A Brief Measure of Language Skills at 3 Years of Age and Special Education Use in Middle Childhood

Published:November 28, 2016DOI:


      To test whether a language screener administered during early childhood predicts special education referrals and placement in middle childhood.

      Study design

      A series of logistic regressions was conducted in a longitudinal study of 731 children. Predictor variables included scores on the early language screener (Fluharty Preschool Speech and Language Screening Test-Second Edition [Fluharty-2]) at ages 3 and 4 years, a standardized measure of academic achievement at age 5 years, and parent report of special education services at ages 7.5, 8.5, and 9.5 years.


      Results showed that higher scores on the Fluharty-2 predicted a reduced likelihood of having an individualized education program (OR 0.48), being referred for special education (OR 0.55), and being held back a grade (OR 0.37). These findings did not vary by sex, race, or ethnicity, and remained significant after controlling for male sex, behavior problems, parental education, and family income. The Fluharty-2 remained predictive of special education outcomes even after controlling for children's academic skills at age 5 years.


      Results suggest that structured, brief assessments of language in early childhood are robust predictors of children's future engagement in special education services and low academic achievement. Primary care physicians may use a multipronged developmental surveillance and monitoring protocol designed to identify children who may need comprehensive evaluation and intervention. Early intervention may reduce the need for costly special education services in the future and reduce comorbid conditions.



      Fluharty-2 (Fluharty Preschool Speech and Language Screening Test-Second Edition), IEP (Individualized education program), Woodcock-Johnson III (Woodcock Johnson III Tests of Achievement)
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        • Council on Children with Disabilities Section on Developmental Behavioral Pediatrics
        • Bright Futures Steering Committee
        • Medical Home Initiatives for Children With Special Needs Project Advisory Committee
        Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening.
        Pediatrics. 2006; 118: 405-420
        • Hix-Small H.
        • Marks K.
        • Squires J.
        • Nickel R.
        Impact of implementing developmental screening at 12 and 24 months in a pediatric practice.
        Pediatrics. 2007; 120: 381-389
        • High P.C.
        • Committee on Early Childhood, Adoption, and Dependent Care and Council on School Health
        School readiness.
        Pediatrics. 2008; 121: e1008-15
        • Altarac M.
        • Saroha E.
        Lifetime prevalence of learning disability among US children.
        Pediatrics. 2007; 119: S77-83
        • Nelson H.D.
        • Nygren P.
        • Walker M.
        • Panoscha R.
        Screening for speech and language delay in preschool children: systematic evidence review for the US Preventive Services Task Force.
        Pediatrics. 2005; 117: e298-319
        • Campbell T.F.
        • Dollaghan C.A.
        • Rockette H.E.
        • Paradise J.L.
        • Feldman H.M.
        • Shriberg L.D.
        • et al.
        Risk factors for speech delay of unknown origin in 3-year-old children.
        Child Dev. 2003; 74: 346-357
        • Hart B.
        • Risley T.R.
        Meaningful differences in the everyday experience of young American children.
        Paul H. Brookes Publishing, Baltimore (MD)1995
        • Dishion T.J.
        • Shaw D.
        • Connell A.
        • Gardner F.
        • Weaver C.
        • Wilson M.
        The Family Check-Up with high-risk indigent families: preventing problem behavior by increasing parents' positive behavior support in early childhood.
        Child Dev. 2008; 79: 1395-1414
        • Fluharty N.B.
        Fluharty preschool speech and language screening test.
        2nd ed. PRO-ED, Inc, Austin (TX)2001
        • Woodcock R.W.
        • McGrew K.S.
        • Mather N.
        Woodcock-Johnson III tests of achievement.
        Riverside, Itasca (IL)2001
        • Robinson E.A.
        • Eyberg S.M.
        The standardization of an inventory of child conduct problem behaviors.
        J Clin Child Psychol. 1980; 9: 22-29
        • Aiken L.S.
        • West S.G.
        Multiple regression: testing and interpreting interactions.
        SAGE, Thousand Oaks (CA)1991
        • van Buuren S.
        Flexible imputation of missing data.
        CRC Press, Boca Raton (FL)2012
        • White I.R.
        • Royston P.
        • Wood A.M.
        Multiple imputation using chained equations: issues and guidance for practice.
        Stat Med. 2011; 30: 377-399
        • R Development Core Team
        [Homepage on the Internet]. R: a language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna (Austria)2015 (Accessed October 1, 2016)
        • Resnick M.B.
        • Gueorguieva R.V.
        • Carter R.L.
        • Ariet M.
        • Sun Y.
        • Roth J.
        • et al.
        The impact of low birth weight, perinatal conditions, and sociodemographic factors on educational outcome in kindergarten.
        Pediatrics. 1999; 104: 1-10
        • Wallace I.F.
        • Berkman N.D.
        • Watson L.R.
        • Coyne-Beasley T.
        • Wood C.
        • Cullen K.
        • et al.
        Screening for speech and language delay in children 5 years old and younger: a systematic review.
        Pediatrics. 2012; 136: e448-62
        • Law J.
        • Boyle J.
        • Harris F.
        • Harkness A.V.
        • Nye C.
        The feasibility of universal screening for primary speech and language delay: findings from a systematic review of the literature.
        Dev Med Child Neurol. 2000; 42: 190-200
        • Margari L.
        • Buttiglione M.
        • Craig F.
        • Cristella A.
        • de Giambattista C.
        • Matera E.
        • et al.
        Neuropsychopathological comorbidities in learning disorders.
        BMC Neurol. 2013; 13: 198-204
        • Entwisle D.R.
        • Alexander K.L.
        • Olson L.S.
        First grade and educational attainment by age 22: a new story.
        Am J Sociol. 2005; 110: 1458-1502
        • Law J.
        • Rush R.
        • Anandan C.
        • Cox M.
        • Wood R.
        Predicting language change between 3 and 5 years and its implication for early identification.
        Pediatrics. 2012; 130: e132-7
        • Briggs R.D.
        • Stettler E.M.
        • Silver E.J.
        • Schrag R.D.A.
        • Nayak M.
        • Chinitz S.
        • et al.
        Social-emotional screening for infants and toddlers in primary care.
        Pediatrics. 2012; 129: e377-84
        • Johnson C.J.
        • Beitchman J.H.
        • Young A.
        • Escobar M.
        • Atkinson L.
        • Wilson B.
        • et al.
        Fourteen-year follow-up of children with and without speech/language impairments: speech/language stability and outcomes.
        J Speech Lang Hear Res. 1999; 42: 744-760
        • Stothard S.E.
        • Snowling M.J.
        • Bishop D.V.M.
        • Chipcase B.B.
        • Kaplan C.A.
        Language-impaired preschoolers: a follow-up into adolescence.
        J Speech Lang Hear Res. 1998; 41: 407-418
        • Snowling M.J.
        • Bishop D.V.M.
        • Stothard S.E.
        • Chipchase B.
        • Kaplan C.
        Psychosocial outcomes at 15 years of children with a preschool history of speech-language impairment.
        J Child Psychol Psychiatry. 2006; 47: 759-765
        • Aylward G.P.
        • Pfeiffer S.I.
        • Wright A.
        • Verlhust S.J.
        Outcomes studies of low birth weight infants published in the last decade: a meta-analysis.
        J Pediatr. 1989; 115: 515-520
        • Bhutta A.T.
        • Cleves M.A.
        • Casey P.H.
        • Cradock M.M.
        • Anand K.J.
        Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis.
        JAMA. 2002; 288: 728-737
        • U.S. Preventive Services Task Force
        Screening for speech and language delay in preschool children: recommendation statement.
        Agency for Healthcare Research and Quality, Rockville (MD)2006