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：对语言困难幼儿的后续研究

背景与目标

由于早期诊断决策的复杂性，我们检查了早期诊断分类的预测价值和早期能力对 22 名有语言困难的临床转诊儿童的后期最佳估计诊断。

方法和程序

初步评估四年后（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。

结果和结果

早期临床分类相对不稳定或难以在年轻时建立。儿童认知和接受语言延迟的严重程度分别是后来对 ID 和 LD 的 BE 诊断的重要预测因子。相比之下，自闭症谱系障碍的 BE 诊断无法从儿童的早期社交沟通问题或受限和重复的行为和兴趣的存在中预测出来。

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，这种障碍通常在首次转诊时未被发现。

启示

因此，治疗资格应基于生物心理社会案例的制定，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，使用维度方法来描述具有轻度到深度接受和/或表达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。我们广泛定义的临床样本反映了被转介进行诊断评估的幼儿的异质性摄入。其他关于诊断稳定性的研究通常只关注一个诊断类别（并明确排除患有其他特定诊断的儿童），而没有考虑到早期鉴别诊断决策的困难和不同类别随时间的稳定性。在临床组内进行鉴别诊断调查，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，