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The Complexity of Early Diagnostic Decision Making: A Follow-Up Study of Young Children with Language Difficulties

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Title: The Complexity of Early Diagnostic Decision Making: A Follow-Up Study of Young Children with Language Difficulties
Language: English
Authors: Jansen, Rianne, Maljaars, Jarymke (ORCID 0000-0002-8555-4584), Zink, Inge, Steyaert, Jean, Noens, Ilse
Source: Autism & Developmental Language Impairments. 2021 6.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 13
Publication Date: 2021
Document Type: Journal Articles
Reports - Research
Descriptors: Clinical Diagnosis, Decision Making, Young Children, Language Impairments, Classification, Intellectual Disability, Autism Spectrum Disorders, Receptive Language, Predictor Variables, Communication Problems, Evaluation Criteria, Eligibility, Case Records, Expressive Language, Foreign Countries
Geographic Terms: Belgium
DOI: 10.1177/2396941520984894
ISSN: 2396-9415
Abstract: 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.
Abstractor: As Provided
Entry Date: 2022
Accession Number: EJ1349660
Database: ERIC
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  Data: The Complexity of Early Diagnostic Decision Making: A Follow-Up Study of Young Children with Language Difficulties
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  Data: English
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  Data: <searchLink fieldCode="AR" term="%22Jansen%2C+Rianne%22">Jansen, Rianne</searchLink><br /><searchLink fieldCode="AR" term="%22Maljaars%2C+Jarymke%22">Maljaars, Jarymke</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-8555-4584">0000-0002-8555-4584</externalLink>)<br /><searchLink fieldCode="AR" term="%22Zink%2C+Inge%22">Zink, Inge</searchLink><br /><searchLink fieldCode="AR" term="%22Steyaert%2C+Jean%22">Steyaert, Jean</searchLink><br /><searchLink fieldCode="AR" term="%22Noens%2C+Ilse%22">Noens, Ilse</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Autism+%26+Developmental+Language+Impairments%22"><i>Autism & Developmental Language Impairments</i></searchLink>. 2021 6.
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  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
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  Data: Y
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  Data: 13
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  Data: 2021
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="DE" term="%22Clinical+Diagnosis%22">Clinical Diagnosis</searchLink><br /><searchLink fieldCode="DE" term="%22Decision+Making%22">Decision Making</searchLink><br /><searchLink fieldCode="DE" term="%22Young+Children%22">Young Children</searchLink><br /><searchLink fieldCode="DE" term="%22Language+Impairments%22">Language Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Classification%22">Classification</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Receptive+Language%22">Receptive Language</searchLink><br /><searchLink fieldCode="DE" term="%22Predictor+Variables%22">Predictor Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+Problems%22">Communication Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation+Criteria%22">Evaluation Criteria</searchLink><br /><searchLink fieldCode="DE" term="%22Eligibility%22">Eligibility</searchLink><br /><searchLink fieldCode="DE" term="%22Case+Records%22">Case Records</searchLink><br /><searchLink fieldCode="DE" term="%22Expressive+Language%22">Expressive Language</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Belgium%22">Belgium</searchLink>
– Name: DOI
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  Data: 10.1177/2396941520984894
– Name: ISSN
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  Group: ISSN
  Data: 2396-9415
– Name: Abstract
  Label: Abstract
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  Data: 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.
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