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Validation of key Denver Developmental Screening Test items: a preliminary study
W K Frankenburg1, C Y Ker, S Engelke
1Department of Pediatrics, University of Colorado Health Sciences Center, Denver 80262.
Insights
Researchers identified 39 key Denver Developmental Screening Test (DDST) items for children aged 0-6 years. This subset efficiently screens for developmental delays, reducing overreferrals while maintaining accuracy.
Area of Science:
- Pediatrics
- Developmental Psychology
- Public Health
Background:
- The Denver Developmental Screening Test (DDST) is a widely used tool for assessing child development.
- Efficient and accurate screening is crucial for early identification of developmental delays.
- Optimizing the DDST can improve resource allocation and reduce unnecessary referrals.
Purpose of the Study:
- To identify a minimal subset of Denver Developmental Screening Test (DDST) items that accurately screen children from birth to 6 years.
- To validate this subset across diverse populations, including high-risk groups.
- To establish guidelines for efficient DDST administration and interpretation.
Main Methods:
- Binary integer programming was employed to analyze DDST item data from a large cohort (n=2343).
- Sequential validation studies were conducted with independent samples (n=113 and n=180).
- Statistical analysis focused on identifying items that maximized the detection of abnormal and questionable DDST results.
Main Results:
- A core set of 39 DDST items was identified, covering all age ranges and developmental domains.
- This 39-item subset demonstrated high accuracy in identifying abnormal (100%) and abnormal/questionable (91.7-97.9%) DDST results across studies.
- Administration requires an average of only four items per age, significantly streamlining the screening process.
Conclusions:
- The identified 39 key DDST items provide a valid and efficient method for developmental screening in young children.
- This optimized subset can help reduce overreferrals in primary care settings, particularly for low-income populations.
- Accurate administration according to the DDST manual is essential for the reliability of the key item subset.
Abstract:
Three sequential studies were undertaken to identify a subset of 39 key Denver Developmental Screening Test (DDST) items covering the ages from birth to 6 years. The first study used binary integer programming with a sample of 2343 children evaluated with the DDST in Denver's Neighborhood Health Program. It identified 35 DDST items that would identify 100% abnormal and 97.9% abnormal and questionable DDSTs. A further validation with 113 Pitt County, North Carolina, children indicated that the addition of four more DDST items to the previous 35 would identify 100% abnormal and 92.6% abnormal and questionable DDSTs. A third study cross-validating the 39 items with a sample of 180 children at "high risk" identified 100% abnormal and 91.7% abnormal and questionable DDSTs. The 39 key DDST items ranged throughout the entire age span and among the DDST's four sectors. Use requires the administration of approximately four items at any one age, on average. Those children with suspect scores on the key DDST items (about 19% of a low-income population) should be screened with the remainder of the DDST to decrease overreferrals. For accuracy, the key DDST items must be administered in the manner prescribed in the DDST manual.