Language Evaluation Scale Trivandrum (LEST 3-6 years) Development and Validation.

Language Evaluation Scale Trivandrum (LEST:3-6 years) with 31-items, was validated against extended REELS with a community sample-606 children (3-6yrs). One item and two item delay as LEST delay showed a sensitivity of (81%, 47%); specificity (68%, 94%), PPV (12%, 31%); NPV (98%, 97%) and accuracy (68.5%, 92%), respectively. LEST (3-6years) is a simple, valid, community screening tool.

CDC Kerala 8: Effectiveness of a clinic based, low intensity, early intervention for children with autism spectrum disorder in India: a naturalistic observational study.

OBJECTIVE: To document the effectiveness of low intensity, clinic based intervention models for Autism Spectrum Disorders (ASD) in countries with low disability resources. METHODS: Thirty-nine participants with a mean (SD) of 36.03(11.15) mo were assessed before and after intervention with Childhood Autism rating scale (CARS), and at baseline with the Denver Developmental Screening Test for quantifying the effectiveness of the clinic-based intervention in ameliorating autism symptoms and studying the effect of developmental disability respectively. Developmental therapists in the clinic gave low-intensity group intervention for 45-60 min to the child through mother and encouraged to continue the training, for 3-4 h, at home to address the specific goals in the three ASD symptom clusters. Most of the children were also placed in play-schools. Follow-up support was given either on a weekly, fortnightly or monthly basis. Data was analyzed using appropriate bivariate and multivariate techniques. RESULTS: There was amelioration in the severity of autism after intervention, which was statistically and clinically significant. Intervention was useful to help children with mild to severe autism. CONCLUSIONS: Low-intensity, clinic-based intervention can be effectively used in situation where there is paucity of disability resources.

CDC Kerala 7: Effect of early language intervention among children 0-3 y with speech and language delay.

OBJECTIVE: To assess the effect of systematic clinic and home based early language intervention program in children reporting to the early language intervention clinic with full partnership of specially trained developmental therapist and the parents. METHODS: All babies between 0 and 3 y referred to Child Development Centre (CDC) Kerala for suspected speech/language delay were assessed and those without hearing impairment were screened first using Language Evaluation Scale Trivandrum (LEST) and assessed in detail using Receptive Expressive Emergent Language Scale (REELS). Those having language delay are enrolled into the early language intervention program for a period of 6 mo, 1 h at the CDC clinic once every month followed by home stimulation for rest of the month by the mother trained at CDC. RESULTS: Out of the total 455 children between 0 and 3 y, who successfully completed 6 mo intervention, the mean pre and post intervention language quotient (LQ) were 60.79 and 70.62 respectively and the observed 9.83 increase was statistically significant. The developmental diagnosis included developmental delay (62.4%), global developmental delay (18.5%), Trisomy and other chromosomal abnormalities (10.5%), microcephaly and other brain problems (9.9%), misarticulation (8.4%), autistic features (5.3%) and cleft palate and lip (3.3%) in the descending order. CONCLUSIONS: In the present study among 455 children between 0 and 3 y without hearing impairment, who successfully completed 6 mo early language intervention, the mean pre and post intervention LQ were 60.79 and 70.62 respectively and the observed 9.83 increase was statistically significant.

CDC Kerala 6: Validation of Language Evaluation Scale Trivandrum (0-3 y) against Receptive Expressive Emergent Language Scale in a developmental evaluation clinic population.

OBJECTIVE: To validate Language Evaluation Scale Trivandrum (LEST) 0-3 y against the reference standard, Receptive Expressive Emergent Language Scale (REELS) in a population of children attending CDC developmental evaluation clinic 0-3 y. METHODS: All the children clinically diagnosed as having speech and language problem in the developmental evaluation clinic of CDC Kerala over a period of 3 y were assessed using LEST (0-3) by trained developmental therapist and REELS by a speech therapist, both blind to the results of each other. RESULTS: Out of a total of 761 children between 0-3 y diagnosed as having speech problems by a Developmental Pediatrician in the developmental evaluation clinic (0-3 y) of CDC Kerala, both LEST and REELS could be administered among 679 children. The screening tool LEST 0-3 had a high sensitivity (84.4%), specificity (80.3%), Positive Predictive Value (PPV) (91.5%), Negative Predictive Value (NPV) (67.1%) and accuracy (83.2%) against the reference standard REELS. CONCLUSIONS: The observation of this study that LEST 0-3 had a high sensitivity, specificity and accuracy against REELS, suggest that in a developmental/speech evaluation clinic LEST could be effectively used in resource poor settings.

Development and validation of language evaluation scale Trivandrum for children aged 0-3 years--LEST (0-3).

OBJECTIVE: To develop and validate a simple screening tool which can be used in the Community to identify delay in language development among children of 0-3 years of age. METHODS: The normal range for the 33 items of Language Evaluation Scale Trivandrum for 0-3years LEST(0-3) were carefully selected from various existing language development charts and scales, by experts keeping in mind the face validity and content validity. The criterion validity was assessed using a community sample of 643 children of 0 to 3 years of age, including 340 (52.9%) boys. LEST (0-3) was validated against Receptive Expressive Energent Language Scale, for screening delay in language development among children of 0-3 years. RESULTS: When one item delay was taken as LEST delay (test positive), the sensitivity and specificity of LEST(0-3), was found to be 95.85% and 77.5%, respectively with a negative predictive value of 99.8% and LR (negative) of 0.05.When two item delay was taken as LEST delay(test positive), the sensitivity and specificity of LEST(0-3), was found to be 66.7% and 94.8% respectively with a negative predictive value of 98.7% and LR (negative) of 0.35. The test-retest and inter-rater reliability were good and acceptable (Inter-class correlation of 0.69 for test-retest and 0.94 for inter-rater). CONCLUSIONS: LEST (0-3) is a simple, reliable and valid screening tool for use in the community to identify children between 0-3 years with delay in language development, enabling early intervention practices.