A comparison of objective, standardised parent-administered questionnaires to that of subjective screening practices for the early detection of developmentaal delay in at-risk infants
Date
2011-03-25
Authors
Silva, Melinda Lee E
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Abstract
Background
The early identification of developmental disorders facilitates early intervention, improving childhood outcomes.
Parent-administered questionnaires have been recommended for this purpose. The PEDS COMBINED, which
includes the Parents Evaluation of Developmental Status (PEDS) and PEDS Developmental Milestones
(PEDS:DM), and the Ages and Stages Questionnaire (ASQ) are parent-administered questionnaires with good
psychometric properties. It has not been determined if they identify the same infants at-risk for developmental
delays however. It is also not know how South African paediatricians monitor childhood development.
Objective
To compare the ASQ, PEDS COMBINED and South African paediatricians’ subjective assessment (PSA) of
neonatal intensive care graduates at 6-months corrected age.
To identify trends in developmental screening practices, including the knowledge and use of parentadministered
screening tools, in a diverse group of paediatricans working in Gauteng, South Africa.
Methods
Developmental screening and referral practices of paediatricians were ascertained by analysis of a short
questionnaire sent to participating paediatricians.
Concordance between the questionnaires and PSA was determined using the kappa coefficient (κ) and Test of
Symmetry (κ ≤ 0.4 indicating poor agreement; κ ≥ 0.75 indicating excellent agreement).
Results
Concordance between the ASQ and PEDS COMBINED was 90.7% (κ = 0.82, ρ = 0.05). The PSA showed poor
concordance with both PEDS COMBINED and ASQ (κ = 0.28, ρ = 0.03 and κ= 0.26, ρ = 0.01 respectively).
The ASQ and PEDS COMBINED identified 40% and 42% of the cohort with developmental concerns and the
PSA identified 6%. Only 13% of paediatricians used specific guidelines for developmental assessment and none
used, or could name any parent-administered questionnaire.
Conclusion
There is excellent agreement between the ASQ and PEDS COMBINED in identifying the same children with
developmental concerns. Paediatricians identified significantly fewer infants and showed statistically significant
poor agreement with both questionnaires. Most paediatricians in Gauteng, South Africa are not using
standardized screening tools to detect developmental delay and have poor knowledge regarding these tools.
Description
MSc (Med), Child Health Neurodevelopment, Faculty of Health Sciences, University of the Witwatersrand
Keywords
developmental screening, developmental delay, PEDS, PEDS:DM, PEDS COMBINED, ASQ, NICU infant, infant, paediatrician, South Africa