This study was designed to validate the Preschool Speech and Language Screening Test. The PSLST was designed to quickly identify those preschool children who appear to be in need of speech and/or language evaluation or intervention. Specifically, the present investigation sought to determine the proportion of children with speech and/or language problems not detected by the screening test and the proportion of children without speech and language problems who failed the PSLST.

The research described here was inspired by a national review which concluded that too many children come into our primary schools with unmet speech and language needs (Bercow, 2008). Teachers are in a position to identify language difficulties but many have expressed uncertainty regarding their role in this process. I believed that the LAMP (Linguistic Assessment for Mapped Provision) screen for language and communication which I had developed would help teachers to identify language concerns and would also increase their professional confidence in this complex area. I had developed the LAMP screening instrument and piloted it over a 2 year period prior to this study. It is employed here as a universal screen that is used in a whole school approach in order to enable teachers to identify language need. The use of the LAMP as a universal screen applied to all the children in a school lessened the likelihood of preconceived notions impacting upon teacher’s perceptions of need in the classroom. The LAMP data allowed schools to track the progress of individual children within a class and whole school context. Teachers need to be aware of any pre-conceptions they may have in relation to the performance of children from different socio economic circumstances. The hypothesis that poverty continues to provide the weightiest detrimental effects upon children’s language development was examined and within the parameters of this study was found to be contestable. Study design: A systematic survey was conducted over 4 Primary schools using the LAMP. Rich picture data was accessed from teacher questionnaires and focus groups involving participants from the schools in the study. The repeated measures design provided information on what teachers had learned in the period of reflection between the screenings. The use of a mixed methods repeated measures design helped me to understand what was difficult for teachers and what the teachers felt would help them. The 4 schools in the study were chosen to reflect varied social contexts in order to explore any impacts of SES on the results. Analysis of data: In a repeated measures design, a LAMP screen was completed for every child across the 4 schools by their teachers in February and then June in one school year. Results of screening were analysed and compared on a range of variables using SPSS. Questionnaires were used to collect teacher perceptions before and after using the LAMP screen. Focus groups were held in the schools at the end of the study to add more information on how helpful teachers felt the process had been in raising their awareness, confidence, and skills in the identification of SLCN. Findings: The main trend observed was a decrease in levels of teacher concern related to children’s speech and language needs from the first to second screening survey. Differences were found at a statistically significant level on a range of variables. The expected differences between high and low socio-economic status (SES) schools were not found. Teachers reported increases in their awareness, confidence, and skill in identifying children’s speech language and communication concerns by the end of the study. Some changes to classroom practice were reported. Conclusions: I propose that use of the LAMP screen increased teacher awareness of the nature of language difficulty and that this heightened awareness was a key variable in the observed changes to language concern scores. The LAMP screening process was seen by schools’ staff to have had a positive effect on teacher’s skills and to be relatively easily assimilated into the school system. However some participants identified a number of challenges relating to time constraints and maintaining the use of LAMP as high profile in the context of competing time demands in their schools. It is suggested that EP services would be in a position to support schools to implement and embed the LAMP screening model as part of their Service provision. It is also proposed that economic deprivation or disadvantage did not appear to be the only important factor to consider when making funding decisions intended to support children’s linguistic competency in schools.

Bakgrund: Barns grundläggande språkkunskaper utvecklas under förskoleåldern (2-6år) och de befinner sig under denna period i ett språkfönster då språkutvecklingen är inne i en gynnsam fas. Upptäcks barn med språksvårigheter och får rätt insatser under denna period förbättras förutsättningarna för barnets fortsatta språkutveckling. Det är barnhälsovården och BHV-sjuksköterskans ansvar att upptäcka barn med atypisk språkutveckling, detta arbete sker genom upprepade språkbedömningar och språkscreeningar under tiden då barnet deltar i barnhälsovårdens verksamhet (0-6år). Syfte: Syftet med studien var att beskriva BHV-sjuksköterskors erfarenheter av att arbeta med barns språkutveckling inom barnhälsovården. Metod: En induktiv ansats valdes där datamaterialet analyserades med kvalitativ innehållsanalys. Åtta intervjuer genomfördes med BHV-sjuksköterskor. Resultat: Ur analysen av datamaterialet framträdde tre kategorier såsom; upptäcker barn med atypisk språkutveckling, samarbetar med föräldrar och använder evidensbaserat screeningsverktyg med sex tillhörande underkategorier. Konklusion: I studien framkommer att BHV-sjuksköterskorna upplever ett stort ansvar i att upptäcka barn med atypisk språkutveckling. Detta för att barn med språksvårigheter får bättre förutsättningar om insatser startar i tidig ålder. Föräldrar upplevs sakna förståelse för barnets språkutveckling och vilken betydelse språket har för barnet. BHV-sjuksköterskorna försöker skapa kunskap och förståelse för barnets språkutveckling hos föräldrarna då de har en central roll i barnets utveckling. / Background: Children's basic language skills develop during the preschool age (2-6 years) and are at this time in a positive progress of language development. If children with language difficulties are detected and gets the right support during this period of time it improves the conditions for the child’s language development. It is the Child health care nurse’s responsibility to identify children with deviant language development. Aim:  The aim of the study was to describe Child health care nurses´ experience of working with children´s language development in Child health centre. Method: An inductive approach was chosen where data was analyzed using qualitative content analysis. Eight interviews were conducted with Child health care nurses. Results:  Three categories emerged from the analysis; detects children with deviant language development, collaborates with parents and use evidence-based screening instrument with six subcategories included.   Conclusion: It emerges from the study that Child health care nurses´ experience a major responsibility to detecting children with deviant language development. This is because children with language difficulties get better prerequisites if insertion starts at early age.  Child health care nurses perceive lack of understanding from parents regarding the child´s language development and the importance of language for the child.

In 2015 a new national Child Health Care Program was introduced in Uppsala County, Sweden. Due to this, the Child Health Center’s speech-language screening for 3-year old’s was moved to 2½ years. The same method of screening - ‘Westerlunds 3-årsmetod’ - is maintained, though there have been a few changes. The children are only expected to use two-word utterances for a passable result, contrary to the earlier requirement for three-word utterances. The absence of three-word utterances now means a follow-up at the age of three. The purpose of the present study was to evaluate the part in “Westerlunds 3-årsmetod” which examines length of utterances, by examining if the absence of three-word utterances could be used as an indicator for language difficulties and whether a postponement of the screening (with approximately a month) could ensue in fewer children being called for a follow-up. The participants were recruited through mail to families with children just above the age for the 2½ year speech-language screening. It proved difficult to find participants for the study with the chosen recruitment method and on that account an additional recruitment was implemented. Despite that, none of the possible participants met all the inclusion criteria in the end, which meant that the prospective analyses could not be performed and therefore the research questions could not be entirely answered. A choice was made to analyze the already collected data, meaning that the entire group of children screened in the right age range (2:6-2:9) were examined. The group consisted of 26 children, 14 girls and 12 boys. The average age was 2:6 years (min: 2:6, max: 2:8). Of these 8% (2 children) were not using three-word utterances, although they also had other difficulties. Based on this group vague indications could be seen suggesting that a connection between age and the time of screening does not exist. Most of the children, 95%, screened at the age of 2:6 years passed the screening without remarks. Furthermore, it turned out that some children were screened as early as 2:5 with passable results. Consequently, no data in this study supports the notion that a postponement of the screening would result in fewer follow-ups. It should be noted that due to insufficient data no clear conclusions can be drawn. / År 2015 infördes det nya nationella barnhälsovårdsprogrammet i Uppsala. Det resulterade i en förflyttning av språkscreeningen på barnavårdscentralen (BVC), från 3 års ålder till 2 ½ år. Samma screeningmetod - Westerlunds 3-årsmetod - används fortfarande, med vissa mindre ändringar. En förändring som skett i och med förflyttningen är att barnen vid 2 ½ år inte längre förväntas tala i treordssatser för godkänt resultat. Istället räcker det att barnen använder tvåordssatser. Avsaknad av treordssatser vid screeningen innebär dock en uppföljning av språkutvecklingen vid 3 år. Syftet med denna studie var att utvärdera hur delmomentet Språkanvändning (som undersöker satslängd) i screeningmetoden fungerar vid 2 ½ års ålder. Detta för att undersöka om avsaknad av treordssatser vid 2 ½ år kan vara en indikation för språkliga svårigheter samt om en senareläggning av screeningen (med någon månad) kan bidra till att färre barn behöver följas upp. Deltagare rekryterades genom brevutskick till familjer med barn som nyligen passerat åldern för 2 ½ -årsscreening på BVC. Det visade sig vara svårt att hitta deltagare till studien med den valda metoden, därav genomfördes en kompletterande rekrytering. Efter fullgjord rekrytering framkom det ändå att ingen av de möjliga deltagarna uppfyllde alla studiens inklusionskriterier, vilket medförde att de tilltänkta analyserna inte kunde genomföras och frågeställningarna inte kunde besvaras. På grund av detta gjordes valet att titta på alla barn som screenats i rätt åldersintervall (2:6 - 2:9 år). Därmed undersöktes 26 barn (14 flickor och 12 pojkar, ålder 2:6 – 2:8 år, medelålder 2:6 år). Av dem var det 8 % (2 barn) som inte talade i treordssatser, dock i kombination med andra svårigheter. Utifrån dessa 26 barn kunde vissa indikationer ses som tyder på att ett samband mellan ålder på barnet och tidpunkt för screening inte existerar. Majoriteten, 95 %, av barnen som screenades vid 2:6 år klarade den helt utan anmärkning. Det visade sig även att ett antal barn screenats så tidigt som vid 2:5 år och ändå presterat utan anmärkning. Därmed ses ingen data i den här studien tala för att en senareläggning av screeningen skulle medföra att färre barn kallas för uppföljning. På grund av bristande data bör det dock påpekas att inga faktiska slutsatser kan dras utifrån den här studien.

L’étude présente l’élaboration du premier outil d’évaluation normalisée du langage destiné aux enfants francophones d’âge préscolaire des pays africains qui se caractérisent par l’absence de services publics en orthophonie et la méconnaissance des retards de langage. En s’inspirant des techniques psychométriques langagières utilisées en Amérique du nord et en se basant sur les théories d’acquisition du langage, on a construit un outil appelé Batterie de tests de dépistage approfondi (BATEDA) qui compte onze tests répartis en trois sous-batteries évaluant respectivement l’intégrité des modalités de transmission du langage (BATEM), les composantes langagières (BATEL) et la mémoire verbale (TMV). A partir d’un échantillon de 159 enfants camerounais francophones, on a normalisé la batterie suivant la cote z et les rangs en centile. Les tests présentent une fiabilité inter-juge et intra-juge (p<0,05), une cohérence interne globale d’environ 96% (α de Cronbach=0,958) et une validité prédictive de la réussite scolaire des enfants (r=0,700). Les stratégies d’application de la BATEDA visent à favoriser la pratique du dépistage systématique et la prise en charge des retards de langage au Cameroun, en mettant à contribution les enseignants et les parents comme principaux intervenants. Les implications de cette étude sont de trois ordres : (1) une meilleure connaissance des difficultés langagières, la revalorisation des personnes atteintes et une attitude de vigilance sociale; (2) l’instauration de la pratique de dépistage précoce favorable à l’intervention; (3) une potentielle diminution du taux d’exclusion et d’abandon scolaire d’enfants présentant des retards langagiers à travers un enseignement ciblé en leur faveur. / The study aims at the building of the first normalized language assessment test intended for French-speaking preschoolers living in African countries where language delays are ignored and where there is a lack of public services in speech-language therapy. Being inspired by the format of standardized language tests, and based on language acquisition theories, we developed a tool named Batterie de tests de dépistage approfondi (BATEDA) which combine eleven tests organized in three batteries assessing respectively modalities (BATEM), language components (BATEL) and memory (TMV). From a sample of 159 Cameroonian French-speaking four-to-five-years old children, the tool has been normalized using standard scores technique (the z score and the percentile). Tests have an inter-scorer reliability, an internal consistency of 96% (α de Cronbach=0,958) and a predictive validity of the primary school success of children (r=0,700). The application strategies of BATEDA aim at encouraging the screening of language delays in order to take charge of these difficulties in Cameroon by implicating teachers and parents as main participants. Among the implications of this study, we have the better knowledge of difficulties related to language delays, the better consideration of children affected, the establishment of early screening and language assessment on behalf of intervention, and a potential decrease of the rate of school abandon and expulsion of children with language delays.

L’étude présente l’élaboration du premier outil d’évaluation normalisée du langage destiné aux enfants francophones d’âge préscolaire des pays africains qui se caractérisent par l’absence de services publics en orthophonie et la méconnaissance des retards de langage. En s’inspirant des techniques psychométriques langagières utilisées en Amérique du nord et en se basant sur les théories d’acquisition du langage, on a construit un outil appelé Batterie de tests de dépistage approfondi (BATEDA) qui compte onze tests répartis en trois sous-batteries évaluant respectivement l’intégrité des modalités de transmission du langage (BATEM), les composantes langagières (BATEL) et la mémoire verbale (TMV). A partir d’un échantillon de 159 enfants camerounais francophones, on a normalisé la batterie suivant la cote z et les rangs en centile. Les tests présentent une fiabilité inter-juge et intra-juge (p<0,05), une cohérence interne globale d’environ 96% (α de Cronbach=0,958) et une validité prédictive de la réussite scolaire des enfants (r=0,700). Les stratégies d’application de la BATEDA visent à favoriser la pratique du dépistage systématique et la prise en charge des retards de langage au Cameroun, en mettant à contribution les enseignants et les parents comme principaux intervenants. Les implications de cette étude sont de trois ordres : (1) une meilleure connaissance des difficultés langagières, la revalorisation des personnes atteintes et une attitude de vigilance sociale; (2) l’instauration de la pratique de dépistage précoce favorable à l’intervention; (3) une potentielle diminution du taux d’exclusion et d’abandon scolaire d’enfants présentant des retards langagiers à travers un enseignement ciblé en leur faveur. / The study aims at the building of the first normalized language assessment test intended for French-speaking preschoolers living in African countries where language delays are ignored and where there is a lack of public services in speech-language therapy. Being inspired by the format of standardized language tests, and based on language acquisition theories, we developed a tool named Batterie de tests de dépistage approfondi (BATEDA) which combine eleven tests organized in three batteries assessing respectively modalities (BATEM), language components (BATEL) and memory (TMV). From a sample of 159 Cameroonian French-speaking four-to-five-years old children, the tool has been normalized using standard scores technique (the z score and the percentile). Tests have an inter-scorer reliability, an internal consistency of 96% (α de Cronbach=0,958) and a predictive validity of the primary school success of children (r=0,700). The application strategies of BATEDA aim at encouraging the screening of language delays in order to take charge of these difficulties in Cameroon by implicating teachers and parents as main participants. Among the implications of this study, we have the better knowledge of difficulties related to language delays, the better consideration of children affected, the establishment of early screening and language assessment on behalf of intervention, and a potential decrease of the rate of school abandon and expulsion of children with language delays.