Infant-Toddler Checklist identifies 18-month-old children with communication difficulties in the Swedish child healthcare setting

Implementation of the Infant-Toddler Checklist in Swedish child health services at 18 months: an observational study

BACKGROUND

Communication and language disorders are common conditions that emerge early and negatively impact quality of life across the life course. Early identification may be facilitated using a validated screening tool such as the Infant-Toddler Checklist (ITC). We introduced the ITC at the 18-month visit to child health services (CHS) in a Swedish county. Using the RE-AIM implementation framework, this study assessed the implementation of the ITC according to five key dimensions: reach, effectiveness, adoption, implementation and maintenance.

METHODS

This observational study used medical records at CHS as data source. Data were collected from children who visited a child health nurse at 17-22 months. The sample included 2633 children with a mean age of 17.8 months, 1717 in the pre-implementation group and 916 in the post implementation group. We calculated the ITC completion rate (reach) and use at each site (adoption). We compared rates of referral to speech and language therapy (effectiveness) before and after implementation of the ITC using OR and 95% CIs. We described actions to facilitate implementation and maintenance of ITC screening over time.

RESULTS

The overall screening rate was 93% (reach) which increased from 80% initially to 94% at the end of the 2-year period (maintenance). All centres used the ITC (adoption). The ITC screen positive rate was 14%. Of children who had reached at least 24 months (n=2367), referral rate was 0.4% pre-implementation versus 6.9% post implementation (OR=18.17, 95% CI 8.15, 40.51, p<0.001) (effectiveness). Implementation strategies included training sessions, collaboration, written and automatic procedures and modifications to the medical records system.

CONCLUSION

The implementation of the ITC was associated with high reach, higher referral rate, complete adoption, and sustained maintenance over time.

Adaptation and validation of the European Portuguese Communication and Symbolic Behaviour Scales Developmental Profile™ (CSBS DP™) Infant-Toddler Checklist

BACKGROUND

As delays or disorders in early language and communication are the most prevalent symptom in children with disabilities, early screening is crucial to promote prevention, early diagnosis, and intervention. However, to the best of our knowledge, no screening tool is available for the joint assessment of early language and social communication skills in European Portuguese (EP)-learning children, which is critical for screening, monitoring and enrolment in appropriate early intervention services.

AIMS

(1) To adapt and validate the EP version of the Communication and Symbolic Behaviour Scales Developmental Profile™ (CSBS DP™) Infant-Toddler Checklist, a parental report for the screening of early language and social communication skills. (2) To conduct a cross-cultural comparison between the EP adaptation and the original US version.

METHODS & PROCEDURES

A total of 611 EP-learning children (ages 6-24 months) were assessed on the CSBS DP Infant-Toddler Checklist. Normative data, psychometric characteristics (i.e., internal consistency and test-retest reliability), and cross-cultural comparison between the EP and the original version were explored.

OUTCOMES & RESULTS

Internal consistency ranged from good to excellent and the test-retest reliability was excellent. The performance of the EP and US samples matched on almost all scores. However, EP children performed significantly better than their American peers in the Social compositive at 22 months and in the Symbolic composite at 20 months. No further differences were found.

CONCLUSIONS & IMPLICATIONS

These findings showed that the EP CSBS DP Infant-Toddler Checklist seems to be a reliable screening tool of communicative and symbolic behaviours for EP-learning children, which can be particularly relevant for decision-making in clinical practice.

WHAT THIS PAPER ADDS

What is already known on the subject Early communication skills are known to be related to later language outcomes. Thus, screening tools for the early identification of children at risk for language and communication impairments, which may lead to monitoring and early intervention, have the potential to promote better outcomes. However, to the best of our knowledge, no screening tool is available for the assessment of early communication abilities in EP-learning children. What this paper adds to existing knowledge This study adapted and validated the EP CSBS DP Infant-Toddler Checklist, the first published parental report checklist for the assessment of early communication skills in EP. It described the psychometric characteristics of the adapted checklist, summarized the newly available normative data for EP-learning infants and toddlers, and compared the performance of EP-learning children with the original standardization sample reported for American English. The results demonstrated that this tool is a reliable instrument for the early screening of language, communicative and symbolic behaviours for EP-learning children between 6 and 24 months of age. What are the potential or actual clinical implications of this work? Given that early screening is crucial to promote prevention, early diagnosis and intervention, the availability of this tool is particularly relevant for children monitoring and their enrolment in appropriate early intervention services, helping decision-making in clinical practice, in line with current guidelines regarding early monitoring and intervention to promote and support better outcomes. Thus, the tool and related normative data will be useful for paediatricians, family doctors, primary healthcare providers, developmental psychologists and speech-language therapists, among other professionals in the healthcare and educational fields, concerned with speech, language, and communication development and impairments.

What kind of information do early parental report instruments provide on language ability at 3;6 when used at 2;0? A longitudinal comparison study

Introduction

Various parental report instruments are available for assessing children's language skills at the end of the second year. However, comparison studies on their usability are lacking, and it is also open to question what kind of information the instruments provide when used in a parallel manner. This longitudinal study investigated which of the available three parental report instruments, when used at 2;0 (year;month), provides the most representative information on language development at 3;6. In addition, since most of the parental report instruments available focus specifically on expressive language, the role of receptive language ability was also investigated when analyzing the explanatory value of parental report instruments.

Methods

The participants were 68 typically developing children. At 2;0, language skills were measured using the following measures: the Infant-Toddler Checklist of the Communication and Symbolic Behavior Scales Developmental Profile (ITC), the Short Form and Long Form versions of the Finnish Communicative Development Inventories (FinCDI-SF, FinCDI-LF), and the Reynell Developmental Language Scales III (RDLS). The outcome measures were receptive/expressive/ general language ability at 3;6 measured using RDLS.

Results

The results of parental report instruments were significantly and positively associated with language ability at 3;6. The correlation between the combined value of ITC and FinCDI-SF and later language ability was stronger than correlations for each measure separately. The regression models with the results of parental report instruments as predictors explained 18-22% (p < 0.00) of the variability in the total RDLS score. However, when receptive language ability at 2;0 was included in the models as a predictor, R2 increased considerably (46-48%, p < 0.00).

Discussion

The results adduce the usability of parental report measures along with the importance of measuring receptive language skills at 2 years of age. In summary, this study provides important insights into the clinical evaluation of early language ability.

Infant-Toddler Checklist identifies 18-month-old children with communication difficulties in the Swedish child healthcare setting

Aim

At present, there is no reliable method to screen for communication difficulties at age 18‐months in the Swedish child health care. This study examined the psychometric properties of the Communication and Symbolic Behavior Scales Developmental Profile Infant‐Toddler Checklist (ITC) when used at the 18‐month visit in the child healthcare setting.

Methods

Children aged 16–20 months (n = 679) were screened. Children were referred for an assessment if they screened positive screen or if the parent or nurse was concerned about the child's communicative development. Two groups of positive screens were used in the analysis (n = 78 children), one based on the ITC result, and one combining the ITC with contradicting information from the nurses' informal clinical assessment.

Results

The AUC ranged from 0.68 to 0.84. The sensitivity was 0.85, and the specificity was 0.59. When the ITC result was combined with the nurses' information, sensitivity increased to 0.88 and specificity to 0.63. The internal consistency was moderate to high, and fit indices were satisfactory.

Conclusion

The results suggest that the ITC can be used to identify children in need of interventions to enhance communication at 18 months of age, especially in combination with the nurse's assessment.