Background & aims

Due to the complexity of early diagnostic decision making, we examined the predictive value of an early diagnostic classification and early abilities on later best estimate diagnosis for 22 clinically referred children with language difficulties.

Methods and procedures

Four years after initial evaluation (Time 1), the clinical files of these children were reviewed. A best-estimate (BE) diagnosis of language disorder (LD), intellectual disability (ID), or autism spectrum disorder (ASD) was established, with ASD being most common.

Outcomes and results

Early clinical classifications were relatively unstable or difficult to establish at a young age. The magnitude of children’s cognitive and receptive language delay was a significant predictor of a later BE diagnosis of ID and LD respectively. A BE diagnosis of ASD, by contrast, could not be predicted from children’s early social communication problems nor the presence of restricted and repetitive behaviors and interests.

Conclusions

Taken together, the results of this study suggest that language difficulties can be an early marker of a neurodevelopmental disorder which is often not identified at the age of first referral.

Implications

Eligibility for treatment should, therefore, be based on biopsychosocial case formulation rather than DSM or ICD diagnostic classification.

What this paper adds?

In this study a dimensional approach was used to characterize the abilities of young children referred with mild to profound receptive and/or expressive language difficulties. Later on, a categorical approach was adopted to establish best estimate diagnoses. Our clinical, broadly defined sample reflects the heterogeneous intake of young children referred for diagnostic assessment. Other studies on diagnostic stability often only focus on one diagnostic category (and are explicitly excluding children with specific other diagnoses), not taking into account the difficulties of early differential diagnostic decision making and stability across different categories over time. Investigations of differential diagnosis within a clinical group, instead of only differentiating children with a specific diagnosis from typically developing children, may be more informative for clinicians.

中文翻译：

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早期诊断决策的复杂性：对有语言困难的幼儿的后续研究

 背景和目标

由于早期诊断决策的复杂性，我们检查了 22 名临床转诊的语言困难儿童的早期诊断分类的预测价值以及后期最佳估计诊断的早期能力。

 方法和程序

初次评估四年后（时间 1），对这些儿童的临床档案进行了审查。建立了语言障碍 (LD)、智力障碍 (ID) 或自闭症谱系障碍 (ASD) 的最佳估计 (BE) 诊断，其中 ASD 最为常见。

 结果和成果

早期的临床分类相对不稳定或难以在年轻时建立。儿童认知和接受性语言延迟的程度分别是后来 BE 诊断为 ID 和 LD 的重要预测因素。相比之下，自闭症谱系障碍 (ASD) 的 BE 诊断无法从儿童早期的社交沟通问题或受限和重复的行为和兴趣的存在来预测。

 结论

总而言之，这项研究的结果表明，语言困难可能是神经发育障碍的早期标志，而这种障碍通常在首次转诊时未被发现。

 影响

因此，治疗资格应基于生物心理社会病例制定，而不是 DSM 或 ICD 诊断分类。

 这篇论文增加了什么？

在这项研究中，采用维度方法来表征具有轻度至重度接受性和/或表达性语言困难的幼儿的能力。后来，采用分类方法来建立最佳估计诊断。我们的临床、广泛定义的样本反映了转介进行诊断评估的幼儿的异质性摄入。关于诊断稳定性的其他研究通常只关注一种诊断类别（并明确排除具有特定其他诊断的儿童），而没有考虑到早期鉴别诊断决策的困难以及不同类别随着时间的推移的稳定性。对临床组内的鉴别诊断进行研究，而不是仅将具有特定诊断的儿童与正常发育的儿童区分开来，可能为临床医生提供更多信息。