Abstract
AimThis study examined children’s health care service use, mothers’ workforce participation, and mothers’ community engagement based on children’s risk of developmental delay.MethodWe used data from the All Our Families study, a prospective pregnancy cohort. Ages and Stages Questionnaire (ASQ) scores at year 2 indicated risk of developmental delay. To investigate the impact of risk of developmental delay when children were not diagnosed, a sensitivity analysis excluded reports of neurodevelopmental disorder (NDD) diagnosis at year 3. Outcomes were maternal reports of children’s health and allied health visits (and estimated costs), and maternal workforce participation and community engagement from year 2 to 3.ResultsAmong 1314 mother–child dyads, 209 (16%) children were classified as being at risk of developmental delay by the ASQ, and 42 (3%) had a reported diagnosis of NDD. Risk of developmental delay was related to increased use of allied health care services (incidence risk ratio 5.04 [year 3]; 95% confidence interval 2.49–10.2) and health visits (incidence risk ratio 1.33 [year 3]; 95% confidence interval 1.14–1.54). The average expected allied health costs were greater for children at risk versus not at risk of developmental delay. However, when excluding children with reported diagnoses of an NDD from this analysis, increased service use and costs in the remaining at‐risk population were not observed. Community engagement and workplace participation among families did not differ on the basis of risk of developmental delay.InterpretationThese results suggest increased health care service use by families of children at risk of developmental delay is driven by those receiving a diagnosis of an NDD in the subsequent year.What this paper adds Early developmental delay risk was related to health care service use and costs.Diagnosis of neurodevelopmental disorder drove increased health care service use and costs.Early developmental delay risk did not relate to parental workforce participation.Early developmental delay risk did not relate to community engagement participation.
Highlights
INTERPRETATION These results suggest increased health care service use by families of children at risk of developmental delay is driven by those receiving a diagnosis of an neurodevelopmental disorder (NDD) in the subsequent year
This study suggests that the majority of children at risk of developmental delay identified through the ASQ did not have more visits with physicians or allied health professionals from the age of 2 to 3 years, relative to children who were not at risk
The increases in health care visits and costs were primarily driven by children who received a diagnosis of an NDD at age 3 years
Summary
This study was approved by the Conjoint Faculties Research Ethics Board at the University of Calgary (reference REB 15-3027). Participants were not recruited from high-risk obstetric practices and tertiary medical clinics. Detailed descriptions of this cohort are available elsewhere.[19,20,21] Briefly, this cohort was recruited during pregnancy by a community based multi-method strategy using community settings, primary health care offices, and community laboratory services. This strategy resulted in a diverse sample of women who were representative of the sociodemographic of the population in the Greater Calgary area. Mothers were asked to complete questionnaires when their child was 2 and 3 years old, as well as at other time points (https://allourfamiliesstudy.com)
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