The use of the Labyrinth Scale in the differential diagnosis of children aged 2 to 4 with a history of psychological distress, autism and different language outcomes.
Tainá Rossato Benfica, Fernanda Nunes Franco, Gustavo Marcelino Siquara and 2 others
The Labyrinth Scale separates ASD from typical development and delayed language acquisition, but the DLD group mean (12.7) sits above the ASD cutoff (12).
A high score does not confirm ASD in a child with a language disorder.
Key findings
1The Labyrinth Scale total score and all four subscales (Verbal Communication, Social Interaction, Nonverbal Communication, Rigid and Repetitive Behaviors) showed statistically significant differences between the ASD group and each of the other three groups (TD, DLA, DLD).
2Eight of nine children with a medical ASD diagnosis scored at or above the Labyrinth Scale cutoff of 12. The one child below the cutoff had received intervention since 11 months of age, which the therapist suggested may explain the lower score.
3The DLD group mean total score was 12.7, above the ASD diagnostic cutoff of 12, indicating substantial score overlap between the two groups that are hardest to tell apart clinically.
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What it does not show
Very small sample: 29 children total, with groups of only 4 to 11. The authors attribute the small size to the pandemic context. Convenience sample recruited from clinics and schools in one Brazilian state; results may not generalise to other populations or settings. Cross-sectional design: a single assessment at one time point, so no information about how scores change with intervention or development. The group composition is inconsistent across the paper: one sentence lists 4 TD, 5 DLA, 10 DLD, 11 ASD (total 30); another lists 5 TD, 4 DLA, 10 DLD, 9 ASD (total 28); the data table shows 5 TD, 5 DLA, 10 DLD, 9 ASD (total 29). No formal sensitivity, specificity, positive predictive value, or negative predictive value is reported. The paper reports group means and between-group differences, which is a weaker basis for judging a diagnostic tool than classification accuracy. The DLD group mean (12.7) is above the ASD cutoff (12), so the scale does not cleanly separate the two conditions that are hardest to distinguish in practice. No blinding of the assessors to the child's existing diagnosis is described.
Declared interests
No funding source declared. No conflicts of interest declared.
The easy way to misread this
Do not read the significant DLD-ASD differences as evidence the scale cleanly separates these two groups. The DLD group mean (12.7) is above the ASD cutoff (12), and with only 10 DLD and 9 ASD children, the overlap means a high score in a child with a language disorder is not a reliable ASD indicator.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →