AIM:

A significant number of children living in Sweden are bilingual, but how language screening is performed in this group is unknown. We investigated child healthcare nurses' perceptions of the language screening of bilingual children aged 30-36 months, together with their clinical practices.

METHOD:

An online questionnaire was completed by 863 nurses who performed language screening of bilingual children in Sweden at least once a month, corresponding to 89% of the target population. Cox regression identified predictors of the nurses' tendency to simplify the screening of bilingual children.

RESULTS:

The nurses reported a greater lack of confidence and more difficulties in interpreting screening outcomes for bilingual than monolingual children (p < 0.001). Half of the nurses simplified the screening processes for bilingual children and 74% postponed referrals to speech and language services, basing these adaptations on their perceptions of the children's Swedish language skills (p < 0.001). Most nurses (82%) believed that language development was slower in bilingual children, and this was the strongest predictor of simplified screening practices (RR=2.00, 95% CI 1.44-2.77).

CONCLUSION:

Child healthcare nurses need easily accessible information and clear guidelines on the language development of bilingual children to ensure that bilingual and monolingual children receive equitable language screening services.

Aim We examined if routine Swedish language screening for developmental language disorder (DLD) carried out at three years of age could be performed as effectively six months earlier. Methods This study observed 105 monolingual Swedish-speaking children (53% boys) aged 29-31 months at three Swedish child health centres. We compared their ability to combine three words, as per the existing protocol, and two words. They also underwent a comprehension task. Speech and language pathologists clinically assessed the children for DLD and their results were compared with the nurse-led screening. Results The results for the three-word and two-word criterion were the following: sensitivity (100% versus 91%) specificity (81% versus 91%), positive predictive (38% versus 56%) and negative predictive value (100% versus 99%). The three-word criterion identified 29 children with possible DLD, including 11 cases later confirmed, and the two-word criterion identified 18 possible cases, including 10 confirmed cases. DLD was overrepresented in the 10% of children who did not cooperate with the nurse-led screening. Conclusion Changing the required word combinations from three to two words worked well. The three-word test identified one extra confirmed case, but resulted in 10 more false positives. Lack of cooperation during screening constituted an increased risk for DLD.

AIM: Bilingual children are at risk of being overlooked for early identification of language difficulties. We investigated the accuracy of four screening models for children aged 2.5. The first model screened the child using their mother tongue, the second screened in Swedish, and the third screened in both languages used by the child. The fourth model consisted of direct screening in Swedish and using parental information about the child's language development in their mother tongue.

METHODS: Overall, 111 bilingual children (51% girls), 29-33 months, were recruited from three child health centres in Gävle, Sweden, from November 2015 to June 2017. All children were consecutively assessed by a speech and language pathologist, blinded to the screening outcomes.

RESULTS: Developmental language disorder was confirmed in 32 children (29%). Only the third model, based on direct assessment using the two languages used by the child, attained adequate accuracy; 88% sensitivity, 82% specificity, 67% positive and 94% negative predictive values.

CONCLUSION: Bilingual children should be screened directly in both their languages in order to achieve adequate accuracy. Such screening procedure is particularly important for children from families with low socio-economic status living in complex linguistic environments.

Background: Early intervention for language difficulties presumes stability in language development. However, the evidence for stability of language disorders in children below 3 years is scarce, in particular for bilingual children. Aim: The study aimed to investigate the stability of early diagnoses of language disorder between the ages of 2.5 and 3 years, and to evaluate the classification accuracy of language screening at 2.5 years re-evaluated 6 months later, for mono- and bilingual children. Methods: A total of 141 children, 48 monolingual and 93 bilingual, who had previously undergone language screening and clinical examination at 2.5 years were re-examined at age 3 by an experienced speech and language pathologist. Results: Five children with moderate/severe language difficulties at 2.5 years had recovered at 3 years while four children with typical language development were newly diagnosed with moderate/severe language difficulties at age 3. The initial language status remained for 132 children. Although the observed changes in diagnoses from 2.5-3 years were statistically significant, the predictive classification accuracy was still within a 95% CI. Conclusion: Although the changes in diagnoses between 2.5 and 3 years were statistically significant, no clinical benefit could be found in postponing the language screening until 3 years. Thus, it is recommended that children with positive screening results at age 2.5 are referred without delay to speech and language services and not subjected to a “wait and see” strategy.