Comparative use of the Ages and Stages Questionnaires in low- and middle-income countries

A predictive model for stunting among children under the age of three

Background

In light of the global effort to eradicate stunting in childhood, the objective of this research endeavor was to assess the prevalence of stunting and associated factors, simultaneously construct and validate a risk prediction model for stunting among children under the age of three in Shenzhen, China.

Methods

Using the stratified random sampling method, we selected 9,581 children under the age of three for research and analysis. The dataset underwent a random allocation into training and validation sets, adhering to a 8:2 split ratio. Within the training set, a combined approach of LASSO regression analysis and binary logistic regression analysis was implemented to identify and select the predictive variables for the model. Subsequently, model construction was conducted in the training set, encompassing model evaluation, visualization, and internal validation procedures. Finally, to assess the model's generalizability, external validation was performed using the validation set.

Results

A total of 684 (7.14%) had phenotypes of stunt. Utilizing a combined approach of LASSO regression and logistic regression, key predictors of stunting among children under three years of age were identified, including sex, age in months, mother's education, father's age, birth order, feeding patterns, delivery mode, average daily parent-child reading time, average time spent in child-parent interactions, and average daily outdoor time. These variables were subsequently employed to develop a comprehensive prediction model for childhood stunting. A nomogram model was constructed based on these factors, demonstrating excellent consistency and accuracy. Calibration curves validated the agreement between the nomogram predictions and actual observations. Furthermore, ROC and DCA analyses indicated the strong predictive performance of the nomograms.

Conclusions

The developed model for forecasting stunt risk, which integrates a spectrum of variables. This analytical framework presents actionable intelligence to medical professionals, laying down a foundational framework and a pivot for the conception and execution of preemptive strategies and therapeutic interventions.

Caregiver report of social-emotional functioning in infants and young children after inflicted traumatic brain injury

Social-emotional difficulties are common sequelae of traumatic brain injury (TBI). Children who have experienced inflicted TBI (iTBI) may be at increased risk for social-emotional problems due to the risk factors associated with both early neurologic injury and with child maltreatment. We characterized the associations among injury severity, caregiver type (i.e., biological parents, non-kinship, kinship), and child social-emotional functioning in 41 infants and young children who had sustained iTBI and were seen in a large, regional children's hospital. This study was a retrospective analysis, utilizing data collected from the medical record as part of routine clinical care. Social-emotional functioning was assessed with the Bayley Scales of Infant and Toddler Development-Third Edition. Children with more severe injuries were rated as having worse social-emotional functioning. Caregiver type was associated with child social-emotional scores, above and beyond injury and demographic predictors. Biological parents were more likely to report better social-emotional skills than non-kinship caregivers, with the pattern of results suggesting that rater bias plays a role in this difference. In order to ensure that children are accurately identified for supports, these relationships should be considered when interpreting caregiver report of social-emotional skills.

The use of parent-completed questionnaires to investigate developmental outcomes in large populations of children exposed to antiseizure medications in pregnancy

OBJECTIVE

This study was undertaken to assess the utility of the Ages and Stages Questionnaire-3rd Edition (ASQ-3) and the Vineland Adaptive Behavior Scales-2nd Edition (VABS-II) as neurodevelopmental screening tools for infants exposed to antiseizure medications in utero, and to examine their suitability for use in large-population signal generation initiatives.

METHODS

Participants were women with epilepsy who were recruited from 21 hospitals in England and Northern Ireland during pregnancy between 2014 and 2016. Offspring were assessed at 24 months old using the Bayley Scales of Infant Development-3rd Edition (BSID-III), the VABS-II, and the ASQ-3 (n = 223). The sensitivity and specificity of the ASQ-3 and VABS-II to identify developmental delay at 24 months were examined, using the BSID-III to define cases.

RESULTS

The ASQ-3 identified 65 children (29.1%) as at risk of developmental delay at 24 months using standard referral criteria. Using a categorical approach and standard referral criteria to identify delay in the ASQ-3 and BSID-III at 24 months, the ASQ-3 showed excellent sensitivity (90.9%) and moderate specificity (74.1%). Utilizing different cut-points resulted in improved properties and may be preferred in certain contexts. The VABS-II exhibited the strongest psychometric properties when borderline impairment (>1 SD below the mean) was compared to BSID-III referral data (sensitivity = 100.0%, specificity = 96.6%).

SIGNIFICANCE

Both the ASQ-3 and VABS-II have good psychometric properties in a sample of children exposed to antiseizure medications when the purpose is the identification of at-risk groups. These findings identify the ASQ-3 as a measure that could be used effectively as part of a tiered surveillance system for teratogenic exposure by identifying a subset of individuals for more detailed investigations. Although the VABS-II has excellent psychometric properties, it is more labor-intensive for both the research team and participants and is available in fewer languages than the ASQ-3.

The association between prenatal bisphenol F exposure and infant neurodevelopment: The mediating role of placental estradiol

BACKGROUND

There are limited population studies on the neurodevelopmental effects of bisphenol F (BPF), a substitute for bisphenol A. Furthermore, the role of placental estradiol as a potential mediator linking these two factors remains unclear.

OBJECTIVE

To examine the association between maternal prenatal BPF exposure and infant neurodevelopment in a prospective cohort study and to explore the mediating effects of placental estradiol between BPF exposure and neurodevelopment in a nested case-control study.

METHODS

The prospective cohort study included 1077 mother-neonate pairs from the Wuhu city cohort study in China. Maternal BPF was determined using the liquid/liquid extraction and Ultra-performance liquid chromatography tandem mass spectrometry method. Children's neurodevelopment was assessed at ages 3, 6, and 12 months using Ages and Stages Questionnaires. The nested case-control study included 150 neurodevelopmental delay cases and 150 healthy controls. Placental estradiol levels were measured using enzyme-linked immunosorbent assay kits. Generalized estimating equation models and robust Poisson regression models were used to examine the associations between BPF exposure and children's neurodevelopment. In the nested case-control study, causal mediation analysis was conducted to assess the role of placental estradiol as a mediator in multivariate models.

RESULTS

In the prospective cohort study, the pregnancy-average BPF concentration was positively associated with developmental delays in gross-motor, fine-motor, and problem-solving ( ORtotal ASQ: 1.14(1.05, 1.25), ORgross-motor: 1.22(1.10, 1.36), ORfine-motor: 1.19(1.07, 1.31), ORproblem-solving: 1.11(1.01, 1.23)). After sex-stratified analyses, pregnancy-average BPF concentration was associated with an increased risk of neurodevelopmental delays in the gross-motor (ORgross-motor:1.30(1.12, 1.51)) and fine-motor (ORfine-motor: 1.22(1.06, 1.40)) domains in boys. In the nested case-control study, placental estradiol mediated 16.6% (95%CI: 4.4%, 35.0%) of the effects of prenatal BPF exposure on developmental delay.

CONCLUSIONS

Our study supports an inverse relationship between prenatal BPF exposure and child neurodevelopment in infancy, particularly in boys. Decreased placental estradiol may be an underlying biological pathway linking prenatal BPF exposure to neurodevelopmental delay in offspring.

Long-term impact of serious neonatal bacterial infections on neurodevelopment

BACKGROUND

Neonatal bacterial infections have long been recognized as an important cause of acute morbidity and mortality, but long-term neurodevelopmental consequences have not been comprehensively described and discussed.

OBJECTIVES

We aimed to summarize evidence on the pathogenesis, diagnosis, and epidemiology of long-term sequelae after neonatal bacterial sepsis and meningitis. We also discuss approaches for future studies to quantify the public health impact of neonatal infection-associated neurodevelopmental impairment.

SOURCES

We identified studies, both research articles and reviews, which provide mechanistic information on the long-term disease, as well as epidemiological studies that describe the frequency of neurodevelopmental impairment in children with and, for comparison, without a history of neonatal bacterial infection. Tools currently used in clinical practice and research settings to assess neurodevelopmental impairment were also reviewed.

CONTENT

We first enumerate potential direct and indirect mechanisms that can lead to brain injury following neonatal infections. We then discuss summary data, either frequencies or measures of association, from epidemiological studies. Risk factors that predict long-term outcomes are also described. Finally, we describe clinical approaches for identifying children with neurodevelopmental impairment and provide an overview of common diagnostic tools.

IMPLICATIONS

The limited number of studies that describe the long-term consequences of neonatal infections, often undertaken in high-income settings and using variable designs and diagnostic tools, are not sufficient to inform clinical practice and policy prioritization. Multi-country studies with follow-up into adolescence, standardized diagnostic approaches, and local comparator groups are needed, especially in low and middle-income countries where the incidence of neonatal sepsis is high.

Positive Parenting and Sociodemographic Factors Related to the Development of Chilean Children Born to Adolescent Mothers

The lack of economic resources has a negative effect on the maternal role of younger mothers. In Chile, the majority of adolescent pregnancies occur in socially and economically vulnerable contexts. The current study aimed to examine the relationship between demographic variables within the family context and parenting behaviors among Chilean adolescent mothers (including affection, responsiveness, encouragement, and teaching). These factors were correlated with communication, problem-solving abilities, and personal-social development in typically developing infants. The study included a sample of 79 Chilean adolescent mother-child dyads with children aged 10 to 24 months. Communication, problem-solving, and personal-social development were assessed using the Ages and Stages Questionnaire-3, along with a demographic information questionnaire. The parenting behaviors mentioned above were observed using the Spanish version of Parenting Interactions with Children: Checklist of Observations Linked to Outcomes. The findings indicated that mothers in employment and those who had not dropped out of school had children with better problem-solving skills. Additionally, children residing with their fathers and female children performed better in communication, problem-solving, and personal-social development. Maternal responsiveness was associated with communication and problem-solving, while maternal encouragement was linked to improved problem-solving skills. Maternal teaching was connected to communication, problem-solving, and personal-social development. The study emphasized the significance of parenting and sociodemographic factors among adolescent mothers and their influence on their children's development.

Diagnostic accuracy of ASQ for screening of neurodevelopmental delays in low resource countries

OBJECTIVE

The Bayley Scales of Infant Development (BSID) is the most used diagnostic tool to identify neurodevelopmental disorders in children under age 3 but is challenging to use in low-resource countries. The Ages and Stages Questionnaire (ASQ) is an easy-to-use, low-cost clinical tool completed by parents/caregivers that screens children for developmental delay. The objective was to determine the performance of ASQ as a screening tool for neurodevelopmental impairment when compared with BSID second edition (BSID-II) for the diagnosis of moderate-to-severe neurodevelopmental impairment among infants at 12 and 18 months of age in low-resource countries.

METHODS

Study participants were recruited as part of the First Bites Complementary Feeding trial from the Democratic Republic of Congo, Zambia, Guatemala and Pakistan between October 2008 and January 2011. Study participants underwent neurodevelopmental assessment by trained personnel using the ASQ and BSID-II at 12 and 18 months of age.

RESULTS

Data on both ASQ and BSID-II assessments of 1034 infants were analysed. Four of five ASQ domains had specificities greater than 90% for severe neurodevelopmental delay at 18 months of age. Sensitivities ranged from 23% to 62%. The correlations between ASQ communications subscale and BSID-II Mental Development Index (MDI) (r=0.38) and between ASQ gross motor subscale and BSID-II Psychomotor Development Index (PDI) (r=0.33) were the strongest correlations found.

CONCLUSION

At 18 months, ASQ had high specificity but moderate-to-low sensitivity for BSID-II MDI and/or PDI <70. ASQ, when administered by trained healthcare workers, may be a useful screening tool to detect severe disability in infants from rural low-income to middle-income settings.

TRIAL REGISTRATION NUMBER

NCT01084109.

Relationship-based intervention for children who were prenatally alcohol exposed in South Africa

BACKGROUND

This early intervention study investigated the effectiveness of a relationship-based, developmental enhancement process for children who were prenatally exposed to alcohol in the South African context.

METHODS

Groups were created according to the child's level of risk for alcohol-related developmental issues based on each mother's alcohol use during pregnancy as assessed using the Alcohol Use Disorders Identification Test (AUDIT). Primary caregiver/child dyads were the focus of the intervention and child development was monitored by the Ages and Stages Questionnaire (ASQ). Eighteen caregiver/child dyads were in the heavily alcohol-exposed group, and 20 caregiver/child dyads were in the no or light alcohol-exposure group. The Home Observation Measurement of the Environment (HOME) was measured pre and post intervention.

RESULTS

The results indicated significant improvements in the home environment (p < .001) post-intervention for the entire cohort. For the total HOME score, there was a statistically significant main effect for time (pre- vs post-test), F(1, 36)= 65.205, p < .001, partial η2 = .64. with 99% confidence limits from .35 to .78. The offspring and parents from both the heavy alcohol exposure group and the no/low alcohol exposure group benefitted from the intervention over the duration of the intervention. Of the HOME domains affected, responsivity was the most improved in the households. The children's scores on the ASQ varied substantially over the months of the intervention, and the offspring of the heavy exposure group often performed significantly worse than the no/low exposure group. Nevertheless, further analysis revealed that children with the lowest performance at baseline improved their performance on most ASQ domains throughout the intervention and performed significantly better on all ASQ domains over time and at completion of the intervention.

CONCLUSIONS

This relationship-based, early intervention program for children resulted in benefits to all of the children over time.

The association between pregnancy-related anxiety and behavioral development in 18-month-old children: The mediating effects of parenting styles and breastfeeding methods

BACKGROUND

Pregnancy-related anxiety (PRA) is a distinct type of anxiety from general anxiety, affects many pregnant women, and is correlated with poor behavioral development in children. However, the mediation paths were unclear.

METHODS

A total of 2032 mother-infant pairs from the Ma'anshan Birth Cohort were included in the current study. Maternal PRA was assessed in the second and third trimesters. Children's behavioral development was evaluated at the age of 18 months. In addition, information on parenting styles and breastfeeding methods was obtained at postpartum. Multivariate regression and structural equation modeling were used to examine the associations between maternal PRA and children's behavioral development.

RESULTS

Significant intercorrelations were found between maternal PRA, the potential mediators (parenting styles and breastfeeding methods), and 18-month-old children's ASQ scores. Parenting styles played an intermediary role in the relationship between maternal PRA and children's behavioral development (β = 0.030, 95 % confidence interval: 0.017-0.051), and the mediating effect accounted for 29.1 % of the total effect. However, breastfeeding methods did not mediate the link between PRA and children's behavior.

LIMITATIONS

Depression and postpartum anxiety were not controlled for in our analysis, which left us unable to estimate the independent impact of PRA on children's behavior.

CONCLUSIONS

Parenting rather than breastfeeding is the mediating factor of behavioral problems in children caused by PRA.

Development of Parent Guidelines for Parent-Performed Developmental Screening Tests

Objectives

Most developmental screening tests have been built as parent-performed questionnaires. However, they often do not guide parents on how to answer the questionnaire. This study aimed to develop easily applicable parent guidelines.

Methods

We implemented the Delphi procedure with 20 panelists. The development of the initial questionnaire was based on the results of two surveys of parents and experts provided by a policy research report that investigated the item adequacy of the Korean Developmental Screening Test. Round one included 33 items comprising all possible measurements in six categories that were identified as difficult to understand or confusing. Round two merged and modified some items and included 32 items. We defined consensus as a median agreement value of one or less and convergence and stability values of 0.5 or less. The subjective usefulness of the parent guidelines was examined based on their previous test experiences.

Results

Consensus was reached after the second round, reflecting the items with the highest level of accuracy in each category. Of the 167 parents who participated in the survey, 113 (67.7%) affirmed the usefulness of the guidelines, while 10 (6.0%) answered that they were not useful. Items that recommended a different scoring strategy in answering the questionnaire from their previous measurements were found to be more useful by the parents.

Conclusion

The parent guidelines, composed of five bullet points, drew on the consensus of the experts. Further studies are required to assess whether these guidelines improve the accuracy of screening tests in clinical settings.

Non-Intrusive Maternal Style as a Mediator between Playfulness and Children’s Development for Low-Income Chilean Adolescent Mothers

The aim of this study was to describe the relationship between low-income Chilean adolescent maternal playfulness and mothers’ non-intrusiveness in their children’s development and to analyze whether a mother’s non-intrusiveness mediates the relationship between maternal playfulness and children’s development. The Parental Playfulness Scale and the Subscale of Intrusiveness from the Early Head Start Research and Evaluation Project were used to assess maternal playfulness and mothers’ non-intrusiveness respectively. Ages and Stages Questionnaire 3rd Edition (ASQ-3) was applied to measure the children’s communication, gross and fine motor skills, problem-solving and personal–social development. The sample consisted of 79 mother–child dyads with children aged 10–24 months (M = 15.5, SD = 4.2) and their mothers aged 15–21 years old (M = 19.1, SD = 1.7). A bivariate analysis showed that maternal playfulness was significantly associated with communication, fine motor, problem-solving and personal–social development. Moreover, higher levels of communication, fine motor skills and problem-solving development were observed in the children of less intrusive mothers. Maternal playfulness had a significant effect on children’s development of language, problem-solving and personal–social skills when their mothers showed less intrusiveness during interaction. These findings contribute to the understanding of the interaction between adolescent mothers and their children. Active play and less intrusiveness can enhance child development.

Concurrent validity of the Ages and Stages Questionnaire Inventory and the Bayley Scales of Infant and Toddler Development in rural Bangladesh

BACKGROUND

Reliable and valid measurement of early child development are necessary for the design of effective interventions, programs, and policies to improve early child outcomes. One widely used measure in low- and middle-income countries (LMICs) is the Bayley Scales of Infant and Toddler Development III (Bayley-III). Alternatively, the Bangladeshi-adapted Ages and Stages Questionnaire Inventory (ASQ:I) can be administered more quickly, inexpensively, and with less training than the Bayley-III. We aimed to assess the concurrent validity of the Bangladeshi-adapted ASQ:I with the Bayley-III in children 4-27 months old in rural Bangladesh.

METHODS

The sample was a sub-sample (n = 244) of endline participants from an evaluation of an early child development intervention (July-August 2018). We assessed concurrent validity between internally age-standardized domain-specific and total scores using Pearson correlations both overall and stratified by age and intervention status. We also assessed correlations between scores and variables theoretically related to child development including maternal education and stimulation in the home.

RESULTS

The overall correlation between ASQ:I and Bayley-III total scores was moderate (r = 0.42 95% CI: 0.30-0.53), with no systematic differences by intervention status. Overall, concurrent validity was highest for the gross motor domain (r = 0.51, 0.40-0.60), and lowest for the fine motor domain (r = 0.20, 0.04-0.33). Total ASQ:I and Bayley-III scores were positively correlated with child stimulation and maternal education.

CONCLUSION

The Bangladeshi-adapted ASQ:I is a low-cost tool that can be feasibly administered in rural Bangladesh, is moderately correlated with the Bayley-III, and can be used to measure child development when human, time, or financial resources are constrained.

REACh for the preschoolers; a developmental assessment tool for 2-5 year old children in Sri Lanka

BACKGROUND

Preschool children in low resource settings are at higher risk of missing developmental potential due to the lack of standardized and validated methods for the timely detection of children with developmental delays or neurodevelopmental disorders. The preschool teacher is a non-specialist resourceful link within the community to detect and offer interventions early. This paper discusses the preliminary iteration of designing and testing the psychometric properties of a developmental assessment for children aged 24 to 60 months in Sri Lanka. This assessment is designed to be conducted by preschool teachers in their preschool setting.

METHODS

Three processes followed: 1. Designing and development of the Ragama Early Assessment for Children (REACh) complete preschool developmental assessment and a tool kit 2. Testing and training teachers on conducting the REACh assessment 3. Preliminary assessment of the psychometric properties including content validity, internal consistency, interrater reliability and concurrent validity.

RESULTS

A literature search identified 11 assessments and 542 items representing cognitive, social-emotional and adaptive, language and motor domains. Content validity was assessed to select and adapt items. A complete assessment tool was designed to be administered in four settings within the preschool. This was further improved during pre and pilot testing and teacher training. Cronbach's alpha measuring internal consistency was > 0.70 for cognitive, language, social-emotional and adaptive domains across all three age groups in 1809 children. Interrater reliability was > 65% for age groups 36-47 and 47- 60 months. Concurrent validity using a clinical gold standard demonstrated sensitivity of more than 0.75 for all age groups with variable specificities (24-35 months: 0.71, 36- 47 months: 0.43 and 48-60 months: 0.67) assessed in 75 children.

CONCLUSIONS

This culturally and linguistically adapted tool was tested nationally in Sri Lanka. The inte-rrater reliability between teachers and research assistants was higher than 65% for all domains in children more than 36 months. The preliminary iteration confirms it as an acceptable screening assessment for all age groups but with significantly lower specificity in the 36-47 month age group. Further improvement in certain domains together with intense teacher training is likely to enhance the validity and reliability of the assessment.

TRIAL REGISTRATION

Ethics clearance for the procedure was granted prospectively from the Ethics Review Committee, Faculty of Medicine, University of Kelaniya (ERC no. P 131/06/2018).

Construction and validation of the Oxford Neurodevelopment Assessment (OX-NDA) in 1-year-old Brazilian children

BACKGROUND

Over 250 million children under 5 years, globally, are at risk of developmental delay. Interventions during the first 2 years of life have enduring positive effects if children at risk are identified, using standardized assessments, within this window. However, identifying developmental delay during infancy is challenging and there are limited infant development assessments suitable for use in low- and middle-income (LMIC) settings. Here, we describe a new tool, the Oxford Neurodevelopment Assessment (OX-NDA), measuring cognition, language, motor, and behaviour, outcomes in 1-year-old children. We present the results of its evaluation against the Bayley Scales of Infant Development IIIrd edition (BSID-III) and its psychometric properties.

METHODS

Sixteen international tools measuring infant development were analysed to inform the OX-NDA's construction. Its agreement with the BSID-III, for cognitive, motor and language domains, was evaluated using intra-class correlations (ICCs, for absolute agreement), Bland-Altman analyses (for bias and limits of agreement), and sensitivity and specificity analyses (for accuracy) in 104 Brazilian children, aged 12 months (SD 8.4 days), recruited from the 2015 Pelotas Birth Cohort Study. Behaviour was not evaluated, as the BSID-III's adaptive behaviour scale was not included in the cohort's protocol. Cohen's kappas and Cronbach's alphas were calculated to determine the OX-NDA's reliability and internal consistency respectively.

RESULTS

Agreement was moderate for cognition and motor outcomes (ICCs 0.63 and 0.68, p < 0.001) and low for language outcomes (ICC 0.30, p < 0.04). Bland-Altman analysis showed little to no bias between measures across domains. The OX-NDA's sensitivity and specificity for predicting moderate-to-severe delay on the BSID-III was 76, 73 and 43% and 75, 80 and 33% for cognition, motor and language outcomes, respectively. Inter-rater (k = 0.80-0.96) and test-rest (k = 0.85-0.94) reliability was high for all domains. Administration time was < 20 minutes.

CONCLUSION

The OX-NDA shows moderate agreement with the BSID-III for identifying infants at risk of cognitive and motor delay; agreement was low for language delay. It is a rapid, low-cost assessment constructed specifically for use in LMIC populations. Further work is needed to evaluate its use (i) across domains in populations beyond Brazil and (ii) to identify language delays in Brazilian children.

A multiphased cultural and contextual adaptation of the Parents' Evaluation of Developmental Status tools for a low-income community: A South African case study

INTRODUCTION

Culturally relevant developmental screening is one of the best ways to appropriately identify developmental delays and disabilities in children as early as possible across diverse cultural backgrounds. This study aimed to adapt the Parents' Evaluation of Developmental Status (PEDS) tools for a low-income community in South Africa by using a detailed multiphased cultural and contextual adaption process.

METHOD AND RESULTS

A three-phase mixed-method design relying on triangulation of data was used. Data were collected at an immunization clinic in a low-income community in Mamelodi, South Africa. Phase 1 was a focus group discussion with 11 community participants. The topics explored the possible changes to the PEDS tools to make them more relevant to the community. Phase 1 informed Phase 2 where 12 early childhood development experts achieved consensus through a two-round survey on a modified Delphi method. In Phase 3, a draft of the PEDS tools-SA was presented to the authors of the PEDS tools for final approval. Of 55 questions that were adapted for the PEDS tools-SA, two original questions (3.6%), 14 questions from the expert suggestions (25.4%) and 39 from the community participant's suggestions (71%) were included. A final version of the PEDS tools-SA was created.

CONCLUSION

This study used a systematic method to adapt the PEDS tools to create the culturally appropriate PEDS tool-SA for a low-income community in South Africa, informed by community stakeholders' views from the first step. This resulted in a high-quality adaptation process that is more likely to result in a tool that is more acceptable to caregivers from a low-income South African community.

Associations of adverse maternal experiences and diabetes on postnatal maternal depression and child social-emotional outcomes in a South African community cohort

Previous literature has identified associations between diabetes during pregnancy and postnatal maternal depression. Both maternal conditions are associated with adverse consequences on childhood development. Despite an especially high prevalence of diabetes during pregnancy and maternal postnatal depression in low- and middle-income countries, related research predominates in high-income countries. In a South African cohort with or without diabetes, we investigated associations between adverse maternal experiences with postnatal maternal depression and child social-emotional outcomes. South African mother-child dyads were recruited from the Bishop Lavis community in Cape Town. Participants consisted of 82 mother-child dyads (53 women had GDM or type 2 diabetes). At 14-20 months postpartum, maternal self-report questionnaires were administered to assess household socioeconomic status, food insecurity, maternal depressive symptoms (Edinburgh Postnatal Depression Scale (EPDS)), maternal trauma (Life Events Checklist), and child social-emotional development (Brief Infant Toddler Social Emotional Assessment, Ages and Stages Questionnaires: Social-Emotional, Second Edition). Lower educational attainment, lower household income, food insecurity, living without a partner, and having experienced physical assault were each associated with postnatal maternal depressive symptoms and clinical maternal depression (EPDS ≥ 13). Maternal postnatal depression, lower maternal educational attainment, lower household income, household food insecurity, and living in a single-parent household were each associated with child social-emotional problems. Stratified analyses revealed maternal experiences (education, income, food insecurity, trauma) were associated with postnatal maternal depressive symptoms and child social-emotional problems only among dyads with in utero exposure to diabetes. Women with pre-existing diabetes or gestational diabetes in LMIC settings should be screened for health related social needs to reduce the prevalence of depression and to promote child social-emotional development.

Fleur J, Hilaire J, Evans A, Long J, Wing D, Carpenter C, Wilson K, Palfrey J, Stulac S. Associations Between Parental Depression, Self-efficacy, and Early Childhood Development in Malnourished Haitian Children

Background. Haiti lacks early childhood development data and guidelines in malnourished populations. Literature shows that developmental interventions are crucial for improving developmental outcomes malnourished children. This study examines the prevalence of early childhood development delays in a cohort of malnourished Haitian children and their associations with parental depression and self-efficacy. Methods. We used cross-sectional data from 42 patients 6 months to 2 years old in Saint-Marc, Haiti. We assessed their developmental status using the Ages and Stages Questionnaire. Parents were surveyed on depression symptoms and self-efficacy using validated surveys developed for low-resource settings. Demographic and socio-economic data were included. Prevalence of early childhood development delays and high parental depression risk were calculated. Multivariable logistic regression analyses were used to test whether parental depression risk and low self-efficacy were associated with a higher risk for childhood developmental delays. Results. Among participants, 45.2% (SD = 7.7%) of children with a recorded ASQ met age-specific cutoffs for developmental delay in one or more domains. 64.3% (SD = 7.4%) of parents were at high risk for depression. 47.6% (SD = 7.7%) of parents reported relatively low self-efficacy. Multivariable analysis showed that low parental self-efficacy was strongly associated with developmental delays (OR 17.5, CI 1.1-270.0) after adjusting for socioeconomic factors. Parental risk for depression was associated with higher odds (OR 4.6, CI 0.4-50.6) of children having developmental delays but did not reach statistical significance in this study. Conclusion. Parental self-efficacy was protectively associated with early childhood developmental delays in malnourished Haitian children. More research is needed to design contextually appropriate interventions.

Changes in the developmental status of preschoolers with sickle cell disease

Developmental monitoring and screening are recommended strategies for identifying children with sickle cell disease at high risk for cerebrovascular complications. Studies examining developmental screenings have provided little data on change over time. We examined screenings longitudinally in 43 children screened as two-year-olds and four-year-olds using the Ages and Stages Questionnaire, 2nd edition. Only two-thirds of children had stable screening outcomes. A new onset of cerebrovascular complications predicted the emergence of developmental delay (P = 0.017). Multivariate analysis suggested a benefit from formal developmental interventions. Regular developmental screening during the preschool period is important to identify systematic changes in developmental status.

Grandi Byen-supporting child growth and development through integrated, responsive parenting, nutrition and hygiene: study protocol for a randomized controlled trial

BACKGROUND

Poor child growth and development outcomes stem from complex relationships encompassing biological, behavioral, social, and environmental conditions. However, there is a dearth of research on integrated approaches targeting these interwoven factors. The Grandi Byen study seeks to fill this research gap through a three-arm longitudinal randomized controlled trial which will evaluate the impact of an integrated nutrition, responsive parenting, and WASH (water, sanitation and hygiene) intervention on holistic child growth and development.

METHODS

We will recruit 600 mother-infant dyads living in Cap-Haitien, Haiti and randomize them equally into one of the following groups: 1) standard well-baby care; 2) nutritional intervention (one egg per day for 6 months); and 3) multicomponent Grandi Byen intervention (responsive parenting, nutrition, WASH + one egg per day for 6 months). Primary outcomes include child growth as well as cognitive, language, motor, and social-emotional development. The study also assesses other indicators of child health (bone maturation, brain growth, diarrheal morbidity and allergies, dietary intake, nutrient biomarkers) along with responsive parenting as mediating factors influencing the primary outcomes. An economic evaluation will assess the feasibility of large-scale implementation of the interventions.

DISCUSSION

This study builds on research highlighting the importance of responsive parenting interventions on overall child health, as well as evidence demonstrating that providing an egg daily to infants during the complementary feeding period can prevent stunted growth. The multicomponent Grandi Byen intervention may provide evidence of synergistic or mediating effects of an egg intervention with instruction on psychoeducational parenting and WASH on child growth and development. Grandi Byen presents key innovations with implications for the well-being of children living in poverty globally.

TRIAL REGISTRATION

NCT04785352 . Registered March 5, 2021 at https://clinicaltrials.gov/.

Relationship between parental report of language skills and children's performance among 3-year-olds: Implications for screening language among preschoolers

AIM

The study compared parental ratings of children's language abilities at 3-years of age with observations of children's language performance by Speech Language Pathologists (SLPs).

METHOD

Children (n=85) around 3-years of age were recruited from a child development clinic. Detailed speech and language assessments were completed during a one-hour semi-structured clinician-child interactive session. Language assessment was carried out using a criterion-referenced checklist and the language sections of the Bayley Scale for Infant Development- 3rd Edition (BSID-III). All parents rated their children's language skills using seven statements related to reception and expression domains of language on a 7-point rating scale. The language status of the child (typical language vs delay) determined by the parental report was matched with the language status as per the child's performance during the SLP assessment.

RESULTS AND DISCUSSION

Mean parental ratings of children assessed as having language delay by an SLP were significantly lower than children with typical language. Total parental rating score correlated highly with overall language scores on BSID-III; the highest correlation was observed for ratings of statements related to expressive language skills focusing on formation of sentences. Parental report of below normal performance on any one of the seven statements demonstrated acceptable sensitivity (0.95) and a high negative predictive value (0.98) with the child's performance as the gold standard.

CONCLUSION

Parental ratings of language skills correlated with child's performance at 3-years of age with a higher agreement for identifying children with delays. Parental reports can be useful to red-flag children for further assessment and continued monitoring of language development in busy developmental clinics and preschools, especially in the context of low-resource settings.

Predictive Validity of Developmental Screening Questionnaires for Identifying Children With Later Cognitive or Educational Difficulties: A Systematic Review

Context: Parent/caregiver completing developmental screening questionnaires (DSQs) for children before 5 years of age is currently recommended. The DSQs recommended by the American Academy of Pediatrics (AAP) are the Ages and Stages Questionnaires (ASQ), Parents' Evaluation of Developmental Status (PEDS), and the Survey of Well-being of Young Children (SWYC). Nevertheless, their predictive validity has not been well-established. Objective: To assess in the current literature, the value of AAP-recommended DSQs (ASQ, PEDS, SWYC) administered between 0 and 5 years of age, for predicting long-term cognitive achievement and/or school performance (CA/SP), after 1 year or more of evaluation and at/or after age 5 years, in the general population. Data Sources: Cochrane, MEDLINE PubMed, CINAHL, EMBASE, Web of Science, Scielo, and Scopus databases (until March 2021). Study Selection: Two authors selected the studies. Forward and backward citation follow-up was done; authors of DSQ were contacted to identify additional studies. Data Extraction: Cohorts were identified, and authors of selected studies were contacted to corroborate and complete extracted data. Results: Thirty-two publications, corresponding to 10 cohorts, were included. All cohorts used ASQ. Only cohort using PEDS was identified but did not meet the inclusion criteria. No cohorts conducted with SWYC were identified. Associations between ASQ and CA/SP were extracted for eight cohorts. The odds ratios were >3, and the area under the curve was 0.66-0.87. A trade-off between sensitivity and specificity was observed. Limitations: Heterogeneity in population characteristics and in DSQ adaptations. Conclusions: A positive association between ASQ and later CA/SP was found in different social, cultural, and economic settings. Additional studies are necessary to determine the impact factors in the predictive capacity of DSQs. Systematic Review Registration: PROSPERO, identifier: CRD42020183883.

Parent-administered Neurodevelopmental Follow up in Children After Picornavirus CNS Infections

BACKGROUND

Data on the neurodevelopment of children who experienced central nervous system (CNS) infections with enteroviruses (EV) or parechoviruses (hPeV) is scarce and mostly limited to follow up of short-term outcomes.

METHODS

Parents of children who presented between 2014 and 2019, underwent a lumbar puncture and whose cerebrospinal fluid was polymerase chain reaction positive for EV or hPeV, were asked to complete a care-giver-administered neurodevelopmental assessment tool (The Ages and Stages Instrument [ASQ3]). Clinical data of the infective episode were collected from patient notes.

RESULTS

Of 101 children, 43 (10 hPeV+, 33 EV+) submitted ASQ3 results. Median age at assessment was 38.9 months (interquartile range, 15.4-54.8), the follow-up interval 3 years (median 37 months; interquartile range, 13.9-53.1). Age, inflammatory markers, and cerebrospinal fluid pleocytosis during the infective event were not associated with ASQ3 scores. In 23 children (17 EV+, 6 hPeV+), no neurodevelopmental concerns were reported. Two more had preexisting developmental delay and were excluded. Of the remaining, 18/41 (43.9%) reported ASQ3 scores indicating need for monitoring or professional review in at least 1 category, not differing by pathogen (EV 14/31, 45.2%; hPeV 4/10, 40%; P = 0.71). Seven children will require formal review, scoring ≥2 SD below the mean in at least 1 category (6/31 EV+, 1/10 hPeV+, P = 0.7), 3 scored ≥2 SD below the mean in more than 1 area.

CONCLUSIONS

Parent-administered developmental assessment of children with a history of early picornavirus infection of the CNS identified a subgroup that requires formal neurodevelopmental review. Wider application of community-based developmental screening will complement our understanding of the impact of CNS infections in early childhood.

Psychometric properties of the ASQ-3 in a nationally representative sample of Uruguay

BACKGROUND

The Ages & Stages Questionnaires Third Version (ASQ-3) identifies the risk of developmental delay in children aged 2 to 66 months. The ASQ-3 is available in many languages. However, there is little evidence of the psychometric properties of the Spanish version and using nationally-representative samples.

AIMS

This study evaluates the reliability and factor solution of the Spanish version of the ASQ-3 (18- to 54-month questionnaires) in a large, representative sample of Uruguayan children. Besides, it explores the association of ASQ-3 scores with sociodemographic characteristics.

METHOD

Participants were 4016 main caregivers selected randomly across the country who completed the ASQ-3 for their children. All participants responded to the ASQ-3 and a sociodemographic questionnaire within the context of a government-run survey of child development.

RESULTS

Most versions of the ASQ-3 in Spanish have acceptable-to-good psychometric properties, supporting the 5-factor-solution. Personal-Social and, to a lesser extent, Problem-solving scores were the subscales that showed more suboptimal internal consistency coefficients. Scores showed higher ceiling effects than the original US sample but varied across domains, with Gross Motor showing the highest pattern. Sex and socioeconomic status are associated with scores of most age-versions and subscales of the ASQ-3.

CONCLUSIONS

In general, results support the reliability and dimensionality of ASQ-3 scores, but psychometric properties varied across age-version and domains. Overall, earlier versions presented less precision, while the Personal-social domain showed reduced reliability in most age-versions.

Effectiveness of an Integrated Care Package for Refugee Mothers and Children: Protocol for a Cluster Randomized Controlled Trial

Background

Thousands of Rohingya refugee mothers at the world’s largest refugee camp located in Bangladesh are at risk of poor mental health. Accordingly, their children are also vulnerable to delayed cognitive and physical development.

Objective

The aim of this study is to evaluate the effectiveness of an integrated care package in reducing the prevalence of developmental delays among children aged 1 year and improving their mothers’ mental health status.

Methods

This is a parallel, two-arm, single-blind, cluster randomized controlled trial (cRCT). A total of 704 mother-child dyads residing at the Kutupalong refugee camp in Cox’s Bazar, Bangladesh, will be recruited from 22 clusters with 32 mother-child dyads per cluster. In the intervention arm, an integrated early childhood development and maternal mental health package will be delivered every quarter to mothers of newborns by trained community health workers until the child is 1 year old. Our primary outcome is a reduction in the prevalence of two or more childhood developmental delays of infants aged 1 year compared to the usual treatment. The secondary outcomes include reduced stunting among children and the prevalence of maternal depression. We will also assess the cost-effectiveness of the integrated intervention, and will further explore the intervention’s acceptability and feasibility.

Results

At the time of submission, the study was at the stage of endpoint assessment. The data analysis started in December 2020, and the results are expected to be published after the first quarter of 2021.

Conclusions

This study will address the burden of childhood developmental delays and poor maternal mental health in a low-resource setting. If proven effective, the delivery of the intervention through community health workers will ensure the proposed intervention’s sustainability.

Trial Registration

ISRCTN Registry ISRCTN10892553; https://www.isrctn.com/ISRCTN10892553

International Registered Report Identifier (IRRID)

DERR1-10.2196/25047

One-Carbon Metabolism in Nepalese Infant-Mother Pairs and Child Cognition at 5 Years Old

BACKGROUND

One-carbon metabolism (OCM) refers to the transfer of methyl groups central to DNA methylation and histone modification. Insufficient access to methyl donors and B-vitamin cofactors affects epigenetic maintenance and stability, and when occurring in early life may impact future health and neurodevelopment.

OBJECTIVE

The objective of this study was to examine the relative associations between one-carbon metabolites in Nepalese mother-infant pairs and child cognition measured at 5 y of age.

METHODS

This is a cross-sectional study from Bhaktapur, Nepal, in a population at high risk of subclinical B-vitamin deficiencies and cumulative infection burden. Venous blood samples from 500 mother-infant pairs were collected when the infants were 2 to 12 mo old, and metabolite concentrations measured by microbiological assays and GC-tandem MS. We re-enrolled 321 of these children at 5 y and assessed cognition by the Ages and Stages Questionnaire, 3rd edition, and subtests from the Developmental Neuropsychological Assessment, 2nd edition (NEPSY-II). The associations of the independent metabolites or unobserved metabolic phenotypes (identified by latent class analysis) with the cognitive outcomes were estimated by seemingly unrelated regression. We explored direct and indirect relations between the OCM pathway and the cognitive outcomes using path analysis.

RESULTS

Infant cystathionine concentration was inversely associated with 4 cognitive outcomes (standardized βs ranging from -0.22 to -0.11, P values from <0.001 to 0.034). Infants with a metabolic phenotype indicating impaired OCM and low vitamin B-12 status had poorer cognitive outcomes compared with infants with normal OCM activity and adequate vitamin B-12 status (standardized βs ranging from -0.80 to -0.40, P < 0.001 and 0.05). In the path analysis, we found several OCM biomarkers were associated with affect recognition through infant plasma cystathionine.

CONCLUSIONS

Elevated plasma cystathionine during infancy reflects a metabolic phenotype of impaired OCM and low vitamin B-12 status and is associated with poorer cognitive function when the children are 5 y old.

The association between dietary diversity and development among children under 24 months in rural Uganda: analysis of a cluster-randomised maternal education trial

OBJECTIVE

To assess the association between dietary diversity and development among children under 24 months in rural Uganda and to establish other factors that could be associated with development among these children.

DESIGN

A secondary data analysis of a cluster-randomised controlled maternal education trial (n 511) was conducted on a sub-sample of 385 children. We used adjusted ORs (AORs) to assess the associations of dietary diversity scores (DDS) and other baseline factors assessed at 6-8 months with child development domains (communication, fine motor, gross motor, personal-social and problem solving) at 20-24 months of age.

SETTING

Rural areas in Kabale and Kisoro districts of south-western Uganda.

PARTICIPANTS

Children under 24 months.

RESULTS

After multivariable analysis, DDS at 6-8 months were positively associated with normal fine motor skills development at 20-24 months (AOR = 1·18; 95 % CI 1·01, 1·37; P = 0·02). No significant association was found between DDS and other development domains. Children who were not ill at 6-8 months had higher odds of developing normal communication (AOR = 1·73; 95 % CI 1·08, 2·77) and gross motor (AOR = 1·91; 95 % CI 1·09, 3·36) skills than sick children. Girls had lower odds of developing normal gross motor skills compared with boys (AOR = 0·58; 95 % CI 0·33, 0·98). Maternal/caregiver nutritional education intervention was positively associated with development of gross motor, fine motor and problem-solving skills (P-values < 0·05).

CONCLUSIONS

We found an association between child DDS at 6-8 months and improvement in fine motor skills development at 20-24 months. Child illness status, maternal/caregiver nutritional education intervention and sex were other significant baseline predictors of child development at 20-24 months.

Developmental and behavioral outcomes of preschool-aged children with biotinidase deficiency identified by newborn screening

Biotinidase deficiency (BD) may cause neurological symptoms and developmental problems. However, newborn screening of BD and early biotin treatment prevent the manifestation of the majority of symptoms. This study intended to examine the developmental and behavioral outcomes as well as maternal anxiety and depressive symptoms of preschool-aged children with BD and to compare these with the outcomes of healthy preschool-aged children. In total, 49 children with BD and 23 healthy children are included. All children were screened for developmental and behavioral problems. Moreover anxiety and depressive symptomatology of their mothers were evaluated. Despite the high percentage of developmental delay in BD group, the numbers of children screened positive for a developmental delay were statistically similar in children with BD and healthy children. Among patients with BD, children with risk of developmental delay had more unfavorable socio-demographic features compared to typically developing ones. Behavioral problem scores, maternal anxiety, and depressive symptoms scores of children with BD were not higher than the healthy children.Conclusion: Children with BD were not different from their healthy peers in terms of developmental and behavioral outcomes. Developmental problems of children with BD may be related to the unfavorable socio-demographic features, not the BD itself. What is known: • Biotinidase deficiency (BD) may result in neurological symptoms and developmental problems. • Newborn screening and early biotin supplementation prevent the manifestation of the majority of symptoms. What is new: • Preschool-aged children with BD identified by newborn screening are not different from their healthy peers in terms of developmental and behavioral outcomes. • Maternal anxiety and depressive symptoms scores of children with BD are similar to scores of healthy children.

Effect of Delayed Cord Clamping on Neurodevelopment at 3 Years: A Randomized Controlled Trial

INTRODUCTION

Iron deficiency (ID) is associated with poor neurodevelopment. We have previously shown that delayed umbilical cord clamping (CC) improves iron stores at 8 months and neurodevelopment at 1 year in term, healthy infants in Nepal.

OBJECTIVE

The aim of this study was to assess the effects of delayed CC (≥180 s) compared to early CC (≤60 s) on neurodevelopment using the Ages and Stages Questionnaire (ASQ) at age 3 years.

METHODS

In 2014, 540 healthy Nepalese infants born at term were randomized in a 1:1 ratio to delayed or early CC. At 3 years of age, ASQ assessment was performed by phone interviews with parents. A score >1 standard deviation below the mean was defined as "at risk" for developmental impairment.

RESULTS

At 3 years of age, 350 children were followed up, 170 (63.0%) in the early CC group and 180 (66.7%) in the delayed CC group. No significant differences in ASQ scores in any domains between groups were found. However, more girls were "at risk" for affected gross motor development in the early CC group: 14 (18.9%) versus 6 (6.3%), p = 0.02.

CONCLUSION

There were no significant differences in ASQ scores in any domains between groups. In the subgroup analysis, fewer girls who underwent delayed CC were "at risk" for delayed gross motor development. Due to the pronounced difference in iron stores at 8 months postpartum in this cohort, follow-up studies at an older age are motivated since neurodevelopmental impairment after early ID may be more detectable with increasing age.

Agreement Between Mothers and Fieldworkers While Assessing Child Development Using Ages and Stages Questionnaires, Third Edition in Nepal

Background: The Ages and Stages Questionnaires, Third Edition (ASQ-3) is becoming a widely used developmental assessment tool. The ASQ-3 can be completed by the caregivers (referred to as “mail out”), or by trained personnel under direct observation of the children (referred to as “home procedure”).

Aim: The study was carried out to compare results obtained by the ASQ mail out with those of the ASQ home procedure in a community setting of Bhaktapur, Nepal.

Methods: Trained fieldworkers (FWs) performed developmental assessment of 134 children aged 9 months in their homes using the ASQ home procedure. A few days before these assessments, mothers were asked to fill in the same ASQ-3 questionnaire. The concordance correlation coefficient (CCC) was calculated to measure their agreement.

Result: The agreement between the ASQ mail out and home procedure was fair for the total score (CCC = 0.54). For the sub-scales, the agreement was good for the gross motor (CCC = 0.65), for the remaining subscales agreement was poor (CCC < 0.4).

Conclusion: In resource limited setting like Nepal, the ASQ mail out represents an easy method to assess child development by caretakers at home; however, with the poor agreement between different methods of assessments, we cannot conclude that a single method is superior or most optimal and this question should be investigated further. When either of the method home procedure or mail out is opted, the results should be interpreted with cautions.

Domain- and sex-specific effects of prenatal exposure to low levels of arsenic on children's development at 6 months of age: Findings from the Ma'anshan birth cohort study in China

The relationship between prenatal arsenic exposure at low levels and poor development in children, especially in regard to neurodevelopment, has aroused several concerns, but the conclusions have been inconsistent. It still remains unclear whether such adverse effect is associated with a specific profile of the developing brain in early life. To investigate the association between arsenic exposure in utero and children's development and behaviour, we performed a large prospective birth cohort study including 2315 mother-infant pairs in Anhui Province, China. The Ages and Stages Questionnaire of China (ASQ-C) was used to assess the status of children's development and behaviour at 6 months postpartum, and the levels of arsenic were determined in umbilical cord serum samples. Odds ratios for suspected developmental delay (SDD) in each domain of the ASQ-C clusters were estimated using logistic regression models. Compared with low arsenic levels group, medium and high arsenic levels were significantly associated with the increased risks of SDD in the personal-social domain among infants aged 6 months after adjustment for all potential confounders (OR = 1.33, 95% CI (1.01, 1.75) and OR = 1.47, 95% CI (1.08, 2.00), respectively). Sex stratification analysis demonstrated that this association was stronger in females. The sensitivity analyses also showed that high cord serum arsenic levels were associated with a 1.80-fold (95% CIs (1.12, 2.90)) higher risk of a more severe developmental delay in the personal-social domain among six-month-old females. Our results suggest that low-level arsenic exposure in utero could have an adverse domain-specific effect on children's development at 6 months of age, particularly among females. Further studies are warranted to support the findings and explore the mechanism of these domain-and sex-specific associations.

Dietary Diversity and Child Development in the Far West of Nepal: A Cohort Study

Poverty adversely affects child development through multiple pathways in low- and middle-income countries. Relationships between diet and child development are poorly understood. In this study, we aimed to explore these associations in a longitudinal cohort of 305 children in rural Nepal (baseline mean age 14 months), evaluating dietary diversity and the consumption of specific food groups at three timepoints over 1.5 years. Child development was assessed using the Ages and Stages questionnaire-version 3 (ASQ-3). Associations between the number of days that children consumed minimum dietary diversity (MDD) (≥4/8 items) and specific food groups over time (range 0–3) and total and subscale ASQ scores at age 23–38 months were estimated using multiple linear and logistic regression, dichotomizing scores at the lowest quartile. After adjusting for confounders, each additional day of consuming MDD was associated with a 35% reduction in the odds of low total ASQ score [OR 0.65, 95% CI (0.46, 0.92)]. The consumption of animal source foods [OR 0.64, (0.46, 0.89)], and vegetables/fruits [OR 0.60, (0.41, 0.90), but not processed foods [OR 0.99, (0.62, 1.59)] was associated with lower odds of low total development. Vegetables, fruits and animal source foods may be important for child development in this setting.

Developmental and behavioral problems in preschool-aged primary ciliary dyskinesia patients

Primary ciliary dyskinesia (PCD) causes a broad spectrum of disease. This study aims to explore the developmental, behavioral, and social-emotional aspects of preschool-aged children with PCD. Fourteen PCD, 17 cystic fibrosis (CF) patients and 15 healthy subjects were enrolled. Developmental features of the participants were evaluated with Ages and Stages Questionnaire. Parents of participants filled out the Child Behavior Checklist (CBCL). The number of children screened positive for developmental delay was statistically higher in the PCD group. Higher numbers of children with PCD were screened positive for developmental delay in communication and problem-solving domains. Delay in fine motor skill domain was more common in children with PCD and CF compared to healthy subjects. There was no difference among the three groups in terms of gross motor and personal-social development. None of the children in all three groups was shown to have social-emotional problems. In CBCL, patients with CF had higher internalizing problem scores. Externalizing and total problem scores did not differ between the three groups. However, among PCD patients, children with developmental delay on more than one domain had higher externalizing and total problem scores.Conclusion: The current study revealed that positive screening for developmental delay is more common in preschool-aged PCD patients compared to patients with CF and healthy children. What is Known: • Intelligence scores of school-aged PCD patients are similar to healthy subjects despite their higher internalizing problem scores on Child Behavior Checklist (CBCL). • School-aged PCD patients exhibit higher hyperactivity and inattention findings. What is New: • Positive screening for developmental delay in communication, problem-solving and fine motor skills is more common in preschool-aged PCD patients. • Preschool-aged PCD patients screened positive for developmental delay in more than one domain have higher externalizing and total problem scores on CBCL.

Comparative use of the Ages and Stages Questionnaires in the USA and Scandinavia: a systematic review

AIM

The aim of this systematic review was to investigate screening practices with the Ages and Stages Questionnaires (ASQ) and the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) in the USA and Scandinavia and to identify practical lessons and research opportunities.

METHOD

The review was performed for ASQ- and ASQ:SE-related studies in children from birth to 5 years. From nine databases and 1689 references (published from 1988-2018), 127 articles were included and categorized using Covidence online software. The Critical Appraisal Skills Programme Checklists were used before data synthesis.

RESULTS

US studies primarily use the ASQ/ASQ:SE to detect delays in general and at-risk populations in medical settings, which increases early detection, clinician-referral, and intervention rates. Scandinavian studies commonly use the ASQ/ASQ:SE to monitor developmental-behavioural differences in intervention/exposure-based cohorts. Pre-visit screening yields completion/return rates of 83% to more than 90% and fosters same-day interpretation. When referrals are indicated, systemwide care coordination or colocation with a developmental-behavioural specialist is beneficial.

INTERPRETATION

Practical implementation lessons are reviewed. Research opportunities include investigating and measuring the ASQ/ASQ:SE's 'overall' sections. Danish, Norwegian, and Swedish translations are available but up-to-date norming and validation studies are needed throughout Scandinavia. Randomized controlled trials are needed to investigate outcomes in screened versus unscreened cohorts.

WHAT THIS PAPER ADDS

General and at-risk populations broadly benefited from periodic Ages and Stages Questionnaires (ASQ) and/or Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) screening. Pre-visit ASQ and/or ASQ:SE screenining implementation systems work best. The ASQ and ASQ:SE 'overall' sections are not quantifiable and under-researched.

Reliability and agreement of ages and stages questionnaires®: Results in late preterm and term-born infants at 24 and 48 months

AIM

To evaluate the reliability of the Ages and Stages Questionnaires (ASQ-3) 24 and 48 month intervals translated to Spanish by Brookes Publishing, and the agreement between both questionnaires, comparing late preterm (LPI) and term-born infants (terms).

METHODS

Two cohort samples of healthy LPI and terms that were born in a private hospital in Barcelona, Spain. Internal consistency was analyzed by Cronbach's alpha scores and Pearson product- moment correlation between the domain scores and the overall score. The agreement was analyzed using Pearson's correlations between the two questionnaires, and the odds ratio (OR) for positive screening at 48 months, given a positive screen in 24 month assessment.

RESULTS

A total of 473 evaluations were analyzed, representing 331 children. Cronbach's alpha scores for the motor domains on both intervals were low, but acceptable compared with the overall score; a strong positive correlation between the domain and overall score were obtained in the majority of the domains. The correlation between the 24 and 48 month total scores were positive, especially for LPI. Having at least 2 domains in the referral zone at 24 months was associated with an OR of 140 [95% CI 14.85; 3575.65] for positive screen at 48 months.

CONCLUSION

The Spanish ASQ-3 24 and 48 month intervals appear to be a reliable for developmental screening and for the follow-up of children, especially for LPI. Having two or more domains in the referral zone at 24 months screening is a significant predictor of developmental delay risk at 48-month questionnaire.

Creation of the WHO Indicators of Infant and Young Child Development (IYCD): metadata synthesis across 10 countries

BACKGROUND

Renewed global commitment to the improvement of early child development outcomes, as evidenced by the focus of the United Nations Sustainable Development Goal 4, highlights an increased need for reliable and valid measures to evaluate preventive and interventional efforts designed to affect change. Our objective was to create a new tool, applicable across multicultures, to measure development from 0 to 3 years through metadata synthesis.

METHODS

Fourteen cross-sectional data sets were contributed on 21 083 children from 10 low/middle-income countries (LMIC), assessed using seven different tools (caregiver reported or directly assessed). Item groups, measuring similar developmental skills, were identified by item mapping across tools. Logistic regression curves displayed developmental trajectories for item groups across countries and age. Following expert consensus to identify well-performing items across developmental domains, a second mapping exercise was conducted to fill any gaps across the age range. The first version of the tool was constructed. Item response analysis validated our approach by putting all data sets onto a common scale.

RESULTS

789 individual items were identified across tools in the first mapping and 129 item groups selected for analysis. 70 item groups were then selected through consensus, based on statistical performance and perceived importance, with a further 50 items identified at second mapping. A tool comprising 120 items (23 fine motor, 23 gross motor, 20 receptive language, 24 expressive language, 30 socioemotional) was created. The linked data sets on a common scale showed a curvilinear trajectory of child development, highlighting the validity of our approach through excellent coverage by age and consistency of measurement across contributed tools, a novel finding in itself.

CONCLUSIONS

We have created the first version of a prototype tool for measuring children in the early years, developed using novel easy to apply methodology; now it needs to be feasibility tested and piloted across several LMICs.