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Hutchins H, Robinson L, Charania S, Ghandour R, Hirsh-Pasek K, Zubler J. Psychometric Assessment of Pilot Language and Communication Items on the 2018 and 2019 National Survey of Children's Health. Acad Pediatr 2022; 22:1133-1141. [PMID: 34968678 PMCID: PMC9694117 DOI: 10.1016/j.acap.2021.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Until recently, normative data on language and communication development among children in the United States have not been available to inform critical efforts to promote language development and prevent impairments. This study represents the first psychometric assessment of nationally representative data derived from a National Survey of Children's Health (NSCH) pilot measure of language and communication development among children ages 1 to 5 years. METHODS We analyzed 14,573 parent responses to language and communication items on the 2018 and 2019 NSCH to evaluate whether the newly added 11 items represent a single latent trait for language and communication development and to determine normative age of success on each item. We applied weighted, one-parameter Item Response Theory to rate and cluster items by difficulty relative to developmental language ability. We examined differential item functioning (DIF) using weighted logistic regression by demographic factors. RESULTS Together, exploratory factor analysis resulting in a single factor > 1 and explaining 93% of the variance and positive correlations indicated unidimensionality of the measure. Item characteristic curves indicated groupings were overall concordant with proposed milestone ages and representative of an approximate 90% success cut-point by child age. Indicated normative age cut-points for 3 of the items differed slightly from proposed milestone ages. Uniform DIF was not observed and potential nonuniform DIF was observed across 5 items. CONCLUSIONS Results have the potential to enhance understanding of risk and protective factors, inform efforts to promote language and communication development, and guide programmatic efforts on early detection of language delays.
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Affiliation(s)
- Helena Hutchins
- Child Development Studies Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (H Hutchins and L Robinson), Atlanta, Ga; Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Research Participation Programs (H Hutchins), Oak Ridge, Tenn.
| | - Lara Robinson
- Child Development Studies Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (H Hutchins and L Robinson), Atlanta, Ga
| | - Sana Charania
- Early Hearing Detection and Intervention Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (S Charania), Atlanta, Ga
| | - Reem Ghandour
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration (R Ghandour), Rockville, Md
| | - Kathy Hirsh-Pasek
- Department of Psychology, Temple University (K Hirsh-Pasek), Philadelphia, Pa; Brookings Institution (K Hirsh-Pasek), Washington, DC
| | - Jennifer Zubler
- Eagle Global Scientific (J Zubler), San Antonio, Tex; Learn the Signs, Act Early Program, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (J Zubler), Atlanta, Ga
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Flower KB, Massie S, Janies K, Bassewitz JB, Coker TR, Gillespie RJ, Macias MM, Whitaker TM, Zubler J, Steinberg D, DeStigter L, Earls MF. Increasing Early Childhood Screening in Primary Care Through a Quality Improvement Collaborative. Pediatrics 2020; 146:peds.2019-2328. [PMID: 32769199 DOI: 10.1542/peds.2019-2328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Multiple early childhood screenings are recommended, but gaps persist in implementation. Our aim for this project was to improve screening, discussion, referral, and follow-up of development, autism spectrum disorder (ASD), maternal depression, and social determinants of health (SDoH) to 90% by July 2018. METHODS This 1-year national quality improvement collaborative involved 19 pediatric primary care practices. Supported by virtual and in-person learning opportunities, practice teams implemented changes to early childhood screening. Monthly chart reviews were used to assess screening, discussion, referral, and follow-up for development, ASD, maternal depression, and SDoH. Parent surveys were used to assess parent-reported screening and referral and/or resource provision. Practice self-ratings and team surveys were used to assess practice-level changes. RESULTS Participating practices included independent, academic, hospital-affiliated, and multispecialty group practices and community health centers in 12 states. The collaborative met development and ASD screening goals of >90%. Largest increases in screening occurred for maternal depression (27% to 87%; +222%; P < .001) and SDoH (26% to 76%; +231%; P < .001). Statistically significant increases in discussion of results occurred for all screening areas. For referral, significant increases were seen for development (53% to 86%; P < .001) and maternal depression (23% to 100%; P = .008). Parents also reported increased screening and referral and/or resource provision. Practice-level changes included improved systems to support screening. CONCLUSIONS Practices successfully implemented multiple screenings and demonstrated improvement in subsequent discussion, referral, and follow-up steps. Continued advocacy for adequate resources to support referral and follow-up is needed to translate increased screening into improved health outcomes.
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Affiliation(s)
- Kori B Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; .,Population Health Improvement Partners, Cary, North Carolina
| | - Sara Massie
- Population Health Improvement Partners, Cary, North Carolina
| | | | | | - Tumaini R Coker
- Department of Pediatrics, School of Medicine, University of Washington and Seattle Children's Research Institute, Seattle, Washington
| | | | - Michelle M Macias
- Division of Developmental-Behavioral Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Toni M Whitaker
- Division of Developmental Pediatrics, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jennifer Zubler
- Learn the Signs. Act Early Program, Division of Birth Defects, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | | | | | - Marian F Earls
- Community Care of North Carolina, Raleigh, North Carolina
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Barger B, Squires J, Greer M, Noyes-Grosser D, Eile JM, Rice C, Shaw E, Surprenant KS, Twombly E, London S, Zubler J, Wolf RB. State Variability in Diagnosed Conditions for IDEA Part C Eligibility. Infants Young Child 2019; 32:231-244. [PMID: 32327900 PMCID: PMC7177194 DOI: 10.1097/iyc.0000000000000151] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
An infant or toddler can begin the process of receiving Part C early intervention services by having a diagnosed condition with a high probability of developmental delay (Individuals with Disabilities Education Improvement Act, 2004). How states define those diagnosed conditions that begin the initiation process varies widely. Lists of diagnosed conditions were collected from state Part C websites and Part C coordinators for a descriptive analysis. Across 49 states, the District of Columbia, and 4 territories, a final list of 620 unique conditions was compiled. No single condition was listed by all jurisdictions. Hearing impairment was the condition listed by the most states (n = 38), followed by fetal alcohol syndrome (n = 34). Of the 620 conditions, 168 (27%) were listed by only 1 state, 554 (89%) were listed by fewer than 10 states, and 66 (11%) were listed by 10 or more states. Of these 66 conditions, 47 (71%) were listed by fewer than 20 states. Most of these 66 conditions (n = 48; 72.7%) had a prevalence of "very rare or rare," 8 (12%) were "common," 6 (9%) were "very common," and 4 (6.1%) were "unknown." The wide heterogeneity in the number and type of diagnostic conditions listed across states should be further investigated as it may represent imbalances in children with diagnosed conditions gaining access to Part C evaluations and individualized family service plans and potentially the services themselves across states. In addition, providing ready access to lists of diagnosed conditions is a simple step that could help states and Part C programs facilitate access to services.
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Affiliation(s)
- Brian Barger
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta (Dr Barger); Disability Research and Dissemination Center, Arnold School of Public Health, University of South Carolina, Columbia (Dr Barger); Center on Human Development, University of Oregon, Eugene (Dr Squires and Ms Twombly); Infant & Toddler Coordinators Association, Indianapolis, Indiana (Ms Greer); Office of Special Education Programs (Dr Noyes-Grosser and Ms Martin Eile) and Office of General Counsel (Dr Surprenant), US Department of Education, Washington, District of Columbia; Department of Psychiatry and Behavioral Sciences (Dr Rice) and Emory School of Public Health (Ms London), Emory University, Atlanta, Georgia; Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill (Ms Shaw); Carter Consulting, Inc, Atlanta, Georgia (Dr Zubler); and National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Rice and Zubler and Mss London and Wolf)
| | - Jane Squires
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta (Dr Barger); Disability Research and Dissemination Center, Arnold School of Public Health, University of South Carolina, Columbia (Dr Barger); Center on Human Development, University of Oregon, Eugene (Dr Squires and Ms Twombly); Infant & Toddler Coordinators Association, Indianapolis, Indiana (Ms Greer); Office of Special Education Programs (Dr Noyes-Grosser and Ms Martin Eile) and Office of General Counsel (Dr Surprenant), US Department of Education, Washington, District of Columbia; Department of Psychiatry and Behavioral Sciences (Dr Rice) and Emory School of Public Health (Ms London), Emory University, Atlanta, Georgia; Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill (Ms Shaw); Carter Consulting, Inc, Atlanta, Georgia (Dr Zubler); and National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Rice and Zubler and Mss London and Wolf)
| | - Maureen Greer
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta (Dr Barger); Disability Research and Dissemination Center, Arnold School of Public Health, University of South Carolina, Columbia (Dr Barger); Center on Human Development, University of Oregon, Eugene (Dr Squires and Ms Twombly); Infant & Toddler Coordinators Association, Indianapolis, Indiana (Ms Greer); Office of Special Education Programs (Dr Noyes-Grosser and Ms Martin Eile) and Office of General Counsel (Dr Surprenant), US Department of Education, Washington, District of Columbia; Department of Psychiatry and Behavioral Sciences (Dr Rice) and Emory School of Public Health (Ms London), Emory University, Atlanta, Georgia; Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill (Ms Shaw); Carter Consulting, Inc, Atlanta, Georgia (Dr Zubler); and National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Rice and Zubler and Mss London and Wolf)
| | - Donna Noyes-Grosser
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta (Dr Barger); Disability Research and Dissemination Center, Arnold School of Public Health, University of South Carolina, Columbia (Dr Barger); Center on Human Development, University of Oregon, Eugene (Dr Squires and Ms Twombly); Infant & Toddler Coordinators Association, Indianapolis, Indiana (Ms Greer); Office of Special Education Programs (Dr Noyes-Grosser and Ms Martin Eile) and Office of General Counsel (Dr Surprenant), US Department of Education, Washington, District of Columbia; Department of Psychiatry and Behavioral Sciences (Dr Rice) and Emory School of Public Health (Ms London), Emory University, Atlanta, Georgia; Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill (Ms Shaw); Carter Consulting, Inc, Atlanta, Georgia (Dr Zubler); and National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Rice and Zubler and Mss London and Wolf)
| | - Julia Martin Eile
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta (Dr Barger); Disability Research and Dissemination Center, Arnold School of Public Health, University of South Carolina, Columbia (Dr Barger); Center on Human Development, University of Oregon, Eugene (Dr Squires and Ms Twombly); Infant & Toddler Coordinators Association, Indianapolis, Indiana (Ms Greer); Office of Special Education Programs (Dr Noyes-Grosser and Ms Martin Eile) and Office of General Counsel (Dr Surprenant), US Department of Education, Washington, District of Columbia; Department of Psychiatry and Behavioral Sciences (Dr Rice) and Emory School of Public Health (Ms London), Emory University, Atlanta, Georgia; Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill (Ms Shaw); Carter Consulting, Inc, Atlanta, Georgia (Dr Zubler); and National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Rice and Zubler and Mss London and Wolf)
| | - Catherine Rice
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta (Dr Barger); Disability Research and Dissemination Center, Arnold School of Public Health, University of South Carolina, Columbia (Dr Barger); Center on Human Development, University of Oregon, Eugene (Dr Squires and Ms Twombly); Infant & Toddler Coordinators Association, Indianapolis, Indiana (Ms Greer); Office of Special Education Programs (Dr Noyes-Grosser and Ms Martin Eile) and Office of General Counsel (Dr Surprenant), US Department of Education, Washington, District of Columbia; Department of Psychiatry and Behavioral Sciences (Dr Rice) and Emory School of Public Health (Ms London), Emory University, Atlanta, Georgia; Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill (Ms Shaw); Carter Consulting, Inc, Atlanta, Georgia (Dr Zubler); and National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Rice and Zubler and Mss London and Wolf)
| | - Evelyn Shaw
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta (Dr Barger); Disability Research and Dissemination Center, Arnold School of Public Health, University of South Carolina, Columbia (Dr Barger); Center on Human Development, University of Oregon, Eugene (Dr Squires and Ms Twombly); Infant & Toddler Coordinators Association, Indianapolis, Indiana (Ms Greer); Office of Special Education Programs (Dr Noyes-Grosser and Ms Martin Eile) and Office of General Counsel (Dr Surprenant), US Department of Education, Washington, District of Columbia; Department of Psychiatry and Behavioral Sciences (Dr Rice) and Emory School of Public Health (Ms London), Emory University, Atlanta, Georgia; Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill (Ms Shaw); Carter Consulting, Inc, Atlanta, Georgia (Dr Zubler); and National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Rice and Zubler and Mss London and Wolf)
| | - Kala Shah Surprenant
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta (Dr Barger); Disability Research and Dissemination Center, Arnold School of Public Health, University of South Carolina, Columbia (Dr Barger); Center on Human Development, University of Oregon, Eugene (Dr Squires and Ms Twombly); Infant & Toddler Coordinators Association, Indianapolis, Indiana (Ms Greer); Office of Special Education Programs (Dr Noyes-Grosser and Ms Martin Eile) and Office of General Counsel (Dr Surprenant), US Department of Education, Washington, District of Columbia; Department of Psychiatry and Behavioral Sciences (Dr Rice) and Emory School of Public Health (Ms London), Emory University, Atlanta, Georgia; Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill (Ms Shaw); Carter Consulting, Inc, Atlanta, Georgia (Dr Zubler); and National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Rice and Zubler and Mss London and Wolf)
| | - Elizabeth Twombly
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta (Dr Barger); Disability Research and Dissemination Center, Arnold School of Public Health, University of South Carolina, Columbia (Dr Barger); Center on Human Development, University of Oregon, Eugene (Dr Squires and Ms Twombly); Infant & Toddler Coordinators Association, Indianapolis, Indiana (Ms Greer); Office of Special Education Programs (Dr Noyes-Grosser and Ms Martin Eile) and Office of General Counsel (Dr Surprenant), US Department of Education, Washington, District of Columbia; Department of Psychiatry and Behavioral Sciences (Dr Rice) and Emory School of Public Health (Ms London), Emory University, Atlanta, Georgia; Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill (Ms Shaw); Carter Consulting, Inc, Atlanta, Georgia (Dr Zubler); and National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Rice and Zubler and Mss London and Wolf)
| | - Sarah London
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta (Dr Barger); Disability Research and Dissemination Center, Arnold School of Public Health, University of South Carolina, Columbia (Dr Barger); Center on Human Development, University of Oregon, Eugene (Dr Squires and Ms Twombly); Infant & Toddler Coordinators Association, Indianapolis, Indiana (Ms Greer); Office of Special Education Programs (Dr Noyes-Grosser and Ms Martin Eile) and Office of General Counsel (Dr Surprenant), US Department of Education, Washington, District of Columbia; Department of Psychiatry and Behavioral Sciences (Dr Rice) and Emory School of Public Health (Ms London), Emory University, Atlanta, Georgia; Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill (Ms Shaw); Carter Consulting, Inc, Atlanta, Georgia (Dr Zubler); and National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Rice and Zubler and Mss London and Wolf)
| | - Jennifer Zubler
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta (Dr Barger); Disability Research and Dissemination Center, Arnold School of Public Health, University of South Carolina, Columbia (Dr Barger); Center on Human Development, University of Oregon, Eugene (Dr Squires and Ms Twombly); Infant & Toddler Coordinators Association, Indianapolis, Indiana (Ms Greer); Office of Special Education Programs (Dr Noyes-Grosser and Ms Martin Eile) and Office of General Counsel (Dr Surprenant), US Department of Education, Washington, District of Columbia; Department of Psychiatry and Behavioral Sciences (Dr Rice) and Emory School of Public Health (Ms London), Emory University, Atlanta, Georgia; Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill (Ms Shaw); Carter Consulting, Inc, Atlanta, Georgia (Dr Zubler); and National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Rice and Zubler and Mss London and Wolf)
| | - Rebecca B Wolf
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta (Dr Barger); Disability Research and Dissemination Center, Arnold School of Public Health, University of South Carolina, Columbia (Dr Barger); Center on Human Development, University of Oregon, Eugene (Dr Squires and Ms Twombly); Infant & Toddler Coordinators Association, Indianapolis, Indiana (Ms Greer); Office of Special Education Programs (Dr Noyes-Grosser and Ms Martin Eile) and Office of General Counsel (Dr Surprenant), US Department of Education, Washington, District of Columbia; Department of Psychiatry and Behavioral Sciences (Dr Rice) and Emory School of Public Health (Ms London), Emory University, Atlanta, Georgia; Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill (Ms Shaw); Carter Consulting, Inc, Atlanta, Georgia (Dr Zubler); and National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Rice and Zubler and Mss London and Wolf)
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