Preschool speech and language screening: further validation of the sentence repetition screening test.

A recent review indicated that only one speech and language screening test (the Sentence Repetition Screening Test; SRST) designed for preschoolers has been successfully validated in a representative population. This study sought to replicate the SRST validation study using a somewhat younger age group and to compare predictive indices to typical measures of parent concern and teacher judgment. A sample of (N = 343) prekindergarten children (ages 54 to 66 months) attending school registration in the spring before kindergarten entry was tested with the SRST. A stratified sample of 76 returned for criteria testing within 2 months. Teacher ratings were obtained 5 months later. Outcome measures were standard language (Bankson and Illinois Test of Psycholinguistic Abilities) and speech articulation (Arizona) tests. With a prevalence of 11%, SRST prediction of language outcomes resulted in the following indices: sensitivity, .62; specificity, .91; predictive validity, .44; overreferral, 8.4%; and underreferral, 4%. Prediction of the articulation outcome with a prevalence of 11% resulted in indices as follows: sensitivity, .57; specificity, .95; predictive validity, .75; overreferral, 3.7%; and underreferral, 8.3%. Teacher ratings and a parent questionnaire (Speech and Language Screening Questionnaire) approached the same rate of prediction of articulation but with a higher overreferral rate. The predictive indices from the SRST exceeded the comparison measures for language outcomes.

Simultaneous Technique for Acuity and Readiness Testing (START): further concurrent validation of an aid for developmental surveillance.

STUDY OBJECTIVE: A brief (8-minute) procedure, now called Simultaneous Technique for Acuity and Readiness Testing or START, has been shown to be efficacious for predicting developmental outcomes and a cost-effective screen for visual acuity. The objective of the two studies reported here was to examine the ability of this procedure to predict concurrent development outcome by using a new simplified scoring system. DESIGN: A prospective design was used. Subjects were screened using START, and then samples were stratified on the basis of developmental screening results (START in study 1 and the revised Denver Developmental Screening Test and a shortened version of the Minnesota Child Development Inventory in study 2) into subsamples (n = 118 and 120) which were administered the standard criterion test (McCarthy Scales of Children's Abilities in one cohort and the Stanford-Binet in the other). SETTING: Prekindergarten registration for a rural school system in North Carolina. SUBJECTS: Two county-wide cohorts of preschool children (n = 352 and 362). MEASUREMENTS AND MAIN RESULTS: Results for prediction of the McCarthy outcomes were as follows: sensitivity, 0.76; specificity, 0.99; predictive value, 0.81; underreferral, 1.3%; overreferral, 1.0%; and percent agreement, 98%. Prediction of Stanford-Binet results was as follows: sensitivity, 0.94; specificity, 0.83; predictive value, 0.22; underreferral, 0.3%; overreferral, 16%; and percent agreement, 84%. Most of the overreferrals for the Stanford-Binet were in the clinically important borderline category. CONCLUSION: These results provide further support for the concurrent validity of START: The results illustrate how routine health procedures can be restructured to obtain clinically useful data on specific child developmental functioning.

Elicited imitation: its effectiveness for speech and language screening.

The authors explored the clinical usefulness of a brief sentence-repetition screening task (SRST), by screening 382 kindergarten children and performing follow-up tests on a stratified sample of 78. Results indicate that an elicited-imitation task can predict the combined outcome of receptive and expressive language problems, as well as articulation problems. Replication, cross-validation and assessment of children with selective receptive impairments are recommended. Nevertheless, the present study demonstrates that the use of sentence-repetition screening tasks could be a very efficient strategy for screening for both language and articulation problems in kindergarten children.

The Fluharty Preschool Speech and Language Screening Test: a population-based validation study using sample-independent decision rules.

Two cohorts of 4- and 5-year-old children (N = 700) were screened with the Fluharty Preschool Speech and Language Screening Test. Two stratified samples (n = 51 cohort 1; n = 147 cohort 2), based on speech/language screening results, were administered criterion tests for articulation (AAPS-R or Templin-Darley) and language (TOLD or TALC-R). Clinical validation indices for combined speech or language outcome in the two cohorts were as follows: sensitivity, .43 and .31 respectively; specificity, .82 and .93; predictive value, .43 and .54; overreferral, 14% and 5%; underreferral, 14% in both cohorts, and percent agreement, 72% and 80%. The measure of sensitivities for language outcomes was lower than the above, whereas sensitivities for articulation was higher. These results suggest that the Fluharty is too insensitive to be relied on for screening programs aimed at identifying preschool children with language disorders, although it appears to have promise for the identification of children with articulation impairments.

Questionnaires in behavioral pediatrics: guidelines for selection and use.

There is a death of information for pediatricians to use in choosing questionnaires that would be useful in medical practice. In this article, general guidelines are presented for primary child health clinicians to use in selecting questionnaires. Concepts such as reliability, validity, readability, response format, scoring and completion time, and norms are reviewed, and the implications of these concepts for practitioners are discussed. Guidelines are applied to selected behavioral questionnaires to illustrate their importance.

Toxocara canis infestation. Clinical and epidemiological associations with seropositivity in kindergarten children.

We studied a cohort of 333 children in kindergarten to determine the prevalence of seropositivity to Toxocara canis, and to detect and measure chronic health effects that might be attributable to past infection. We found that 23.1% of the children had serologic evidence of infection (antibody titer greater than or equal to 1:32), assayed by means of an enzyme-linked immunosorbent assay. Black children were more frequently infested than white children, as were children of parents who did not graduate from high school. In a subsample of seropositive and seronegative children, we found associations between seropositivity and both pica and puppy ownership; we did not find differences in the symptoms and signs that occur in toxocaral visceral larva migrans nor differences in measures of growth and nutrition. No child had ocular toxocariasis although 31.8% (106) of the children had antibody titers greater than or equal to 1:16. In a population in which approximately 20 to 30% of the children show serologic evidence of Toxocara infestation, care must be taken in differentiating toxocariasis-like ophthalmic lesions, due to the potential for the coincidental occurrence of retinoblastoma in a child who is seropositive for the Toxocara parasite.

Questionnaire use in pediatric practice. Survey of practice.

A sample of members of the American Academy of Pediatrics were surveyed to determine the nature and extent of questionnaire use in pediatric practice and to assess practitioners' attitudes toward questionnaires. Thirty-eight percent of 169 respondents (of 300 contacted) reported that they were using a questionnaire in their clinical practice and an additional 36 percent indicated interest in possible future use. Most (89%) questionnaires were constructed by the practitioners themselves. Questionnaire use was associated with group practice and prepaid fee plans. Efficiency was the most common reason given for questionnaire use and impersonality was the most commonly cited objection. Practitioners' attitudes toward questionnaires are discussed.

Preschool Denver Developmental Screening Test as a predictor of later school problems.

We compared three preschool tests as predictors of school problems at the end of first grade. A stratified sample of 113 4 1/2- to 5 1/2-year-old children, oversampling those at risk for developmental difficulties, was administered the Denver Developmental Screening Test (DDST), the Stanford-Binet IQ test (SB), and a two-stage shortened form of the DDST in the spring before school entry. Data from achievement tests, special class placement, and grade retention were obtained for 106 of the children at the end of first grade. Eighty-four percent of children with abnormal DDST scores had school difficulties by the end of first grade, compared with 47% of children with scores in the questionable range and only 15% of children in the normal range. Prediction from the SB was not as accurate; 72% of the children who scored less than 68 and 42% of those who scored between 68 and 84 on the preschool SB had school problems. Prediction for those children who had abnormal or questionable scores on the two-stage DDST was as good as prediction from the full DDST. However, far fewer of the total number of school problems were identified by the two-stage DDST. It appears that the DDST can be used on an individual basis for prediction of school problems.

Toxocara canis infection: clinical and epidemiological associations with seropositivity in kindergarten children.

To determine epidemiological and clinical associations with Toxocara canis seropositivity, we studied 333 (87%) children of a cohort of 383 five- to seven-year-olds. The prevalence of seropositivity (antibody titer to T canis, greater than or equal to 1:32) was 23.1%. Black children were more frequently seropositive than were white children, as were children of parents who did not graduate from high school. In a sample of seropositive and seronegative children, seropositivity was associated with both a history of pica and puppy ownership, but not with a greater frequency of symptoms and signs that occur in visceral larva migrans or with poor growth. No child had evidence of ocular toxocariasis on retinal examination. For the whole sample, poor reading achievement, marked distractibility, and lower intelligence were associated with seropositivity, but by using multiple regression analysis, we found that these associations may be attributable to confounding variables.

Cognitive development related to performance on preschool hearing screening tests.

Behavioral responses to routine hearing screening were measured on 730 preschool children (ages 52 to 70 months). A stratified sample (which oversampled children "at risk" for developmental delay) also received a standardized test of cognitive abilities (McCarthy Scales or the Stanford-Binet). The results revealed that children without audiologic pathology who failed one or more of three hearing test behavioral scales scored significantly lower on the McCarthy Scales or Stanford-Binet than other children. Children failing two or more scales formed a definite risk group, with a group mean approximately two standard deviations below the national mean on both the McCarthy Scales and the Stanford-Binet. The data thus indicate that it is possible to gather simultaneous information about hearing ability and cognitive status.

Hyperplasia of the myenteric plexus. Its association with early infantile megacolon and neurofibromatosis.

An infant with cutaneous criteria for neurofibromatosis had hyperplasia of the intestinal myenteric plexus and a clinical presentation mimicking Hirschsprung's disease. Many of his phenotypic features are also found in multiple endocrine neoplasia type IIb, a condition in which hyperplasia of the myenteric plexus is common. This case illustrates the overlapping nature of neural crest-derived conditions and the variable presentation of megacolon (ganglionic or aganglionic) in infancy.

Adaptations of the Denver Developmental Screening Test: a study of preschool screening.

Developmental screening tests are only rarely used in pediatric practice, reportedly because of lack of available time. This study evaluated a shortened form of the Denver Developmental Screening Test (DDST-S) consisting of only those items immediately to the left of the child's individual are line, three in each sector or a total of 12. This DDST-S was administered to four cohorts of preschool children (aged 52 to 64 months), 1,819 children in all. Subsamples of these children returned within three months for one of several developmental (criterion) tests (McCarthy Scales of Children's Abilities, the complete DDST, or the Stanford-Binet). The DDST-S was scored by selecting the profile of passes and failures most predictive of McCarthy test results, using indices of copositivity, connegativity, underreferral, and overreferral as the basis for the decision. Utilizing this scoring system, use of the DDST-S was able to identify low scorers (those scoring less than 70) on the Stanford-Binet (sensitivity = .67, specificity = .95, predictive value = .54, underreferral = 2.5%, overreferral = 4%) as well as the complete DDST. Low scoring children could thus be identified in less than half the time required by the complete DDST. A two-stage DDST-S and DDST procedure was found to have even greater predictive value (76%; 100% if borderline cases [score of 70 to 80] are considered positive) than either form alone.