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Why Screening Canadian Preschoolers for Language Delays Is More Difficult Than It Should Be

Frisk, Virginia PhD; Montgomery, Lorna BSc, Dip P & OT; Boychyn, Ellen BSc, PT; Young, Roxanne BASc ECEC; vanRyn, Elizabeth MSc; McLachlan, Dorothy SpCC; Neufeld, Judi BEd

doi: 10.1097/IYC.0b013e3181bc4db6

We examined the ability of four American screening tests to identify preschool-age Canadian children with language delays. At 54 months, 110 children from five Ontario infant and child development programs completed the Ages and Stages Questionnaire, Battelle Developmental Inventory Screening Test, Brigance Preschool Screen, and Early Screening Profiles. Their results on the language measures were then compared with their performance on the Preschool Language Scales, 4th ed., and the Bracken Basic Concepts Scale—Revised at 5 years. None of the screening tests had adequate sensitivity (SN) and specificity (SP) when identifying receptive language delays; only one screen had adequate SN and SP for expressive language delays. Adjusting cutoffs based on ROC curve analyses improved the ability of some screens to identify language delays, but combining tests did not improve discriminability. Our results indicate that language screening measures are not interchangeable. We recommend the provision of detailed SN and SP information for each scale of screening tests so that early interventionists can evaluate the adequacy of each component of a screening test. When norming tests, appropriate analyses should be conducted to determine whether American norms are appropriate for use with Canadian children, given the differences in the demographics and educational systems of the two countries.

Hospital for Sick Children, University of Toronto (Dr Frisk), Infant and Child Development Services Peel, Trillium Health Centre, Mississauga (Ms Montgomery), Infant and Child Development Services Durham, Durham Region Health Department, Whitby (Ms Boychyn), Children's Resource Services, The Regional Municipality of Halton, Oakville (Ms Young), Trellis Mental Health and Developmental Services, Guelph (Ms vanRyn), Infant and Child Development Services Dufferin, Dufferin Child and Family Services, Orangeville (Ms McLachlan), and Waterloo Region Infant Development Program, Waterloo (Ms Neufeld), Ontario, Canada.

Corresponding Author: Virginia Frisk, PhD, Infant and Child Development Services Peel, 6660 Kennedy Rd, Ste 200, Mississauga, Ontario, Canada L5T 2M9 (

This research was funded by the Central West Region Ministry for Children and Youth, and Infant and Child Development Services Durham as part of the Central West Region and Durham Infant and Child Development Initiative. We thank the families and children who participated in this research and the consultants who conducted the screening and 5-year testing. We gratefully acknowledge Rebecca Bakos and Andrea Robb for their double-scoring of the test protocols, Eunice Lee for data entry, Dr Eric Youngstrom for information regarding ROC curve analysis, Rhonda Amsel for statistical consultation, Craig Steverango for statistical analysis, and Drs Lorna Jakobson and Brenda Miles for their review of this manuscript prior to submission.

©2009Lippincott Williams & Wilkins, Inc.