Parent-completed developmental screening in a Norwegian population sample: a comparison with US normative data

Screen time and early childhood development in Ceará, Brazil: a population-based study

Background

Globally, children’s exposure to digital screens continues to increase and is associated with adverse effects on child health. We aimed to evaluate the association of screen exposure with child communication, gross-motor, fine-motor, problem-solving, and personal-social development scores.

Methods

We conducted a population-based, cross-sectional study with cluster sampling among children 0–60 months of age living in the state of Ceará, Brazil. Child screen time was assessed by maternal report and the World Health Organization (WHO) recommendations were used to define excessive screen time exposure. Child development was assessed with the Brazilian Ages and Stages Questionnaire. Generalized linear regression was used to determine the association of screen exposure with developmental outcomes. We also examined the potential non-linear relationship of screen time with development scores using spline analyses.

Results

A total of 3155 children 0–60 months of age had screen time exposure evaluated and 69% percent were identified as exposed to excessive screen time. This percentage of excess screen time increased with child age from 41.7% for children 0–12 months to 85.2% for children 49–60 months. Each additional hour of screen time was associated with lower child communication (standardized mean difference (SMD): -0.03; 95% CI: − 0.04, − 0.02), problem solving (SMD: -0.03; 95% CI: − 0.05, − 0.02) and personal-social (SMD: -0.04; 95% CI: − 0.06, − 0.03) domain scores.

Conclusions

Excess screen time exposure was highly prevalent and independently associated with poorer development outcomes among children under 5 years of age in Ceará, Brazil.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12136-2.

International study of 24-h movement behaviors of early years (SUNRISE): a pilot study from Bangladesh

BACKGROUND

The World Health Organization (WHO) released guidelines for physical activity, sedentary behavior, and sleep for children under 5 years of age in 2019. In response to these guidelines, this pilot study aimed to (i) determine the proportion of preschool children (ages 3-4 years) who met the WHO guidelines; (ii) examine the feasibility of the proposed protocol for the SUNRISE study; and (iii) assess the impact of the COVID-19 pandemic on movement behaviors of preschool children in Bangladesh.

METHODS

Time spent in physical activity, sedentary behavior and sleep were objectively measured using two types of accelerometers (ActiGraph wGT3x-BT and ActivPAL4). Screen time and sleep quality were assessed via parent questionnaire. Fine and gross motor skills were measured using the Ages and Stages Questionnaire (3rd edition). Three executive functions were assessed using the Early Years Toolbox. Focus groups were conducted with parents and childcare staff to determine the feasibility of the protocol. Follow-up data during COVID-19 pandemic was collected from parents over phone.

RESULTS

Data from 63 preschool-aged children and their parents was analyzed in this pilot study. Only three children (4.7%) met all components of the WHO guidelines. Separately, children meeting physical activity, sedentary screen time and sleep guidelines were 71.9%, 17.5%, and 59.7% respectively. The proportion of all children who were developmentally on-track for the gross and fine motor skills was 58.7% and 50.8%, respectively. Parents and educators reported that the protocol was feasible except for the activPAL-4 accelerometer. Approximately, 39% of children (14 out of 37) who wore this device developed itchy skin and rashes resulting in the suspension of using this device mid-way through data collection. During COVID-19, there was a significant decrease in children's total physical activity (- 193 min/day), and time spent outside on weekdays (- 75 min/day) and weekend days (- 131 min/day) and a significant increase in sedentary screen time (+85 min/day).

CONCLUSION

Only a low proportion of children met the WHO guidelines. Methods and devices (except ActivPAL4) used in this pilot study proved to be feasible and this has paved the way to conduct the main SUNRISE study in Bangladesh. Future measures should be taken to address the issue of movement behaviors of children during the time of pandemics like COVID-19.

Preterm birth and risk for language delays before school entry: A sibling-control study

We investigated whether children born preterm are at risk for language delay using a sibling-control design in the Norwegian Mother and Child Cohort Study (MoBa), conducted by the Norwegian Institute of Public Health. Participants included 26,769 siblings born between gestational weeks 23 and 42. Language delay was assessed when the children were 1.5, 3, and 5 years old. To adjust for familial risk factors, comparisons were conducted between preterm and full-term siblings. Pregnancy-specific risk factors were controlled for by means of observed variables. Findings showed that preterm children born before week 37 had increased risk for language delays at 1.5 years. At 3 and 5 years, only children born before week 34 had increased risk for language delay. Children born weeks 29–33 and before week 29 had increased risk for language delay at 1.5 years (RR = 4.51, 95% CI [3.45, 5.88]; RR = 10.32, 95% CI [6.7, 15.80]), 3 years (RR = 1.50, 95% CI [1.02, 2.21]; RR = 2.78, 95% CI [1.09, 7.07]), and 5 years (RR = 1.63, 95% CI [1.06, 2.51]; RR = 2.98, 95% CI [0.87, 10.26]), respectively. In conclusion, children born preterm are at risk for language delays, with familial confounders only explaining a moderate share of the association. This suggests a cause-effect relationship between early preterm birth and risk for language delay in preschool children.

Maternal and neonatal factors associated with child development in Ceará, Brazil: a population-based study

Background

The first 1000 days of life are a critical period when the foundations of child development and growth are established. Few studies in Latin America have examined the relationship of birth outcomes and neonatal care factors with development outcomes in young children. We aimed to assess the association between pregnancy and neonatal factors with children’s developmental scores in a cross-sectional, population-based study of children in Ceará, Brazil.

Methods

Population-based, cross-sectional study of children aged 0–66 months (0–5.5 years) living in Ceará, Brazil. We examined the relationship of pregnancy (iron and folic acid supplementation, smoking and alcohol consumption) and neonatal (low birth weight (LBW) gestational age, neonatal care interventions, and breastfeeding in the first hour) factors with child development. Children’s development was assessed with the Ages and Stages Questionnaire (ASQ-BR). We used multivariate generalized linear models that accounted for clustering sampling to evaluate the relationship of pregnancy and neonatal factors with development domain scores.

Findings

A total of 3566 children were enrolled. Among pregnancy factors, children whose mothers did not receive folic acid supplementation during pregnancy had lower fine motor and problem-solving scores (p-values< 0.05). As for neonatal factors, LBW was associated with 0.14 standard deviations (SD) lower (CI 95% -0.26, − 0.02) communication, 0.24 SD lower (95% CI: − 0.44, − 0.04) fine motor and 0.31 SD lower (CI 95% -0.45, − 0.16) problem-solving domain scores as compared to non-LBW children (p values < 0.05). In terms of care, newborns that required resuscitation, antibiotics for infection, or extended in-patient stay after birth had lower development scores in selected domains. Further, not initiating breastfeeding within the first hour after birth was associated with lower gross motor and person-social development scores (p-values < 0.05).

Conclusion

Pregnancy and neonatal care factors were associated with later child development outcomes. Infants at increased risk of suboptimal development, like LBW or newborns requiring extended in-patient care, may represent groups to target for supplemental intervention. Further, early integrated interventions to prevent adverse pregnancy and newborn outcomes may improve child development outcomes.

International Study of Movement Behaviors in the Early Years (SUNRISE): Results from SUNRISE Sweden's Pilot and COVID-19 Study

The International Study of Movement Behaviors in the Early Years (SUNRISE) was initiated in response to the 2019 WHO guidelines for physical activity, sedentary behavior, and sleep in children aged 0–5 years. This Swedish pilot study aimed to: (i) assess the proportion of preschoolers meeting the guidelines, (ii) evaluate the feasibility of the methods for the SUNRISE study, and (iii) assess how movement behaviors have been affected in preschoolers during the COVID-19 pandemic. Physical activity and sleep (waist-worn ActiGraph); screen time and movement behaviors (parental questionnaire); motor skills (Ages and Stages Questionnaire); and executive functions (3 iPad games) were assessed in 100 Swedish preschoolers (n = 58 boys). There were 19.4% of preschoolers (n = 14) who met the WHO guidelines. The motor skill and executive function assessments were feasible; however, 20% refused to wear the ActiGraph overnight. Additionally, during the pandemic Swedish children’s physical activity, time spent outside on weekdays and weekend days, and screen time significantly increased (+53; +124; +68; +30min/day, respectively, all p-values ≤ 0.001). Methods for the SUNRISE study were feasible in a Swedish context; however, considerations to switch to a wrist-worn accelerometer should be made. Furthermore, children’s physical activity increased during the pandemic, which is likely due to how the rules/restrictions were implemented in Sweden.

Prevalence and socioeconomic determinants of development delay among children in Ceará, Brazil: A population-based study

Objective

To assess the prevalence of child development delay and to identify socioeconomic determinants.

Study design

We conducted a population-based cross-sectional study of children 2 to 72 months of age residing in the state of Ceará, Brazil. In total, 3200 households were randomly selected for participation in the study and had child development assessed with the Ages and Stages Questionnaire (ASQ) version 3. Development delay was defined as a score of less than -2 standard deviations below the median of the Brazilian ASQ standard. We present population-level prevalence of delay in five development domains and assess socioeconomic determinants.

Results

A total of 3566 children completed the ASQ development assessment of which 9.2% (95% CI: 8.1–10.5) had at least one domain with development delay. The prevalence of delay increased with age in all domains and males were at higher risk for communication, gross motor and personal-social development delays as compared to females (p-values <0.05). We found robust associations of indicators of socioeconomic status with risk of development delay; increasing monthly income and higher social class were associated with reduced risk of delay across all domains (28,2% in the poorest and 21,2% in richest for any delay, p-values <0.05 for all domains). In addition, children in poor households that participated in conditional cash transfer (CCT) programs appeared to have reduced risk of delay as compared to children from households that were eligible, but did not participate, in CCT programs.

Conclusions

There is a relatively high population-level prevalence of development delay in at least one domain among children 0–6 years of age in Ceará, Brazil. Integrated child development, social support, and poverty reduction interventions may reduce the population-level prevalence of development delay in Ceará and similar settings.

Diet and Neurodevelopmental Score in a Sample of One-Year-Old Children-A Cross-Sectional Study

Environmental factors in the first years of life are crucial for a child’s neurodevelopment. Research on the association between breastfeeding and neurodevelopment is inconclusive, while research on the possible association between other dietary factors and neurodevelopment is inadequate in children as young as one year of age. The aim of the present study was to investigate associations between both breastfeeding and other dietary factors and the neurodevelopment of one-year-old children in Norway. Methods: Participants were recruited from kindergartens in four Norwegian counties in 2017. A questionnaire including questions about dietary factors and breastfeeding, and a standardised age-related questionnaire on neurodevelopment (the Ages and Stages Questionnaire), were completed by parents of one-year-olds. Linear regressions adjusting for relevant covariates were conducted to explore the associations. Results: In our sample of 212 one-year-old children, a longer duration of breastfeeding was associated with higher neurodevelopmental scores. Dietary intake of fish, fruits and vegetables was also strongly associated with higher neurodevelopmental scores, even after adjustment for breastfeeding and maternal education. Conclusion: Our results indicate that healthy dietary factors are important for neurodevelopment in young children, with measurable effects already at the age of one year.

Impact of early protein and energy intakes on neurodevelopment at 2 years of corrected age in very low birth weight infants: A single-center observational study

Introduction

Aggressive nutritional strategy, particularly enhancing early provision of energy and protein, has appeared to reduce postnatal growth failure and improve later developmental outcomes. But the amount of macronutrients required remains unclear. The aim of this study was to investigate the impact of protein and energy intakes during the first two weeks after birth on neurodevelopmental outcomes.

Methods

This retrospective cohort study of very low birth weight infants born between January 2012 and December 2015 was conducted at one tertiary neonatal intensive care unit. The primary outcome was a neurodevelopmental impairment (NDI) at 2 years corrected age defined by a cerebral palsy or a 24 month Ages and Stages Questionnaires score on any of the five domains lower than 2 standard deviation below the mean score. Multivariable logistic regression analysis was used to adjust for perinatal and postnatal confounders.

Results

Among 245 (73%) infants discharged home alive, 159 (65%) had follow-up at 2 years. Infants with NDI (55/159, 35%) were more likely male gender (67.3% versus 46.2%, P = 0.02) and experienced more patent ductus arteriosus (PDA) ligation (20% versus 5.8%, P = 0.01) than control. After adjusting for confounders, first-week protein intake (OR: 2.27 [CI: 1.07–5.14]; P < 0.05), second-week non-protein energy intake (OR: 1.03 [CI: 1.01–1.05]; P < 0.01) and PDA ligation (OR: 6.81 [1.80–28.46]; P < 0.01) had significant independent association with higher likelihood of NDI at 2 years.

Conclusion

Providing nutrition above the optimal level may not be beneficial and may even be harmful. These results confirm the recent recommendation to decrease amino acid intakes published in the latest ESPGHAN guidelines.

Acceptability and understanding of the Ages & Stages Questionnaires®, Third Edition, as part of the Healthy Child Programme 2-year health and development review in England: Parent and professional perspectives

BACKGROUND

The Healthy Child Programme is the universal public health system in England to assess and monitor child health from 0 to 19. Following a review of measures for closer monitoring at age 2 years, the Department of Health for England implemented the Ages & Stages Questionnaires®, Third Edition (ASQ-3™; Hereon, ASQ-3).

AIM

The aim of this study was to evaluate the acceptability and understanding of the ASQ-3 in England by health professionals and parents.

METHOD

A mixed-methods approach was used. This paper reports on the qualitative data drawn from interviews with 40 parents and 12 focus groups with 85 health professionals. The data were analysed using applied thematic analysis.

FINDINGS

Overall, parents and health professionals found the ASQ-3 acceptable and understandable and could use it as a measure at age 2 years. The ability to work in partnership was valued. Some limitations included potential to cause anxiety, concerns around the safety of some of the items, and use of Americanized language. Health professional's training in the use the ASQ-3 was inconsistent.

CONCLUSION

The ASQ-3 is an acceptable and understandable measure to use as part of the 2-year assessment with some adaptations to the English context and some standardized training for health professionals.

A cluster randomized web-based intervention trial to reduce food neophobia and promote healthy diets among one-year-old children in kindergarten: study protocol

BACKGROUND

A child's first years of life are crucial for cognitive development and future health. Studies show that a varied diet with a high intake of vegetables is positive for both weight and cognitive development. The present low intake of vegetables in children's diets is therefore a concern. Food neophobia can be a barrier for vegetable intake in children. Our hypothesis is that interventions that can increase children's intake of vegetables should be introduced early in life to overcome children's neophobia. This study aims to develop, measure and compare the effect of two different interventions among one-year-old children in kindergartens to reduce food neophobia and promote healthy diets.

METHODS

The kindergartens are randomized to one of three groups: two different intervention groups and one control group. We aimed to include a total of 210 children in the study. The first intervention group will be served a warm lunch meal with a variety of vegetables, 3 days a week during the intervention period of 3 months. The second intervention group will be served the same meals and, in addition, kindergarten staff will be asked to implement pedagogical tools including sensory lessons, adapted from the Sapere method, and advices on meal practice and feeding practices. The control group continues their usual meal practices. Parents and kindergarten staff will complete questionnaires regarding food neophobia, food habits and cognitive development at baseline and post intervention. A similar intervention among 2-year-old children in kindergarten has been implemented and evaluated earlier. We will investigate whether a digital version of this intervention has an effect, because digital interventions can be easily implemented nationwide. We will also investigate whether there are benefits of conducting such interventions in younger children, before the onset of food neophobia. Questionnaires, information videos and recipes will be digitally distributed.

DISCUSSION

Results of this study will provide new knowledge about whether a sensory education and a healthy meal intervention targeting children, kindergarten staff and parents will reduce levels of food neophobia in children, improve parental and kindergarten feeding practices, improve children's dietary variety, improve children's cognitive development and reduce childhood overweight.

TRIAL REGISTRATION

ISRCTN98064772 .

Maternal DHA Status during Pregnancy Has a Positive Impact on Infant Problem Solving: A Norwegian Prospective Observation Study

Docosahexaenoic acid (DHA, 22:6, n-3) is a long-chain polyunsaturated fatty acid necessary for normal brain growth and cognitive development. Seafood and dietary supplements are the primary dietary sources of DHA. This study addresses the associations between DHA status in pregnant women and healthy, term-born infant problem-solving skills assessed using the Ages and Stages Questionnaire. The fatty acid status of maternal red blood cells (RBCs) was assessed in the 28th week of gestation and at three months postpartum. The infants’ fatty acid status (RBC) was assessed at three, six, and twelve months, and problem-solving skills were assessed at six and twelve months. Maternal DHA status in pregnancy was found to be positively associated with infants’ problem-solving skills at 12 months. This association remained significant even after controlling for the level of maternal education, a surrogate for socio-economic status. The infants’ DHA status at three months was associated with the infants’ problem solving at 12 months. The results accentuate the importance for pregnant and lactating women to have a satisfactory DHA status from dietary intake of seafood or other sources rich in DHA.

Neurodevelopmental outcome at 2 years for preterm children born at 22 to 34 weeks' gestation in France in 2011: EPIPAGE-2 cohort study

Objectives To describe neurodevelopmental outcomes at 2 years corrected age for children born alive at 22-26, 27-31, and 32-34 weeks' gestation in 2011, and to evaluate changes since 1997.Design Population based cohort studies, EPIPAGE and EPIPAGE-2.Setting France.Participants 5567 neonates born alive in 2011 at 22-34 completed weeks' gestation, with 4199 survivors at 2 years corrected age included in follow-up. Comparison of outcomes reported for 3334 (1997) and 2418 (2011) neonates born alive in the nine regions participating in both studies.Main outcome measures Survival; cerebral palsy (2000 European consensus definition); scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ; at least one of five domains below threshold) if completed between 22 and 26 months corrected age, in children without cerebral palsy, blindness, or deafness; and survival without severe or moderate neuromotor or sensory disabilities (cerebral palsy with Gross Motor Function Classification System levels 2-5, unilateral or bilateral blindness or deafness). Results are given as percentage of outcome measures with 95% confidence intervals.Results Among 5170 liveborn neonates with parental consent, survival at 2 years corrected age was 51.7% (95% confidence interval 48.6% to 54.7%) at 22-26 weeks' gestation, 93.1% (92.1% to 94.0%) at 27-31 weeks' gestation, and 98.6% (97.8% to 99.2%) at 32-34 weeks' gestation. Only one infant born at 22-23 weeks survived. Data on cerebral palsy were available for 3599 infants (81.0% of the eligible population). The overall rate of cerebral palsy at 24-26, 27-31, and 32-34 weeks' gestation was 6.9% (4.7% to 9.6%), 4.3% (3.5% to 5.2%), and 1.0% (0.5% to 1.9%), respectively. Responses to the ASQ were analysed for 2506 children (56.4% of the eligible population). The proportion of children with an ASQ result below threshold at 24-26, 27-31, and 32-34 weeks' gestation were 50.2% (44.5% to 55.8%), 40.7% (38.3% to 43.2%), and 36.2% (32.4% to 40.1%), respectively. Survival without severe or moderate neuromotor or sensory disabilities among live births increased between 1997 and 2011, from 45.5% (39.2% to 51.8%) to 62.3% (57.1% to 67.5%) at 25-26 weeks' gestation, but no change was observed at 22-24 weeks' gestation. At 32-34 weeks' gestation, there was a non-statistically significant increase in survival without severe or moderate neuromotor or sensory disabilities (P=0.61), but the proportion of survivors with cerebral palsy declined (P=0.01).Conclusions In this large cohort of preterm infants, rates of survival and survival without severe or moderate neuromotor or sensory disabilities have increased during the past two decades, but these children remain at high risk of developmental delay.

Preterm delivery and risk for early language delays: a sibling-control cohort study

BACKGROUND

Studies suggest that preterm delivery is a risk factor for early language delays, but knowledge is scarce about the persistence of the delays and whether the association is of a linear kind. To resolve this, effects of confounding risk factors that are both shared within a family and pregnancy specific need to be distinguished from effects of preterm delivery. Our study examines the association between early gestational age and language outcomes, using a sibling-control design.

METHODS

The sample comprises 22,499 siblings from the Norwegian Mother and Child Birth Cohort Study, recruited between 1999 and 2008. Mothers rated child language comprehension and production at 18 and 36 months. Analyses compared siblings discordant on gestational age group (early preterm, delivery at week 22-33; late preterm, 34-36; early term, 37-38; full term, >38) and type of onset of delivery (spontaneous; provider-initiated), and compared these findings with conventional cohort analyses.

RESULTS

The findings revealed inverse linear relations between the gestational age groups, and persistent but diminishing language delays. Effects of preterm delivery were substantial on both language production and comprehension at 18 months. By 36 months, the effects of preterm delivery were weaker, but still extensive, in particular for language production in provider-initiated births. When comparing sibling-control with cohort analyses, preterm group was less important among spontaneous births, but remained important in provider-initiated births. Familial and pregnancy risk factors partly explained this.

CONCLUSIONS

Distinctive factors seem to underlie effects of preterm delivery across spontaneous and provider-initiated births.

Ages & Stages Questionnaire-Brazil-2011: Adjustments on an Early Childhood Development Screening Measure

Introduction. Professionals who assess early childhood development highly benefit from reliable development screening measures. The Ages & Stages Questionnaire was adapted Brazil in 2010 and named ASQ-BR. Modifications in some items were required to improve the instrument’s psychometric properties. The present study modified the ASQ-BR to verify if those changes increase its characteristics. Method. This study researched 67 522 children from 972 public day care centers and preschools. Changes in items were made considering Cronbach’s α and item-to-total correlations. Reliability, dimensionality, and item-to-total correlations were calculated. Results. Regarding dimensionality, 86.2% of the scales in ASQ-BR-2011 were unidimensional. Internal consistency showed improvement from 2010 to 2011: 53.8% of the scales increased the α statistics against 41.2% that decreased, and 5.0% remained the same. Finally, 65.2% of the modified items showed improvement. Conclusions. Overall, the instrument’s psychometrics improved from 2010 to 2011, especially in the personal/social domain. However, it still leaves room for improvement in future studies.

Developmental screening in a Canadian First Nation (Mohawk): psychometric properties and adaptations of ages & stages questionnaires (2nd edition)

Background

The need for early intervention tools adapted to the First Nation culture is well documented. However, standards derived from First Nation communities are absent from the literature. This study examines the psychometric properties of an adaptation of a caregiver-completed screening tool, the Ages & Stages Questionnaires (ASQ), for the Mohawk population.

Methods

Participants who completed the questionnaires include 17 teachers, along with the parents of 282 children (130 girls and 152 boys) between the ages of 9 and 66 months who attend the Child and Family Center Mohawk Territory, Quebec.

Results

For the internal consistency of the four questionnaires (36-, 42-, 48- and 54-month intervals), Cronbach’s alphas varied between .61 and .84. Five results were below 0.60: “gross motor” (Q36 and Q42), “problem solving” (Q36) and “personal-social” (Q36 and Q42). A comparison of the results shows that parents and teachers agreed in 85% of the cases concerning the referral of the child for further evaluation. Moreover, the group discussion with the parents revealed that the use of the questionnaire was appreciated and was deemed appropriate for use within the community.

Conclusion

The results show that the ASQ is a screening test that may be appropriate for use with children from communities that are seemingly very different in terms of geographic, climatic and cultural backgrounds. This preliminary study with the Child and Family Center appears to support further study and the use of the ASQ with the Mohawk population.

Usefulness of parent-completed ASQ for neurodevelopmental screening of preterm children at five years of age

INTRODUCTION

Preterm children are at greater risk of developmental impairment and require close follow-up for early and optimal medical care. Our goal was to examine use of the parent-completed Ages and Stages Questionnaire (ASQ) as a screening tool for neurodevelopmental disabilities in preterm infants at five years of age.

PATIENTS AND METHODS

A total of 648 preterm children (<35 weeks gestational age) born between 2003 and 2004 and included in the regional Loire Infant Follow-up network were evaluated at five years of age. ASQ was compared with two validated tools (Intelligence Quotient and Global School Adaptation Score) and the impact of maternal education on the accuracy of this questionnaire was assessed.

RESULTS

Overall ASQ scores for predicting full-scale IQ<85 and GSA score produced an area under the receiver operating characteristic curve of 0.73±0.03 and 0.77±0.03, respectively. An ASQ cut-off value of 285 had optimal discriminatory power for identifying children with IQ scores<85 and GSA scores in the first quintile. ASQ values<285 were significantly associated with a higher risk of non-optimal neurologic outcomes (sensitivity of 0.80, specificity of 0.54 for IQ<85). ASQ values>285 were not distinctive for mild delay or normal development. In children with developmental delay, no difference was found when ASQ scores according to maternal education levels were analyzed.

CONCLUSIONS

ASQ at five years is a simple and cost-effective tool that can detect severe developmental delay in preterm children regardless of maternal education level, while its capacity to identify children with mild delay appears to be more limited.

The assessment of developmental status using the Ages and Stages questionnaire-3 in nutritional research in north Indian young children

OBJECTIVE AND BACKGROUND

For large epidemiological studies in low and middle-income countries, inexpensive and easily administered developmental assessment tools are called for. This report evaluates the feasibility of the assessment tool Ages and Stages Questionnaire 3.edition (ASQ-3) "home procedure" in a field trial in 422 North Indian young children.

METHODS

ASQ-3 was translated and adjusted for a North Indian Hindi setting. Three examiners were trained by a clinical psychologist to perform the assessments. During the main study, ten % of the assessments were done by two examiners to estimate inter-observer agreement. During all sessions, the examiners recorded whether the scoring was based on observation of the skill during the session, or on caregiver's report of the child's skill. Intra class correlation coefficient was calculated to estimate the agreement between the raters and between the raters and a gold standard. Pearson product moment correlation coefficient and standardized alphas were calculated to measure internal consistency.

PRINCIPAL FINDINGS

Inter-observer agreement was strong both during training exercises and during the main study. In the Motor subscales and the Problem Solving subscale most items could be observed during the session. The standardized alphas for the total ASQ-3 scale across all ages were strong, while the alpha values for the different subscales and age levels varied. The correlations between the total score and the subscale scores were consistently strong, while the correlations between subscale scores were moderate.

CONCLUSIONS/SIGNIFICANCE

We found that the translated and adjusted ASQ-3 "home procedure" was a feasible procedure for the collection of reliable data on the developmental status in infants and young children. Examiners were effectively trained over a short period of time, and the total ASQ scores showed adequate variability. However, further adjustments are needed to obtain satisfying alpha values in all subscales, and to ensure variability in all items when transferred to a North Indian cultural context.

Action imitation at 1½ years is better than pointing gesture in predicting late development of language production at 3 years of age

This study examined whether poor pointing gestures and imitative actions at 18 months of age uniquely predicted late language production at 36 months, beyond the role of poor language at 18 months of age. Data from the Norwegian Mother and Child Cohort Study were utilized. Maternal reports of the children's nonverbal skills and language were gathered for 42,517 children aged 18 months and for 28,107 of the same children at 36 months. Panel analysis of latent variables revealed that imitative actions, language comprehension, and language production uniquely contributed to predicting late development of language production, while pointing gestures did not. It is suggested that the results can be explained by underlying symbolic representational skills at 18 months.

Validity and reliability of a structured interview for early detection and risk assessment of parenting and developmental problems in young children: a cross-sectional study

BACKGROUND

Preventive child health care is well suited for the early detection of parenting and developmental problems. However, as far as the younger age group is concerned, there are no validated early detection instruments which cover both the child and its environment. Therefore, we have developed a broad-scope structured interview which assesses parents' concerns and their need for support, using both the parental perspective and the experience of the child health care nurse: the Structured Problem Analysis of Raising Kids (SPARK). This study reports the psychometric characteristics of the SPARK.

METHOD

A cross-sectional study of 2012 18-month-old children, living in Zeeland, a province of the Netherlands. Inter-rater reliability was assessed in 67 children. Convergent validity was assessed by comparing SPARK-domains with domains in self-report questionnaires on child development and parenting stress. Discriminative validity was assessed by comparing different outcomes of the SPARK between groups with different levels of socio-economic status and by performing an extreme-groups comparison. The user experience of both parents and nurses was assessed with the aid of an online survey.

RESULTS

The response rate was 92.1% for the SPARK. Self-report questionnaires were returned in the case of 66.9% of the remaining 1721 children. There was selective non-reporting: 33.1% of the questionnaires were not returned, covering 65.2% of the children with a high-risk label according to the SPARK (p < 0.001). Inter-rater reliability was good to excellent with intraclass correlations between 0.85 and 1.0 for physical topics; between 0.61 and 0.8 for social-emotional topics and 0.92 for the overall risk assessment. Convergent validity was unexpectedly low (all correlations ≤0.3) although the pattern was as expected. Discriminative validity was good. Users were satisfied with the SPARK and identified some topics for improvement.

CONCLUSION

The SPARK discriminates between children with a high, increased and low risk of parenting and developmental problems. It does so in a reliable way, but more research is needed on aspects of validity and in other populations.

Examination of the cut-off scores determined by the Ages and Stages Questionnaire in a population-based sample of 6 month-old Norwegian infants

Background

Few population-based samples have previously published performance on the Ages and Stages Questionnaire (ASQ), a recommended screening tool to detect infant developmental delay. The aim of the study was to investigate performance on the ASQ in a population-based sample of 6-month-old infants.

Methods

In this population-based questionnaire study from Oslo, Norway, the 30 item ASQ 6 month Questionnaire (N = 1053) were included, however without the pictograms, and compared to the Norwegian reference sample (N.ref) (N = 169) and to US cut-off values. Exclusion criteria were maternal non-Scandinavian ethnicity, infant age < 5.0 or > 7.0 months (corrected age), twins, and birth weight < 2.5 kg. Cut-off = 2.5 percentile (equivalent to mean minus 2 standard deviations). Pearson's Chi square and Mann-Whitney U were used to compare items and areas, respectively, with N.ref.

Results

The reported ASQ scores were lower on all but one of the 10 significantly different items, and in all areas except Personal social, compared to the N.ref sample. The estimated cut-off values for suspected developmental delay (Communication 25, Gross motor 15, Fine motor 18, Problem solving 25 and Personal social 20) were lower than the recommended American (US) values in all areas, and lower than the Norwegian values in two areas. Scores indicating need for further assessment were reached by 13.8% or 20.5% of the infants (missing items scored according to the US or the Norwegian manual), and by 33.8% or 30.3% of the infants using the recommended US or the Norwegian cut-off values, in this population-based sample. The Fine motor area demonstrated a large variability depending on the different cut-off and scoring possibilities. Both among the items excluding pictograms and the items that do not have pictograms, approximately every third item differed significantly compared to the N.ref sample.

Conclusion

The psychomotor developmental scores were lower than in the reference samples in this study of ASQ 6 month Questionnaire; to our knowledge the first study to be both representative and comparatively large. Approximately every third child with birth weight above 2.5 kg, received scores suggesting further assessment using recommended ASQ cut-off scores.

Parent-completed developmental screening in premature children: a valid tool for follow-up programs

Our goals were to (1) validate the parental Ages and Stages Questionnaires (ASQ) as a screening tool for psychomotor development among a cohort of ex-premature infants reaching 2 years, and (2) analyse the influence of parental socio-economic status and maternal education on the efficacy of the questionnaire. A regional population of 703 very preterm infants (<35 weeks gestational age) born between 2003 and 2006 were evaluated at 2 years by their parents who completed the ASQ, by a pediatric clinical examination, and by the revised Brunet Lezine psychometric test with establishment of a DQ score. Detailed information regarding parental socio-economic status was available for 419 infants. At 2 years corrected age, 630 infants (89.6%) had an optimal neuromotor examination. Overall ASQ scores for predicting a DQ score ≤85 produced an area under the receiver operator curve value of 0.85 (95% Confidence Interval:0.82–0.87). An ASQ cut-off score of ≤220 had optimal discriminatory power for identifying a DQ score ≤85 with a sensitivity of 0.85 (95%CI:0.75–0.91), a specificity of 0.72 (95%CI:0.69–0.75), a positive likelihood ratio of 3, and a negative likelihood ratio of 0.21. The median value for ASQ was not significantly associated with socio-economic level or maternal education. ASQ is an easy and reliable tool regardless of the socio-economic status of the family to predict normal neurologic outcome in ex-premature infants at 2 years of age. ASQ may be beneficial with a low-cost impact to some follow-up programs, and helps to establish a genuine sense of parental involvement.

Cross-cultural adaptation of a pre-school screening instrument: comparison of Korean and US populations

BACKGROUND

Accurate and efficient developmental screening measures are critical for early identification of developmental problems; however, few reliable and valid tests are available in Korea as well as other countries outside the USA. The Ages and Stages Questionnaires (ASQ) was chosen for study with young children in Korea.

METHODS

The ASQ was translated into Korean and necessary cross-cultural adaptations were made. The translated version was then distributed and completed by 3220 parents of young children between the ages of 4 months and 5 years. Reliability was studied including domain correlations, internal consistency, and performance of identification cut-off scores for the Korean population. Rasch analyses including tests of Differential Item Functioning, contrasting Korean and US samples were also performed.

RESULTS

In general, internal consistency of the Korean ASQ was high, with overall correlations 0.75 for communication, 0.85 for gross motor, 0.74 for fine motor, 0.72 for problem solving, and 0.65 for personal-social. Validity, including concurrent validity, also had strong evidence. Mean scores of children on the Korean translation of the ASQ and the US normative sample were generally similar. Rasch analyses indicated the majority of items functioned similarly across the Korean sample.

CONCLUSIONS

In general, the ASQ was translated with cultural appropriateness in mind and functioned as a valid and reliable parent-completed screening test to assist in early identification of young children with developmental delays. Further research is needed to confirm these results with a larger and more diverse Korean sample.

Evaluation of the Ages and Stages Questionnaires in identifying children with neurosensory disability in the Magpie Trial follow-up study

AIM

To evaluate performance of the Ages and Stages Questionnaires (full ASQ), and a shortened version (short ASQ), in detecting children with severe neurosensory disability in the Magpie Trial follow-up study.

METHODS

All children, born to women in the Magpie Trial and selected for follow-up, with a completed full 30 items and/or short 9-items ASQ were included in this analysis. Sensitivity and specificity, corrected for verification bias, were computed to assess detection ability.

RESULTS

Of the 2046 children who completed a full ASQ, 406 (19.8%) failed the assessment, 54 of whom had confirmed neurosensory disability. Adjusted sensitivity and specificity (95% confidence intervals) were 87.4% (62.9-96.6%), and 82.3% (80.5-83.9%), respectively. Two of the five domains in the full ASQ (Fine Motor and Problem Solving) contributed little to detection ability. Sensitivity and specificity for the short ASQ were 69.2% and 95.7%, respectively.

CONCLUSIONS

Sensitivity of the full ASQ for severe neurosensory disability is generally good, and does not appear to be much reduced by restricting questions to three out of the five domains. The short ASQ reported here reduced performance, although this might be improved by a different choice of questions or scoring system.

Long-term outcome of children born after a first-trimester measurement of nuchal translucency at the 99th percentile or greater with normal karyotype: a prospective study

OBJECTIVE

This study was undertaken to assess the long-term outcome of children born after a first-trimester measurement of nuchal translucency (NT) at the 99th percentile or greater during routine first-trimester screening in an unselected population.

STUDY DESIGN

One hundred sixty-two infants were born alive. Clinical examination as well as a questionnaire to the parents (Ages and Stages Questionnaires [ASQ]) at the age of 2 years were obtained in 160 children. Our study population was compared with an external control group made of the 370 term control children.

RESULTS

The prevalence of abnormal clinical pediatric examination and ASQ results at 2 years were not associated with NT thickness. Comparison with an external control group did not demonstrate an increased incidence of developmental delay.

CONCLUSION

Parents should be informed that when the fetus is shown to be normal by ultrasound at 22-24 weeks of gestation the risk of adverse neonatal outcome or developmental delay in early childhood is not increased.