Adaptation and validation of receptive expressive emergent Language Test-3: Evidence from Hindi speaking children with cochlear implant

Introduction: Selection of an effective tool for assessment of language learning outcomes in post cochlear implantation is always an important but challenging task. Receptive expressive emergent language test-3rd Eds. (REELT-3) is one of the comprehensive language assessment tools used in India. In case of administration of REELT-3, which is standardized in English speaking typically developing western population, to another language speaking population with post-cochlear implant condition, the test outcome may get compromised owing to linguistics and population variability. The objective of the study is to test and validate REELT-3 in Hindi speaking children with cochlear implantation.

Methods: Ninety six typically developing children (22.3 ± 6.9 months, 48 boys and 48 girls) and 96 children with cochlear implantation (25.8 ± 9.2 months, 57 boys and 39 girls) participated in this study. As per the eligibility criteria of REELT-3, infants and toddlers with cochlear implant of age below 36 months participated in this study. Criterion, content and construct validity were tested using correlation based statistical analysis.

Results: High content validity was established by obtaining very low correlation coefficient r = 0.16 across two distinct population of typically developing children and children with cochlear implantation. Similarly, correlation coefficient of r = 0.84 revealed high criterion validity across REELT-3 in English and Hindi speaking conditions. Finally, correlation coefficient of r = 0.87was obtained between language raw score and chronological age to establish construct validity. Chronbach alpha coefficient (Chronbach α = 0.85) and interclass correlation coefficient 0.87was observed for REELT-3 which suggests good internal consistency and test-retest reliability, respectively. Receiver Operating Characteristics curve analysis of the REELT-3 suggested that area under curve 0.95 (95% CI = 0.89-0.99, p < 0.001) is excellent. The cut-off Language Ability Score (LAS) was determined as 74.5 with the sensitivity of 87.9% and specificity of 84.1% infer high sensitivity and specificity.

Conclusions: These results validate that REELT-3 can be used in assessment of language outcome in Hindi speaking children with post-cochlear implantation. Clinical assessment of receptive and expressive language will be beneficial in effective evaluation as well as in therapeutic planning.