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The ten questions screen for childhood disabilities: its uses and limitations in Pakistan
M S Durkin1, Z M Hasan, K Z Hasan
1G H Sergievsky Centre, Columbia University, New York, NY 10032, USA.
Insights
The ten questions screen effectively identifies children at high risk for serious disabilities in resource-limited settings. However, it is not a diagnostic tool and can overestimate disability prevalence without clinical confirmation.
Area of Science:
- Global child health
- Epidemiology
- Disability assessment
Background:
- Accurate childhood disability assessment is challenging in resource-limited regions.
- Existing screening tools may lack validation for diverse populations.
Purpose of the Study:
- To evaluate the accuracy of the ten questions screen for identifying childhood disability in epidemiologic studies.
- To assess its utility in populations with limited resources for professional child development assessments.
Main Methods:
- A two-phase study involving a household survey and screening of children.
- A cluster sample of 6365 children aged 2-9 years in Karachi, Pakistan.
- Subsampling for clinical assessments to validate screening results.
Main Results:
- The ten questions screen shows high sensitivity (84-100%) for serious cognitive, motor, and seizure disabilities.
- Sensitivity is limited (<80%, down to 4%) for specific disability types, including mild vision and hearing impairments.
- Positive screening results, without clinical confirmation, lead to overestimation of serious disability prevalence (>300%).
Conclusions:
- The ten questions screen functions as a valuable screening tool, not a diagnostic assessment.
- It efficiently identifies high-risk children, enabling targeted allocation of scarce resources.
- Its primary utility is in risk stratification for further investigation in low-resource settings.
Objective:
To assess the accuracy of the ten questions screen as a measure of childhood disability for epidemiologic studies in populations lacking resources for professional assessment of children's development and functioning.
Design:
Household survey and screening of children in phase one followed by clinical assessments in phase two.
Setting:
Karachi, Pakistan.
Participants:
A cluster sample of 6365 children, aged 2 to 9 years, screened using the ten questions and a subsample referred for clinical assessments.
Main Results:
Although the sensitivity of the ten questions as a global screen for serious cognitive, motor, and seizure disabilities is high (84-100%), its sensitivity for identifying and distinguishing specific types of disability and for detecting vision, hearing, and mild disabilities, overall, is limited (generally < 80% and as low as 4% for mild vision disability). The predictive value of a positive screening result is also limited-using the ten questions in surveys without clinical confirmation results in overestimation of the prevalence of serious disability by more than 300%.
Conclusions:
The ten questions screen is not an assessment tool. Its utility lies in its ability to screen or select a fraction of the population at high risk for serious disability. As a screening tool, it allows scarce diagnostic and other professional resources to be efficiently directed toward those at high risk.