Children learn to articulate speech sounds as they develop, with some sounds taking more time than others [1]. Screening is the preliminary step to determine if sensory, behavioral and developmental skills are progressing as expected, or if there are causes for concern for further evaluation. Language Evaluation Scale Trivandrum (LEST 0-3 years) [2] is a simple screening tool developed and validated by Child Development Centre (CDC), Kerala, and was found useful for early intervention [3]. The prevalence of speech and language delay in literature below 6 years old is 3.8% [4]. As majority of children present with speech and language problem in the pre-school years, the present study aimed to develop the scale for children aged 3-6 years [LEST (3-6 yrs)], and validate it using the ‘available’ reference standard, extended Receptive Expressive Emergent Language Scale (extended REELS) [5].

Receptive-expressive Emergent Language Scale Free Download
Receptive-expressive Emergent Language Scale Free Download

LEST (3-6) with 31 test items, was developed at CDC Kerala and validated in a community sample of children. The detailed methodology was reported in a previous article on LEST (0-3) [2].The additional test items and the ranges were selected from different existing developmental/speech and language assessment scales, tools or guidelines like, Hearing check list by American Speech-Language-Hearing Association [6], Speech and language development in babies by Abby Deliz [7], Gilman and Gorman’s Speech Language Development Chart [8], Speech Sound Development Chart by Sander’s [9], and Ages and stages milestones for receptive and expressive language acquisition by Caroline Bowen [10].

Children between 3-6 years belonging to 11 Anganwadis from an urban ward, 20 Anganwadis from a rural Panchayat and 3 Anganwadis from tribal area, participated in this study. LEST (3-6), was applied by two trained persons having similar educational qualification as that of an ICDS Supervisor, and 'extended REELS' by two Speech and Language therapists. For LEST [3-6], a vertical line was assumed by keeping a scale vertically, at the chronological age in months given horizontally in the ‘X’ axis (Web Fig. 1). All items falling short on the left side of the age line was expected to be done by the child. If not done, it was taken as that item delay. First preference was given for observation of the child and testing of the items; if it was not possible, for some of the items, parental reporting was considered valid.

In the English speaking countries there are many tools available for the assessment of language; for example Early Language Milestone Scale for 0–3 years, and REELS (Receptive Expressive Emergent Language Scale), (original REELS and Newer versions of REELS) etc. Owing to linguistic variation across languages, these tools are generally not. The Bzoch-League Receptive-Expressive Emergent Language Scale (REEL Scale) / Assessing Language Skills in Infancy There is no file associated with this item. Search this record. An all in one speech and language screening tool for elementary school ages! This is a printable comprehensive informal speech and language screening tool that targets oral motor functioning, voice, fluency, pragmatics, articulation skills, receptive language and expressive language.

The test re-test reliability (intra-class correlation of 0.61; 95% CI 0.41-0.76) and inter-rater reliability (intra-class correlation of 0.96; 95% CI 0.93-0.97) were acceptable in valid samples of 50 children.

Test results for both LEST (3–6) and the reference standard were available for a sample of 606 children (292 boys); 247 (3-4 years), 221 (4-5 years), 138 (5-6 years). Table I shows the results with one-item delay and two-item delay as test positive, against extended REELS. One-item delay and two-item delay showed a sensitivity of 81% and 47%; specificity 68% and 94%: positive predictive value 12% and 31%; negative predictive value 98% and 97%; and accuracy 68.5% and 92%, respectively. Changing the tool positivity from one-to-two item delay, resulted in decrease of sensitivity from 81% to 47% though specificity increased from 68% to 94%.

Score on the REEL (Bzoch-League Receptive-Expressive Emergent Language Scale) 2. Estimation of the construct validity (does it measure what it claims to measure) of the LDS was obtained from completed LDS assessments (.99 coefficient of reproducibility for both receptive and expressive language scales).
Receptive expressive emergent language scale free customerservice@alimed.com TESTS OF GENERAL DEVELOPMENT SPECIFIC SPEECH/LANGUAGE ASSESSMENT TESTS TESTS OF GENERAL DEVELOPMENT AGES AND STAGES QUESTIONNAIRE (ASQ) Type of Test Set of 11 developmental questionnaires periodically sent to parents of children who show potential developmental problems.

One-item	Two-item delay
delay %	%(95% CI)
(95% CI)
Sensitivity	81 (64-93)	47 (29-65)
Specificity	68 (64-72)	94 (92-96)
Positive Predictive Value	12 (8-18)	31 (18-45)
Negative Predictive Value	98 (97-99)	97 ( 95-98)
Positive Likelihood Ratio	2.5 (2-3)	7.9 (4.8 -13)
Negative Likelihood Ratio	0.28 (0.13-0.57)	0.56 (0.41-0.78)
Accuracy	68.5 (65-72)	92 (89-94)
Prevalence and Bias Adjusted Kappa	0.37	0.83

For LEST(3-6) as a screening tool for Language delay, we suggest delay in two item as test positive, because of the relatively higher positive predictive value and lesser false positives in the screened sample, with an excellent negative predictive value (97%). Since speech and language development is a continuous process without a definite line for normal/abnormal, and with limited resources for language stimulation/therapy available, a lower sensitivity (47%) may be accepted. The choice between one-item and two-item delay as 'LEST delay' depends on the need, whether to have a highly sensitive test with a low positive predictive value or to have a more specific test having a higher positive predictive value, and a lower, but acceptable sensitivity. This depends also on resources available for further evaluation of screen positives, having larger (with one-item delay) or smaller (with two-item delay) false positives in screened sample.

We conclude that LEST (3-6 years) is a simple, reliable and valid Indian tool for identifying children of 3-6 years with language delay in the community.

Acknowledgments: Paul Russell and CDC Kerala Research team including Indulekha, Letha, Abhiram, Princly, Vinod, Bincymol, Leena and Asokan. We also thank Kunnampallilgejo John for sharing extended REELS for this study. Funding: NRHM and CDC, Kerala.

References

1. Owens RE. Language Development: An Introduction. Allyn & Bacon, Inc., 1996. Available from: http://raisingchildren.net.au/articles/language_development. html. Accessed August 14, 2015.

2. Nair M K C, Nair G H, Mini A O, Indulekha S, Letha S, Russell P S. Development and validation of language evaluation scale Trivandrum for children aged 0-3 years-LEST (0-3). Indian Pediatr. 2013;50:463-7.

3. Nair M K, Mini A O, Bhaskaran D, Harikumaran Nair G S, George B, Leena ML, et al. CDC Kerala 6: Validation of Language Evaluation Scale Trivandrum (0-3 y) against receptive expressive emergent language scale in a developmental evaluation clinic population. Indian J Pediatr. 2014;81:99-101.

Receptive Expressive Emergent Language Scale Free