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Updated: Jun 1, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Parent-completed developmental screening in premature children: a valid tool for follow-up programs
Cyril Flamant1, Bernard Branger, Sylvie Nguyen The Tich
1Department of Neonatal Medicine, University Hospital, Nantes, France. cyril.flamant@chu-nantes.fr
Insights
The Ages and Stages Questionnaires (ASQ) reliably screen psychomotor development in 2-year-old ex-premature infants. This tool is effective regardless of socioeconomic status, aiding early detection and parental involvement.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Screening Tools
Background:
- Preterm infants face higher risks of psychomotor developmental delays.
- Early identification of developmental issues is crucial for timely intervention.
- Parental screening tools can facilitate early detection in large cohorts.
Purpose of the Study:
- To validate the parental Ages and Stages Questionnaires (ASQ) for psychomotor development screening in ex-premature infants at 2 years corrected age.
- To assess the impact of socioeconomic status and maternal education on ASQ efficacy.
- To evaluate ASQ's predictive accuracy against established psychometric tests.
Main Methods:
- A cohort of 703 very preterm infants (<35 weeks gestational age) were assessed at 2 years.
- Parents completed the ASQ; infants underwent pediatric examination and the revised Brunet Lezine psychometric test (DQ score).
- Statistical analysis included receiver operating characteristic (ROC) curve analysis to determine ASQ's discriminatory power.
Main Results:
- The ASQ demonstrated good predictive value for identifying a developmental quotient (DQ) score ≤85 (Area Under Curve = 0.85).
- An ASQ cut-off score of ≤220 showed optimal discrimination (sensitivity 0.85, specificity 0.72).
- ASQ scores were not significantly associated with socioeconomic status or maternal education, indicating broad applicability.
Conclusions:
- The parental Ages and Stages Questionnaires (ASQ) is a valid and reliable screening tool for psychomotor development in 2-year-old ex-premature infants.
- ASQ efficacy is independent of socioeconomic factors, making it suitable for diverse populations.
- ASQ offers a low-cost, beneficial addition to follow-up programs, promoting parental engagement in infant development.
Abstract:
Our goals were to (1) validate the parental Ages and Stages Questionnaires (ASQ) as a screening tool for psychomotor development among a cohort of ex-premature infants reaching 2 years, and (2) analyse the influence of parental socio-economic status and maternal education on the efficacy of the questionnaire. A regional population of 703 very preterm infants (<35 weeks gestational age) born between 2003 and 2006 were evaluated at 2 years by their parents who completed the ASQ, by a pediatric clinical examination, and by the revised Brunet Lezine psychometric test with establishment of a DQ score. Detailed information regarding parental socio-economic status was available for 419 infants. At 2 years corrected age, 630 infants (89.6%) had an optimal neuromotor examination. Overall ASQ scores for predicting a DQ score ≤85 produced an area under the receiver operator curve value of 0.85 (95% Confidence Interval:0.82-0.87). An ASQ cut-off score of ≤220 had optimal discriminatory power for identifying a DQ score ≤85 with a sensitivity of 0.85 (95%CI:0.75-0.91), a specificity of 0.72 (95%CI:0.69-0.75), a positive likelihood ratio of 3, and a negative likelihood ratio of 0.21. The median value for ASQ was not significantly associated with socio-economic level or maternal education. ASQ is an easy and reliable tool regardless of the socio-economic status of the family to predict normal neurologic outcome in ex-premature infants at 2 years of age. ASQ may be beneficial with a low-cost impact to some follow-up programs, and helps to establish a genuine sense of parental involvement.
