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Developmental assessment of preterm infants at 2 years: validity of parent reports
Samantha Johnson1, Dieter Wolke, Neil Marlow
1School of Human Development, University of Norttingham, Nottingham, UK. sam.johnson@nottingham.ac.uk
Insights
The Parent Report of Children's Abilities (PARCA-R) accurately identifies cognitive delays in very-preterm infants. This validated questionnaire offers a cost-effective tool for developmental screening and outcome measurement.
Area of Science:
- Developmental Pediatrics
- Neonatology
- Psychometrics
Background:
- Parental questionnaires offer a cost-effective alternative to standardized testing for assessing child development.
- The Parent Report of Children's Abilities-Revised (PARCA-R) was previously validated for very-preterm infants at 2 years corrected age.
- Revalidation in a larger, more inclusive sample is crucial for confirming its utility.
Purpose of the Study:
- To revalidate the PARCA-R for assessing cognitive abilities in a diverse cohort of very-preterm infants.
- To evaluate the concurrent validity and diagnostic utility of the PARCA-R against a gold-standard developmental assessment.
- To establish optimal cut-off scores for identifying cognitive delay using the PARCA-R.
Main Methods:
- 164 very-preterm infants (<32 weeks gestation) were assessed at 2 years corrected age using the Mental Development Index (MDI) of the Bayley Scales of Infant Development-II (BSID-II).
- Parents completed the PARCA-R questionnaire concurrently.
- Statistical analyses, including correlation and receiver operating characteristic (ROC) curve analysis, were performed to determine validity and diagnostic accuracy.
Main Results:
- A significant positive correlation (r=0.77) was found between PARCA-R Parent Report Composite (PRC) scores and MDI scores, confirming concurrent validity.
- The PARCA-R demonstrated strong diagnostic utility, with an optimal PRC cut-off of <44 showing high sensitivity (85%) and specificity (87%) for identifying MDI <70.
- The negative predictive value was excellent (98%), indicating high confidence in ruling out cognitive delay when the PARCA-R score is above the cut-off.
Conclusions:
- The PARCA-R is a valid and reliable tool for assessing cognitive development in very-preterm infants at 2 years corrected age.
- The questionnaire possesses significant diagnostic utility for identifying cognitive delay, serving as an effective screening tool.
- PARCA-R facilitates outcome measurement, developmental screening, and enhances parental engagement during follow-up assessments.
Abstract:
Parental questionnaires are inexpensive alternatives to standardized testing for outcome measurement. The Parent Report of Children's Abilities has previously been revised (PARCA-R) and validated for use with very-preterm infants at 2 years of age. This study revalidated the PARCA-R for assessing cognition in a larger and more inclusive sample of preterm infants. One hundred and sixty-four children (82 males, 82 females) of <32 weeks' gestation (median 29wks, interquartile range [IQR] 28-30wks); and median birthweight 1200g (IQR 925-1463g) were evaluated using the Mental Development Index (MDI) of the Bayley Scales of Infant Development - 2nd edition (BSID-II) at 2 years' corrected age. Parents completed the PARCA-R questionnaire. Significant correlations between PARCA-R Parent Report Composite (PRC) scores and MDI scores (r=0.77, 95% confidence interval [CI] 0.69-0.82, p<0.01) demonstrated concurrent validity. A receiver operating characteristic-determined PRC cut-off of <44 had optimal discriminatory power (area under curve 0.92) for identifying MDI <70, with 85% sensitivity (95% CI 0.58-0.96), 87% specificity (95% CI 0.81-0.92), 98% negative predictive value (95% CI 0.95-1), and 37% positive predictive value (95% CI 0.22-0.54). The PARCA-R has good concurrent validity and diagnostic utility for identifying cognitive delay in very-preterm infants at 2 years of age. It is useful for outcome measurement, developmental screening, and facilitating parental involvement at follow-up.
