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Purpose: To assess the diagnostic accuracy of a new Test of Early Nonword Repetition (TENR) for 2-year-old children., Method: 232 British-English-speaking children aged 27 (+/-3) months were assessed on 3 standardized tests (receptive and expressive vocabulary and visual processing) and a novel nonword repetition (NWR) test. Parents completed a British adaptation of the MacArthur-Bates Communicative Development Inventory: Words and Sentences (CDI:WS-UK; Klee & Harrison, 2001). The diagnostic accuracy of two versions (1-3 syllables and 1-4 syllables) of a new NWR test was examined. Standard diagnostic accuracy measures of sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratios were generated., Results: 177 children (80%) completed the 1-3 syllable task, and 96 children (73%) completed the 1-4 syllable task. The 1-3 syllable version produced a positive likelihood ratio (LR+) of 7.8 (confidence interval [CI] = 4.5-13.6) and a negative likelihood ratio (LR-) of .28 (CI = .12-.65). The 1-4 syllable version of the NWR test produced a LR+ of 14.88 (CI = 6.1-36.2) and a LR- of .13 (CI = .02-.83)., Conclusion: The TENR could be useful for identifying 2-year-old children at risk of language impairment.

In a previous study, we reported the results of an early language screening program in which 306 children were screened using a parent-report questionnaire sent through the mail (Klee et al., 1998). A sample of the children screened were given clinical evaluations within a month of screening (n = 64) and again 1 year later (n = 36). Although the screening program correctly identified 91% of 2-year-olds with language delay, it produced a large number of over-referrals. In the present study we examine a revised screening criterion designed to reduce the number of false positives. The revised criterion generated fewer positive screens overall than the original and resulted in improved specificity (96% vs. 87%) and positive predictive value (77% vs. 51%), while maintaining the high sensitivity (91%) and negative predictive value (98%) of the original criterion. We also propose a screening score based on the new criterion, designed to inform the process of deciding which children to bring in for further evaluation.

The NSST was administered to 900 children aged three years to seven years, 11 months. Using a step-wise multiple regression model, the test was shortened from 20 to 11 test items receptively and expressively, while accounting for 95% of total test score variance. This shortened form, taking approximately 10 minutes to administer, was normed in six-month intervals as opposed to the one-year intervals of the original NSST. A cross validation sample of 301 children was used to demonstrate that comparable clinical decisions are made employing either form.