ESSENCE-Q obtained in routine Japanese public child health check-ups may be a valuable tool in neurodevelopmental screening

Harnessing the power of child development records to detect early neurodevelopmental disorders using Bayesian analysis

AIM

This study aims to analyse the developmental data from public health nurses (PHNs) to identify early indicators of neurodevelopmental disorders (NDDs) in young children using Bayesian network (BN) analysis to determine factor combinations that improve diagnosis accuracy.

METHODS

The study cohort was 501 children who underwent health checkups at 18 and 36-month. Data included demographics, pregnancy, delivery, neonatal factors, maternal interviews, and physical and neurological findings. Diagnoses were made by paediatricians and child psychiatrists using standardised tools. Predictive accuracy was assessed by the receiver operating characteristic (ROC) curve analysis.

RESULTS

We identified several infant/toddler factors significantly associated with NDD diagnoses. Predictive factors included meconium-stained amniotic fluid, 1 min Apgar score, and early developmental milestones. ROC curve analysis showed varying predictive accuracies based on evaluation timing. The 10-month checkup was valid for screening but less reliable for excluding low-risk cases. The 18-month evaluation accurately identified children at NDD risk.

CONCLUSION

The study demonstrates the potential of using developmental records for early NDD detection, emphasising early monitoring and intervention for at-risk children. These findings could guide future infant mental health initiatives in the community.

Validity of the ESSENCE-Q neurodevelopmental screening tool in Japan

AIM

To assess the validity of the Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations-Questionnaire (ESSENCE-Q), a simple screening tool for neurodevelopmental problems, in Japan.

METHOD

Parents/caregivers completed the 11-item ESSENCE-Q for 77 612 children aged 2 years 6 months included in a national birth cohort study. Information about neurodevelopmental disorders (NDDs: autism spectrum disorder; intellectual disability and/or developmental language disorder; motor delay/motor disorder) was collected at age 3 years. Each ESSENCE-Q item was scored on a binary (0,1) scale, with a total score range of 0 to 11. Total scores and individual items were compared across children with and without NDDs.

RESULTS

NDDs were recorded in 854 children (1.1%). With a total ESSENCE-Q score cut-off of ≥3, receiver operating characteristic curve analysis showed an area under the curve of 0.91, with sensitivity 84.9%, specificity 84.8%, positive predictive value 5.9%, and negative predictive value 99.8%. The proportion of parental concerns at 2 years 6 months differed significantly by NDD status for communication (89.5% vs 14.2%) and general development (80.2% vs 7.4%). ESSENCE-Q total scores were moderately negatively correlated (-0.36, p < 0.001) with Japanese Ages and Stages Questionnaire scores.

INTERPRETATION

The parent/caregiver-completed ESSENCE-Q is useful as a tool for screening out children with neurotypical development at this early age. Further research into longer-term predictive validity will be possible as more NDD diagnoses are given as the children grow up.

The ESSENCE-Q: Can specialist supervision improve scoring agreement across specialist and public health nurses/nursery teachers?

AIM

This study aimed to explore whether the supervision of community public health nurses (PHNs) and nursery school teachers (NSTs) by a specialist, familiar with Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE), improved the agreement of ESSENCE-Questionnaire (ESSENCE-Q) scoring, across raters.

METHODS

A PHN, two NSTs, and a speech-language pathologist (SLP), familiar with ESSENCE, independently assessed 32 children. The ESSENCE-Q results were divided into the first (child 1-18) and second groups (the 19th child and the following children). Changes in score discrepancies were analysed for ESSENCE-Q cutoff scores and total ESSENCE-Q scores across raters. The SLP scores were used as a reference to evaluate sensitivity and specificity.

RESULTS

The total ESSENCE-Q scores of the PHN and NSTs showed higher concordance in the second group (p < 0.05). Comparisons of the differences between the PHN/NSTs and SLP in total ESSENCE-Q scores showed a significantly smaller difference in the NSTs' scores in the second group (p < 0.05).

CONCLUSION

The findings suggest that specialist supervision may lead to a better agreement between PHN and NSTs regarding ESSENCE-Q scores.

Developmental screening tools for identification of children with developmental difficulties in high-income countries: a systematic review

Objective

To examine and synthesize the literature on the use of universal developmental screening and surveillance tools in high-income countries in relation to (1) psychometric properties; (2) knowledge, acceptability, and feasibility of tools; and (3) follow-up taken following screening/surveillance.

Method

A PRISMA-compliant systematic review was performed in the PsychInfo, PubMed, and Embase databases. Studies published in the English language were included if they reported results evaluating a universal developmental screening or surveillance measurement tool. Articles on service providers' and/or parents' views on developmental screening were also included. Two independent reviewers extracted data and assessed for risk of bias using the Mixed Methods Appraisal Tool and the Quality Assessment of Diagnostic Accuracy Studies Tool. Results were synthesized qualitatively.

Results

Initial searches identified 2,078 articles, of which 52 were included in the final review. Findings showed that several articles assessing the accuracy of screening tools have been published, and together, they suggest that the accuracy of screening tools varies across cultures and countries. Furthermore, available literature indicated that administering universal developmental screening tools was feasible and acceptable, though only a small number of studies are available. Results also showed a limited number of studies looking at actions taken following positive screening results.

Conclusion

As the evidence stands, more research assessing the acceptability, feasibility, and accuracy of developmental screeners, is needed.

Systematic review registration

This review has been registered with the University of York Centre for Reviews and Dissemination (PROSPERO; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=337320, registration number CRD42022337320).

Pre-/perinatal reduced optimality and neurodevelopment at 1 month and 3 years of age: Results from the Japan Environment and Children's Study (JECS)

Neurodevelopmental disorders (NDDs) in children are associated with a complex combination of genetic and/or environmental factors. Pre-/perinatal events are major known environmental suboptimal factors, and their individual and combined contributions vary. This study investigated the association between pre-/perinatal reduced optimality and child development observed by parents at 1 month, as well as NDDs at 3 years of age (i.e., motor delay, intellectual disability, developmental language disorder, and autism spectrum disorder), in the context of the Japan Environment and Children's Study. The study also assessed whether child development at 1 month predicted NDDs at 3 years of age. Associations between 25 pre-/perinatal factors and (a) developmental concerns at 1 month of age and (b) NDDs at 3 years were analyzed (n = 71,682). Binomial regression models were used to investigate risk ratios of the developmental outcome at each time point for total pre-/perinatal reduced optimality scale scores, as well as for individual pre-/perinatal factors of the reduced optimality scale. Finally, we assessed the ability of parental observations of offspring development at 1 month to predict NDDs at 3 years. Total reduced optimality scores were positively associated with 1-month developmental concerns and 3-year NDDs, with higher scores (i.e., a reduction in optimality) associated with an increased risk of both NDDs and earlier parental concerns. Neonatal transportation, epidural analgesia, advanced maternal age, cesarean section delivery, Apgar score ≤8, and hyperbilirubinemia were identified as individual risk factors for 3-year NDDs, overlapping with 14 risk factors for 1-month developmental concerns except Apgar score ≤8. Among six developmental items assessed at 1 month of age, concerns about gross motor function and difficulty holding/trouble calming down had the strongest associations with later-diagnosed motor delay and autism spectrum disorder, respectively. Five perinatal factors and advanced maternal age were associated with NDD at 3 years of age, as were early parental developmental concerns regarding their offspring's overall development, indicating the importance of careful follow-up of offspring born with pre-/perinatal reduced optimality. The results also implicated early parental concerns, as early as 1 month, may also be a useful indicator of later NDD status.

The ESSENCE-Questionnaire for Neurodevelopmental Problems - A Swedish School-Based Validation Study in 11-Year-Old Children

Purpose

To determine the prevalence of parent-rated developmental concern using the ESSENCE-Q (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations-Questionnaire, 12-items, score range 0-24) and to ascertain the predictive validity and optimal cutoff level of the instrument in a school-based sample of 11-year-old children.

Methods

In a cross-sectional, school-based study, participants underwent a clinical assessment by a physician and a psychologist, teachers and parents completed the SDQ (Strength and Difficulties Questionnaire), medical health records and national tests were reviewed, and parents independently completed the ESSENCE-Q. In a case-conference outcomes were defined as a) the need for further clinical work-up due to suspected neurodevelopmental problems (NDPs) and b) degree of investigator-rated symptoms/impairment from NDPs on the CGI-S (Clinical Global Impression-Severity instrument, range 1-7, 4-7 defined as clinically symptomatic). Classification and optimal cutoffs of the ESSENCE-Q were determined using ROC (Receiver Operating Characteristic) analysis.

Results

Out of 343 eligible children, 223 enrolled, of whom 173 (50% of all eligible) had a parent-rated ESSENCE-Q. At least one of the 12 possible concerns was reported by parents of 36% of participants. Overall, in 101 (57%) participants a work-up was warranted, and 64 (37%) were clinically symptomatic from NDPs. The AUC of the ESSENCE-Q in detecting need for work-up was 0.70 (95% confidence interval [CI] 0.63-0.77), and the AUC in detecting clinically symptomatic participants was 0.82 (95% CI 0.76-0.88). ESSENCE-Q ratings correlated positively with CGI-S scores (r=0.48, p<0.05). A cutoff of ≥3 had the highest accuracy (78%) with a negative predictive value of 82%. Ratings >6 conferred few false positives cases with positive likelihood ratios >10 and positive predictive values of 86% or more.

Significance

This study of the ESSENCE-Q in 11-year-old children suggests it might be an acceptable instrument for screening of NDPs in children in middle school, optimally in conjunction with other methods.

Early neurodevelopmental problems and risk for avoidant/restrictive food intake disorder (ARFID) in 4-7-year-old children: A Japanese birth cohort study

Background

An overrepresentation of neurodevelopmental problems (NDPs) has been observed in individuals with avoidant/restrictive food intake disorder (ARFID). Previous studies on the association between ARFID and NDPs have been limited by cross-sectional data from clinical samples of small size. This study aimed to extend previous research by using prospectively collected data in a non-clinical child cohort. We examined the occurrence of early NDPs in 4-7-year-old children with suspected ARFID and how predictive early NDPs are of ARFID.

Methods

Data were collected via parent-report a sub-sample of the Japan Environment and Children's Study (JECS) including 3728 children born 2011-2014 in Kochi prefecture. NDPs were assessed biannually between 0.5 and 3 years of age with the Ages and Stages Questionnaire-3, at age 2.5 years with the ESSENCE-Q, and at age 1 and 3 years via parent-reported clinical diagnoses. ARFID was identified cross-sectionally (at age 4-7 years) using a newly developed screening tool. Logistic regressions were used to test association of (1) a composite early NDP risk score, (2) specific early NDPs, and (3) neurodevelopmental trajectories over time with ARFID.

Results

Children in the highest risk percentiles of the NDP risk score had roughly three times higher odds of having suspected ARFID; the absolute risk of later ARFID for children above the 90th percentile was 3.1%. Early NDPs (excluding early feeding problems) were more predictive of later ARFID than were early feeding problems. Specific NDPs predictive of ARFID were problems with general development, communication/language, attention/concentration, social interaction, and sleep. Neurodevelopmental trajectories of children with and without suspected ARFID started to divert after age 1 year.

Conclusions

The results mirror the previously observed overrepresentation of NDPs in ARFID populations. In this non-clinical child cohort, early feeding problems were common and rarely developed into ARFID; however, our findings imply that they should be monitored closely in children with high NDP risk to prevent ARFID.

Predictive validity of ESSENCE Q screening tool for early detection of neurodevelopmental disorder in children

INTRODUCTION

Neurodevelopmental disorders (NDD) are a group of conditions that typically manifest early during the child's development with lifelong consequences. Early identification using efficient screening tools can positively modify the natural history of the disorder. ESSENCE Q is a simple questionnaire to detect ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations to reflect the co-existence of NDDs in children less than five years). There are limited studies on the validity of ESSENCE Q in detecting NDDs in young children in India.

METHODS

We did a cross-sectional study in a tertiary care hospital to evaluate the validity of ESSENCE Q in detecting neurodevelopmental disorders. We translated the ESSENCE Q and subsequently used it to screen for NDD in 100 children aged 12-60 months. Clinical consensus diagnosis by two experienced experts was taken as the gold standard.

RESULTS

23% were diagnosed as having NDD as per the clinical consensus diagnosis. Around half the children (46%) were "at-risk for NDD" based on the ESSENCE Q scale. We found an optimal cut-off for ESSENCE Q of more than or equal to 4 with a sensitivity of 96%, a specificity of 82%, and a Youden index of 0.77.

CONCLUSION

ESSENCE Q has good predictive validity to be used as a quick and easy screening tool to detect NDDs in young children under the age of 5 years.

How Accurately Does the Information on Motor Development Collected During Health Checkups for Infants Predict the Diagnosis of Neurodevelopmental Disorders? - A Bayesian Network Model-Based Study

PURPOSE

We investigated to what extent early motor development problems predict a future diagnosis of neurodevelopmental disorders (NDDs)/Early Symptomatic Syndromes Eliciting Neurodevelopmental Examinations (ESSENCE) by using a Bayesian network model (BN).

SUBJECTS AND METHODS

Subjects were the children who had participated in the 18- and 36-month checkups in two cities in Japan between April 2014 and March 2015. Their motor development data at the 4-, 10- and 18-month-checkups were collected with ethical consideration. The diagnosis was confirmed at the age of six, after regular assessment in all developmental areas at a neurodevelopmental clinic. The accuracy of prediction of NDD based on posterior probabilities determined using the BN was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The posterior probability (the optimal cut-off value) yielding the maximum Youden Index (sensitivity + specificity - 1) is determined with the ROC curve, and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and utility index (UI) were computed.

RESULTS

BN models showed associations between early motor items and developmental coordination disorders, borderline intelligence/intellectual disability, and speech and language disorder. The ROC curve for any NDD had an AUC of 0.735. The posterior probability with the maximal Youden Index was 0.138; at the optimal cut-off value, the sensitivity, specificity, PPV, NPV, UI+, and UI- were 0.619, 0.761, 0.250, 0.940, 0.155 and 0.715, respectively.

CONCLUSION

We utilized a novel approach in detailing the associations between certain early motor problems and specific NDDs. We showed that the presence of motor development problems early in development increases the probability of a future diagnosis of any NDD. Still, the sensitivity of early motor development problems as a screening tool was not high enough to be the sole instrument for detecting NDDs. The need for a broad, holistic ESSENCE perspective when looking at the course of motor development problems was stressed.

The ESSENCE-Questionnaire in Medical Records Screening for Neurodevelopmental Symptoms/Problems: Utility and Clinical Validity

PURPOSE

Determine the prevalence of symptoms of neurodevelopmental problems (NDPs) with a semi-structured review of fourth grade students' medical records, its interrater agreement and validity as compared with clinical assessment.

METHODS

A school-based sample of 11-year-old children provided child health care (CHC) records and school health care (SHC) records. A pediatric neurologist, child psychiatrist and an adult psychiatrist scored the records, with the "Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations-Questionnaire" (ESSENCE-Q, 12 items scored 0-2, summary score range 0-24). Agreement was measured with model-based kappa and intraclass correlation coefficient (ICC). Ratings were validated against a multidisciplinary assessment involving a physician, psychologist, teacher- and parental behavioral rating scales rendering a clinical global impression severity rating (CGI-S, range 1-7) of NDPs.

RESULTS

Out of 223 participants, medical charts were available from 201, of whom 169 were rated by all three raters. Kappa agreement was moderate/strong (~0.8) for 7 of the 12 questionnaire items. Measured with the ICC, concordance in the summary score was good for agreement (~0.8) and excellent (~0.9) for consistency. Test-retest reliability was excellent (ICC = ~0.9). Area under the curve for the ESSENCE-Q in predicting clinical-level problems (CGI ≥4) was ~80% for all three raters, albeit with differing optimal cutoffs.

CONCLUSION

Using the ESSENCE-Q as a template, NDPs appear to be common in medical records, are identified reliably, and predict clinical-level concern. Medical records screening may facilitate a structured review of medical records in work-ups or be applied in conjunction with other screening measures for neurodevelopmental disorders. However, differences in calibration currently preclude defining a universal cutoff for using the ESSENCE-Q for medical records screening.