Identifying neurodevelopmental disabilities from nationalised preschool health check

Area of Science:

• Pediatric Health
• Developmental Psychology
• Public Health Surveillance

Background:

• Psychometric screening models for identifying neurodevelopmental disabilities (NDDs) have shown limited success.
• Aotearoa/New Zealand utilizes the Before School Check (B4SC) for routine developmental surveillance in preschool children, incorporating psychometric and physical health screening.
• Existing methods for NDD identification often rely on individual screening measures, potentially limiting predictive accuracy.

Purpose of the Study:

• To evaluate if combining multiple screening measures within the B4SC can enhance the prediction of neurodevelopmental disabilities (NDDs) in preschool children.
• To compare the predictive performance of a composite screening model against current referral pathways.

Main Methods:

• Linked administrative health data were used to identify NDDs (including ADHD, ASD, and intellectual disability) in a national cohort of children who underwent the B4SC.
• Cox proportional hazards models were employed to predict NDD onset using various combinations of screening predictors.
• Harrell's c-statistic was used to compare the predictive power of composite models against a model based on recommended psychometric referral cutoffs.

Main Results:

• The study analyzed data from 287,754 children, identifying NDDs in 10,953 (3.8%).
• The optimal composite model, integrating the Strengths and Difficulties Questionnaire, Parental Evaluation of Developmental Status, vision screening, and biological sex, demonstrated 'excellent' predictive power (C-statistic: 0.83).
• This composite model significantly outperformed existing referral pathways (C-statistic: 0.68) and improved NDD detection sensitivity by 13% without compromising specificity.

Conclusions:

• Combining B4SC screening measures through composite modeling substantially improves the identification of preschool children with NDDs compared to relying on individual psychometric tests.
• This enhanced identification can optimize access to crucial academic, personal, and family support services for children with NDDs.
• The findings support the integration of a multi-measure approach in early childhood developmental surveillance programs.