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Published on: August 25, 2014
Parent screening questionnaires to detect cognitive and language delay at 2 years in high-risk infants: an analysis
Kate L Rawnsley1,2, Lex W Doyle2,3,4,5, Peter J Anderson2,6
1Department of Physiotherapy, The University of Melbourne, Carlton, Victoria, Australia kate.rawnsley@student.unimelb.edu.au.
Insights
Neither the Parent Report of Children's Abilities-Revised (PARCA-R) nor the Ages & Stages Questionnaires Third Edition (ASQ-3) accurately screened for cognitive delay in extremely preterm infants. Both tools were better at identifying language delay, with PARCA-R outperforming ASQ-3.
Area of Science:
- Developmental Pediatrics
- Neonatal Follow-up
- Screening Tools Accuracy
Background:
- Extremely preterm (EP) infants and those with extremely low birth weight (ELBW) are at high risk for developmental delays.
- Accurate and timely developmental screening is crucial for early intervention in this vulnerable population.
- The Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) is a standard measure for assessing infant development.
Purpose of the Study:
- To evaluate the accuracy of the Parent Report of Children's Abilities-Revised (PARCA-R) and the Ages & Stages Questionnaires Third Edition (ASQ-3) in detecting cognitive and language delay in EP/ELBW infants.
- To compare the performance of PARCA-R and ASQ-3 against the Bayley-III as the gold standard.
- To assess the utility of combining both screening tools.
Main Methods:
- A prospective cohort study was conducted in Victoria, Australia.
- 211 infants born EP/ELBW were assessed at 2 years corrected age.
- Developmental delay was defined as a score of <-1 SD on the Bayley-III cognitive and language scales. PARCA-R and ASQ-3 were administered for screening.
Main Results:
- Neither PARCA-R nor ASQ-3 demonstrated substantial agreement with Bayley-III for cognitive delay detection (Kappa values: PARCA-R 0.43, ASQ-3 0.15).
- PARCA-R showed higher sensitivity (70%) and specificity (73%) than ASQ-3 (62% sensitivity, 53% specificity) for cognitive delay.
- Combining PARCA-R and ASQ-3 increased sensitivity (78%) but decreased specificity (45%) for detecting delay; similar trends were observed for language delay.
Conclusions:
- Current developmental screening questionnaires, PARCA-R and ASQ-3, have limited accuracy in identifying cognitive delay in extremely preterm infants.
- Both tools are more effective in screening for language delay, with PARCA-R being more accurate than ASQ-3.
- While combining PARCA-R and ASQ-3 enhances sensitivity for detecting developmental delay, it significantly compromises specificity, necessitating careful consideration in clinical application.
Objective:
To determine the accuracy of two developmental screening questionnaires to detect cognitive or language delay, defined using the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III), in children born extremely preterm (EP: <28 weeks' gestation) or extremely low birth weight (ELBW: <1000 g).
Design:
Prospective cohort study.
Setting:
State of Victoria, Australia.
Patients:
211 infants born EP/ELBW assessed at 2 years' corrected age (mean 2.2, SD 0.2).
Main Outcome Measures:
Cognitive and language delay (<-1 SD) on the Bayley-III. The screening questionnaires were the Parent Report of Children's Abilities-Revised (PARCA-R) and the Ages & Stages Questionnaires Third Edition (ASQ-3).
Results:
The PARCA-R performed better than the ASQ-3, but neither questionnaire had substantial agreement with the Bayley-III to detect cognitive delay; kappa (95% CI): PARCA-R 0.43 (0.23, 0.63); ASQ-3 0.15 (-0.05, 0.35); sensitivity (95% CI): PARCA-R 70% (53%, 84%) ASQ-3 62% (47%, 76%); specificity (95% CI): PARCA-R 73% (60%, 84%) ASQ-3 53% (38%, 68%). When both tools were used in combination (below cut-off on at least one assessment), sensitivity increased to 78% (60%, 91%) but specificity fell to 45% (29%, 62%). Similar trends were noted for language delay on the Bayley-III, although kappa values were better than for cognitive delay.
Conclusions:
Neither screening questionnaire identified cognitive delay well, but both were better at identifying language delay. The PARCA-R detects delay on the Bayley-III more accurately than the ASQ-3. Sensitivity for detecting delay is greatest when the PARCA-R and ASQ-3 were used in combination, but resulted in lower specificity.
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