young children: Results from a longitudinal national survey, Arch. Pediatr. Adolesc. Med. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    This heterogeneity may lead to the inclusion of different clinical populations and different conclusions.

    “Obviously, this may lead to the inclusion of different clinical populations and different conclusions (see also [22]).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Bishop, 2017, The Catalise-2 Consortium. Phase 2 of CATALISE: A multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology, J. Child Psychol. Psychiatry Allied Discip. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Renfrew bus story has adequate sensitivity (84.4) but weak specificity (78.1).

    “the “Renfrew bus story”, i.e., a retelling test [149], has adequate sensitivity (84.4) but weak specificity (78.1)”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [148] Vance, 1994, Selection of preschool language tests: A data-based approach, Lang. Speech Hear. Serv. Sch. source

      Not checked in the free run.

    • cites [149] Pankratz, 2007, The diagnostic and predictive validity of the Renfrew Bus Story, Lang. Speech Hear. Serv. Sch. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Risk factors interact with each other in complex ways.

    “As also suggested by Bettio et al. [73], risk factors interact with each other in complex ways.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] Bettio, 2019, Risk and protective factors for language development delay, Psicol. Estud.

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    The available literature suggests that a timely screening can be performed between 2 and 3 years of age, whereas a timely DLD diagnosis can be performed around 4 years of age.

    “The available literature suggests that a timely screening can be performed between 2 and 3 years of age, whereas a timely DLD diagnosis can be performed around 4 years of age.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Screening tools often include early predictors among their items.

    “Screening tools often include early predictors among their items.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The limited evidence on the diagnostic accuracy of the tools used in clinical practice should not be taken as evidence of low levels of accuracy and reliability, but rather as evidence of the need for dedicated studies.

    “Similarly, as noted also by Denman et al. [70], the limited evidence on the diagnostic accuracy of the tools used in clinical practice should not be taken as evidence of low levels of accuracy and reliability, but rather as evidence of the need for dedicated studies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [70] Denman, 2017, Psychometric properties of language assessments for children aged 4–12 years: A systematic review, Front. Psychol. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    A further limitation is the difficulty to translate the results into recommendations for clinical services.

    “This contributes to a further limitation, namely the difficulty to translate the results into recommendations for clinical services.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Premisenone given

    The use of reliable screening and diagnostic tools presupposes the existence of shared scientific literature providing all the relevant information, such as sensitivity, specificity, replicability, and population representativeness, involved in tool validation.

    “Clearly, the use of reliable screening and diagnostic tools presupposes the existence of shared scientific literature providing all the relevant information, such as sensitivity, specificity, replicability, and population representativeness, involved in tool validation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    A first limitation of the present review, emerging especially from the systematic reviews, concerns the generalizability of the results and paucity of data on languages other than English.

    “A first limitation, emerging especially from the systematic reviews, concerns the generalizability of the results and paucity of data on languages other than English.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Identifying DLD within the preschool period involves identifying children at risk within the age of 3 years and making a diagnosis between 4 and 5 years, whereas the status of children between 3 and 4 years remains unspecified.

    “A third issue concerns age and the importance of identifying DLD within the preschool period, by identifying children at risk within the age of 3 years and by making a diagnosis between 4 and 5 years, whereas the status of children between 3 and 4 years remains unspecified.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The identification of a more precise optimal age range is not easy because of difficulty distinguishing delay and disorder, extreme variability of linguistic and communicative development in children between 3 and 5 years, and need to account for variability in age of emergence of different language skills.

    “The importance of an early detection is widely recognized, but the identification of a more precise optimal age range is not easy for a number of reasons: (a) the difficulty to distinguish between delay and disorder and to identify a pre-symptomatic phase that may differentiate between them; (b) the extreme variability of linguistic and communicative development in children between 3 and 5 years;”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Relatives, teachers or healthcare professionals could be highly accurate observers to note early predictors or concomitant markers of the presence of DLD.

    “Relatives, teachers or healthcare professionals could be highly accurate observers to note early predictors or concomitant markers of the presence of DLD.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Delayed identification has long-lasting negative consequences.

    “However, delayed identification has long-lasting negative consequences.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Screening a large set of children, including children with low risk, increases the probability of false positives.

    “Screening a large set of children, including children with low risk, increases the probability of false positives.”
    Quote in the paperNot a substantial claim
93 of 93

  • The authors state this as an assumption.

    The 10th percentile is an appropriate threshold for at-risk status.

    “Assuming the 10th percentile as a threshold for at-risk status”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Children may begin to show language deficits as early as infancy, but DLD cannot be reliably diagnosed until age four.

    “Children may begin to show language deficits as early as infancy, but DLD cannot be reliably diagnosed until age four [14]”

    From Tracking Acquisition of Language in Kids (TALK) study protocol: A longitudinal investigation of infants at high vs. low risk for atypical speech and language development (2026) · cites this paper as [14]

    The Results (section 3.2) describe early signs, including gesture production at 12 months and vocabulary at 15 months, that may predict later language difficulties. The Discussion (sections 4 and 4.3) suggests diagnosis around age four or between four and five, but leaves the status of children aged three to four unspecified; it does not establish that reliable diagnosis is impossible before four. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Four-stage model uses a fifth stage label

    Minor

    The method is described as a four-stage model, but its enumerated stages reach "(v)".

  • GAPS is cited to references for different tests

    Minor

    The concluding citation assigns references 146 and 147 to GAPS, but the reference list identifies them as manuals for the Test of Language Development-Primary and Woodcock-Johnson IV Tests of Oral Language. The paper earlier cites references 150 and 151 for GAPS.

2 of 2

No citation lists for this paper

No citation lists for this paper yet — checked again daily.

References 141 · Cited by 207

Research works printed but not linked: 24

  1. Capirci, 2008, Gesture and speech. The emergence and development of a strong and changing partnership, Gesture, 8, 22, 10.1075/gest.8.1.04cap · DOI
  2. Tomblin, 2003, The stability of Primary Language Disorder: Four years after kindergarten diagnosis, J. Speech Lang. Hear. Res., 46, 1283, 10.1044/1092-4388(2003/100) · DOI
  3. Communication & Language Acquisition Studies in Typical & Atypical Populations–CLASTA, and Federazione Logopedisti Italiani–FLI (2019). Consensus Conference sul Disturbo Primario del Linguaggio, CLASTA. Available online: https://www.disturboprimariolinguaggio.it/wp-content/uploads/2019/11/Documento-Finale-Consensus-Conference-2.pdf.
  4. Stothard, 1998, Language-impaired preschoolers: A follow-up into adolescence, J. Speech Lang. Hear. Res., 41, 407, 10.1044/jslhr.4102.407 · DOI
  5. Norbury, C.F., Tomblin, J.B., and Bishop, D.V.M. (2008). Validating diagnostic standards for Specific Language Impairment using adolescent outcomes. Understanding Developmental Language Disorders: From Theory to Practice, Psychology Press.
  6. Spaulding, 2006, Eligibility criteria for language impairment: Is the low end of normal always appropriate?, Lang. Speech Hear. Serv. Sch., 37, 61, 10.1044/0161-1461(2006/007) · DOI
  7. Gerber, S.E., and Mencher, G.T. (1988). The San Diego longitudinal study: Evaluating the outcomes of preschool impairment in language development. International Perspectives on Communication Disorders, Gallaudet University Press.
  8. Candiani, G., Colombo, C., Daghini, R., Magrini, N., Mosconi, P., Nonino, F., and Satolli, R. (2013). Manuale Metodologico: Come Organizzare una Conferenza di Consenso (Engl. Transl: Methodological Manual: How to Organize a Consensus Conference), Istituto Superiore di Sanità, Sistema Nazionale Linee Guida (SNLG). Available online: https://www.psy.it/wp-content/uploads/2018/02/Manuale-Metodologico-Consensus.pdf.
  9. Bettio, 2019, Risk and protective factors for language development delay, Psicol. Estud., 24, e41889
  10. Rescorla, 1989, The Language Development Survey: A screening tool for delayed language in toddlers, J. Speech Hear. Disord., 54, 587, 10.1044/jshd.5404.587 · DOI · Paper page
  11. Rescorla, 2001, Validation of the language development survey (LDS): A parent report tool for identifying language delay in toddlers, J. Speech Lang. Hear. Res., 44, 434, 10.1044/1092-4388(2001/035) · DOI
  12. Wetherby, 2003, Early identification of children with communication disorders: Concurrent and predictive validity of the CSBS Developmental Profile, Infant Young Child., 6, 161, 10.1097/00001163-200304000-00008 · DOI
  13. Sturner, 1993, The Fluharty Preschool Speech and Language Screening Test: A population-based validation study using sample independent decision rules, J. Speech Hear. Res., 36, 738, 10.1044/jshr.3604.738 · DOI
  14. Fluharty, N. (2001). Fluharty Preschool Speech and Language Screening Test–Second Edition (Fluharty-2), Pro-Ed.
  15. Kersten, 2010, SETK 3-5: A developmental language test on German for 3-to-5-year old children, Bilingual Preschools, Volume 1: Learning and Development, Volume 1, 119
  16. Semel, E., Wiig, E.H., and Secord, W.A. (2004). Clinical Evaluation of Language Fundamentals-Preschool, Pearson Psychcorp. [2nd ed.].
  17. Wiig, E.H., Semel, E., and Secord, W.A. (2013). Clinical Evaluation of Language Fundamentals, Pearson Psychcorp. [5th ed.].
  18. Seymour, H.N., Roeper, T.W., de Villiers, J., de Villiers, P.A., and Pearson, B.Z. (2005). Diagnostic Evaluation of Language Variation, Pearson Psychcorp.
  19. Carrow-Woolfolk, E. (2011). Oral and Written Language Scales, Pearson Psychcorp.. [2nd ed.].
  20. Vance, 1994, Selection of preschool language tests: A data-based approach, Lang. Speech Hear. Serv. Sch., 25, 15, 10.1044/0161-1461.2501.15 · DOI
  21. Pankratz, 2007, The diagnostic and predictive validity of the Renfrew Bus Story, Lang. Speech Hear. Serv. Sch., 38, 390, 10.1044/0161-1461(2007/040) · DOI
  22. Greenslade, 2009, The diagnostic accuracy and construct validity of the structured photographic expressive language test—Preschool: Second edition, Lang. Speech Hear. Serv. Sch., 40, 150, 10.1044/0161-1461(2008/07-0049) · DOI
  23. Perona, 2005, Diagnostic accuracy of the structured photographic expressive language test: Third edition (SPELT–3), Lang. Speech Hear. Serv. Sch., 36, 103, 10.1044/0161-1461(2005/010) · DOI
  24. Archibald, 2009, On the sensitivity and specificity of non-word repetition and sentence recall to language and memory impairments in children, J. Speech Lang. Hear. Res., 52, 899, 10.1044/1092-4388(2009/08-0099) · DOI

Authors
Sansavini, A., Favilla, M. E., Guasti, M. T., Marini, A., Millepiedi, S., Di Martino, M. V., Vecchi, S., Battajon, N., Bertolo, L., Capirci, O., Carretti, B., Colatei, M. P., Frioni, C., Marotta, L., Massa, S., Michelazzo, L., Pecini, C., Piazzalunga, S., Pieretti, M., Rinaldi, P., Salvadorini, R., Termine, C., Zuccarini, M., D’Amico, S., De Cagno, A. G., Levorato, M. C., Rossetto, T., & Lorusso, M. L.
Affiliations
  • University of Bologna (IT)
  • Department of Education and Human Sciences, University of Modena and Reggio Emilia, Viale Allegri 9, 42121 Reggio Emilia, Italy
  • University of Milano-Bicocca (IT)
  • University of Udine (IT)
  • Department of Mental Health, ATNO, Via Cocchi, 7/9, 56121 Pisa, Italy
  • Health Professions Integrated Service, Azienda Ospedaliera dei Colli di Napoli, 80131 Napoli, Italy
  • Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00154 Rome, Italy
  • Ca' Foncello Hospital (IT)
  • AIRIPA Associazione Italiana per la Ricerca e l’Intervento nella Psicopatologia dell’Apprendimento, Via Astichello, 10, 35135, Padova, Galleria G. Berchet, 3, 35131 Padova, Italy
  • National Research Council (IT)
  • University of Padua (IT)
  • University of L'Aquila (IT)
  • Studio di Psicoterapia e Riabilitazione dell’età evolutiva, Via Annone 1, 00199 Roma, Italy
  • Bambino Gesù Children's Hospital (IT)
  • Azienda Usl Toscana Centro (IT)
  • Federazione Logopedisti Italiani, Via Daniello Bartoli, 00152 Roma, Italy
  • University of Florence (IT)
  • University of Milan (IT)
  • Fondazione Stella Maris (IT)
  • University of Insubria (IT)
  • IRCCS Eugenio Medea (IT)
Corresponding author
Sansavini, Alessandra
ORCID
Venue
Brain Sciences
Publisher
MDPI AG
Published
2021-05-17
Volume
11
Issue
5
Pages
654
ISSN
2076-3425 (ISSN-L)
DOI
10.3390/brainsci11050654
PMC
PMC8156743
OpenAlex
W3163121887
Cited by
207
References
141
Citations by year
2026: 46 · 2025: 63 · 2024: 43 · 2023: 37 · 2022: 16 · 2021: 2
FWCI
5.32
Type
journal article
Language
en
Open access
Licence
Locations
  • Brain Sciences (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Florence Research (University of Florence) (submittedVersion, other-oa)
  • IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
  • Archivio Istituzionale della Ricerca - Università degli Studi dell Aquila (submittedVersion, public-domain)
  • Institutional Research Information System (University of Udine) (submittedVersion, cc-by-nc-nd)
  • BOA (University of Milano-Bicocca) (submittedVersion, cc-by)
  • Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • IrInSubria (University of Insubria) (submittedVersion, other-oa)
  • Padua Research Archive (University of Padova) (submittedVersion, cc-by)
Funders
  • Consiglio Nazionale delle Ricerche
  • Istituto di Scienze e Tecnologie della Cognizione
Topics
  • Social Sciences › Psychology › Developmental and Educational Psychology › Language Development and Disorders
  • Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
  • Social Sciences › Psychology › Developmental and Educational Psychology › Reading and Literacy Development
Keywords
specific language impairment, early predictors, preschool children, language screening, diagnostic tools, psycholinguistic assessment, family history (medicine), socioeconomic status, sensitivity and specificity, early detection

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