AUTHOR=So Kevin K. H. , To Carol K. S. 

TITLE=Systematic Review and Meta-Analysis of Screening Tools for Language Disorder

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.801220

DOI=10.3389/fped.2022.801220

ISSN=2296-2360

ABSTRACT=Language disorder is a prevalent developmental disorder associating with long-term sequelae. However, routine screening is controversial and is not universally part of early childhood health surveillance. Evidence concerning the detection accuracy, benefits, and harms of screening remains inadequate. In October 2020, a systematic review was conducted to investigate the accuracy of available screening tools and the potential sources of variability. A literature search was conducted using CINAHL Plus, ComDisCome, PsycInfo, PsycArticles, ERIC, PubMed, Web of Science, and Scopus. Studies describing, developing, or validating screening tools for language disorder under the age of 6 were included. 
QUADAS-2 was used to evaluate risk of bias in individual studies. Meta-analyses were performed on the reported accuracy of the screening tools. The performance of the screening tools was explored by plotting hierarchical summary receiver operating characteristic (HSROC) curves. The effects of the proxy used in defining language disorders, test-administrators, screening-diagnosis interval, and age of screening on screening accuracy were investigated by meta-regression.  
Of the 2366 articles located, 47 studies involving 67 screening tools were included. About one-third of the tests (35.4%) achieved at least fair accuracy, while only a small proportion (13.8%) achieved good accuracy. HSROC curves revealed a remarkable variation in sensitivity and specificity for the three major types of screening, which used the child’s actual language ability, clinical markers, and both as the proxy. None of these three types of screening tools achieved good accuracy. Meta-regression showed that using the child’s actual language as the proxy demonstrated better sensitivity than that of clinical markers. Tools using long screening-diagnosis intervals had a lower sensitivity than those using short intervals. Parent-reports showed a level of accuracy comparable to those administered by trained examiners. Screening tools used under and above 4yo have similar sensitivity and specificity. In conclusion, there are still gaps between the available screening tools for language disorders and the adoption of these tools in population screening. Future tool development can focus on maximizing accuracy and identifying metrics that are sensitive to the dynamic nature of language development. This review was registered on Prospero with a registration ID of CRD42020210505.