PDF(Pubmed)
Abstract：
BACKGROUND: Developmental language disorder (DLD) is one of the most common neurodevelopmental conditions. Due to variable rates of language growth in children under 5 years, the early identification of children with DLD is challenging. Early indicators are often outlined by speech pathology regulatory bodies and other developmental services as evidence to empower caregivers in the early identification of DLD.
OBJECTIVE: To test the predictive relationship between parent-reported early indicators and the likelihood of children meeting diagnostic criteria for DLD at 10 years of age as determined by standardized assessment measures in a population-based sample.
METHODS: Data were leveraged from the prospective Raine Study (n = 1626 second-generation children: n = 104 with DLD; n = 1522 without DLD). These data were transformed into 11 predictor variables that reflect well-established early indicators of DLD from birth to 3 years, including if the child does not smile or interact with others, does not babble, makes only a few sounds, does not understand what others say, says only a few words, says words that are not easily understood, and does not combine words or put words together to make sentences. Family history (mother and father) of speech and language difficulties were also included as variables. Regression analyses were planned to explore the predictive relationship between this set of early indicator variables and likelihood of meeting DLD diagnostic criteria at 10 years.
RESULTS: No single parent-reported indicator uniquely accounted for a significant proportion of children with DLD at 10 years of age. Further analyses, including bivariate analyses testing the predictive power of a cumulative risk index of combined predictors (odds ratio (OR) = 0.95, confidence interval (CI) = 0.85-1.09, p = 0.447) and the moderating effect of sex (OR = 0.89, CI = 0.59-1.32, p = 0.563) were also non-significant.
CONCLUSIONS: Parent reports of early indicators of DLD are well-intentioned and widely used. However, data from the Raine Study cohort suggest potential retrospective reporting bias in previous studies. We note that missing data for some indicators may have influenced the results. Implications for the impact of using early indicators as evidence to inform early identification of DLD are discussed.
CONCLUSIONS: What is already known on the subject DLD is a relatively common childhood condition; however, children with DLD are under-identified and under-served. Individual variability in early childhood makes identification of children at risk of DLD challenging. A range of \'red flags\' in communication development are promoted through speech pathology regulatory bodies and developmental services to assist parents to identify if their child should access services. What this paper adds to the existing knowledge No one parent-reported early indicator, family history or a cumulation of indicators predicted DLD at 10 years in the Raine study. Sex (specifically, being male) did not moderate an increased risk of DLD at 10 years in the Raine study. Previous studies reporting on clinical samples may be at risk of retrospective reporting bias. What are the potential or actual clinical implications of this work? The broad dissemination and use of \'red flags\' is well-intentioned; however, demonstrating \'red flags\' alone may not reliably identify those who are at later risk of DLD. Findings from the literature suggest that parent concern may be complemented with assessment of linguistic behaviours to increase the likelihood of identifying those who at risk of DLD. Approaches to identification and assessment should be considered alongside evaluation of functional impact to inform participation-based interventions.
OBJECTIVE: To test the predictive relationship between parent-reported early indicators and the likelihood of children meeting diagnostic criteria for DLD at 10 years of age as determined by standardized assessment measures in a population-based sample.
METHODS: Data were leveraged from the prospective Raine Study (n = 1626 second-generation children: n = 104 with DLD; n = 1522 without DLD). These data were transformed into 11 predictor variables that reflect well-established early indicators of DLD from birth to 3 years, including if the child does not smile or interact with others, does not babble, makes only a few sounds, does not understand what others say, says only a few words, says words that are not easily understood, and does not combine words or put words together to make sentences. Family history (mother and father) of speech and language difficulties were also included as variables. Regression analyses were planned to explore the predictive relationship between this set of early indicator variables and likelihood of meeting DLD diagnostic criteria at 10 years.
RESULTS: No single parent-reported indicator uniquely accounted for a significant proportion of children with DLD at 10 years of age. Further analyses, including bivariate analyses testing the predictive power of a cumulative risk index of combined predictors (odds ratio (OR) = 0.95, confidence interval (CI) = 0.85-1.09, p = 0.447) and the moderating effect of sex (OR = 0.89, CI = 0.59-1.32, p = 0.563) were also non-significant.
CONCLUSIONS: Parent reports of early indicators of DLD are well-intentioned and widely used. However, data from the Raine Study cohort suggest potential retrospective reporting bias in previous studies. We note that missing data for some indicators may have influenced the results. Implications for the impact of using early indicators as evidence to inform early identification of DLD are discussed.
CONCLUSIONS: What is already known on the subject DLD is a relatively common childhood condition; however, children with DLD are under-identified and under-served. Individual variability in early childhood makes identification of children at risk of DLD challenging. A range of \'red flags\' in communication development are promoted through speech pathology regulatory bodies and developmental services to assist parents to identify if their child should access services. What this paper adds to the existing knowledge No one parent-reported early indicator, family history or a cumulation of indicators predicted DLD at 10 years in the Raine study. Sex (specifically, being male) did not moderate an increased risk of DLD at 10 years in the Raine study. Previous studies reporting on clinical samples may be at risk of retrospective reporting bias. What are the potential or actual clinical implications of this work? The broad dissemination and use of \'red flags\' is well-intentioned; however, demonstrating \'red flags\' alone may not reliably identify those who are at later risk of DLD. Findings from the literature suggest that parent concern may be complemented with assessment of linguistic behaviours to increase the likelihood of identifying those who at risk of DLD. Approaches to identification and assessment should be considered alongside evaluation of functional impact to inform participation-based interventions.
摘要：
背景：发育性语言障碍（DLD）是最常见的神经发育疾病之一。由于5岁以下儿童的语言增长率不同，早期识别患有DLD的儿童具有挑战性。言语病理学监管机构和其他发展服务机构通常概述早期指标，作为授权护理人员早期识别DLD的证据。
目的：测试父母报告的早期指标与儿童在10岁时符合DLD诊断标准的可能性之间的预测关系，如通过基于人群的样本中的标准化评估措施所确定的。
方法：数据来自前瞻性雷恩研究（n=1626个第二代儿童：n=104个有DLD；n=1522个无DLD）。这些数据被转化为11个预测变量，反映了从出生到3年的DLD的早期指标，包括如果孩子不微笑或与他人互动，不胡言乱语，只有几个声音，不明白别人说什么，只说了几句话，说的话不容易理解，并且不组合单词或将单词放在一起组成句子。还包括言语和语言障碍的家族史（母亲和父亲）作为变量。计划进行回归分析，以探索这组早期指标变量与10年时符合DLD诊断标准的可能性之间的预测关系。
结果：没有单亲报告的指标在10岁时患有DLD的儿童中占显著比例。进一步分析,包括双变量分析,测试组合预测因子的累积风险指数的预测能力(比值比(OR)=0.95,置信区间(CI)=0.85-1.09,p=0.447)和性别的调节作用(OR=0.89,CI=0.59-1.32,p=0.563)也不显著.
结论：关于DLD的早期指标的家长报告是善意和广泛使用的。然而,来自Raine研究队列的数据提示在之前的研究中可能存在回顾性报告偏倚.我们注意到，某些指标的数据缺失可能影响了结果。讨论了使用早期指标作为早期识别DLD的证据的影响。
结论：已知的DLD是一种相对常见的儿童疾病；然而，患有DLD的儿童身份不足，服务不足。儿童早期的个体差异使得识别有DLD风险的儿童具有挑战性。通过言语病理学监管机构和发展服务机构促进交流发展中的一系列“危险信号”，以帮助父母确定他们的孩子是否应该获得服务。本文对现有知识的补充没有一个家长报告的早期指标，在雷恩研究中，家族史或预测10年DLD的指标累积。性别（具体来说，在Raine研究中，男性）在10年时并未减轻DLD风险的增加。以前报告临床样本的研究可能存在回顾性报告偏倚的风险。这项工作的潜在或实际临床意义是什么？“红旗”的广泛传播和使用是善意的；然而，仅展示“危险信号”可能无法可靠地识别那些有DLD风险的人。文献的结果表明，父母的关注可以补充对语言行为的评估，以增加识别有DLD风险的人的可能性。应在评估功能影响的同时考虑确定和评估的方法，以告知基于参与的干预措施。
目的：测试父母报告的早期指标与儿童在10岁时符合DLD诊断标准的可能性之间的预测关系，如通过基于人群的样本中的标准化评估措施所确定的。
方法：数据来自前瞻性雷恩研究（n=1626个第二代儿童：n=104个有DLD；n=1522个无DLD）。这些数据被转化为11个预测变量，反映了从出生到3年的DLD的早期指标，包括如果孩子不微笑或与他人互动，不胡言乱语，只有几个声音，不明白别人说什么，只说了几句话，说的话不容易理解，并且不组合单词或将单词放在一起组成句子。还包括言语和语言障碍的家族史（母亲和父亲）作为变量。计划进行回归分析，以探索这组早期指标变量与10年时符合DLD诊断标准的可能性之间的预测关系。
结果：没有单亲报告的指标在10岁时患有DLD的儿童中占显著比例。进一步分析,包括双变量分析,测试组合预测因子的累积风险指数的预测能力(比值比(OR)=0.95,置信区间(CI)=0.85-1.09,p=0.447)和性别的调节作用(OR=0.89,CI=0.59-1.32,p=0.563)也不显著.
结论：关于DLD的早期指标的家长报告是善意和广泛使用的。然而,来自Raine研究队列的数据提示在之前的研究中可能存在回顾性报告偏倚.我们注意到，某些指标的数据缺失可能影响了结果。讨论了使用早期指标作为早期识别DLD的证据的影响。
结论：已知的DLD是一种相对常见的儿童疾病；然而，患有DLD的儿童身份不足，服务不足。儿童早期的个体差异使得识别有DLD风险的儿童具有挑战性。通过言语病理学监管机构和发展服务机构促进交流发展中的一系列“危险信号”，以帮助父母确定他们的孩子是否应该获得服务。本文对现有知识的补充没有一个家长报告的早期指标，在雷恩研究中，家族史或预测10年DLD的指标累积。性别（具体来说，在Raine研究中，男性）在10年时并未减轻DLD风险的增加。以前报告临床样本的研究可能存在回顾性报告偏倚的风险。这项工作的潜在或实际临床意义是什么？“红旗”的广泛传播和使用是善意的；然而，仅展示“危险信号”可能无法可靠地识别那些有DLD风险的人。文献的结果表明，父母的关注可以补充对语言行为的评估，以增加识别有DLD风险的人的可能性。应在评估功能影响的同时考虑确定和评估的方法，以告知基于参与的干预措施。
