New Mandarin Assessment Tool Shows Promise for Early Language Delays in Toddlers with ASD and DLD

August 22, 2026 3 Min Read

Introduction

Early identification of language delays in toddlers is crucial, especially for conditions such as autism spectrum disorder (ASD) and developmental language disorder (DLD). Both disorders often present with language challenges but differ in social communication and behavioral features. A recent study has evaluated a culturally adapted tool designed to assess early language and communication in Mandarin-speaking toddlers, offering insights into its diagnostic and concurrent validity.

Study Overview and Methods

The study involved 213 children aged 24 to 36 months, including 89 diagnosed with ASD, 60 with DLD, and 64 typically developing (TD) toddlers. Participants were recruited from a tertiary hospital’s Child Healthcare Department between 2020 and 2022. Diagnoses were confirmed by multidisciplinary teams using DSM-5 and CATALISE criteria.

Caregivers completed the Diagnostic Receptive and Expressive Assessment of Mandarin-Infant & Toddler (DREAM-IT), a tool assessing receptive and expressive language, cognitive play, and social communication. Researchers analyzed the tool’s ability to differentiate between diagnostic groups using receiver operating characteristic (ROC) curve analyses and logistic regression. They also compared DREAM-IT results with established developmental and autism-related measures such as the Gesell Developmental Schedules (GDS), Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), and Autism Diagnostic Observation Schedule-2 (ADOS-2).

Key Findings

The DREAM-IT demonstrated strong accuracy in distinguishing children with ASD or DLD from typically developing peers, with area under the curve (AUC) values ranging from 0.84 to 0.998. However, its ability to differentiate between ASD and DLD was more limited and specific to certain domains.

Among the assessed domains, receptive language showed the most robust discrimination between ASD and DLD (AUC = 0.81), with a sensitivity of 69.1% and specificity of 84.3%. Expressive language, cognitive play, and social communication domains individually showed poor to limited discrimination (AUC between 0.51 and 0.57).

Logistic regression analysis indicated that both receptive and expressive language independently contributed to distinguishing ASD from DLD, achieving an overall classification accuracy of 79.2%.

Furthermore, DREAM-IT classifications exhibited moderate to substantial agreement with established developmental and autism-specific instruments (Cohen’s κ ranging from 0.62 to 0.82).

Developmental age comparisons revealed that toddlers with ASD had more pronounced delays in receptive language and social communication, while those with DLD showed the greatest lag in expressive language.

Clinical Implications

The Mandarin DREAM-IT provides valuable caregiver-reported information on early language and communication development in toddlers. Its strength lies in characterizing domain-specific developmental patterns, which can complement other diagnostic tools within a multi-method assessment framework.

However, the tool should not be used in isolation to diagnose ASD or DLD or to differentiate definitively between these conditions. Instead, results should be interpreted alongside developmental history, direct clinical observation, developmental testing, and autism-specific assessments.

Limitations and Considerations

While the DREAM-IT shows promise, its limited ability to distinguish ASD from DLD across all domains highlights the complexity of early diagnosis. The overlap in expressive language, cognitive play, and social communication between these groups suggests that comprehensive evaluation remains essential.

Conclusion

This study supports the clinical utility of the Mandarin DREAM-IT as a culturally appropriate tool that aligns moderately to strongly with established measures. It offers a useful addition to early assessment strategies for Mandarin-speaking toddlers presenting with language delays.

For more detailed information, see the original study at PubMed.