{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:18:00Z","timestamp":1790162280625,"version":"4.1.0"},"reference-count":42,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100017958","name":"Health Commission of Hubei Province","doi-asserted-by":"publisher","award":["WJ2023M020"],"award-info":[{"award-number":["WJ2023M020"]}],"id":[{"id":"10.13039\/100017958","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp;amp; Comm Disor"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early language delay is a common presenting concern among toddlers with autism spectrum disorder (ASD) and developmental language disorder (DLD), creating challenges for clinical assessment and referral decisions. Although ASD and DLD differ in core social\u2010communicative features, restricted\/repetitive behaviours, and developmental mechanisms, language\u2010focused assessment may provide complementary information about early communicative profiles. However, culturally adapted tools for assessing early language and communication in Mandarin\u2010speaking toddlers remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 213 children aged 24\u201336 months (ASD\u00a0=\u00a089, DLD\u00a0=\u00a060, TD\u00a0= 64) were recruited from the Child Healthcare Department of a tertiary hospital between 2020 and 2022. Clinical diagnoses were established by multidisciplinary teams based on DSM\u20105 and CATALISE criteria. Caregivers completed the Diagnostic Receptive and Expressive Assessment of Mandarin\u2010Infant &amp; Toddler (DREAM\u2010IT), which evaluates receptive and expressive language, cognitive play, and social communication. Receiver operating characteristic (ROC) curve analyses assessed discriminative validity across diagnostic groups, logistic regression examined the contribution of DREAM\u2010IT domains to ASD\u2010versus\u2010DLD classification, and concurrent validity was evaluated against GDS, ABC, CARS, and ADOS\u20102.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      DREAM\u2010IT showed strong diagnostic accuracy in distinguishing children with ASD or DLD from TD children (AUC\u00a0=\u00a00.84\u20130.998), but its ASD\u2010versus\u2010DLD discrimination was domain\u2010specific and more limited. Receptive language provided the strongest ASD\u2010versus\u2010DLD discrimination (AUC\u00a0=\u00a00.81; sensitivity\u00a0=\u00a069.1%; specificity\u00a0=\u00a084.3%; optimal cutoff\u00a0=\u00a086.5), whereas expressive language, cognitive play, and social communication showed poor\u2010to\u2010limited standalone performance (AUC\u00a0=\u00a00.51\u20130.57). Logistic regression indicated that receptive language (OR\u00a0=\u00a01.10,\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      &lt;\u00a00.05) and expressive language (OR\u00a0=\u00a00.77,\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      =\u00a00.015) independent contributed to ASD\u2010versus\u2010DLD discrimination, with an overall classification accuracy of 79.2%. DREAM\u2010IT classifications demonstrated moderate\u2010to\u2010substantial agreement with established developmental and autism\u2010related instruments, including GDS, ABC, CARS, and ADOS\u20102 (Cohen's\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u00a0=\u00a00.62\u20130.82). Developmental age comparisons revealed domain\u2010specific lags, with ASD characterized by greater receptive and social delays and DLD showing the largest lag in expressive language.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The Mandarin DREAM\u2010IT provides clinically useful information about early language and communication development in Mandarin\u2010speaking toddlers with ASD and DLD and shows moderate\u2010to\u2010strong concurrent alignment with established developmental and autism\u2010related measures. Its primary value lies in characterizing domain\u2010specific developmental patterns and offering useful complementary information within a broader, multi\u2010method diagnostic framework for Mandarin\u2010speaking populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>WHAT THIS PAPER ADDS<\/jats:title>\n                    <jats:p>\n                      <jats:italic>What is already known on this subject<\/jats:italic>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Differentiating autism spectrum disorder (ASD) from developmental language disorder (DLD) in toddlers is clinically important but challenging. Both conditions may present with early language delay, while ASD is characterised by core social\u2010communication difficulties and restricted or repetitive behaviours. Accurate interpretation therefore requires a multi\u2010method assessment integrating language evaluation, developmental history, direct observation, and autism\u2010specific measures. However, culturally and linguistically appropriate tools for characterising early language and communication in Mandarin\u2010speaking toddlers remain limited.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                      <jats:italic>What this study adds to the existing knowledge<\/jats:italic>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>This study evaluated the diagnostic accuracy and concurrent validity of the Mandarin DREAM\u2010IT in 213 toddlers with ASD, DLD, or typical development. DREAMIT showed good\u2010to\u2010excellent accuracy in distinguishing children with ASD or DLD from typically developing children, but ASD\u2010versus\u2010DLD discrimination was more limited and domain\u2010specific. Receptive language provided the clearest discriminatory signal, whereas expressive language, cognitive play, and social communication showed substantial overlap. DREAM\u2010IT developmental age scores showed moderate correlations with corresponding GDS measures, and its descriptive rule\u2010based patterns showed substantial agreement with autism\u2010specific instruments.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                      <jats:italic>What are the potential or actual clinical implications of this study?<\/jats:italic>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>DREAM\u2010IT may provide useful caregiver\u2010reported information about receptive language, expressive language, cognitive play, and social communication in Mandarin\u2010speaking toddlers. Its main clinical value lies in characterising domain\u2010specific developmental patterns and providing complementary information within a broader, multi\u2010method assessment framework. It should not be used as a standalone instrument to diagnose ASD or DLD or to differentiate between them. Results should be interpreted alongside developmental history, direct clinical observation, developmental testing, and autism\u2010specific measures.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1460-6984.70321","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:29:40Z","timestamp":1787322580000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the Diagnostic and Concurrent Validity of the DREAM\u2010IT in Mandarin\u2010Speaking Toddlers With Autism Spectrum Disorder and Developmental Language Disorder"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0602-2641","authenticated-orcid":false,"given":"Jinzhu","family":"Zhao","sequence":"first","affiliation":[{"name":"Division of Child Healthcare, Department of Pediatrics Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dandan","family":"Wu","sequence":"additional","affiliation":[{"name":"Yangzhou Maternal and Child Health Care Hospital Affiliated to Yangzhou University  Yang Zhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutong","family":"Li","sequence":"additional","affiliation":[{"name":"Boston University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Xiong","sequence":"additional","affiliation":[{"name":"Division of Child Healthcare, Department of Pediatrics Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Tang","sequence":"additional","affiliation":[{"name":"Division of Child Healthcare, Department of Pediatrics Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolin","family":"Hu","sequence":"additional","affiliation":[{"name":"Division of Child Healthcare, Department of Pediatrics Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueman Lucy","family":"Liu","sequence":"additional","affiliation":[{"name":"Hainan Boao Bethel International Medical Center  Boao China"},{"name":"University of Texas  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8830-8189","authenticated-orcid":false,"given":"Yan","family":"Hao","sequence":"additional","affiliation":[{"name":"Division of Child Healthcare, Department of Pediatrics Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/20473869.2022.2132669"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00913694"},{"key":"e_1_2_10_5_1","volume-title":"Bayley Scales of Infant and Toddler Development","author":"Bayley N.","year":"2006"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/1460\u20106984.12335"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.12721"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.893226"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tics.2012.02.007"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/13682820801921601"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1044\/2017_JSLHR-L-16-0256"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rasd.2010.09.001"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jir.12691"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/02699206.2022.2135024"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci11050589"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1362361305051395"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469\u20107610.1980.tb01797.x"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_10_19_1","first-page":"115","volume-title":"Speech and Language Impairments in Children: Causes, Characteristics, Intervention and Outcome","author":"Leonard L. 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