In a class or group of twenty children, - statistically - one child has a developmental language disorder (DLD). For children with DLD it is very difficult to keep up at school. The problems in the language also easily lead to miscommunication, which can cause behavioral problems. The timely recognition of a DLD is of great importance for early treatment. This way you can prevent or reduce problems at school, at home and in the children's leisure time. At the moment, children with DLD are not always identified early.Problems in language development can be identified early, for example at the age of two by child health workers. Parents, kindergarten teachers and elementary school teachers can also identify problems in children's language development. This requires a language screening instrument that can easily determine whether a child's language is 'at risk' or 'not at risk'. Early identification of language problems is important, but until today children are still missed. In this dissertation I present a new instrument for the identification of problems in the language development of children from one to six years old, the Early Language Scale (ELS). I also describe the development of the milestones in the language development of children, how good the current screening at the age of two at the health care office is and what parents think of this language screening. The ELS appears to detect DLD in young children well and can therefore make an important contribution to the detection of these problems at the primary health care.
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Only a small number of children with atypical language development who can benefit from early intervention are actually identified before reaching school age. Our aim was to explore perceptions of caregivers of monolingual and multilingual children with and without atypical language development in order to provide relevant themes for improving language screening and referral in Well Child Care (WCC). We interviewed 38 Dutch caregivers of monolingual and multilingual children with and without atypical language development. They were recruited via kindergarten, nurseries, and speech and language pathologists. First, we analyzed the interviews of caregivers of monolingual children with atypical language development and caregivers of multilingual children. Second, we adopted data source triangulation with the interviews of caregivers of monolingual children without atypical language development for further exploration of the results of the first round. Third, we categorized emerging codes across identified subthemes and themes. We identified six subthemes: (1) Perception WCC; (2) Perception consult at the WCC; (3) Opinion of the consult at the WCC; (4) Desires regarding WCC; (5) Parent factors, and (6) Child factors (first and second round). Target themes, relating to the themes and subthemes, that can be used to enhance structural language screening in WCC are: a more family oriented consult, better interprofessional collaboration, and more specific knowledge about language development and different referral routes for children with atypical language development.
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AIM: Little is known about predictive validity of and professionals' adherence to language screening protocols. This study assessed the concurrent and predictive validity of the Dutch well child language screening protocol for two-year-old children and the effects of protocol deviations by professionals.METHODS: A prospective cohort study of 124 children recruited and tested between October 2013 and December 2015. Children were recruited from four well child clinics in urban and rural areas. To validate the screening, we assessed children's language ability with standardized language tests following the two-year screening and one year later. We assessed the concurrent and predictive validity of the screening and of protocol deviations.RESULTS: At two years, the sensitivity and specificity of the language-screening were 0.79 and 0.86, and at three years 0.82 and 0.74, respectively. Protocol deviations by professionals were rare (7%) and did not significantly affect the validity of the screening.CONCLUSION: The language-screening protocol was valid for detecting current and later language problems. Deviations from the protocol by professionals were rare and did not affect the concurrent nor predictive validity of the protocol. The two-year language screening supports professionals working in preventive child health care and deserves wider implementation in well child care.
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Lopend onderzoek in het kader van de onderzoekslijn Kind, Taal & Ontwikkeling. Deze onderzoekslijn maakt deel uit van het Lectoraat Transparante Zorgverleningen en het Lectoraat Integraal Jeugdbeleid. Language problems have impact on school succes (Beichtman et al., 1996, Nelson et al., 2006), behavior (Coster et al., 1999), and quality of life (Van Agt, 2011). Also the comorbidity with other developmental disorders like dyslexia, ADHD and ASS is high (Gerrits, 2011). Psychological wellbeing depends on the interaction with others (Steenbeek & Geert, 2007), in which speech and language are important tools. Identification of children at risk for speech and language delays and related problems may lead to appropriate follow-up and interventions at a young age, when chances for improvement are best (Nelson, 2006). Therefore, it is of great importance to monitor the speech and language development and its consequences during early childhood. In the Netherlands, several protocols exist to detect children with speech and language delay and to guide them to appropriate care. Though, the balance between health benefits, costs, scope and adverse results of these protocols are not evaluated. In 2009, the RIVM and the NCJ formulated a practice based guideline for the screening of children with speech and language delays in Child Health Care (CHC). This position statement is based on consensus in the field. The goal of this study is to collect evidence for the scientific underpinnings of the current practice-based guidelines of the NCJ. We want to evaluate the improvements of speech and language outcomes as well as non speech and language outcomes a year after CHC-screening 2-year-old children.
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The aim of this study was to assess the criterion validity of a new screening instrument, the Early Language Scale (ELS), for the identification of young children at risk for developmental language disorder (DLD), and to determine optimal age-adjusted cut-off scores. We recruited a community-based sample of 265 children aged 1 to 6 years of age. Parents of these children responded on the ELS, a 26-item "yes-no" questionnaire. The children were assessed with extended language tests (language comprehension, word production, sentence production, communication). A composite score out of these tests (two tests below - 1 SD or one below - 1.5 SD) was used as reference standard. We assessed the validity of the ELS, measured by sensitivity, specificity, predictive values, and AUC. The optimal sensitivity/specificity age-dependent cut-off ELS score was at 15th percentile. Sensitivity and specificity were 0.62 and 0.93, respectively. Positive predictive value was moderate (0.53), negative predictive value was high (0.95), the positive likelihood ratio was 9.16, and negative likelihood ratio was 0.41. The area under the ROC curve was 0.88. The items covered the increasing language development for the ages from 1 to 6.Conclusion: The ELS is a valid instrument to identify children with DLD covering an age range of 1 to 6 years in community-based settings.What is Known:• Early identification and treatment of developmental language disorders can reduce negative effects on children's emotional functioning, academic success, and social relationships.• Short, validated language screening instruments that cover the full age range of early childhood language development lack.What is New:• The 26-item Early Language Scale (ELS) is a valid instrument to identify children at risk for developmental language disorder in well-child care and early educational settings among Dutch children aged 1-6 years.
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Bespreking proefschrift 'Uniform screening for atypical language development in Dutch child health care'
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Purpose: Most speech-language pathologists (SLPs) working with children with developmental language disorder (DLD) do not perform language sample analysis (LSA) on a regular basis, although they do regard LSA as highly informative for goal setting and evaluating grammatical therapy. The primary aim of this study was to identify facilitators, barriers, and needs related to performing LSA by Dutch SLPs working with children with DLD. The secondary aim was to investigate whether a training would change the actual performance of LSA. Method: A focus group with 11 SLPs working in Dutch speech-language pathology practices was conducted. Barriers, facilitators, and needs were identified using thematic analysis and categorized using the theoretical domain framework. To address the barriers, a training was developed using software program CLAN. Changes in barriers and use of LSA were evaluated with a survey sent to participants before, directly after, and 3 months posttraining. Results: The barriers reported in the focus group were SLPs’ lack of knowledge and skills, time investment, negative beliefs about their capabilities, differences in beliefs about their professional role, and no reimbursement from health insurance companies. Posttraining survey results revealed that LSA was not performed more often in daily practice. Using CLAN was not the solution according to participating SLPs. Time investment remained a huge barrier. Conclusions: A training in performing LSA did not resolve the time investment barrier experienced by SLPs. User-friendly software, developed in codesign with SLPs might provide a solution. For the short-term, shorter samples, preferably from narrative tasks, should be considered.
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Background: Early detection and remediation of language disorders are important in helping children to establish appropriate communicative and social behaviour and acquire additional information about the world through the use of language. In the Netherlands, children with (a suspicion of) language disorders are referred to speech and hearing centres for multidisciplinary assessment. Reliable data are needed on the nature of language disorders, as well as the age and source of referral, and the effects of cultural and socioeconomic profiles of the population served in order to plan speech and language therapy service provision. Aims: To provide a detailed description of caseload characteristics of children referred with a possible language disorder by generating more understanding of factors that might influence early identification. Methods & Procedures: A database of 11,450 children was analysed consisting of data on children, aged 2–7 years (70% boys, 30% girls), visiting Dutch speech and hearing centres. The factors analysed were age of referral, ratio of boys to girls, mono‐ and bilingualism, nature of the language delay, and language profile of the children. Outcomes & Results:Results revealed an age bias in the referral of children with language disorders. On average, boys were referred 5 months earlier than girls, and monolingual children were referred 3 months earlier than bilingual children. In addition, bilingual children seemed to have more complex problems at referral than monolingual children. They more often had both a disorder in both receptive and expressive language, and a language disorder with additional (developmental) problems. Conclusions & Implications: This study revealed a bias in age of referral of young children with language disorders. The results implicate the need for objective language screening instruments and the need to increase the awareness of staff in primary child healthcare of red flags in language development of girls and multilingual children aiming at earlier identification of language disorders in these children.
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Active learning has become an increasingly popular method for screening large amounts of data in systematic reviews and meta-analyses. The active learning process continually improves its predictions on the remaining unlabeled records, with the goal of identifying all relevant records as early as possible. However, determining the optimal point at which to stop the active learning process is a challenge. The cost of additional labeling of records by the reviewer must be balanced against the cost of erroneous exclusions. This paper introduces the SAFE procedure, a practical and conservative set of stopping heuristics that offers a clear guideline for determining when to end the active learning process in screening software like ASReview. The eclectic mix of stopping heuristics helps to minimize the risk of missing relevant papers in the screening process. The proposed stopping heuristic balances the costs of continued screening with the risk of missing relevant records, providing a practical solution for reviewers to make informed decisions on when to stop screening. Although active learning can significantly enhance the quality and efficiency of screening, this method may be more applicable to certain types of datasets and problems. Ultimately, the decision to stop the active learning process depends on careful consideration of the trade-off between the costs of additional record labeling against the potential errors of the current model for the specific dataset and context.
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PURPOSE: To study the preliminary effects and feasibility of the “Traffic Light Method for somatic screening and lifestyle” (TLM) in patients with severe mental illness. DESIGN AND METHODS: A pilot study using a quasi-experimental mixed method design with additional content analyses of lifestyle plans and logbooks. FINDINGS: Significant improvements were found in body weight and waist circumference. Positive trends were found in patients’ subjective evaluations of the TLM. The implementation of the TLM was considered feasible. PRACTICE IMPLICATIONS: The TLM may contribute to a higher quality of care regarding somatic screening and lifestyle training.
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