Screening for developmental delay in the setting of a community pediatric clinic: a prospective assessment of parent-report questionnaires

Pediatrician and parental evaluation of child neurodevelopment at 2 years of age

BACKGROUND

The early identification of infants with a risk for neurodevelopmental disorders in the first few years of life is essential for better developmental outcomes. Screenings should be carried out by combining the family pediatricians' and parents' perspectives, the two fundamental sources of information on children's health. The present study has three aims: (a) to test the feasibility of parent-report instruments to detect warning signs in their children's development; (b) to ascertain whether there is an agreement between the family pediatricians' (FP) clinical judgments of warning signs and the parental perceptions; (c) to determine whether there is a link between parents' distress and child development.

METHODS

Within the NASCITA birth cohort, in addition to the family pediatrician's clinical evaluation with routine tools, the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) was completed by parents to assess the child's language, social skills, behavior, and sensory areas. Parents were also asked to complete the Parenting Stress Index, Short Form (PSI-SF) to verify the magnitude of stress in the parent-child system. Univariate and multivariate analyses were performed to evaluate the association between child and parental characteristics and the presence of warning signs.

RESULTS

The follow-up assessment was completed for 435 infants: 69 (15.8%) presented warning signs: 43 in the pediatrician's assessment and 36 in the M-CHAT-R (10 in both). A total of 16 children (14 with warning signs) received a diagnosis after a specialist evaluation. Being male (OR 2.46, 95%CI: 1.23-4.91) and having sleep disorders (OR 2.43, 95% CI 1.17-5.04) was associated with a greater likelihood of warning signs in the multivariate analysis, while reading aloud was a protective factor (not exposed versus exposed (OR = 3.14; 95% CI 1.60-6.17). For 73 children (18.4%), at least one parent tested positive for PSI-SF. An increased prevalence of parental distress was observed in children with warning signs (OR 2.36, 95% CI 1.27-4.37).

CONCLUSIONS

Integrating physician and parental perspectives during well-child visits and in clinical practice appears feasible and can improve the identification of children at risk of developmental disorders.

Gross motor developmental delay and associated factors among under-five children attending public health facilities of Dessie city, Ethiopia

BACKGROUND

Child psychomotor development and factors affecting it today is the subject of interest of many studies, in particular by the experts involved in the protection and improvement of children's health. There is limited evidence on developmental delay among under-five children in low-income countries like Ethiopia. The aim of this study was to assess gross motor developmental delay and associated factors among under-five children attending public health facilities of Dessie city, Ethiopia.

METHODS

Facility based cross sectional study design was used among under-five children attending under-five OPD in public health facilities of Dessie town from July 1, 2020 to August 15, 2021. A total of, 417 under-five children were systematically selected based on their average number of clients in a month. A pretested structured questionnaire was used for data collection, and data was entered into Epi-data 3.1 version and it was exported to STATA version 14 for analysis. Binary logistic regression analysis was used to identify factors associated with the outcome variable. Odds ratio with 95% confidence interval was used to show the strength and direction of association respectively and P-value less than 0.05 is used to declare statistical significance.

RESULTS

The overall proportion of gross motor developmental delay among under-five children attending health facilities of Dessie city, Ethiopia was 16.31%, 95% CI: (13.05, 20.19). Increased age of the child [AOR = 0.97, 95% CI: (0.96, 0.99)], increased gestational age during pregnancy [AOR = 0.47, 95% CI: (0.37, 0.65)], being male [AOR = 5.26, 95% CI: (1.76, 15.67)], having history of alcohol intake during pregnancy [AOR = 7.40, 95% CI: (2.36, 23.25)], taking iron during pregnancy [AOR = 0.04, 95% CI: (0.01, 0.15)], facing fetal and/or maternal complication [AOR = 4.98, 95% CI: (1.20, 20.62)], having instrumental delivery [AOR = 9.78, 95% CI: (2.48, 38.60)] were significantly associated with gross motor developmental delay.

CONCLUSIONS

The gross motor developmental delay among under-five children was higher as compared to other literatures. This study indicated that, age and sex of the child, iron and alcohol intake during pregnancy, gestational age, mode of delivery and any complication to her and or her neonate were independent variables which showed statistical significant association. The physicians should advise mothers to take iron-folic acid supplement properly and to avoid intake of alcohol during pregnancy. In addition, they should focus on those mothers who faced any complication to her and/or her neonate and better to discourage instrumental delivery unless there are no other options.

Natural history and mid-term neurodevelopmental outcome of fetuses with isolated mild ventriculomegaly diagnosed in the second half of pregnancy

INTRODUCTION

Prenatal diagnosis and counseling of isolated ventriculomegaly (VM) represent a considerable challenge. We aimed to analyze the intrauterine evolution, associated anomalies, and neurodevelopmental outcome using the Battelle Development Inventory (BDI) of fetuses with an initial diagnosis of isolated mild VM.

MATERIAL AND METHODS

Retrospective cohort study of fetuses diagnosed with mild isolated VM (10 -12 mm) between 2012 and 2016 in a tertiary hospital. In 2018, parents were invited to complete the structured BDI test for the neurodevelopmental evaluation of their children in five domains (personal-social skills, adaptive behavior, psychomotor ability, communication, and cognition). Results exceeding two standard deviations were considered abnormal and referred to an expert neuropediatrician.

RESULTS

We identified 43 cases of mild isolated VM. In 5 (11%), structural abnormalities were detected during prenatal follow-up, being related to non-regressive forms (p = .01) and bilateral VM (p = .04). The BDI test was completed by 19/43 (44%). The global score was abnormal in 10/19 (53%). Of them, the neuropediatrician confirmed a neurodevelopmental delay solely in 3 cases that had already been diagnosed with neurological disorders. The most affected domains were gross motor skills (63%), personal-social (63%), and adaptive domains (47%). Communicative and cognitive areas were abnormal in 26% of cases.

CONCLUSION

In fetuses with isolated mild VM detected in the second half of pregnancy, 53% had an abnormal BDI test at 2-6 years, but a neurological disorder was only confirmed in the 30% of them.

The Association Between Family Resources and Language Among Young Children Who are Deaf and Hard of Hearing

OBJECTIVE

Our study (1) examined demographic factors in families with children with bilateral hearing loss and how they relate to Family Resource Scale (FRS) questionnaire data and (2) examined correlations between FRS data and measures of language.

METHODS

Children aged 6 months to 10 years with bilateral hearing loss were enrolled. Parents completed the FRS questionnaire to assess their access to socioeconomic resources at the first language measurement visit. Assessments measured receptive and expressive language, nonverbal intelligence quotient, and adaptive functioning.

RESULTS

Among the 85 children included in the analysis, approximately 40% had hearing loss classified as mild to moderate and 25% had a cochlear implant. Participants' mean FRS score was 130 (SD 16.6) (with the highest possible score of 150 and indicating better access to resources). Significant positive correlations ( p -value ≤ 0.05) were found between maternal education, paternal education, and family income and several FRS subscales (Growth and Support, Necessities in Health, Childcare, Personal Resources). Significant positive correlations were found between the Necessities in Health subscale and all the language measurements.

CONCLUSION

Children whose parents reported better access to socioeconomic resources related to health care had higher language performance scores. Although early access to intervention services has improved for deaf or hard-of-hearing children, there are other variables contributing to language development, including access to socioeconomic resources. This study highlights the need for further research addressing more specific and modifiable resources to improve language performance for deaf or hard-of-hearing children.

Psychometric Properties and Validation of the Italian Version of Ages & Stages Questionnaires Third Edition

Objectives: The Ages & Stages Questionnaires Third Version (ASQ-3) identifies the risk of developmental delay in children aged 1 to 66 months. The aim of this study was to determine a reliable and valid instrument for the Italian population to enable the screening of children's development. Methods: Data from 2278 Italian children (age range: 1-66 months) were used to evaluate item discrimination power using the corrected item-total correlation. Internal consistency was analyzed by Cronbach's alpha scores and a Confirmative Factor Analysis was conducted to test the factor structure of the test. Data were also collected to examine the ASQ-3 test-retest reliability and concurrent validity, which was investigated using the Griffiths Scales of Child Development, Third Edition, the Peabody Developmental Motor Scale, Second Edition, and the Developmental Profile, Third Edition tools. In order to evaluate discriminant validity, differences between typical development children and several clinical groups have been performed. Finally, two different cut-off scores have been proposed. Results: The results showed that the questionnaires are composed of high-quality items; the original factor structure has been confirmed and strong Pearson product-moment correlation coefficients between the overall and the total for each domain (ranging from 0.73 to 0.88). The Italian version of the ASQ-3 had adequate internal consistency and a strong agreement between observations with two weeks' intervals. Moreover, the test showed a high discriminant validity due to the possibility of fully discriminating between typical development children and several clinical groups. Finally, two different cut-off scores have been identified using ROC curves in order to have a screening and a diagnostic cut-off value. Conclusion: This study evaluated the psychometric properties of the Italian adaptation of ASQ-3 questionnaires. We demonstrated the validity of the ASQ-3 and determined new cut-off scores for Italian children. Early identification and accurate assessment are important starting points to better understand and anticipate the needs of children and their link to services.

Infant Saliva Levels of microRNA miR-151a-3p Are Associated with Risk for Neurodevelopmental Delay

Prompt recognition of neurodevelopmental delay is critical for optimizing developmental trajectories. Currently, this is achieved with caregiver questionnaires whose sensitivity and specificity can be limited by socioeconomic and cultural factors. This prospective study of 121 term infants tested the hypothesis that microRNA measurement could aid early recognition of infants at risk for neurodevelopmental delay. Levels of four salivary microRNAs implicated in childhood autism (miR-125a-5p, miR-148a-5p, miR-151a-3p, miR-28-3p) were measured at 6 months of age, and compared between infants who displayed risk for neurodevelopmental delay at 18 months (n = 20) and peers with typical development (n = 101), based on clinical evaluation aided by the Survey of Wellbeing in Young Children (SWYC). Accuracy of microRNAs for predicting neurodevelopmental concerns at 18 months was compared to the clinical standard (9-month SWYC). Infants with neurodevelopmental concerns at 18 months displayed higher levels of miR-125a-5p (d = 0.30, p = 0.018, adj p = 0.049), miR-151a-3p (d = 0.30, p = 0.017, adj p = 0.048), and miR-28-3p (d = 0.31, p = 0.014, adj p = 0.048). Levels of miR-151a-3p were associated with an 18-month SWYC score (R = -0.19, p = 0.021) and probability of neurodevelopmental delay at 18 months (OR = 1.91, 95% CI, 1.14-3.19). Salivary levels of miR-151a-3p enhanced predictive accuracy for future neurodevelopmental delay (p = 0.010, X² = 6.71, AUC = 0.71) compared to the 9-month SWYC score alone (OR = 0.56, 95% CI, 0.20-1.58, AUC = 0.567). This pilot study provides evidence that miR-151a-3p may aid the identification of infants at risk for neurodevelopmental delay. External validation of these findings is necessary.

A report on the blended short-term supplementary course on "Developmental Care for infants and toddlers" taught with a multidisciplinary approach for pediatricians -qualitative and quantitative study

BACKGROUND

The implementation of follow-up programs for high-risk infants and toddlers aimed to promptly diagnose developmental delays and disorders and initiate early intervention to help improve their developmental status, reduce their care costs in the future, as well as improve their productivity as members of society. There is a lack of qualified specialists in the infant and toddler development field in Iran. To compensate for the lack of training in this area, for the first time, Tabriz University of Medical Sciences has designed a short-term supplementary course of "Developmental Care for Infants and Toddlers". Due to the multidisciplinary nature of the field of child development, this course has been designed as such. The current study aimed to evaluate this course and explain the graduates' relevant experiences using a multidisciplinary approach.

METHODS

The current study is a quantitative/qualitative study conducted in two phases. In the first step, the learners were asked to assess the teaching quality of the short-term supplementary course of "Developmental Care for Infants and Toddlers" in 5 areas of "educational design," "course administrators' support", " learners' motivation ", "acquisition of general learning and specialized skills" using the Australian Course Experience Questionnaire (CEQ). All graduates completed the questionnaires. The data from the questionnaires were analyzed using descriptive statistics of medians, and interquartile ranges in SPSS software. The second step was a qualitative study to explain the graduates' experiences of this course with a multidisciplinary approach. The samples were selected using a purposive sampling technique. The samples were those who had completed the course mentioned above, had rich experiences in this field, and were willing to share them. The data were collected through semi-structured interviews and analyzed using conventional content analysis.

RESULTS

In general, the graduates' satisfaction with the course in terms of the five areas studied was evaluated as follows: Educational design, motivating participants to do their best had the greatest median. 5(4-5), Learning objectives; in all items, the median was 4. Course content and resources; all items median were 4 .Relevant learner assessment methods; in all items, the median was 4.The median learners' satisfaction in the areas of "course administrators' support" in all items was 4 and "learners' motivation ", was 5. Learner's motivation" in all items it was 4, indicating the highest level of satisfaction with the "acquisition of specialized skills". In the area of education design, the highest satisfaction was found with the appropriateness of teaching strategies. The codes extracted from the analysis of interviews with the graduates, are divided into four categories: "Ethical and professional commitment of course teachers", "Being a role model in the observance of patients and their caregivers' rights", "Course planning with a multidisciplinary approach and teamwork" as well as "The use of virtual platforms to strengthen and maintain team communication between learners".

CONCLUSION

This course was the first experience of applying a multidisciplinary approach in an interprofessional course. Ideally, it is indispensable for the Iranian medical education system to move away from specialization and connect all related specialties and disciplines to achieve its educational and therapeutic goals. Therefore, the design of this course can be applied as an educational model for other disciplines and clinical courses.

Utility of the Ages and Stages Questionnaire to Identify Developmental Delay in Children Aged 12 to 60 Months: A Systematic Review and Meta-analysis

Importance

The Ages and Stages Questionnaire (ASQ) is a commonly used developmental screening tool, but its utility is debated.

Objectives

To conduct a a systematic review and meta-analysis to evaluate ASQ's utility as a screening or diagnostic tool to identify developmental delay in children aged 12-60 months.

Data Sources

Medline, EMBASE, CINAHL, PsycINFO, and Mednar were searched from inception until December 2021.

Study Selection

Studies meeting both criteria were included. ASQ was performed at age 12 to 60 months or where the median age at ASQ was at least 12 months and formal developmental assessments were done within 2 months of ASQ.

Data Extraction and Synthesis

True positive, false positive, false negative, and true negatives from individual studies were extracted. Meta-analysis was conducted with Stata version 16.1. Risk of bias was assessed using the QUADAS-2 tool. Certainty of evidence (COE) was assessed using GRADE guidelines.

Main Outcomes and Measures

Ability of ASQ scores more than 2 SDs below the mean in more than 1 domain (ASQ-2SD) to identify any developmental delay or severe delay. Based on generally accepted interpretation of likelihood ratio (LR) values, a positive LR (PLR) more than 5 and a negative LR (NLR) of 0.2 or less were considered necessary to rule in or rule out developmental delay, respectively, with at least moderate probability.

Results

Initial search yielded 5777 citations of which 43 were included in the review. Of them, 36 were included in the meta-analysis. The pooled sensitivity, specificity, PLR, and NLR are as follows: ASQ-2SD to predict any delay in 1 or more domain (n = 16), 0.77 (95% CI, 0.64-0.86), 0.81 (95% CI, 0.75-0.86), 4.10 (95% CI, 3.17-5.30), and 0.28 (95% CI, 0.18-0.44); ASQ-2SD to predict severe delay in 1 or more domain (n = 15), 0.84 (95% CI, 0.75-0.90), 0.77 (95% CI, 0.71-0.82), 3.72 (95% CI, 2.98-4.64), and 0.20 (95% CI, 0.13-0.32); ASQ-2SD motor domain to predict motor delay (n = 7), 0.41 (95% CI, 0.26-0.57), 0.94 (95% CI, 0.87-0.97), 6.5 (95% CI, 3.8-11.1), and 0.63 (95% CI, 0.50-0.81); and ASQ-2SD cognitive domain to predict cognitive delay (n = 2), 0.44 (95% CI, 0.24-0.65), 0.93 (95% CI, 0.81-0.95), 6.4 (95% CI, 2.4-16.8), and 0.61 (95% CI, 0.43-0.86). The COE was low/very low.

Conclusions and Relevance

If a child aged 12 to 60 months passes all ASQ domains, there is a moderate probability that they do not have severe developmental delay (low COE). If a child aged 12-60 months fails the motor or cognitive domain of ASQ, there is a moderate probability that they have some motor or cognitive delay, respectively (very low COE).

Trial Registration

PROSPERO (CRD42021268543).

Role of Pediatricians, Pediatric Associations, and Academic Departments in Ensuring Optimal Early Childhood Development Globally: Position Paper of the International Pediatric Association

ABSTRACT

Early childhood (birth-8 years), particularly the first 3 years, is the most critical time in development because of the highly sensitive developing brain. Providing appropriate developmental care (i.e., nurturing care, as defined by the World Health Organization [WHO]) during early childhood is key to ensuring a child's holistic development. Pediatricians are expected to play a critical role in supporting early childhood development (ECD) through providing developmental services such as developmental monitoring, anticipatory guidance, screening, and referral to medical and/or community-based services when delay is identified. Pediatricians are also expected to serve as advocates within their clinics and communities for improved delivery of ECD services, such as advocating for increasing funding for ECD initiatives, increasing insurance coverage of ECD services, and working to increase other pediatricians' awareness of the principles of ECD and how to deliver developmental services. However, this does not always occur. Typically, pediatricians' training and practice emphasizes treating disease rather than enhancing ECD. Pediatricians are further hindered by a lack of uniformity across nations in guidelines for developmental monitoring and screening. In this article, we present the vision of the International Pediatric Association (IPA) of the roles that pediatricians, academic departments, medical training programs, and pediatric associations should fulfill to help support ECD, including raising ECD to higher levels of priority in routine pediatric care. First, we present the challenges that face these goals in supporting ECD. We then propose, with supportive literature, strategies and resources to overcome these challenges in collaboration with local and international stakeholders, including the IPA, the WHO, UNICEF, and the World Bank.

Does Long-Term Enrollment in Day-Care Maintain or Increase Early Developmental Gains-Findings from an Intervention Study in Rural Bangladesh

Objective: Community day-care centers (or crèches) are gaining popularity; access to these centers can reduce cognitive gaps. This paper describes the sustained impact of enrollment in day-cares on cognitive gains. Methods: As part of a larger study, a census of all children was conducted in 2012−2013 to identify children between 9 and 17 months of age in rural Bangladesh. A sub-sample of children (n = ~1000) were assigned to receive either a day-care or playpen. Children from two sub-districts were randomly selected and assessed at 9−17 months of age for cognitive and behavioral domains using the Ages and Stages Questionnaire-III. The same children were then followed-up with after one year to see if the scores obtained by the children in the day-care intervention were different from those enrolled in the playpen intervention using a difference-in-difference estimator. Results: Children enrolled in the day-care intervention performed better (in communication, gross-motor, personal-social, and problem-solving domains) than children enrolled in the playpens when followed up with after a one-year period. Total scores were 0.31 (95% CI 0.141−0.472) higher (p value < 0.001) among children in the day-cares. Family care indicators as well as the child’s and mother’s weight were significantly associated with sustained and increased cognitive gains. Conclusion and relevance: The cognitive and psychosocial improvements seen with short-term exposure to structured ECD programs (day-care) were observed to be sustained over time with continued exposure. Home stimulation and parental involvement add to the long-term benefits of ECD.

Designing and validating the Dubai Tool for Developmental Screening (DTDS)

BACKGROUND

Early detection of developmental problems is vital for facilitating early access to targeted intervention and augmenting its beneficial outcomes. Standardized developmental screening tools are known to enhance detection rates of developmental problems compared to clinical judgment alone and are widely recommended to be used in infants and young children. Most of the available developmental screening tools have been developed in Western countries. Many of their items may not be suitable for other cultures while others are expensive. Currently, none of the developmental screening tools have been validated in the United Arab Emirates (UAE), with only a few available in the Arabic language.

OBJECTIVE

To create and validate a developmental screening tool, in both English and Arabic, that is simple, quick to use, and culturally relevant to the United Arab Emirates (UAE) child population aged 9-48 months.

METHODS

The available literature was used to create a list of developmental milestones in five domains for children aged 9-48 months, divided into seven age groups. The selected milestones were used to create questionnaires in both English and Arabic, which were pilot tested twice. Each time, the results were analyzed and used to select, modify, and rephrase questions. Validation of the Dubai Tool for Developmental Screening (DTDS) was done against Parents' Evaluation of Developmental Status (PEDS) as a gold standard instrument. The DTDS and PEDS were administered cross-sectionally to parents of 1,400 children in seven age groups. Sensitivity, specificity, and kappa agreement of the DTDS compared with PEDS were calculated.

RESULTS

The DTDS had a sensitivity of 100% in four age groups and 75-78% in the other three age groups. Specificity ranged from 96 to 99% across all age groups. The kappa measure showed substantial agreement in five age groups, a moderate agreement in one age group, and a fair agreement in one age group.

CONCLUSIONS

The DTDS is a valid screening tool for early identification of developmental delays and disabilities in early childhood.

Comparison of the Parents' Evaluation of Developmental Status and Ages and Stages Questionnaire Developmental Screening Tests in a Eurasian Country

OBJECTIVE

The Parents' Evaluation of Developmental Status (PEDS) and the Ages and Stages Questionnaire (ASQ) are developmental screening tools that are commonly used in pediatric practice worldwide. We aimed to compare the screening results of the PEDS and the ASQ in children with a wide range of ages and to evaluate the degree of agreement between the tests across the age groups.

METHODS

The study was conducted with the participation of 327 children aged 3 to 72 months. Participants were administered the PEDS and then the ASQ. Children with known developmental disabilities were included in the study to represent a real-world clinical practice setting and evaluated with a clinical workup.

RESULTS

The median age of the children was 35.1 months, with a range of 3 to 72 months. The percentage of children with known developmental disabilities was 16.5%. The actual agreement between the PEDS and ASQ was 74% with a concordance represented by Cohen κ of 0.422 (p < 0.001) in the total sample. Furthermore, the agreement was higher in children aged 25 to 36 months and 37 to 48 months than for the other ages.

CONCLUSION

We compared the clinical features of the ASQ and PEDS across the age groups, and they demonstrated moderate agreement. The present study also showed the performance of the PEDS and suggests that it should certainly be used for developmental screening in routine child health care practice in Eurasia, thus supporting the use of such parent-completed developmental tools that should be encouraged for universal screening.

Developmental Service Referrals and Utilization Among Young Children in Protective Custody

Children in foster care are at high risk for developmental delay. In this retrospective cohort study of young children presenting to a foster care clinic, 77% were not receiving developmental services and 75% failed developmental screening. Of those potentially eligible, 60% were not referred for developmental services.

A Prediction Model for Detecting Developmental Disabilities in Preschool-Age Children Through Digital Biomarker-Driven Deep Learning in Serious Games: Development Study

Background

Early detection of developmental disabilities in children is essential because early intervention can improve the prognosis of children. Meanwhile, a growing body of evidence has indicated a relationship between developmental disability and motor skill, and thus, motor skill is considered in the early diagnosis of developmental disability. However, there are challenges to assessing motor skill in the diagnosis of developmental disorder, such as a lack of specialists and time constraints, and thus it is commonly conducted through informal questions or surveys to parents.

Objective

This study sought to evaluate the possibility of using drag-and-drop data as a digital biomarker and to develop a classification model based on drag-and-drop data with which to classify children with developmental disabilities.

Methods

We collected drag-and-drop data from children with typical development and developmental disabilities from May 1, 2018, to May 1, 2020, via a mobile application (DoBrain). We used touch coordinates and extracted kinetic variables from these coordinates. A deep learning algorithm was developed to predict potential development disabilities in children. For interpretability of the model results, we identified which coordinates contributed to the classification results by applying gradient-weighted class activation mapping.

Results

Of the 370 children in the study, 223 had typical development, and 147 had developmental disabilities. In all games, the number of changes in the acceleration sign based on the direction of progress both in the x- and y-axes showed significant differences between the 2 groups (P<.001; effect size >0.5). The deep learning convolutional neural network model showed that drag-and-drop data can help diagnose developmental disabilities, with an area under the receiving operating characteristics curve of 0.817. A gradient class activation map, which can interpret the results of a deep learning model, was visualized with the game results for specific children.

Conclusions

Through the results of the deep learning model, we confirmed that drag-and-drop data can be a new digital biomarker for the diagnosis of developmental disabilities.

Developmental delay among children under two years of age in slums of Burdwan Municipality: A cross-sectional study

Context:

Development is an ongoing process through which an individual acquires competence to function adequately. Developmental delay is said to occur when a child fails to reach the age-appropriate anticipated milestones. This imparts long-term direct as well as indirect effects on the health of a community obviating routine measurement of its prevalence especially in high-risk populations.

Aim:

To find out the prevalence and correlates of developmental delay among children under two years of age in slums of Burdwan Municipality, West Bengal.

Settings and Design:

A community-based descriptive cross-sectional study.

Methods and Materials:

This study was conducted between September-November 2019 among 240 study subjects selected by multistage simple random sampling. Data were collected by interviewing the respondents using a predesigned, pretested schedule. Developmental status was assessed by applying Trivandrum Developmental Screening Chart (TDSC). Chi-square test and logistic regression was done to find associations.

Results:

Prevalence of developmental delay was 6.6%(95%CI 3.6-9.8) and proportion was more among male infants. Chi square test revealed gender (p = 0.03), mothers' education (p = 0.00), socio-economic status (p = 0.00), parity (p = 0.02), birth spacing (p = 0.01) birth weight (p = 0.00) to be significantly associated with developmental delay and multivariable analysis showed all the factors to be significant predictors except gender, parity and birth spacing. Gestational duration, maternal age at delivery, mode of delivery was not found to be significantly associated with developmental delay.

Conclusion:

Developmental delay is considerably high in the study area. A larger study using appropriate tool and follow-up may elicit the burden and associated determinants.

Concurrent validity of the Warner Initial Developmental Evaluation of Adaptive and Functional Skills and the Bayley Scales of Infant and Toddler Development, Third Edition

AIM

To determine the concurrent validity of the Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA-FS), a criterion-specified questionnaire that assesses a child's adaptive skills in everyday contexts, and the Bayley Infant and Toddler Scales of Development, Third Edition (Bayley-III).

METHOD

In a prospective cohort study, 431 WIDEA-FS and Bayley-III assessments were completed among 341 children, aged 10 to 36 months corrected age (158 females, 183 males; median [interquartile range] gestational age at birth 32wks [29-38]), monitored in a high-risk neonatal intensive care unit follow-up clinic.

RESULTS

WIDEA-FS scores were significantly associated with Bayley-III scores in all domains. Lower scores on the WIDEA-FS were significantly associated with an increased risk of adverse developmental performance on all Bayley-III scales. The association was strongest for motor and language Bayley-III scores when tested at <30 months of age, and for cognitive Bayley-III scores when tested at ≥30 months of age.

INTERPRETATION

The WIDEA-FS has concurrent validity with the Bayley-III and may be a useful tool in high-risk follow-up settings.

WHAT THIS PAPER ADDS

WIDEA-FS mobility, communication, and social cognition domains are concurrently valid in infants at high-risk for neurodevelopmental disability. Bayley-III motor, language, and cognitive composite scores are concurrently valid in the same group. The WIDEA-FS mobility and communication domains may be most clinically useful in children <30 months.

Activity competence among infants and toddlers with developmental disabilities: Rasch analysis of the Infant Toddler Activity Card Sort (ITACS)

Background

Development is rapid in the first years of life. Developmental delays appearing during this critical period have the potential to persist throughout the child’s life. Available standardized assessments for this age record a child’s ability to successfully complete discrete skills but fail to capture whether the child incorporates those skills into daily routines that are meaningful to the child and family. The Infant Toddler Activity Card Sort (ITACS) is a newly developed photograph-based early intervention tool to measure the participation-related concept of activity competence using caregiver report. The purpose of the present study was to use Rasch analysis to determine if ITACS items comprehensively measure the construct of child activity competence.

Results

A total of 60 child/caregiver dyads participated. The dichotomous caregiver-reported responses (present vs. absent) on the 40 individual ITACS items were used in Rasch analysis, and three iterations of the model were completed. The final model included 51 child/caregiver dyads and 67 ITACS assessments with a good spread of individual ability measure (6.47 logits). All items demonstrated adequate infit except for “sleeping” (range 0.68–1.54). Five items (sleeping, eating at restaurants, brushing teeth, crawling, and interact with pets) demonstrated high Mean Square (MNSQ) outfit statistics and one (take a bath) demonstrated low MNSQ outfit. ITACS items demonstrated a good spread of item difficulty measures (6.27 logits), and a clear ceiling was observed. Three activity items (smiling, breastfeeding, and playing with adults) were rarely endorsed as concerns. The activities most likely to be reported as challenging were “crying/communicating” and “going to school”. Person and item reliability statistics were adequate (0.79 and 0.80, respectively). The separation between individuals and between items were adequate to good (1.96 and 1.99, respectively).

Conclusions

Findings indicate that ITACS items are measuring a unidimensional construct--activity competence in early childhood. The Rasch analysis of caregiver responses suggest that some activities are more likely to be considered challenging and may be important targets for intervention. These results provide evidence to further validate the ITACS as a caregiver report measure and support its use in the early intervention setting to facilitate caregiver driven goal development.

Measurement of Social Communication, Emotion and Cognitive Development from 6 Months to 8 Years Old: In a Taiwan Birth Cohort Study

This study aimed to investigate (1) the reliability and validity of the Taiwan Birth Cohort Study-Developmental Instrument (TBCS-DI) 8-year-old scale; (2) the pathway relationship among the cognitive, emotional and social-communication dimensions of the TBCS-DI 8-year-old scale; (3) the predictive validity and association of the TBCS-DI dimensions at 6, 18, 36, and 66 months, with the dimensions of the 8-year-old scale. The Taiwan Birth Cohort Study dataset of 19,516 children followed from 6 months to the age of eight was used. The TBCS-DI 8-year-old scale showed good reliability and validity. A recursive relationship of emotion as the basis, affecting cognition and later social communication was found. Children's 18-month development was able to predict the development of children at 8 years, implying that 18 months may be a critical age for screening and intervention. Clinical intervention should also take into consideration the cultural disparity of emotional development in Asian countries.

Implementation of a Physician Incentive Program for 18-Month Developmental Screening in Ontario, Canada

OBJECTIVES

To evaluate factors associated with uptake of a financial incentive for developmental screening at an enhanced 18-month well-child visit (EWCV) in Ontario, Canada.

STUDY DESIGN

Population-based cohort study using linked administrative data of children (17-24 months of age) eligible for EWCV between 2009 and 2017. Logistic regression modeled associations of EWCV receipt by provider and patient characteristics.

RESULTS

Of 910 976 eligible children, 54.2% received EWCV (annually, 39.2%-61.2%). The odds of assessment were lower for socially vulnerable children, namely, those from the lowest vs highest neighborhood income quintile (aOR, 0.84; 95% CI, 0.83-0.85), those born to refugee vs nonimmigrant mothers (aOR, 0.90; 95% CI, 0.88-0.93), and to teenaged mothers (aOR, 0.70; 95% CI, 0.69-0.71)). Children were more likely to have had developmental screening if cared for by a pediatrician vs family physician (aOR, 1.28; 95% CI, 1.13-1.44), recently trained physician (aOR, 1.38; 95% CI, 1.29-1.48 for ≤5 years in practice vs ≥21 years) and less likely if the physician was male (aOR, 0.64; 95% CI, 0.61-0.66). For physicians eligible for a pay-for-performance immunization bonus, there was a positive association with screening.

CONCLUSIONS

In the context of a universal healthcare system and a specific financial incentive, uptake of the developmental assessment increased over time but remains moderate. The implementation of similar interventions or incentives needs to account for physician factors and focus on socially vulnerable children to be effective.

Accuracy of parent-reported ages and stages questionnaire in assessing the motor and language skills of preterm infants

BACKGROUND

Parent-completed tools like the Ages and Stages Questionnaire Third Edition (ASQ-3) are important in developmental screening. As a screening tool, a high negative predictive value (NPV) is critical to avoid missing the diagnosis of developmental delay. This study evaluated the NPV and accuracy of the ASQ-3 in assessing the development of preterm infants.

METHODS

Infants born at <32 weeks and/or <1250 grams, presenting to the Neonatal Neurodevelopmental Clinic at the Singapore General Hospital for follow-up from January 2014 to June 2017, at 6, 12, and 18 months corrected age, were included. The ASQ-3 and standardized tests - Peabody Developmental Motor Scale-Second Edition (PDMS-2) and Preschool Language Scale, Fourth Edition UK (PLS-4 UK) - were administered. ASQ-3 gross motor and fine motor scores were compared to PDMS-2 at 6 and 12 months, and ASQ-3 communication scores to PLS-4 UK at 18 months.

RESULTS

At 6 months (n = 145), NPV for gross motor and fine motor were 96.4% (accuracy 80.0%) and 95.4% (accuracy 77.2%) respectively. At 12 months (n = 127), NPV for gross motor and fine motor were 88.9% (accuracy 79.8%) and 82.8% (accuracy 74.0%) respectively. At 18 months (n = 113), NPV for language was 56.9% (accuracy 63.7%).

CONCLUSIONS

The ASQ-3 showed high NPV and accuracy in screening gross motor and fine motor skills at 6 and 12 months, but not in screening language skills at 18 months. Judicious use of the ASQ-3 may allow for more effective utilization of resources.

ECHO Autism: Integrating Maintenance of Certification with Extension for Community Healthcare Outcomes Improves Developmental Screening

OBJECTIVE

Recent estimates indicate that most pediatricians do not consistently meet the American Academy of Pediatrics developmental screening guidelines, contributing to the delay of vital evaluations and interventions for autism spectrum disorder (ASD). Our objective was to evaluate the utility of Maintenance of Certification (MOC) Quality Improvement (QI) training designed to improve developmental screening rates in underserved, rural primary care practices. Trainings on best screening practices were disseminated to primary care providers (PCPs) through Extension for Community Healthcare Outcomes (ECHO) Autism, a virtual learning network.

METHOD

Across 2 cohorts, 24 PCPs were enrolled in MOC Part 4 training modules delivered through the ECHO Autism QI Learning Network. Throughout the 12 months of enrollment, PCPs reported information on general and ASD-specific developmental screenings conducted at 18- and 24-month well-child visits. A 1-year follow-up was conducted to assess the maintenance of screening rates.

RESULTS

Baseline rates for general and ASD-specific developmental screenings were 53.3% and 68.3%, respectively. By the end of the 12-month learning module, screening rates increased significantly for general development (88.6%) and ASD-specific screenings (99.0%). At the 1-year follow-up, the rate for general developmental screening was 96.7% and for ASD-specific screening was 97.1%.

CONCLUSION

Maintenance of Certification Part 4 training delivered through the ECHO Autism QI Learning Network was found to be incentivizing and highly effective in shaping and maintaining PCP developmental screening practices. Improved screening rates show promise in decreasing time to critical developmental evaluations, interventions, and resources. Our methodology is likely transferable to other ECHO communities and may facilitate expedient implementation of best practice standards in primary care.

Validity of the Early Years Check-In (EYCI) in a Cross-Sectional Sample of Families

Background: The objective of the present study was to develop and test the validity of the Early Years Check-In (EYCI), a new tool that measures parent and educator concerns regarding children's development. The study examined the EYCI's agreement with 3rd edition of the Bayley Scales of Infant and Toddler Development (BSID-III) an established measure of child development. Two possible thresholds were explored: one to identify children with a probable delay, and another to identify children at the borderline functioning threshold. Methods: Parents of children aged 18 to 42 months were recruited from childcare settings across Ontario, Canada. The study proceeded in two phases. Phase I, intended to pilot the measure, included 49 children. Phase II, a test of the validity of the final version, included 199 children. Parents and educators completed the EYCI for the child, while a blinded assessor completed the BSID-III. Results: The EYCI demonstrated good sensitivity and specificity (86 and 82%, respectively) as a parent-completed tool that identifies children with a probable delay. However, the positive predictive value (15%) suggests the EYCI is likely to over identify children. When identifying children who demonstrated borderline delay, the EYCI demonstrated good sensitivity (80%) but poor specificity (49%). Results from educator-completed EYCIs were poor for both probable and borderline delay. Conclusions: While further research is required, the EYCI shows promise as a parent-completed tool, particularly to identify more-severe cases of delay. Results with educators were poor overall. Future research investigating accuracy of educators in different types of early childcare centres is needed.

An App for Identifying Children at Risk for Developmental Problems Using Multidimensional Computerized Adaptive Testing: Development and Usability Study

BACKGROUND

The use of multidomain developmental screening tools is a viable strategy for pediatric professionals to identify children at risk for developmental problems. However, a specialized multidimensional computer adaptive testing (MCAT) tool has not been developed to date.

OBJECTIVE

We developed an app using MCAT, combined with Multidimensional Screening in Child Development (MuSiC) for toddlers, to help patients and their family members or clinicians identify developmental problems at an earlier stage.

METHODS

We retrieved 75 item parameters from the MuSiC literature item bank for 1- to 3-year-old children, and simulated 1000 person measures from a normal standard distribution to compare the efficiency and precision of MCAT and nonadaptive testing (NAT) in five domains (ie, cognitive skills, language skills, gross motor skills, fine motor skills, and socioadaptive skills). The number of items saved and the cutoff points for the tool were determined and compared. We then developed an app for a Web-based assessment.

RESULTS

MCAT yielded significantly more precise measurements and was significantly more efficient than NAT, with 46.67% (=(75-40)/75) saving in item length when measurement differences less than 5% were allowed. Person-measure correlation coefficients were highly consistent among the five domains. Significantly fewer items were answered on MCAT than on NAT without compromising the precision of MCAT.

CONCLUSIONS

Developing an app as a tool for parents that can be implemented with their own computers, tablets, or mobile phones for the online screening and prediction of developmental delays in toddlers is useful and not difficult.

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

AIM

Our aim was to extend the validity of a questionnaire developed for screening and identifying early symptomatic syndromes eliciting neurodevelopmental clinical examinations-questionnaire (ESSENCE-Q) in young children.

METHODS

Early symptomatic syndromes eliciting neurodevelopmental clinical examinations-questionnaire data for 207 children, living in Aki City, Japan, in 2014-2015, were obtained from mothers, public health nurses and psychologists at 20- and 40-month routine check-ups at child healthcare centres. These were checked against subsequent ESSENCE diagnoses made by physicians. Receiver operating characteristic curves were constructed, and the area under the curves was compared. Sensitivity, specificity, positive predictive values (PPVs) and negative predictive values were calculated at optimal cut-off values. The clinical utility index was also calculated.

RESULTS

When the ESSENCE-Q was used by public health nurses, it demonstrated good validity, in terms of high sensitivity and high NPVs, at the 20-month check-up, but not at 40 months. Psychologists demonstrated good validity at both ages, but mothers did not. Good negative utility indexes, indicating screening accuracy, were obtained from the psychologists at both check-ups and from nurses at 20 months.

CONCLUSION

The ESSENCE-Q results used by nurses and psychologists showed good validity. Future studies should confirm the effectiveness of this tool to identify children in need of clinical detailed neurodevelopmental assessment.

Association between Malaria Infection and Early Childhood Development Mediated by Anemia in Rural Kenya

Malaria is a leading cause of morbidity and mortality among children under five years of age, with most cases occurring in Sub-Saharan Africa. Children in this age group in Africa are at greatest risk worldwide for developmental deficits. There are research gaps in quantifying the risks of mild malaria cases, understanding the pathways linking malaria infection and poor child development, and evaluating the impact of malaria on the development of children under five years. We analyzed the association between malaria infection and gross motor, communication, and personal social development in 592 children age 24 months in rural, western Kenya as part of the WASH Benefits environmental enteric dysfunction sub-study. Eighteen percent of children had malaria, 20% were at risk for gross motor delay, 21% were at risk for communication delay, and 23% were at risk for personal social delay. Having a positive malaria test was associated with increased risk for gross motor, communication, and personal social delay while adjusting for child characteristics, household demographics, study cluster, and intervention treatment arm. Mediation analyses suggested that anemia was a significant mediator in the pathway between malaria infection and risk for gross motor, communication, and personal social development delays. The proportion of the total effect of malaria on the risk of developmental delay that is mediated by anemia across the subscales was small (ranging from 9% of the effect on gross motor development to 16% of the effect on communication development mediated by anemia). Overall, malaria may be associated with short-term developmental delays during a vulnerable period of early life. Therefore, preventative malaria measures and immediate treatment are imperative for children’s optimal development, particularly in light of projections of continued high malaria transmission in Kenya and Africa.

Using accelerometry for measurement of motor behavior in children: Relationship of real-world movement to standardized evaluation

BACKGROUND

When detected, children with asymmetrical motor impairment are referred for therapeutic interventions to maximize the child's ability to reach their health and developmental potential. Referal is dependent on standardized evaluation, which rarely examines upper extremity (UE) function within the context of real-world activity. Accelerometry provides an efficient method to objectively measure movement in children. The purpose of this study was to compare accelerometry to clinical assessment, specifically the Melbourne Assessment of Unilateral Upper Limb Function-2 (MA-2).

METHODS

A total of 52 children between 1-17 years of age with asymmetrical motor deficits and age matched controls participated in this study. Participants wore bilateral accelerometers for 4 x 25 h. The use ratio (UR) and mono-arm use index (MAUI) were calculated to quantify asymmetrical impairment. The Melbourne Assessment of Unilateral Upper Limb Function-2 (MA-2) was administered and compared to accelerometry variables.

RESULTS

The UR and MAUI were significantly different in children with and without deficits. The MAUI was significantly correlated with all domains of the MA-2: accuracy (r = 0.44, p = 0.026); fluency (r = 0.52, p = 0.006); dexterity (r = 0.53, p = 0.005); and range of motion (r = 0.49, p = 0.011).

CONCLUSIONS

Our findings suggest a relationship between real-world movement and clinical evaluation.

The Developmental Screening Behaviors, Skills, Facilitators, and Constraints of Family Nurse Practitioners in Primary Care: A Qualitative Descriptive Study

INTRODUCTION

Researchers have found that many primary care providers are not following developmental screening recommendations. Few studies exist on the screening behaviors of advanced practice nurses.

METHODS

A qualitative descriptive study explored the screening behaviors, skills, and environmental facilitators/constraints of 24 family nurse practitioners (FNPs) who cared for pediatric patients from birth to 5 years of age in primary care settings. An inductive approach to content analysis was used to interpret the data.

RESULTS

Five main themes emerged: (a) Developmental Screening Behaviors During Well-Child Visits, (b) Developmental Screening Behaviors When a Concern Was Raised, (c) Need for Additional Developmental Screening Skills, (d) Factors That Support Developmental Screening, and (e) Factors That Limit Developmental Screening. Sixteen subthemes supported the main themes.

DISCUSSION

Most FNPs were not using standardized tools. Behaviors mainly consisted of actions that were informal. FNPs were not familiar with current recommendations, and they had difficulty describing most instruments.

Detection of Pediatric Upper Extremity Motor Activity and Deficits With Accelerometry

IMPORTANCE

Affordable, quantitative methods to screen children for developmental delays are needed. Motor milestones can be an indicator of developmental delay and may be used to track developmental progress. Accelerometry offers a way to gather real-world information about pediatric motor behavior.

OBJECTIVE

To develop a referent cohort of pediatric accelerometry from bilateral upper extremities (UEs) and determine whether movement can accurately distinguish those with and without motor deficits.

DESIGN, SETTING, AND PARTICIPANTS

Children aged 0 to 17 years participated in a prospective cohort from December 8, 2014, to December 29, 2017. Children were recruited from Ranken Jordan Pediatric Bridge Hospital, Maryland Heights, Missouri, and Washington University School of Medicine in St Louis, St Louis, Missouri. Typically developing children were included as a referent cohort if they had no history of motor or neurological deficit; consecutive sampling and matching ensured equal representation of sex and age. Children with diagnosed asymmetric motor deficits were included in the motor impaired cohort.

EXPOSURES

Bilateral UE motor activity was measured using wrist-worn accelerometers for a total of 100 hours in 25-hour increments.

MAIN OUTCOMES AND MEASURES

To characterize bilateral UE motor activity in a referent cohort for the purpose of detecting irregularities in the future, total activity and the use ratio between UEs were used to describe typically developing children. Asymmetric impairment was classified using the mono-arm use index (MAUI) and bilateral-arm use index (BAUI) to quantify the acceleration of unilateral movements.

RESULTS

A total of 216 children enrolled, and 185 children were included in analysis. Of these, 156 were typically developing, with mean (SD) age 9.1 (5.1) years and 81 boys (52.0%). There were 29 children in the motor impaired cohort, with mean (SD) age 7.4 (4.4) years and 16 boys (55.2%). The combined MAUI and BAUI (mean [SD], 0.86 [0.005] and use ratio (mean [SD], 0.90 [0.008]) had similar F1 values. The area under the curve was also similar between the combined MAUI and BAUI (mean [SD], 0.98 [0.004]) and the use ratio (mean [SD], 0.98 [0.004]).

CONCLUSIONS AND RELEVANCE

Bilateral UE movement as measured with accelerometry may provide a meaningful metric of real-world motor behavior across childhood. Screening in early childhood remains a challenge; MAUI may provide an effective method for clinicians to measure and visualize real-world motor behavior in children at risk for asymmetrical deficits.

The Impact of Early Neuroimaging and Developmental Assessment in a Preterm Infant Diagnosed with Cerebral Palsy

Premature infants are at risk for cerebral palsy (CP) that is typically diagnosed between 18-24 months. We present a case study of an infant who was discharged from the neonatal intensive care unit (NICU) without obvious neurological deficits but was later diagnosed with hemiplegic CP. The infant was enrolled in an infant motor study, which included neuroimaging and developmental motor assessments. At term, anatomical MRI showed bilateral periventricular leukomalacia, abnormal brain metabolites in frontal white matter via MR spectroscopy (MRS), and low fractional anisotropy (FA) values obtained from diffusional kurtosis imaging (DKI) in several cortical white matter tracts compared to a group of typically developing infants without neuroimaging abnormalities. In addition, the infant scored below average on a developmental assessment administered at term and three months as well as on the standard Bayley III assessment at 12 months. Abnormal neuroimaging and low scores on the early developmental assessment prompted referral for intervention services at two months. With intensive therapy, by 45 months, the infant was average in self-care, mobility, and communication skills, although below average in visual motor and gross motor coordination. This case highlights the clinical impact of early detection and referral using combined neuroimaging and developmental testing.

When Do Clinicians Decide to Screen Children for Mental Health-Behavioral-Developmental Delays/Disorders: Is it Time to Reconsider Policy Recommendations?

OBJECTIVES

To determine at which ages providers choose to screen for mental, behavioral, and developmental disorder/delay (MBDD), and what they find; and which, if any, public and professional guidelines are most effective at identification.

STUDY DESIGN

Naturalistic retrospective cohort study of 215 general pediatric and family practice clinics within 24 US states involving 160 634 encounters during which MBDD screening tests were administered.

RESULTS

Almost all clinicians (96%) administered screens at ages targeted by the American Academy of Pediatrics (AAP), that is, 9, 18, 24, and/or 30 months of age, but also at younger and older ages: 57% opted to screen at ≥5 years of age. Of the 8% of children at risk for probable MBDD, 27% were detected at American Academy of Pediatrics-targeted ages-71% across the birth to 5-year age range and an additional 29% at ≥5 years of age. Children >30 months of age were 3 times more likely to have probable MBDD than were younger children, and those >5 years of age were almost 4 times more likely to have probable MBDD. Older children were more likely to have psychosocial risk factors, but age itself was the most powerful predictor.

CONCLUSIONS

Most clinicians preferred to screen across the birth to 8-year age range and their findings revealed that most MBDDs cannot be detected in the earliest years of life. Policies regarding the timing of screening should be expanded to include all well visits and between visits if needed.

Socioemotional developmental surveillance in young children: monitoring and screening best identify young children that require mental health treatment

BACKGROUND

Widely recommended socioemotional developmental surveillance methods include monitoring and development screening techniques. Currently, very little research has compared the effectiveness of monitoring and screening together, and existing research primarily focuses on the relationship between surveillance techniques and referrals or receipt of early intervention (EI). This study investigates the relationship between monitoring and screening and mental health treatment receipt in 3-5 year olds.

METHODS

The authors conducted logistic regression analyses on data from the National Surveys of Children's Health (NSCH; 2007) and NSCH (2011/2012) on the odds of mental health treatment receipt in children aged 3-5 years of age who either received (a) screening only, (b) monitoring only, (c) both monitoring and screening, or (d) no monitoring or screening. Sociodemographic control variables were also considered.

RESULTS

In both 2007 and 2011/2012 datasets, monitoring and screening together was the best predictor of mental health treatment receipt. Neither screening alone nor monitoring alone was associated with mental health treatment receipt.

CONCLUSIONS

Children who received monitoring and screening together had the greatest odds of treatment receipt compared with children receiving screening only, monitoring only, or no monitoring or screening.

Trajectories of maternal stress and anxiety from pregnancy to three years and child development at 3 years of age: Findings from the All Our Families (AOF) pregnancy cohort

BACKGROUND

Existing literature on maternal distress has focused on stress and anxiety during the pregnancy or postnatally and their relationship with child development. However, few studies have investigated the association between maternal stress and anxiety symptoms over time and child development in preschool children. The aim of this study was to examine the association between trajectories of maternal stress and anxiety symptoms from mid-pregnancy to three years postpartum and child development at age three years.

METHODS

Data were analyzed from 1983 mother-child dyads who participated in the three year follow-up of the All Our Families (AOF) study. Latent class analysis (LCA) was conducted to identify trajectories of women's stress and anxiety across from mid-pregnancy to three years postpartum. Multivariate logistic regression was used to explore the relationship between the stress and anxiety trajectories and child developmental delays while adjusting for the covariates.

RESULTS

LCA identified three distinct trajectories of maternal stress and anxiety symptoms over time. Multivariate analysis showed mothers assigned to the high anxiety symptoms class had an increased risk (adjusted OR 2.80, 95% CI 2.80 (1.42 ─ 5.51), p = 0.003) of having a child with developmental delays at 3 years.

LIMITATIONS

The use of self-reported maternal mental health symptoms and no data on fathers' mental health are our study's limitations.

CONCLUSIONS

The findings from a population-based Canadian sample provide empirical support for a relationship between maternal anxiety overtime and risk of child developmental delays. Identifying and supporting mothers experiencing high anxiety symptoms in the perinatal period may mitigate the risk of these delays in children.

Timing, intensity, and duration of household food insecurity are associated with early childhood development in Kenya

This study examines the association between 3 dimensions of food insecurity (timing, intensity, and duration) and 3 domains of child development (gross motor, communication, and personal social). Longitudinal data from 303 households (n = 309 children) visited 9 times over 2 years were collected. Children in households experiencing severe food insecurity 3 months prior (timing) had significantly lower gross motor (β -0.14; 95% CI [0.27, -0.0033]; p = .045), communication (β -0.16; 95% CI [-0.30, -0.023]; p = .023), and personal social (β -0.20; 95% CI [-0.33, -0.073]; p = .002) Z-scores, using lagged longitudinal linear models controlling for current food insecurity; these results were attenuated in full models, which included maternal education, household asset index, and child anthropometry. Children in households that experienced greater aggregate food insecurity over the past 2 years (intensity) had significantly lower gross motor (β -0.047; 95% CI [-0.077, -0.018]; p = .002), communication (β -0.042; 95% CI [-0.076, -0.0073]; p = .018), and personal social (β -0.042; 95% CI [-0.074, -0.010]; p = .010) Z-scores; these results were also attenuated in full models. Children with more time exposed to food insecurity (duration) had significantly lower gross motor (β -0.050; 95% CI [-0.087, -0.012]; p = .010), communication (β -0.042; 95% CI [-0.086, 0.0013]; p = .057), and personal social (β -0.037; 95% CI [-0.077, 0.0039]; p = .076) Z-scores; these results were no longer significant in full models. Our findings suggest that acute and chronic food insecurity and child development are related, but that many associations are attenuated with the inclusion of relevant covariates.

Better together: Developmental screening and monitoring best identify children who need early intervention

BACKGROUND

Widely recommended developmental surveillance methods include developmental monitoring (DM) and development screening (DS). Much research has been done on DS, but very little research has compared the effectiveness of DM and DS together.

OBJECTIVES

To investigate the relationship between DM and DS in Part C early intervention (EI) service receipt.

METHODS

Authors used data from the 2007/2008 and 2011/2012 National Survey of Children's Health (NSCH). Authors report the prevalence of children aged 10 months to 3 years who received (a) DM only, (b) DS only, (c) both DM and DS, and (c) no DM or DS across survey years. Authors compare the odds of EI receipt across these groups.

RESULTS

During both periods, estimated EI receipt prevalence was higher for children receiving both DM and DS (8.38% in 2007/2008; 6.47% in 2011/2012) compared to children receiving no DM or DS (1.31% in 2007/2008; 1.92% in 2011/2012), DM alone (2.74% in 2007/2008; 2.70% in 2011/2012), or DS alone (3.59% in 2007/2008; 3.09% in 2011/2012) (for both time frames, p < .05). From 2007/2008 to 2011/2012, the proportion of children receiving DS only and both DM and DS increased, while children receiving DM only and no DM or DS decreased.

CONCLUSIONS

Children receiving DM and DS together were more likely to receive EI compared to children receiving DM alone, DS alone, or neither DM nor DS. These findings support the AAP recommendations indicating that DM and DS are complementary strategies for improving early identification and linkage to EI for young children.

Designing and Validation of a Hindi-language Parent Self-report Developmental Screening Tool

AIM

To design and validate Hindi-language parent self-report developmental screening questionnaires for 9-month and 18-month-old Indian children.

DESIGN

Cross-sectional study.

SETTING

Tertiary-care pediatric hospital from April 2014 to March 2016.

PARTICIPANTS

In each age group (9-month and 18-month), 45 children were enrolled for designing of questionnaires (30 for obtaining parental observations of current development and 15 for pre-testing). For validation of tool, 100 children (60 low risk and 40 high risk) were enrolled in each age group.

METHODS

For designing, observations regarding current developmental milestones were obtained from parents and a list of all enumerated milestones was prepared. After detailed discussion by a team of developmental pediatricians, pediatric resident, clinical psychologist and language specialist, milestones were chosen for drafting of questionnaires. In each age group, drafts were pre-tested and required modifications were done. The final questionnaires contained 20 items each to be scored on a Likert scale (total score ranging from 20 to 60, a lower score indicating a higher risk of developmental delay). These questionnaires were validated against Developmental Assessment Scale for Indian Infants (DASII), a gold standard instrument.

RESULTS

On ROC analysis, the 9-month and 18-month screening tool had area under curve of 0.988 and 0.953, respectively, for detecting developmental delay. Score ≤50 on the 9-months questionnaire had sensitivity of 100% and specificity of 87.2%. Score ≤49 on the 18-months questionnaire had sensitivity of 91.4% and specificity of 88.7%.

CONCLUSION

The new questionnaires have a promising role in developmental screening of children at the time of routine immunizations in our country.

The impact of anemia and body mass index (BMI) on neuromotor development of preschool children

OBJECTIVE

According to data from the World Health Organization (WHO), anemia is a prevalent health problem that leads to increased morbidity and mortality, especially in preschool children. Anemia is recognized as a major health problem due to its negative effects on the mental and physical development during childhood. The aim of our study was to determine the levels of anemia of children in a kindergarten affiliated to the Directorate of National Education using a non-invasive method, and to investigate the effects of anemia on the physical, mental and neuromotor development of children.

METHOD

The levels of anemia was evaluated by using a non-invasive measurement device. Data collection was performed by means of a questionnaire to evaluate the children's physical development and set Denver Developmental Screening Test II scores.

RESULTS

Our findings show that 21% of non-anemic and 15% of anemic children are in the suspected abnormal group according to their DDST II total score. Furthermore, it has been identified that mild anemia has a positive effect on neuromotor development, while overweight and obesity affect neuromotor development in a negative way.

CONCLUSION

According to the results obtained from the study, mild anemia may have a positive effect on the children's neuromotor development, while malnutrition could have a negative impact.

Developmental Assessments during Injury Research: Is Enrollment of Very Young Children in Crèches Associated with Better Scores?

The Developmental Study is part of a larger intervention on “saving of lives from drowning (SoLiD)” where children were enrolled either into crèches (daycare centers) or playpens to prevent drowning in rural Bangladesh. Sampling ~1000 children between the ages of 9–17 months, we compared problem-solving, communication, motor and personal-social outcomes assessed by the Ages and Stages Questionnaire in the two interventions. After controlling for variables such as home stimulation in multivariate regressions, children in crèches performed about a quarter of a standard deviation better in total scores (p < 0.10) and 0.45 standard deviations higher in fine motor skills (p < 0.05). Moreover, once the sample was stratified by length of exposure to the intervention, then children in crèches performed significantly better in a number of domains: those enrolled the longest (about 5 months) have higher fine motor (1.47, p < 0.01), gross motor (0.40, p < 0.05) and personal-social skills (0.95, p < 0.01) than children in playpens. In addition, children in crèches with the longer exposure (about 5 months) have significantly higher personal-social and problem-solving scores than those in crèches with minimum exposure. Enrollment in crèches of very young children may be positively associated with psychosocial scores after accounting for important confounding variables.

ASQ-3 scores are sensitive to small differences in age in a Peruvian infant population

OBJECTIVE

The Ages and Stages Questionnaires Edition 3 (ASQ-3) are a well-validated international screen for developmental delays in young children. However, previous studies demonstrate variable scores between children eligible to take the same ASQ-3 interval. This study aimed to determine a relationship between age and ASQ-3 score for each screening interval.

METHODS

This was a baseline exploratory cross-sectional study of infants under 2 years old evaluated for the Peruvian social programme Cuna Más. Participants were included in Cuna Más if they lived in districts with fewer than 2000 inhabitants or 400 homes, indicating a predominantly rural population. The appropriate ASQ-3 screening interval was administered to each subject. Subjects were divided into four 2-week chronological subgroups based on age within each 2-month screening window and aggregated across all 12 screening intervals. Fisher's exact test, analysis of variance and Bonferonni post hoc test were used to compare differences between age subgroups. Linear regression was performed to assess the relationship between ASQ-3 score and both aggregated and disaggregated age subgroup.

RESULTS

A total of 5850 Peruvian infants were evaluated in 2013. Mean age was 13 ± 6.6 months, 50.7% were male and mean maternal education was 6.6 ± 4.0 years; 34.8% infants were stunted, 7.8% were underweight, 0.9% were wasted and 2% had age adjusted greater than 35 days for prematurity for ASQ-3 interval assignment. Mean total ASQ-3 was 42.2 ± 8.2. The ASQ-3 allocated 49.6% with suspected delay in one or more developmental areas. Before and after adjusting for wealth quintile, maternal education level, infant nutritional status and prematurity adjustment, age subgroup remained significantly associated with total ASQ-3 score (β = 1.8, CI: 1.7-2.0, P < 0.001), sectional ASQ-3 score (all P < 0.001) and inversely associated with one or more scores indicating suspected developmental delay (P < 0.001).

CONCLUSIONS

The ASQ-3 may underestimate the sensitivity of child development to small differences in age in this population.

Evaluation of a Zulu translation of the Parents' Evaluation of Developmental Status

BACKGROUND

One of the greatest challenges in early communication intervention in South Africa is developing and implementing successful identification strategies in primary health care (PHC). A shortage of trained PHC personnel is one of the barriers to providing adequate health services in South Africa. This dearth of services creates the need to substitute clinician-administered developmental screening tools with parent-administered tools.

AIM

To determine the accuracy of the Zulu Parents' Evaluation of Developmental Status (PEDS) in comparison with the outcome of the English PEDS.

SETTING

The data were collected in a clinical, non-contrived environment at Stanza Bopape Community Health Clinic in Mamelodi, City of Tshwane.

METHODS

The PEDS is a standardised, parent-completed questionnaire regarding the child's general development. The English PEDS was translated into Zulu by a Zulu linguist. There were 99 potential participants in the study of whom 83 met the necessary prerequisites.

RESULTS

Of the participants whose home language is Zulu, 54% preferred the PEDS in English over the PEDS in Zulu. This indicates a skewed preference towards English, with only slight associations between language preference and age, education and home language.

CONCLUSION

The Zulu PEDS displayed high positive and negative correspondences, representative of an accurate translation of the English PEDS. It is recommended that this study should be repeated in a community where the majority are Zulu home language speakers.

The attitudes of family physicians toward a child with delayed growth and development

Aim The purpose of this study was to assess the attitude of family physicians toward a child with delayed growth and development.

BACKGROUND

Primary healthcare professionals play a key role in monitoring growth and development, the best indicator of the child's health status. If delayed growth and development can be detected early, then it is usually possible to restore functioning.

METHODS

This descriptive study was performed in Samsun, Turkey, in May and June 2015. In total, 325 family physicians were included. The study consisted of two parts. In the first session of the research, the story of an 18-month-old child with delayed growth and development was presented using visual materials. An interview between the child's mother and a member of primary healthcare staff was then enacted by two of the authors using role-playing. Subsequently, participants were given the opportunity to ask the mother and member of primary healthcare staff questions about the case. During the sessions, two observers observed the participants, took notes and compared these after the presentation. In the second part of the study, the participants were asked to complete a questionnaire consisting of three open-ended questions. Findings When asking questions of the mother, family physicians generally used accusatory and judgmental language. One of the questions most commonly put to the mother was 'Do you think you are a good mother?' Family physicians were keen to provide instruction for the patient and relatives. Family physicians to a large extent thought that the problem of a child with delayed growth and development can be resolved through education.

CONCLUSIONS

Family physicians' manner of establishing relations with the patient and relatives is inappropriate. We therefore think that they should receive on-going in-service training on the subject.

Longitudinal patterns of early development in Canadian late preterm infants: A prospective cohort study

This prospective, longitudinal cohort study examined longitudinal patterns of early development in Canadian children born late preterm. A convenience sample of 82 mothers and their healthy, singleton, late preterm children participated. Mothers completed the Ages and Stages Questionnaires at 4, 8, and 18 months corrected age. Concerns were most commonly reported in the communication and gross motor domains, especially early in development. The proportion of children scoring below the referral cut-off in at least one domain at 4, 8, and 18 months was, respectively, 25.6, 25.6, and 14.6%. Only two children (2.4%) scored below referral cut-off in at least one domain at all three time points. At ages four and eight months, the late preterm sample had significantly lower communication and gross motor scores than the Ages and Stages Questionnaires normative sample. At age four months, there was also a significant difference on the fine motor domain. There were no significant differences at age 18 months. Healthy late preterm children appear to catch up to population norms by age 18 months corrected age. Longer term studies are needed to further clarify early indicators of delay in late preterm children and identity those who require close developmental monitoring.

Parental Obesity and Early Childhood Development

BACKGROUND

Previous studies identified associations between maternal obesity and childhood neurodevelopment, but few examined paternal obesity despite potentially distinct genetic/epigenetic effects related to developmental programming.

METHODS

Upstate KIDS (2008-2010) recruited mothers from New York State (excluding New York City) at ∼4 months postpartum. Parents completed the Ages and Stages Questionnaire (ASQ) when their children were 4, 8, 12, 18, 24, 30, and 36 months of age corrected for gestation. The ASQ is validated to screen for delays in 5 developmental domains (ie, fine motor, gross motor, communication, personal-social functioning, and problem-solving ability). Analyses included 3759 singletons and 1062 nonrelated twins with ≥1 ASQs returned. Adjusted odds ratios (aORs) and 95% confidence intervals were estimated by using generalized linear mixed models accounting for maternal covariates (ie, age, race, education, insurance, marital status, parity, and pregnancy smoking).

RESULTS

Compared with normal/underweight mothers (BMI <25), children of obese mothers (26% with BMI ≥30) had increased odds of failing the fine motor domain (aOR 1.67; confidence interval 1.12-2.47). The association remained after additional adjustment for paternal BMI (1.67; 1.11-2.52). Paternal obesity (29%) was associated with increased risk of failing the personal-social domain (1.75; 1.13-2.71), albeit attenuated after adjustment for maternal obesity (aOR 1.71; 1.08-2.70). Children whose parents both had BMI ≥35 were likely to additionally fail the problem-solving domain (2.93; 1.09-7.85).

CONCLUSIONS

Findings suggest that maternal and paternal obesity are each associated with specific delays in early childhood development, emphasizing the importance of family information when screening child development.

Ages and Stages Questionnaire: a global screening scale

With standardized screening tools, research studies have shown that developmental disabilities can be detected reliably and with validity in children as young as 4 months of age by using the instruments such as the Ages and Stages Questionnaire. In this review, we will focus on one tool, the Ages and Stages Questionnaire, to illustrate the usefulness of developmental screening across the globe.

Screening for Developmental Disorders in 3- and 4-Year-Old Italian Children: A Preliminary Study

BACKGROUND

The "Osserviamo" project, coordinated by the Municipality of Rome and the Department of Pediatrics and Child Neuropsychiatry of Sapienza University, aimed to validate an Italian version of the Ages and Stages Questionnaire-3 and to collect, for the first time in Italy, data on developmental disorders in a sample of 4,000 children aged 3 and 4 years. The present paper presents the preliminary results of the "Osserviamo" project.

METHODS

600 parents of children between 39 and 50 months of age (divided in two age stages: 42 and 48 months) were contacted from 15 kindergarden schools.

RESULTS

23.35% of the whole sample scored in the risk range of at least one developmental area of the Ages and Stages Questionnaire-3rd Edition (ASQ-3) and 7.78% scored in the clinical range. Specifically, 23.97% of the children in the 42-month age stage scored in the risk range and 5.79% scored in the clinical range. Males scored lower than females in the fine motor skills and personal-social development domains. Moreover, 22.79% of the children in the 48-month age stage scored in the risk range, while 9.55% scored in the clinical range. Males scored lower than females in fine motor skills.

CONCLUSION

Italian validation of the ASQ-3 and recruitment of all 4,000 participants will allow these data on the distribution of developmental disorders to be extended to the general Italian pediatric population. One main limitation of the study is the lack of clinical confirmation of the data yielded by the screening programme, which the authors aim to obtain in later stages of the study.

Preliminary Validation of a Parent-Child Relational Framework for Teaching Developmental Assessment to Pediatric Residents

OBJECTIVE

A parent-child relational framework was used as a method to train pediatric residents in basic knowledge and observation skills for the assessment of child development. Components of the training framework and its preliminary validation as an alternative to milestone-based approaches are described.

METHODS

Pediatric residents were trained during a 4-week clinical rotation to use a semistructured interview and observe parent-child behavior during health visits using clinical criteria for historical information and observed behavior that reflect developmental change in the parent-child relationship. Clinical impressions of concern versus no concern for developmental delay were derived from parent-child relational criteria and the physical examination. A chart review yielded 330 preterm infants evaluated using this methodology at 4 and 15 months corrected age who also had standardized developmental testing at 6 and 18 months corrected age. Sensitivities and specificities were computed to examine the validity of the clinical assessment compared with standardized testing. A subset of residents who completed 50 or more assessments during the rotation was timed at the end of 4 weeks.

RESULTS

Parent-child behavioral markers elicited from the history and/or observed during the health visit correlated highly with standardized developmental assessment. Sensitivities and specificities were 0.72/0.98 and 0.87/0.96 at 4 to 6 and 15 to 18 months, respectively. Residents completed their assessments <1 minute on average if they had completed at least 50 supervised assessments.

CONCLUSIONS

A parent-child relational framework is a potentially efficient and effective approach to training residents in the clinical knowledge and skills of child development assessment.