Children who screen positive for language delay but not autism: from 2.5 to 6 years of age

Abstract

Background: Language disorders (LDs) are prevalent, affecting approximately 10% of children. Among them, 7.5% have developmental language disorder (DLD), while 2.5% have LD associated with a known medical condition. In Sweden, nearly all children undergo language screening through the Child Health Services (CHS) between 2.5 and 3 years of age. In Gothenburg, autism screening is also conducted at 2.5 years. Aim: To clinically describe and longitudinally follow the language and neurodevelopmental trajectories of children referred to the Paediatric Speech and Language Pathology Clinic (SLP Clinic) after screening positive for language problems but not for autism at the 2.5-year screening at CHS. Methods: In 2016, at a mean age of 2.9 years, 100 mono- or multilingual children, referred to the SLP Clinic, participated in a language assessment. Parents completed a newly developed questionnaire (2-5) concerning their child’s development (motor, language, memory, attention, impulsivity, learning, social skills and behaviour). At age 6 years, 85 of the 100 children participated in a follow-up language assessment. Parents completed questionnaires about child development (same areas as at 2.9 years) and parents and children reported on child quality of life (QoL). A review of paediatric records was conducted after the SLP assessment with a view to obtain information about language interventions and other possible diagnoses. Results: At 2.9 years, 87 children met DLD criteria and parent-reported concerns were mainly related to the child's language, communication and social skills. At age 6 years, 68 children had diagnosis of DLD, 6 had speech sound disorder, and 11 had no language disorder diagnosis. Half of the parents of children with DLD reported concerns about child development, predominantly related to language, but some also reported other concerns e.g. about executive functions. Parents reported no impaired QoL, although some of the children themselves reported challenges in school and social functioning. At both 2.9 years and 6 years, the multilingual children in the DLD group performed significantly worse than the monolingual children on the language tests, except for the phonological and non-verbal tasks at 6 years of age. The review of paediatric records revealed that families only participated in half of the offered intervention sessions. Monolingual families participated to a greater extent in the introduction of alternative and augmentative communication (pictural support). In agreement with the family, the SLP completed contact with monolingual families at a significantly higher rate than multilingual ones. Out of the 85 6-year-old children, 20 had received an additional ESSENCE diagnosis (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations), 5 of whom had autism. Conclusion: DLD was found to be persistent in both monolingual and multilingual children, with multilingual children having greater language difficulties already at 2.9 years based on the test results. At age 6 years, some children perceived their QoL as partially impaired, which was not confirmed by their parents. The presence of additional neurodevelopmental diagnoses at age 6, underscores the need for follow-up of these children using a holistic ESSENCE perspective.