Case-control accuracy study for TOY8 digital developmental screening tool for detecting delays among children aged
Teck-Hock Toh1,2,3,4, Yvonne Mei-Fong Lim5, Jeffrey Soon-Yit Lee1,2
1Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia.
Frontiers in Pediatrics
|December 18, 2025
Summary
The TOY8 smartphone tool effectively screens for developmental delays in young children, showing good accuracy and high parental acceptance. This digital solution is ideal for early detection in resource-limited settings.
Area of Science:
- Pediatric developmental screening
- Digital health tools
- Global child development
Background:
- Developmental delays impact up to 18% of children globally, disproportionately affecting disadvantaged populations.
- Existing screening tools are often resource-intensive and language-dependent, limiting use in low- and middle-income countries.
- TOY8 is a novel, smartphone-based developmental screening tool for children aged 3-5 years, developed in Malaysia and available in Malay and English.
Purpose of the Study:
- To validate the TOY8 screening tool against the established Griffiths Scales of Child Development, 3rd Edition (Griffiths III).
- To determine optimal cut-off scores for TOY8 to accurately identify developmental delays.
- To assess parental perceptions regarding the feasibility and acceptability of using TOY8.
Main Methods:
- A case-control study was conducted in Sarawak, Malaysia, involving 127 children (64 with developmental delay, 63 without).
- Participants completed the TOY8 screening followed by the Griffiths III assessment.
- Screening performance was analyzed using sensitivity, specificity, likelihood ratios, and receiver operating characteristic (ROC) analyses, with parental feedback collected via questionnaires.
Main Results:
- TOY8 demonstrated good sensitivity (0.77) for detecting any developmental delay and high sensitivity (0.84) for severe delays.
- Cognitive, speech-language, and fine motor domains showed excellent discrimination (AUC 0.82-0.84), while gross motor and personal-adaptive domains had lower sensitivity.
- Parents reported high ease of use (98.4%), usefulness (99.2%), and acceptability (96.9%) for the TOY8 tool.
Conclusions:
- The TOY8 tool, validated in Malaysia, shows good accuracy for developmental screening, especially in school readiness domains.
- Its ease of use, brevity, and positive parental feedback support its feasibility for community and preschool settings.
- TOY8 provides a scalable solution for early developmental detection in resource-limited contexts, aligning with UN SDGs 3 and 10.
