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Objective: This study, which was carried out under routine conditions, evaluates the predictability of a global rating of children’s speaking manner made by Child Health Centre nurses. The global rating was added to a formalized screening of 3-yr olds, which intended to identify severely language disabled children. This screening procedure is used in several Swedish counties and the participation rate is nearly 100%. The main questions of the study are: (i) can a global rating of speech ability in children, who have passed the 3-yr screening, predict the outcome of a new population screening 1 yr later? and if so (ii) what is the most efficient cut-off point? Methods: The global ratings of the 3-yr olds were made using a 100 mm visual analogue scale (VAS). At the age of 4 yrs, 2065 globally rated children with no objections from the 3-yr screening participated in a second, well-established assessment. The purpose of this second screening was to identify not only severe but also moderate disability. Results: The mean VAS value of the global ratings was 62 mm. One-third of the ratings fell on the lower half of the scale. With a cut-off level set at =50 mm on the VAS two newly-identified, severely disabled children and 74% of the moderately disabled 4-yr olds were identified. Conclusion: The results suggest that the global rating in connection to the 3-yr screening would serve as a useful tool for selective screening of 4-yr olds, and thus, reduce the work load. Published by arrangement with John Wiley & Sons.

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