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Diagnostic accuracy of ASQ for screening of neurodevelopmental delays in low resource countries
Albert Manasyan1,2, Ariel A Salas3, Tracy Nolen4
1Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA AlbertManasyan@uabmc.edu.
Insights
The Ages and Stages Questionnaire (ASQ) shows high specificity for identifying severe neurodevelopmental impairment in infants, making it a useful screening tool in low-resource settings. While sensitivity is moderate-to-low, ASQ can aid healthcare workers in detecting significant developmental delays.
Area of Science:
- Global Health
- Pediatric Neurodevelopment
- Screening Tools
Background:
- The Bayley Scales of Infant Development (BSID) is a diagnostic standard but difficult to implement in low-resource countries.
- The Ages and Stages Questionnaire (ASQ) is a low-cost, parent-completed tool for screening developmental delays.
Purpose of the Study:
- To evaluate the performance of the ASQ as a screening tool for neurodevelopmental impairment.
- To compare ASQ screening with the BSID-II diagnostic standard in infants aged 12 and 18 months in low-resource settings.
Main Methods:
- 1034 infants from the Democratic Republic of Congo, Zambia, Guatemala, and Pakistan were assessed.
- Neurodevelopmental assessments were conducted using both ASQ and BSID-II by trained personnel at 12 and 18 months.
Main Results:
- At 18 months, ASQ demonstrated specificities over 90% for severe neurodevelopmental delay across four domains.
- Sensitivities for ASQ ranged from 23% to 62%.
- The strongest correlations were between ASQ communication and BSID-II Mental Development Index (MDI) (r=0.38), and ASQ gross motor and BSID-II Psychomotor Development Index (PDI) (r=0.33).
Conclusions:
- ASQ exhibits high specificity but moderate-to-low sensitivity for identifying infants with MDI and/or PDI <70 at 18 months.
- When administered by trained healthcare workers, ASQ can be a valuable screening tool for severe disabilities in infants in low- and middle-income countries.
Objective:
The Bayley Scales of Infant Development (BSID) is the most used diagnostic tool to identify neurodevelopmental disorders in children under age 3 but is challenging to use in low-resource countries. The Ages and Stages Questionnaire (ASQ) is an easy-to-use, low-cost clinical tool completed by parents/caregivers that screens children for developmental delay. The objective was to determine the performance of ASQ as a screening tool for neurodevelopmental impairment when compared with BSID second edition (BSID-II) for the diagnosis of moderate-to-severe neurodevelopmental impairment among infants at 12 and 18 months of age in low-resource countries.
Methods:
Study participants were recruited as part of the First Bites Complementary Feeding trial from the Democratic Republic of Congo, Zambia, Guatemala and Pakistan between October 2008 and January 2011. Study participants underwent neurodevelopmental assessment by trained personnel using the ASQ and BSID-II at 12 and 18 months of age.
Results:
Data on both ASQ and BSID-II assessments of 1034 infants were analysed. Four of five ASQ domains had specificities greater than 90% for severe neurodevelopmental delay at 18 months of age. Sensitivities ranged from 23% to 62%. The correlations between ASQ communications subscale and BSID-II Mental Development Index (MDI) (r=0.38) and between ASQ gross motor subscale and BSID-II Psychomotor Development Index (PDI) (r=0.33) were the strongest correlations found.
Conclusion:
At 18 months, ASQ had high specificity but moderate-to-low sensitivity for BSID-II MDI and/or PDI <70. ASQ, when administered by trained healthcare workers, may be a useful screening tool to detect severe disability in infants from rural low-income to middle-income settings.
Trial Registration Number:
NCT01084109.
