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

Screening for Autism Spectrum Disorder in Young Children: Still Not Enough Evidence

BACKGROUND

Early detection of autism spectrum disorder (ASD) has the potential to significantly reduce the impact of the condition, however previous reviews have found little evidence to support screening programs for ASD in young children.

METHODS

We conducted a review with the aim of updating evidence on 3 aspects: (a) diagnostic stability of ASD in young children; (b) accuracy of ASD screening tools in young children; and (c) the benefits of early interventions in screen-detected young children with ASD.

RESULTS

A total of 33 studies were included in our review. Five studies looking at diagnostic stability reported estimates ranging from 71.9% to 100%, however the majority only included a follow-up of 24 months and all studies raised concerns regarding the risk of bias due particularly to lack of blinding, sample size, and patient flow. A total of 25 studies, reported in 26 articles, were identified that reported accuracy data on 11 screening tools. Most of the reports were concerned with versions of M-CHAT, reporting sensitivity estimates from 0.67 to 1.0; however, many of these were deemed to be of high risk of bias due to lack of blinding and follow-up. Four studies reported on early interventions in screen-detected children; however, the majority did not find significant improvements on the relevant outcomes.

CONCLUSIONS

Overall, the evidence on screening for ASD in young children captured by this review is not conclusive regarding the 3 aspects of screening in this population. Future studies should attempt to ensure blinded diagnostic assessments, include longer follow-up periods and limit attrition.

Construction and validation of ShaMaq developmental screening tool

INTRODUCTION

The diagnosis of developmental delay and early intervention ameliorates long-term sequelae. There is a need for an appropriate, regionally adapted and reliable developmental screening tool to be used in low and middle-income countries with scarce resources.

AIM

The aim of this research is to construct and validate a screening tool for identifying developmental delay in Pakistani children.

METHOD

ShaMaq developmental screening tool (SDST) was developed consisting of five proformas to be administered at different age groups: 6-8 weeks (Group 1), 6-10 months (Group 2), 18-24 months (Group 3), 3-3.5 years (Group 4), and 4.5-5.5 years (Group 5). On an average, Groups 1-3 took 10-15 min, whereas Groups 4 and 5 took 20-25 min. We sampled children between the ages of 6 weeks to 5.5 years and tested them all within their designated age groups. Internal consistency was assessed by Cronbach's alpha. Interobserver testing was done for reliability and concurrent validity was undertaken by using the senior consultant developmental paediatrician's final diagnosis as the gold standard.

RESULTS

Out of 550 healthy children, 8-19% in the five groups were found to have some form of developmental delay using SDST. Approximately 50% of the families were in the low-to-moderate income bracket, and nearly 93% lived in a joint family system. Internal consistency of items in the five groups ranged from 0.784 to 0.940, whereas both interobserver reliability and concurrent validity ranged from 0.737 to 1.0. SDST showed 94.4% sensitivity and 92.9% specificity.

CONCLUSION

SDST is an effective tool for identifying delay in healthy children with good internal consistency, reliability, and validity.

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.

Behavioral gender differences across Pre-School Children with Autism Spectrum Disorders: a cross-sectional study

There is increasing literature showing that the presentation of Autism Spectrum Disorder (ASD) could be different according to the sex of the patient. Through the analysis of the Autism Diagnostic Interview Revised interview results of a study group consisting of 56 preschool children diagnosed with ASD potential differences in the presentation of ASD were searched. Variables investigated were verbal abilities, the presence/absence of unusual sensory interests, as well as of echolalia. The results showed significant differences between gender in restricted and repetitive behavior (p < 0.01), in particular for those children who have no unusual sensory interest (p < 0.05) and with minimal verbal ability (p < 0.05). The findings contribute providing evidences on phenotypical differences in preschool children with a diagnosis of Autism Spectrum Disorder.

The efficacy of executive function interventions in children with autism spectrum disorder: a systematic review and meta-analysis

INTRODUCTION

Children with Autism Spectrum Disorder (ASD) experience difficulties in Executive Functions (EFs) performance. However, the efficacy of EF intervention needs to be further investigated.

OBJECTIVE

To evaluate the efficacy of different EF interventions in children and adolescents with ASD.

METHODS

A systematic review and meta-analysis were carried out according to PRISMA guidelines. Relevant databases including PubMed, PsycINFO, Scopus, and Web of Science were searched up to November 2019. Papers included in the study have the following characteristics: randomized controlled trial or quasi-experimental design and published in English or Spanish.

RESULTS

After the elimination of duplicates, 949 were screened. Among these, six were included in the systematic review. The main approaches for EF in ASD were computer-based interventions, cognitive-behavioral therapy, and assisted-animal therapy. Statistically significant results (p = 0.003) were found in using exergames.

CONCLUSION

Different approaches can be used for improving EF intervention, with positive effects on working memory, behavior, and flexibility.

Translation and Cultural Adaptation of the Ages and Stages Questionnaires (ASQ) Worldwide: A Scoping Review

OBJECTIVE

This scoping review aims to provide a data mapping and narrative synthesis of the available peer-reviewed scientific literature on the translation and cultural adaptation processes relative to the Ages and Stages Questionnaires (ASQ) as reported by the authors. It also seeks to paint an overall portrait of the implementation of the translated and culturally adapted ASQ worldwide.

METHODS

Articles published between 1995 and May 11, 2018, were identified via systematic searches of peer-reviewed literature carried out using CINAHL, Scopus, MEDLINE, Education Source, PsycINFO, and ERIC. The articles included in the qualitative synthesis were coded based on an extraction form developed for the study.

RESULTS

In the 46 articles surveyed, 37 different cultural adaptations were identified in 29 languages and 27 countries. Translations were included in 33 cultural adaptations, and language modifications were reported in 18 adaptations. The forward-backward translation method was reported in 25 cases. The authors declared having made cultural content, language, visual, and/or conceptual modifications in 26 adaptations. Cultural content modifications were reported in 24 adaptations. At least one method (pilot study, individual interview, survey or focus group with respondents) was reported in 24 adaptations.

CONCLUSION

Cultural modifications were relatively minor and were, in general, made to establish equivalence with the source version. As well, the processes used to translate and culturally adapt the ASQ varied widely based on the types of methods. Additional work should be conducted to document the process of this crucial phase.

Criterion Validity and Reliability of SF-12 Health Survey Version 2 (SF-12v2) in a Student Population during COVID-19 Pandemic: A Cross-Sectional Study

OBJECTIVE

The novel coronavirus SARS-CoV-2, responsible for the COVID-19 pandemic, led to strict domestic quarantine, social isolation policies, and consequently significant psycho-emotional and lifestyle changes. The individual and societal fear and anxiety cause significant stress affecting health-related quality of life (HRQOL). There is evidence of the psychological and mental health effects of the current pandemic on students, who are known to be a vulnerable population. A decrease in physical activity was reported among students, and it is known to contribute to stress levels, which is strongly associated with HRQOL. This study is aimed at evaluating the validity and reliability of SF-12 Health Survey version 2 (SF-12v2) in the assessment of self-perceived quality of life of Italian students following lifestyle changes due to the outbreak of COVID-19.

METHODS

A cross-sectional study was conducted with university students attending the faculty of Medicine and Surgery or Health Professions. The Physical Component Summary (PCS12) and the Mental Component Summary (MCS12) of SF-12v2 were compared to the Perceived Stress Scale (PSS). Internal consistency was examined using Cronbach's Alpha Coefficient. Concurrent validity was evaluated comparing SF-12v2 values to PSS scores, and the Pearson Correlation Coefficient (PCC) was calculated. Cross-cultural validity was investigated through several analyses for correlations between SF-12v2 scores and the gender of participants, University of Italy, body mass index (BMI), and time spent sitting and exercising.

RESULTS

The SF-12v2 questionnaire was administered to 583 medical and health professionals' students in July 2020. Cronbach's Alpha showed acceptable reliability for PCS12 and MCS12. In line with expectations, PCS12 scores differed by BMI groups, while the MCS12 was associated with PSS score and showed differences between genders, BMI groups, time spent sitting, and time spent exercising.

CONCLUSION

The Italian version of SF-12v2 is a valid and reliable instrument to assess health-related quality of life among medical and health professionals' students.

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.

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.