Developmental Screening Tool Research Articles

From Descriptive to Predictive: Linking Early Childhood Developmental and Behavioral Screening Results With Educational Outcomes in Kindergarten.

To assess the predictive value of a pediatric screening tool by linking 2 independent databases: an educational database that includes data from standardized academic assessments administered during kindergarten and a pediatric database that includes screening results. A database that includes results of the Survey of Well-being of Young Children (SWYC) completed during pediatric visits were linked to an educational database that includes STAR Early Literacy examinations in kindergarten. Linear multilevel regression modeling was used to examine if screening results on the developmental and behavioral sections of the most recently completed SWYC form predicted trends in the percentile rank on the STAR exam over the school year, adjusting for potential confounders. Linking the 2 databases resulted in a sample of 586 children who were administered at least one SWYC evaluation between 24 and 48 months and completed at least one STAR Early Literacy examination in kindergarten. The sample represents a diverse population with 55% Hispanic children, 25% Non-Hispanic black children, and 91% of children receiving a subsidized lunch. After adjusting for confounders, children with a positive developmental or behavioral screen had significantly lower percentile ranks on the STAR exam. Early developmental and behavioral screening results predicted performance on the STAR exam in kindergarten. Children with developmental and behavioral concerns may be less ready to enter kindergarten than peers without such concerns. These preliminary findings provide proof-of-principle of the potential utility of developmental screening tools in identifying children with reduced school readiness who may benefit from intervention prior to kindergarten.

Predictive Validity of the Infant Toddler Checklist in Primary Care at the 18-month Visit and School Readiness at 4 to 6 Years.

The American Academy of Pediatrics recommends developmental surveillance and screening in early childhood in primary care. The 18-month visit may be an ideal time for identification of children with delays in language and communication, or symptoms of autism spectrum disorder (ASD). Little is known about the predictive validity of developmental screening tools administered at 18 months. Our objective was to examine the predictive validity of the Infant Toddler Checklist (ITC) at the 18-month health supervision visit, using school readiness at kindergarten age as the criterion measure. We designed a prospective cohort study, recruiting in primary care in Toronto, Canada. Parents completed the ITC at the 18-month visit. Teachers completed the Early Development Instrument (EDI) when the children were in Kindergarten, age 4-6 years. We calculated screening test properties with 95% confidence intervals (CIs). We used multivariable logistic and linear regression analyses adjusted for important covariates. Of 293 children (mean age 18 months), 30 (10.2%) had a positive ITC including: concern for speech delay (n=11, 3.8%), concern for other communication delay (n=13, 4.4%), and concern for both (n=6, 2.0%). At follow-up (mean age 5 years), 54 (18.4%) had overall EDI vulnerability, 19 (6.5%) had vulnerability on the 2 EDI communication domains. The ITC sensitivity ranged from 11% to 32%, specificity from 91% to 96%, false positive rates from 4% to 9%, PPV from 16% to 35%, NPV from 83% to 95%. A positive ITC screen and ITC concern for speech delay were associated with lower scores in EDI communication skills and general knowledge (β=-1.08; 95% CI: -2.10, -0.17; β=-2.35; 95% CI: -3.63, -1.32) and EDI language and cognitive development (β=-0.62; 95% CI: -1.25, -0.18; β=-1.22; 95% CI: -2.11, -0.58). The ITC demonstrated high specificity suggesting that most children with a negative ITC screen will demonstrate school readiness at 4-6 years, and low false positive rates, minimizing over-diagnosis. The ITC had low sensitivity highlighting the importance of ongoing developmental surveillance and screening.

Wezesha Watoto: Implementation of Clinic-Based Developmental Screening in Kenya

Background: The importance of child developmental screening is gaining increased traction within low-resourced settings, but little is known about the implementation of screening programs within clinical systems. This study aimed to evaluate the acceptability, feasibility, fidelity, and sustainability of integrating a child developmental screening tool in a maternal and child health (MCH) clinic in western Kenya.
 Methods: This implementation study takes place within infrastructure of Academic Model Providing Access to Healthcare (AMPATH). Developmental screening was integrated into MCH care in September 2021 and is ongoing for children ages 18-36 months with perinatal HIV exposure. Feasibility, sustainability, and fidelity are measured with weekly time-motion analysis of clinic flow and daily clinic record review. Acceptability, feasibility, and sustainability were evaluated using semi-structured interviews of caregivers and clinic staff, completed at baseline and 6 months post-implementation. Mixed methods data were analyzed using descriptive statistics, thematic coding, and triangulation.
 Results: Since onset, 187 children were screened (69.8% of eligible children), with rate of screening consistent over time. Average time to complete screening is 5.4 minutes and decreasing over time. Perceived time of screening was inflated at baseline (≈16min) and 6 months (≈20min). Facilitators to screening included staff teamwork and caregiver cooperation. Lack of time and child’s mood were barriers. Caregivers appreciated others’ concern for their child’s development and noted ease in answering questions. Staff’s remarks were congruent, while emphasizing the need for motivating incentives for children and staff. At 6 months, staff noted screening had become routine. They desired feedback on performance and provided ideas for improvement. Caregivers frequently asked about availability of assistance if potential delays are identified during screening.
 Conclusion: The integration of developmental screening is aided by positive perceptions from both clinic staff and caregivers. Regular retraining, staff feedback, and referral resources may optimize integration. Research evaluating cost effectiveness is needed.

Development and validation of the Ibadan Simplified Developmental Screening chart.

Developmental assessment remains an integral part of the routine evaluation of the wellbeing of every child. Children in resource-poor countries are not routinely assessed for signs of developmental delay and developmental disorders are frequently overlooked. A major gap exists in the availability of culturally appropriate and cost-effective developmental screening tools in many low and middle income countries (LMICs) with large populations. To bridge the existing gap, we describe the process of the development and validation of the Ibadan Simplified Developmental Screening (ISDS) chart, for routine developmental screening in Nigerian children. We developed an item pool across 4 domains of development namely, the gross motor, vision-fine motor, communication and socio-behavioural domains. The ISDS chart consists of 3-4 item questions for each domain of development, and responses are to be provided by the caregiver. Each chart is age-specific, from 6 weeks to 12 months. A total score derived from the summation of the scores in each domain are plotted on the ISDS scoring guide with a pass or fail score. Each child was evaluated by the Ages and Stages Questionnaire as the standard. A total of 950 infants; 453 males and 497 females were enrolled. The estimates of internal consistency between the two instruments ranged between 0.7-1.0. Using the ASQ as the gold standard, the ISDS chart demonstrated a sensitivity of 98.8%, 78.4% and 99.7% in the gross motor, communication and the social and emotional domains respectively, for detecting infants who might require further assessment for developmental delays. The indigenous tool fills a major gap in the need for cost-effective interventions for developmental monitoring in LMICs. Future work should include the deployment of the tool in the wider population, using digital health approaches that could underpin policy making in the region.

Systematic Review and Meta-analysis: Real-World Accuracy of Children’s Developmental Screening Tests

This review presents a list of developmental screening tests used in clinical settings worldwide and provides a broad estimate of their accuracy (PROSPERO: CRD42021236474). Following the PRISMA Diagnostic Test Accuracy (DTA) guidelines, this review involved searching PubMed, PsycINFO, Cochrane, EMBASE, CINAHL, and Google Scholar (for manual searching). Inclusion criteria included studies published in English through 2020 that compared the accuracy of developmental screening tests against developmental diagnostic tests among children under 13 years of age. Six researchers, in pairs, independently selected the studies and extracted the data. A hierarchical model was applied to meta-analyze the diagnostic accuracy of the tests, and meta-regression was used to identify the moderators using R 4.1.3 software. The meta-analysis included 56 studies (17 screening tests and 61 outcomes). The most frequently used screening tests were the Ages and Stages Questionnaire (ASQ), Denver Developmental Screening Test (DDST), and Parent's Evaluation of Developmental Status (PEDS). The pooled sensitivity and specificity were 0.75 (95% CI= 0.69-0.80) and 0.76 (95% CI= 0.71-0.80), and the overall diagnostic accuracy of the total outcomes (area under the curve) was 0.80. High heterogeneity was observed between the included studies with various thresholds of the tests. Participants' developmental concerns at the baseline significantly moderated the accuracy of the screening tests, resulting in double the positive predictive value and prevalence compared to those without the concerns. We recommend a standardized process of validation studies for diagnostic accuracy, to ensure the effectiveness of developmental screening tests in clinical settings. Accuracy of Developmental Screening Tools among Children in Real World: a Systematic Review and Meta Analysis; https://www.crd.york.ac.uk/; CRD42021236474.

Impact of Screen Media Usage on Early Childhood Development

Objective: To see the impact of screen media usage on early childhood development.
 Study Design: Cross-sectional study.
 Place and Duration of study: Developmental Behavioural Paediatrics Department, Children’s Hospital and Institute of Child Health, Lahore Pakistan, from Oct to Dec 2020.
 Methodology: This study included 100 children with an age range between 15-36 months and divided into two groups. Group-1 was children with communication behaviour disorders (CBD) (n=50), and Group-2 was typically developing (TD)children (n=50). ShaMaq Developmental Screening Tool (SDST) was administered to children to screen their development.Childhood behaviours were rated on a scale of 0-10 on a Behaviour rating scale.
 Results: Children with CBD had poor eye contact, response to names, poor imitation, poor pointing and poor one-step command following (p<0.001) compared to typically developing children. Children with CBD had poor eating habits (p<0.01),were more restless (p<0.001), and had a developmental delay (p<0.001) on SDST as compared to the other group. In children with CBD, the extent of screen media exposure was significantly correlated with restlessness (p<0.05) and poor pointing(p<0.01).
 Conclusion: Exposure to screen media at an early age and prolonged use of screens can lead to adverse developmental outcomes and behaviour issues in children. This is more evident in children with CBD than in typically developing children.

The Molteno Adapted Scale: A child development screening tool for healthcare settings

The Molteno Adapted Scale (MAS) is a developmental screening tool for children up to five years of age, used by medical practitioners in the Western Cape, South Africa. It generates subquotients for language, personal and social, fine and gross motor domains. The general quotient is the average of all four subquotients, with a score 85 indicating risk for global developmental delay. The authors aimed to determine the concurrent validity of the MAS, using the Bayley Scales of Infant and Toddler Development-3rd edition (BSID) as a comprehensive assessment reference measure. A total of 103 (55 girls) participants were enrolled from a longitudinal cohort study, of which 90 (49 girls) were assessed on both the MAS and BSID at 11–14 months, 53 (27 girls) at 30–42 months of age and 44 (21 girls) at both timepoints. The low number of developmentally delayed children precluded estimation of diagnostic accuracy of the MAS. Therefore, the authors determined Pearson correlation coefficients (r) for the MAS and BSID across similar domains at 11–14 months (n = 90) and 30–42 months (n = 53) and used the Bland–Altman analysis to detect bias between the MAS and BSID domain scores. Correlation was moderate to high between MAS and BSID domains, except for fine motor in 1-year-olds (r = 0.23), but Bland–Altman analysis found discordance especially between the MAS and BSID language and motor scores at the upper and lower performance ranges. Future studies should aim to standardise the operational procedures of the MAS, validate it across a wider age-range, and include children with varying degrees of delay.

Utility of the Ages and Stages Questionnaire to Identify Developmental Delay in Children Aged 12 to 60 Months

The Ages and Stages Questionnaire (ASQ) is a commonly used developmental screening tool, but its utility is debated. To conduct a a systematic review and meta-analysis to evaluate ASQ's utility as a screening or diagnostic tool to identify developmental delay in children aged 12-60 months. Medline, EMBASE, CINAHL, PsycINFO, and Mednar were searched from inception until December 2021. Studies meeting both criteria were included. ASQ was performed at age 12 to 60 months or where the median age at ASQ was at least 12 months and formal developmental assessments were done within 2 months of ASQ. True positive, false positive, false negative, and true negatives from individual studies were extracted. Meta-analysis was conducted with Stata version 16.1. Risk of bias was assessed using the QUADAS-2 tool. Certainty of evidence (COE) was assessed using GRADE guidelines. Ability of ASQ scores more than 2 SDs below the mean in more than 1 domain (ASQ-2SD) to identify any developmental delay or severe delay. Based on generally accepted interpretation of likelihood ratio (LR) values, a positive LR (PLR) more than 5 and a negative LR (NLR) of 0.2 or less were considered necessary to rule in or rule out developmental delay, respectively, with at least moderate probability. Initial search yielded 5777 citations of which 43 were included in the review. Of them, 36 were included in the meta-analysis. The pooled sensitivity, specificity, PLR, and NLR are as follows: ASQ-2SD to predict any delay in 1 or more domain (n = 16), 0.77 (95% CI, 0.64-0.86), 0.81 (95% CI, 0.75-0.86), 4.10 (95% CI, 3.17-5.30), and 0.28 (95% CI, 0.18-0.44); ASQ-2SD to predict severe delay in 1 or more domain (n = 15), 0.84 (95% CI, 0.75-0.90), 0.77 (95% CI, 0.71-0.82), 3.72 (95% CI, 2.98-4.64), and 0.20 (95% CI, 0.13-0.32); ASQ-2SD motor domain to predict motor delay (n = 7), 0.41 (95% CI, 0.26-0.57), 0.94 (95% CI, 0.87-0.97), 6.5 (95% CI, 3.8-11.1), and 0.63 (95% CI, 0.50-0.81); and ASQ-2SD cognitive domain to predict cognitive delay (n = 2), 0.44 (95% CI, 0.24-0.65), 0.93 (95% CI, 0.81-0.95), 6.4 (95% CI, 2.4-16.8), and 0.61 (95% CI, 0.43-0.86). The COE was low/very low. If a child aged 12 to 60 months passes all ASQ domains, there is a moderate probability that they do not have severe developmental delay (low COE). If a child aged 12-60 months fails the motor or cognitive domain of ASQ, there is a moderate probability that they have some motor or cognitive delay, respectively (very low COE). PROSPERO (CRD42021268543).

Designing and validating the Dubai Tool for Developmental Screening (DTDS).

BackgroundEarly detection of developmental problems is vital for facilitating early access to targeted intervention and augmenting its beneficial outcomes. Standardized developmental screening tools are known to enhance detection rates of developmental problems compared to clinical judgment alone and are widely recommended to be used in infants and young children. Most of the available developmental screening tools have been developed in Western countries. Many of their items may not be suitable for other cultures while others are expensive. Currently, none of the developmental screening tools have been validated in the United Arab Emirates (UAE), with only a few available in the Arabic language.ObjectiveTo create and validate a developmental screening tool, in both English and Arabic, that is simple, quick to use, and culturally relevant to the United Arab Emirates (UAE) child population aged 9–48 months.MethodsThe available literature was used to create a list of developmental milestones in five domains for children aged 9–48 months, divided into seven age groups. The selected milestones were used to create questionnaires in both English and Arabic, which were pilot tested twice. Each time, the results were analyzed and used to select, modify, and rephrase questions. Validation of the Dubai Tool for Developmental Screening (DTDS) was done against Parents' Evaluation of Developmental Status (PEDS) as a gold standard instrument. The DTDS and PEDS were administered cross-sectionally to parents of 1,400 children in seven age groups. Sensitivity, specificity, and kappa agreement of the DTDS compared with PEDS were calculated.ResultsThe DTDS had a sensitivity of 100% in four age groups and 75–78% in the other three age groups. Specificity ranged from 96 to 99% across all age groups. The kappa measure showed substantial agreement in five age groups, a moderate agreement in one age group, and a fair agreement in one age group.ConclusionsThe DTDS is a valid screening tool for early identification of developmental delays and disabilities in early childhood.

Predictive validity of the Infant Toddler Checklist in primary care at the 18-month visit and developmental diagnosis at 3–5 years: a prospective cohort study

ObjectiveThere is international variation in recommendations regarding developmental screening and growing recognition of the low sensitivity of commonly used developmental screening tools. Our objective was to examine the predictive validity...

Exploring the feasibility of validating early developmental screening tools for American Indian and Alaska Native children.

Screening children from birth through age 5 is critical to early identification of challenges and referral to intervention to support optimal development. Screening of American Indian and Alaska Native (AIAN) children lags behind that of other children, partly due to the lack of screening tools validated for this population. This study tested the feasibility of an online data collection strategy for use in a future study of the validity of existing screening instruments for AIAN children. Parents of AIAN children in four communities were recruited to complete screeners, provide demographic information, and provide feedback on experiences with online data collection. Participants were given the option of receiving screening results from the local early childhood program through which they were recruited. 240 participants began the process, 183 were enrolled in a partner program and reported a birthdate for at least one AIAN child, 157 had an age-eligible child, 81 began the consent process, 62 consented, and 39 fully completed data collection. Most participants were female and AIAN, the majority reported that online data collection was easy. Collecting screener validation data on a large sample of AIAN children may be able to utilize online data collection tools, with in-person support to facilitate participation.

Uptake of the culturally appropriate ASQ-TRAK developmental screening tool in the Australian Aboriginal and Torres Strait Islander context.

Recently in Australia, access to culturally safe developmental practices for Aboriginal and Torres Strait Islander families has been enhanced by the availability of a culturally appropriate developmental screening tool, the Ages and Stages Questionnaire - Talking about Raising Aboriginal Kids (ASQ-TRAK). This paper aims (i) to describe the uptake of the ASQ-TRAK developmental screening tool in Aboriginal Community Controlled Organizations and mainstream services in Australia and (ii) to explore the extent to which organizations using the ASQ-TRAK have engaged training for staff. A retrospective review of ASQ-TRAK sales and training records from January 2015 to May 2020 to determine the ASQ-TRAK distribution by jurisdiction and service type and the number of services that have engaged training. Five hundred ASQ-TRAK kits have been distributed across 77 agencies. Of those, 100 kits (20%) have been purchased by Aboriginal Community Controlled Organizations. Most have been distributed in the Northern Territory (NT) (178, 36%), Western Australia (165, 33%) and South Australia (64, 13%). Of the 15 ASQ-TRAK training workshops, nine have been in the NT. Of the 196 practitioners trained, 25 were identified as facilitators for their organization. Despite substantive research translation across Australia, with evidence of its acceptability in different contexts, most Aboriginal Community Controlled Organizations have not yet accessed the ASQ-TRAK, and most organizations have not participated in training. There is an imperative to progress knowledge translation to improve quality and accessibility of culturally appropriate developmental care. Adequately resourced ASQ-TRAK implementation support is needed to ensure sustainable implementation at scale.

Longitudinal associations between infant movement behaviours and development

BackgroundThis study aimed to address methodological limitations of the evidence that informed national and international movement behaviour guidelines for the early years. Specifically, the primary objective was to examine the longitudinal associations of infant physical activity (i.e., tummy time) and sedentary behaviour (i.e., back time, screen time, reading time, restrained time) with gross motor development. Secondary and tertiary objectives were to examine longitudinal associations of: (1) infant physical activity and sedentary behaviour with communication, fine motor, personal-social, and problem solving development, and (2) sleep time with primary and secondary outcomes.MethodsParticipants were 411 parents and their infants from the Early Movers project in Edmonton, Canada. Physical activity, sedentary behaviour, and sleep were measured with a parental questionnaire and the Ages & Stages Questionnaire (ASQ-3) developmental screening tool was administered at 2, 4, and 6 months. Parents reported the dates six major gross motor milestones (i.e., independent sitting, crawling, assisted standing, assisted walking, independent standing, independent walking) were acquired in the first 18 months of life according to World Health Organization criteria. In a subsample (n = 125), gross motor development was assessed using the Alberta Infant Motor Scale (AIMS) at 6 months.ResultsHigher tummy time across time points was significantly associated with higher ASQ-3 gross motor and personal-social development scores over time, higher total AIMS scores at 6 months, and earlier acquisition of all gross motor milestones. Higher reading time across time points was significantly associated with higher ASQ-3 fine motor, gross motor, personal-social, and total development scores over time. In contrast, higher back time across time points was significantly associated with lower total AIMS scores at 6 months and the later acquisition of assisted standing, assisted walking, and independent walking. Similarly, higher restrained time across time points was significantly associated with a later acquisition of supported walking.ConclusionsTummy time was consistently longitudinally associated with more advanced gross motor development and reading with more advanced total development. Whereas, some detrimental associations were observed for back and restrained time. Findings support the promotion of tummy time and certain sedentary behaviours (i.e., reading) in young infants to enhance overall development.

Indonesian Parents’ Evaluation of Developmental Status (PEDS) as Developmental Screening Tool for 0-3 Years Old Children

Background: Child development is an individualized, dynamic, and complex process. Screening for developmental delays in children is challenging. Parents have important roles in recognizing developmental delays in children, hence parent-completed questionnaire is a feasible option to screen for any developmental delays. The objective of this study is to analyze the items of Indonesian PEDS in 0-3 years old children as a screening tool for their development and behavior. Methods: This cross-sectional study was performed in Surabaya from August to September 2020. The questionnaire was distributed to mothers whose children were 0-3 years old. The item discrimination analysis was grouped into 0-17 months and 18-36 months. A point-biserial correlation test was carried out with a minimum significant correlation coefficient was 0.3 and a p-value <0.05. Results: A total of 92 mothers were enrolled in this study. Forty mothers were included in the 0-17 months group and 52 mothers in the 18-36 months group. There were four significant aspects of child development in the 0–17-month group, yet only expressive language and articulation had a strong correlation coefficient. While in the 18–36-month group, global/cognitive and social-emotional had a strong correlation coefficient. The other aspects had a correlation coefficient of > 0.3 (p<0.05) in both groups. Conclusion: The Indonesian PEDS is a potential developmental screening tool for Indonesian children aged 0-3 years old.

Predictive utility of the ages and stages questionnaire for below average cognitive ability at age 5

Abstract Background The first 1000 days of life are a period of unique sensitivity and plasticity during which critical cognitive abilities are formed. For children at risk of later cognitive difficulties, this period is the ideal target for early intervention initiatives. Routine developmental screening tools aim to identify infants who would benefit from early intervention. While these tools have been validated for detecting children with more severe neurodevelopmental disorders, their ability to identify the larger proportion with below average cognitive ability has not been sufficiently explored. The aim of this study was to examine the predictive utility of the Ages and Stages Questionnaire (ASQ), for identifying children with later below average cognitive function. Methods The study population (n = 8260) is formed from two national cohort studies, the Growing Up in Ireland Infant cohort (n = 7,444) and the Cork BASELINE cohort (n = 816). The ASQ was completed at 8- and 24-months respectively. Cognitive assessments were performed at age 5. Those scoring <1 standard deviation below the mean were categorised as below average cognitive ability. Applying the currently used onward referral criterion (one fail in any domain) the sensitivity, specificity, positive and negative predictive values of the 8- and 24-month ASQ for detecting children with later below average cognitive function were calculated. Results The sensitivities of the 8-month and 24-month ASQ for detecting children with below average cognitive ability were 16.4% (95% CI 14.0-19.0) and 20.8% (95% CI 13.6-30.2) respectively, with specificity of 92.0% (95% CI 91.3-92.6) and 91.1% (95% CI 88.6-93.2). Conclusions The ASQ has a low sensitivity for identifying children with below average cognitive ability at age 5. The findings of this study suggest that if we are to intervene early in the developmental trajectory for children with below average cognitive ability alternative methods of identifying high risk infants are needed. Key messages The ages and stages questionnaire, a widely used routine infant developmental screening tool, has a low sensitivity between 16%-21% for detecting later below average cognitive ability. To enable intervention in the first 1000 days of life for children at risk of later below average cognitive ability alternative methods of screening and risk identification require investigation.

The ASQ-TRAK: Validating a culturally adapted developmental screening tool for Australian Aboriginal children

BackgroundDevelopmental monitoring, performed using culturally relevant tools, is of critical importance for all young children. The ASQ-TRAK is the culturally and linguistically adapted Ages and Stages Questionnaire (ASQ-3), a developmental screening tool, for Australian Aboriginal children. While the ASQ-TRAK has been well received in practice, investigating its psychometric properties will enable professionals to make informed decisions about its use. AimsTo conduct a rigorous validation study of the ASQ-TRAK by applying Kane's argument-based approach. SubjectsThe ASQ-TRAK, Bayley-III and/or BDI-2 were administered cross-sectionally to 336 Australian Aboriginal children aged 2–48 months across ten participating sites in the Northern Territory and South Australia. A sample of staff and caregivers completed feedback surveys about the ASQ-TRAK. ResultsASQ-TRAK domain scores were moderately positively correlated with corresponding domain scores on the Bayley-III or BDI-2. Inter-rater and inter-instrument reliability were high. Sensitivity (83%), specificity (83%) and negative predictive value (99%) were acceptable. Staff and caregivers expressed high levels of satisfaction with the ASQ-TRAK. ConclusionsRegular developmental screening can provide important information about developmental vulnerability and the need for services. The ASQ-TRAK should be administered by trained Aboriginal community-based workers and the implementation approach carefully planned. Areas for future research include longitudinal follow-up of children, investigating existing norms and cut-off scores, and considering the appropriateness of the ASQ-TRAK with Aboriginal people from different locations. The ASQ-TRAK has the potential to fill an important gap by enabling better access to high-quality developmental monitoring and targeted early intervention.

Neurodisability: Effective tools with limited resources

An estimated 150 million children suffer from some kind of disability; Most of these children live in low- and middle-income countries (LMNCs) with very limited resources. Early identification of developmental disability is essential to provide early intervention. Specific child development assessment tools (CDATs) are used to evaluate these interventions. Several well validated developmental screening and assessment tools are available in developed countries. An important challenge is in using these tools in resource constrained settings as they are often not culture -free, need skilled professionals, take a long time to administer, and translation licenses are very expensive.

Agreement and Reliability of Parental Reports and Direct Screening of Developmental Outcomes in Toddlers at Risk.

Developmental screening is a practice that directly benefits vulnerable and low-income families and children when it is regular and frequently applied. A developmental screening tool administered by parents called CARE is tested. CARE contains a compilation of activities to report and enhance development at home. Hundred and fifty-seven families in Bogotá (Colombia) initially responded to a call to participate in developmental screening tools’ validation and reliability study. All children (Average: 42.7 months old; SD: 9.4; Min: 24, Max: 58) were screened directly by trained applicants using a Spanish version of the Denver Developmental Screening test [i.e., the Haizea-Llevant (HLL) screening table]. After a first screening, 61 dyads were positive for follow-up and received a second HLL screening. Fifty-two out of 61 dyads use and returned CARE booklet after 1-month screening at home. The comparative analysis for parent reports using CARE and direct screening observation included (a) the effects of demographic variables on overall and agreement, (b) agreement and congruence between the CARE report classification and direct screening classification (“At risk” or “Not at risk”), (c) receiver operating characteristic analysis, (d) item-Level agreement for specific developmental domains, and (e) acceptability and feasibility analysis. Results and conclusions show the parental report using the CARE booklet as a reliable screening tool that has the potential to activate alerts for an early cognitive delay that reassure clinicians and families to further specialized and controlled developmental evaluations and act as a screen for the presence of such delay in four developmental dimensions.

Evaluating the PEDS:DM Developmental Screening Tool in Zulu and Northern Sotho

Screening of children's developmental milestones is imperative for early identification of developmental delays and early intervention. Translated developmental screening tools increase accessibility and in turn enable timely identification and intervention, which allows children to reach their potential. This quantitative study evaluated the translation accuracy of the Northern Sotho and Zulu Parents Evaluation Development Status: Developmental Milestones (PEDS:DM) in comparison with the English version of the tool. The study was conducted at a regional healthcare facility in South Africa. Stratified convenience sampling was utilised with a total of 546 caregivers representing children from 1 month to 6 years of age. The findings generally reflected a strong correspondence between the English and Northern Sotho, and the English and Zulu PEDS:DM tool, respectively. A few test items in the expressive language domain did not correspond significantly between languages. This could be due to cultural and social differences and should be investigated.

Awareness screening and referral patterns among pediatricians in the United States related to early clinical features of spinal muscular atrophy (SMA)

BackgroundSpinal Muscular Atrophy (SMA), a leading genetic cause of death in infants, is an autosomal recessive neuromuscular disease characterized by progressive muscle weakness and atrophy. While early diagnosis of SMA is critical to modifying disease progression and improving outcomes, serious diagnostic delays persist. There is a need to improve SMA awareness, screening, and referral patterns.MethodsTwo online surveys, developed by Cure SMA for general pediatricians, were distributed by Medscape Education via email (September 2018, n = 300, December 2019, n = 600). The surveys asked about adherence to the American Academy of Pediatrics (AAP) developmental screening and surveillance guidelines, comfort with identification of early signs of neuromuscular disease (NMD), familiarity with SMA, and barriers to timely referral.ResultsIn 2018, 70.3% of survey respondents indicated comfort in identifying early signs of NMD and 67.3% noted familiarity with SMA. 52.7% correctly indicated the need for genetic testing to make a definitive diagnosis of SMA, 74.0% meet or exceed developmental screening recommendations, and 52.0% said they would immediately refer to a specialist. In 2019, with a larger sample, 73.0% adhere to developmental screening guidelines, and awareness of the genetic testing requirement for SMA was significantly lower by 7.7% (p < 0.03). Specialist wait times emerged as a barrier to referral, with 64.2% of respondents citing wait times of 1–6 months.ConclusionsMany pediatricians underutilize developmental screening tools and lack familiarity with diagnostic requirements for SMA. Continuing efforts to expand awareness and remove barriers to timely referral to SMA specialists, including reducing appointment wait times, are needed.