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The development and productivity of a measure for identifying low language abilities in children aged 24–36 months

Lookup NU author(s): Professor James LawORCiD, Dr Jenna Charlton, Robert Rush, Vicky Gilroy, Professor Cristina McKeanORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Background: Accurate early identification of children with low language ability is important but existing measures generally have low sensitivity. This remains an area of concern for preventive and public health services. This study aimed to create and evaluate a measure of child language, communication and related risks which can be used by community health nurses to accurately identify children with low language aged 24-30 months. Methods: The Early Language Identification Measure (ELIM) was developed and comprised five measurement sections, each measuring different aspects of development combined into a single measure. This was tested blind against a reference standard language measure, the Preschool Language Scale-5 (PLS-5), at the universal 24–30-month health visitor review in England. The threshold for likely low language was the tenth centile or below on the PLS-5. The aim was to ascertain the performance of the five individual sections in the scale, and consider the optimum combination of sections, for predicting low language ability. Specificity, sensitivity, and positive and negative predictive values were reported for each of the five sections of the ELIM alone and in conjunction with each other. The performance for children from monolingual English-speaking families and those who spoke languages other than English were also considered separately. Results: Three hundred and seventy-six children were assessed on both the ELIM identification measure and the PLS-5 with 362 providing complete data. While each section of the ELIM predicted low language ability, the optimal combination for predicting language outcome was the parent reported vocabulary checklist coupled with the practitioner observation of the child’s communication and related behaviours. This gave a sensitivity of 0·98 with a specificity of 0·63. Conclusions: A novel measure has been developed which accurately identifies children at risk of low language, allowing clinicians to target resources efficiently and intervene early.

Publication metadata

Author(s): Law J, Charlton J, Wilson P, Rush R, Gilroy V, McKean C

Publication type: Article

Publication status: Published

Journal: BMC Pediatrics

Year: 2023

Volume: 23

Online publication date: 29/09/2023

Acceptance date: 17/05/2023

Date deposited: 19/06/2023

ISSN (electronic): 1471-2431

Publisher: BioMed Central Ltd.


DOI: 10.1186/s12887-023-04079-x


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Funder referenceFunder name
Public Health England
UK’s Department for Education