Development and preliminary testing of the Brief Developmental Assessment: an early recognition tool for children
Jo Wray1, Katherine L Brown1, Deborah Ridout2
11Charles West Division,Great Ormond Street Hospital for Children NHS Foundation Trust,Great Ormond Street,London,United Kingdom.
Insights
A new Brief Developmental Assessment tool helps identify neurodevelopmental concerns in children with congenital heart disease (CHD). Early detection through this tool aids timely intervention for better outcomes.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Quality Improvement Science
Background:
- Neurodevelopmental abnormalities are prevalent in children with congenital heart disease (CHD), posing significant concerns for families and healthcare providers post-cardiac surgery.
- Current UK practice lacks routine developmental monitoring for children with CHD, potentially leading to delayed detection and intervention for neurodevelopmental issues.
Purpose of the Study:
- To develop and pilot an early recognition tool for assessing neurodevelopmental progress in pediatric patients with CHD.
- To create a practicable tool for use by non-specialist pediatric cardiac health professionals in various clinical settings.
Main Methods:
- The Brief Developmental Assessment was created using quality improvement methodology, involving iterative development and pilot testing.
- The tool covers key developmental domains including motor skills, communication, and socialisation, with items tailored for five age bands.
- It incorporates direct observation and parental report, designed for use without specialized equipment.
Main Results:
- The assessment tool includes items from established developmental measures and features a traffic light scoring system to flag potential delays.
- Preliminary testing demonstrated excellent inter-rater reliability and the ability to identify children with known developmental risks.
- The tool showed largely acceptable internal reliability and feasibility for clinical use.
Conclusions:
- The evolution and preliminary testing of the Brief Developmental Assessment tool for children with heart disease are encouraging.
- The tool shows promise for early identification of neurodevelopmental concerns, warranting further validation in larger studies.
Abstract:
Introduction Neurodevelopmental abnormalities are common in children with CHD and are the highest-priority concerns for parents and professionals following cardiac surgery in childhood. There is no additional routine monitoring of development for children with CHD in the United Kingdom; hence, neurodevelopmental concerns may be detected late, precluding early referral and intervention.
Methods:
An early recognition tool - the "Brief Developmental Assessment" - was developed using quality improvement methodology involving several iterations and rounds of pilot testing. Our requirements were for a tool covering important developmental domains and practicable for use within inpatient and outpatient settings by paediatric cardiac health professionals who are non-developmental specialists, without specialised equipment and which involved direct observation, as well as parental report.
Results:
Items were included in the tool based on existing developmental measures, covering the domains of gross and fine motor skills, daily living skills, communication, socialisation, and general understanding. Items were developed for five age bands - 0-16 weeks, 17-34 weeks, 35-60 weeks, 15 months-2.9 years, and 3-4.9 years - and the final versions included a traffic light scoring system for identifying children with possible delay in any or all domains. Preliminary testing indicated excellent inter-rater reliability, an ability to detect children with a diagnosis known to be associated with developmental delay, and largely acceptable internal reliability.
Conclusion:
We report the evolution and preliminary testing of an early recognition tool for assessing the development of children with heart disease; this was encouraging and sufficiently good to support further validation in a larger study.
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