Diagnostic Accuracy and Concurrent Validity of the Diagnostic Receptive and Expressive Assessment of Mandarin-Comprehensive (Dream-C) for Developmental Language Disorder in China

IF 2.1 3区医学 Q2 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY

International Journal of Language & Communication Disorders Pub Date : 2025-11-10 DOI:10.1111/1460-6984.70158

Jinzhu Zhao, Lina Tang, Jinhui Li, Tianyi He, Tingting Xiong, Lu Xu, Xuejin He, Shan Huang, Xueman Lucy Liu, Yan Hao

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引用次数: 0

Abstract

Background

Standardised Mandarin assessment tools for examining difficulties in language comprehension and expression at different developmental stages are limited in China. The first comprehensive standardised Mandarin assessment tool is the Diagnostic Receptive and Expressive Assessment of Mandarin-Comprehensive (DREAM-C), which is normed for children aged 2.5–8 years in Mainland China.

Aims

This study aimed to explore the evidence-based validity of DREAM-C in children with Developmental Language Disorder (DLD) to make it clinically useful in Hubei Province, China. To evaluate the diagnostic performance of three commonly used assessment tools in identifying DLD among Mandarin-speaking children in China, using multidisciplinary clinical diagnosis as the reference standard, with particular focus on the diagnostic accuracy and concurrent validity of the DREAM-C.

Methods and Procedures

The detailed medical history of children with speech, language and communication needs in child healthcare paediatric outpatient clinics was taken by clinicians and speech-language therapists and assessed using the DREAM-C, Gesell Developmental Schedules (GDS), and Wechsler Preschool and Primary Intelligence Scale (WPPSI-IV) in Tongji Hospital in Hubei Province, China, from December 2018 to January 2020. The sensitivity, specificity, percent agreement and correlation coefficient for the three assessments were compared for 320 children with DLD and 101 typical children.

Outcomes & Results

The mean age of participants was 3.81 years (range: 2.5–5.7) for the DLD group and 4.08 years (range: 2.5–6.0) for the TD group. Results showed that the sensitivity and specificity of DREAM-C were as high as that of the GDS (>0.80) in children with DLD, and the Verbal Comprehension Index (VCI) in WPPSI-IV had a low sensitivity (0.58) in the DLD group. The percent agreement between the DREAM-C subscales and language developmental quotient (DQ) of GDS was also high (70.63%–88.75%). The scores of each subscale of DREAM-C had a moderate and significant positive correlation with the language DQ of GDS (r = 0.35–0.56, p < 0.05). The scores of each subtest of DREAM-C had significantly low correlation with the verbal comprehension index in WPPSI-IV (r = 0.27–0.39, p < 0.05) in the DLD group.

Conclusions and Implications

The findings indicate that DREAM-C demonstrates good diagnostic accuracy and concurrent validity for identifying language difficulties in children with DLD. It may represent a valuable assessment option for Mandarin-speaking children with suspected DLD. Further research is warranted to examine its longitudinal applicability, cross-regional generalizability, and use in diverse clinical practice settings.

WHAT THIS PAPER ADDS

What is already known on the subject

In English-speaking countries, well-established comprehensive language scales with robust validity and reliability standards have been extensively developed and utilised. Conversely, the profession of speech-language pathology is still emerging in mainland China. This situation has resulted in a significant shortage of standard, norm-referenced language assessments for children with language impairments. Among the limited tools available, the Diagnostic Receptive and Expressive Assessment of Mandarin-Comprehensive (DREAM-C) has stood out in recent years.

What this paper adds to the existing knowledge

In China, developmental–behavioural paediatricians often rely on comprehensive developmental scales to identify children at risk for developmental delay and to evaluate if a child's language development aligns with age expectations. Specialised language assessments, however, are not as commonly employed. This study investigates the evidence-based validity of the DREAM-C in comparison to traditional developmental scales for diagnosing children with DLD.

What are the potential or actual clinical implications for this work?

DREAM-C demonstrates diagnostic accuracy in identifying language impairments, which may support developmental–behavioural paediatricians and speech-language therapists establish an appropriate individual intervention plan for children in clinical practice.

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中国发展性语言障碍的普通话综合诊断性接受性和表达性评估（Dream-C）的诊断准确性和同时效度

背景：在中国，用于测试不同发展阶段语言理解和表达困难的标准化普通话评估工具是有限的。第一个全面标准化的普通话评估工具是普通话综合接受和表达诊断性评估（DREAM-C），这是中国大陆为2.5-8岁儿童制定的标准。目的：本研究旨在探讨DREAM-C在发展性语言障碍（DLD）儿童中的循证效度，使其在湖北省具有临床应用价值。以多学科临床诊断为参考标准，评估三种常用评估工具在中国普通话儿童DLD诊断中的诊断效果，特别关注DREAM-C的诊断准确性和并发效度。方法和程序：2018年12月至2020年1月，在中国湖北省同济医院的儿童保健儿科门诊，临床医生和语言治疗师详细记录了有语言、语言和交流需求的儿童的病史，并使用dreamc、Gesell发育量表（GDS）和韦氏学前和初级智力量表（WPPSI-IV）进行评估。对320例DLD患儿和101例典型患儿的三种评估方法的敏感性、特异性、一致性百分比和相关系数进行比较。结果和结果：DLD组参与者的平均年龄为3.81岁（范围：2.5-5.7），TD组参与者的平均年龄为4.08岁（范围：2.5-6.0）。结果显示，DREAM-C在DLD患儿中的敏感性和特异性与GDS相当（>0.80），而WPPSI-IV的言语理解指数（VCI）在DLD组中的敏感性较低（0.58）。DREAM-C量表与GDS的语言发展商（DQ）的一致性也很高（70.63% ~ 88.75%）。DREAM-C各分量表得分与GDS的语言DQ呈中度显著正相关（r = 0.35-0.56, p）。结论与意义：研究结果表明，DREAM-C对DLD患儿的语言障碍有较好的诊断准确性和并发效度。它可能是一个有价值的评估选择，以普通话为母语的儿童疑似DLD。进一步的研究是必要的，以检查其纵向适用性，跨地区的普遍性，并在不同的临床实践设置使用。本文补充的内容：在英语国家，完善的综合语言量表具有强大的效度和信度标准，已被广泛开发和使用。相反，语言病理学专业在中国大陆仍处于萌芽阶段。这种情况导致严重缺乏针对语言障碍儿童的标准的、参照规范的语言评估。在有限的可用工具中，DREAM-C（普通话综合诊断接受和表达能力评估）近年来脱颖而出。在中国，发展行为儿科医生通常依靠综合发展量表来识别有发展迟缓风险的儿童，并评估儿童的语言发展是否符合年龄预期。然而，专门的语言评估并不常用。本研究探讨了DREAM-C与传统发育量表在诊断儿童DLD方面的循证有效性。这项工作的潜在或实际临床意义是什么？DREAM-C显示了识别语言障碍的诊断准确性，这可能支持发展行为儿科医生和语言治疗师在临床实践中为儿童建立适当的个人干预计划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Language & Communication Disorders AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY-REHABILITATION

CiteScore

3.30

自引率

12.50%

发文量

116

审稿时长

6-12 weeks

期刊介绍： The International Journal of Language & Communication Disorders (IJLCD) is the official journal of the Royal College of Speech & Language Therapists. The Journal welcomes submissions on all aspects of speech, language, communication disorders and speech and language therapy. It provides a forum for the exchange of information and discussion of issues of clinical or theoretical relevance in the above areas.