Effect of delay at 12 months of age on developmental status at 48 months of age determined using the ages and stages questionnaire: The Japan environment and children's study

Abstract

Introduction Few population-based studies have previously indicated the trajectory of developmental evaluation using an objective evaluation tool, Ages and Stages Questionnaire (ASQ). The ASQ is a screening tool originally designed to assess children's developmental performance and is the most commonly used parent-completed developmental screener worldwide. The Japan Environment and Children's Study (JECS) is an ongoing, nationwide birth cohort study that initiated in 2011 to investigate environmental factors affecting children's health and development. In this population-based questionnaire study, the 30-item ASQ completed at ages of 12 and 48 months were included. JECS has been conducted in 15 regional centres located throughout Japan. Using a temporary data of a regional centre of the JECS in Yamanashi, this study aimed to examine whether the evaluation at the age of 12 months predicts developmental delay at the age of 48 months. Methods In this study, 1704 participants completed the ASQ at 12 and 48 months. The ASQ consists of five domains: communication (CO), gross motor (GM), fine motor (FM), problem solving (PS) and personal social (PES). Cut-off values of less than two standard deviations (SDs) and 1 SD below the mean for the ASQ in each domain were used to define ‘fail’ and, ‘need to follow-up (follow-up)’, respectively, as recommended in a previous study in the United States. Multiple logistic regression analyses were conducted to examine whether the ‘fail’ and ‘follow-up’ at 12 months predicts ‘fail’ at 48 months in each domain. Results At 12 months, ‘fail’ and ‘follow-up’ rates in each domain were 8% and 27% (CO), 17% and 21% (GM), 12% and 17% (FM), 19% and 20% (PS), and 18% and 19% (PES), respectively. At 48 months, the ‘fail’ rates were 3.4% (CO), 4.1% (GS), 1.1% (FM), 3.0% (PS) and 1.7% (PES), respectively. ‘Fail’ at 12 months in every domain were significantly predictive of ‘fail’ at 48 months [CO, odds ratio (OR): 5.7, 95% confidence interval (CI): 3.6–9.2; GM, OR: 5.4, 95% CI: 3.1–9.4; FM, OR: 9.6, 95% CI: 3.1–29.5; PS, OR: 10.6, 95% CI: 5.1–22; PES, OR: 6.4, 95% CI: 3.0–14.1]. In contrast, ‘follow-up’ in the PES domain was not associated with ‘fail’ at 48 months (OR: 0.33, 95% CI: 0.04–2.6). The other domains of ‘follow-up’ at 12 months were significantly associated, although the OR were smaller than ‘fail’ at 12 months (CO, OR: 2.9, 95% CI: 1.6–5.2; GM, OR: 2.1, 95% CI: 1.1–4.0; FM, OR: 4.3, 95% CI: 1.2–15.1; PS, OR: 3.2, 95% CI: 1.3–7.7). Conclusion There were some differences in screening rates between in Japan and the US. The magnitude of predictability of a later developmental delay is specific depending on the domain.