Developing a population-based proxy score of social developmental delay for pre-school children in a lower-middle...

The distribution of early social developmental delays, which are often associated with autism spectrum disorder (ASD), is not well documented in low and middle-income countries. The UNICEF Multiple Indicator Cluster Survey (MICS) collects population-representative data on child health in many countries.

The objective of the study was to create a social developmental delay scale to estimate population-based early social delay relevant for ASD among pre-school children and identify characteristics associated with delay in a lower-middle-income country.

Data were from the Honduran 2019 MICS6. We created a 10-point social developmental delay proxy score (SDDPS) with scores ≥3 indicating possible delay. Using data from children 48-59-month-old (n = 1723), reported by primary caregivers, we estimated prevalence of social developmental delays; we used linear and Poisson regressions to characterize associations between SDDPS and socio-demographic characteristics.

Applying the SDDPS, 4.6 % (95 % CI: 0.61 %:8.66 %) of 4-year-olds in Honduras had scores consistent with social developmental delays, indicated by 3 or more domains of concern relating to learning behavior and social interaction. Sixty-five percent had one or two domains of possible concern, with scores in domains relating to learning behavior being the most common. Differences across sex, age, urbanicity, and socioeconomic status were not significantly associated with delays in multivariate models.

Existing surveys may be used to yield population-relevant data on social developmental delay in settings where more sensitive measures are not available at the population level. The SDDPS provided a preliminary estimate of the prevalence of social developmental delays in a lower-middle income Latin American country. The scale must be validated for use in this and other populations.