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Published on: August 25, 2014
Development of a triage tool for neurodevelopmental risk in children aged 30 months
Fiona Sim1, Caroline Haig2, John O'Dowd3
1Centre for Rural Health, University of Aberdeen, Centre for Health Sciences, Old Perth Rd, Inverness IV2 3JH, Scotland, UK.
Insights
Simple screening tools, the Sure Start Language Measure (SSLM) and Strengths and Difficulties Questionnaire (SDQ), show promise for identifying young children at risk of developmental delays and psychiatric disorders, aiding clinical judgment.
Area of Science:
- Child Psychology
- Developmental Pediatrics
- Public Health Screening
Background:
- Neurodevelopmental and neuropsychiatric disorders in early childhood are linked to long-term educational, health, and social challenges.
- Early identification of these disorders is crucial for mitigating their impact, yet validated screening tools are scarce.
- Existing screening methods often lack robust validation for predicting future developmental outcomes.
Purpose of the Study:
- To develop and evaluate the predictive validity of simple screening tools for neurodevelopmental problems in 30-month-old children.
- To assess the ability of the Sure Start Language Measure (SSLM) and Strengths and Difficulties Questionnaire (SDQ) to predict later developmental and psychiatric disorders.
- To determine the combined performance of SSLM and SDQ in identifying children at risk for neurodevelopmental issues.
Main Methods:
- A community sample of 30-month-old children was screened using the SSLM and SDQ.
- Predictive validity was assessed by comparing screening results with detailed psychometric assessments 1-2 years later.
- Receiver Operating Characteristic (ROC) analysis, including area under the curve (AUC), was used to evaluate screening performance.
Main Results:
- The SSLM demonstrated strong predictive accuracy for language disorder (AUC 0.905) and global developmental delay (AUC 0.983).
- The SDQ effectively predicted psychiatric disorders at follow-up (AUC 0.821).
- Combined SSLM and SDQ screening showed 87% sensitivity and 64% specificity for predicting any neurodevelopmental problem, with a 97% negative predictive value.
Conclusions:
- While not sufficient as a stand-alone population screening tool, the SSLM and SDQ show promise in identifying at-risk preschool children.
- These tools can aid clinical judgment as interim triage measures, particularly in resource-limited settings.
- Further validation and consideration of high false positive rates are necessary for population-level screening.
Abstract:
Neurodevelopmental and neuropsychiatric disorders in young children predict educational, health and social problems. Early identification may significantly reduce this burden but relevant tools largely lack validation. We aimed to develop and evaluate the predictive validity of a simple screening tool for neurodevelopmental problems in a community sample of 30 month old children. A sample of children was selected from a community cohort screened at 30 months by health visitors using the Sure Start Language Measure (SSLM) and the Strengths and Difficulties Questionnaire (SDQ) in 2011. Predictive validity was assessed by comparing screening results with detailed psychometric data from the same sample 1-2 years later. Screening performance using different thresholds was explored using Receiver Operating Characteristic (ROC) with ROC area under the curve (AUC) and bootstrapping techniques. The SSLM predicted both language disorder identified by the New Reynell Developmental Language Scales (NRDLS) at follow-up (AUC 0.905) and global developmental delay assessed by the Griffiths Mental Development Scales (AUC 0.983). The SDQ administered at 30 months predicted psychiatric disorders identified by the Development and Wellbeing Assessment (DAWBA) at follow-up (AUC 0.821). Using optimal cut-offs for the SDQ and SSLM at 30 months, both tools together had sensitivity 87%; specificity 64%; positive predictive value 31%; and negative predictive value 97% in the prediction of any kind of neurodevelopmental problem 1-2 years later. The combined measure reported here is not yet sufficient as a stand-alone population screening tool for neurodevelopmental disorders. The SSLM and SDQ did however show promise in identifying preschool children at risk of ongoing language, psychiatric disorders and global developmental delay 1-2 years later but with fairly high false positive rates. Given that current developmental risk prediction in resource-poor settings is little better than random assignment, the SDQ and SSLM may aid clinical judgement when used as interim triage tools for practitioners with no specialist knowledge, in the context of longitudinal follow-up arrangements.
