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Justification: Global developmental delay (GDD) is a relatively common neurodevelopmental disorder; however, paucity of published literature and absence of uniform guidelines increases the complexity of clinical management of this condition. Hence, there is a need of practical guidelines for the pediatrician on the diagnosis and management of GDD, summarizing the available evidence, and filling in the gaps in existing knowledge and practices. Process: Seven subcommittees of subject experts comprising of writing and expert group from among members of Indian Academy of Pediatrics (IAP) and its chapters of Neurology, Neurodevelopment Pediatrics and Growth Development and Behavioral Pediatrics were constituted, who reviewed literature, developed key questions and prepared the first draft on guidelines after multiple rounds of discussion. The guidelines were then discussed by the whole group in an online meeting. The points of contention were discussed and a general consensus was arrived at, after which final guidelines were drafted by the writing group and approved by all contributors. The guidelines were then approved by the Executive Board of IAP. Guidelines: GDD is defined as significant delay (at least 2 standard deviations below the mean with standardized developmental tests) in at least two developmental domains in children under 5 years of age; however, children whose delay can be explained primarily by motor issues or severe uncorrected visual/ hearing impairment are excluded. Severity of GDD can be classified as mild, moderate, severe and profound on adaptive functioning. For all children, in addition to routine surveillance, developmental screening using standardized tools should be done at 9-12 months,18-24 months, and at school entry; whereas, for high risk infants, it should be done 6-monthly till 24 months and yearly till 5 years of age; in addition to once at school entry. All children, especially those diagnosed with GDD, should be screened for ASD at 18-24 months, and if screen negative, again at 3 years of age. It is recommended that investigations should always follow a careful history and examination to plan targeted testing and, vision and hearing screening should be done in all cases prior to standardized tests of development. Neuroimaging, preferably magnetic resonance imaging of the brain, should be obtained when specific clinical indicators are present. Biochemical and metabolic investigations should be targeted towards identifying treatable conditions and genetic tests are recommended in presence of clinical suspicion of a genetic syndrome and/or in the absence of a clear etiology. Multidisciplinary intervention should be initiated soon after the delay is recognized even before a formal diagnosis is made, and early intervention for high risk infants should start in the nursery with developmentally supportive care. Detailed structured counselling of family regarding the diagnosis, etiology, comorbidities, investigations, management, prognosis and follow-up is recommended. Regular targeted follow-up should be done, preferably in consultation with a team of experts led by a developmental pediatrician/ pediatric neurologist.
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Introduction : Recent advances and improvements in technology in Neonatal Intensive Care Unit (NICU) over the past few decades have increased th survival of preterm infants. India ranks first amongst the number of preterm birth. Though the survival of preterm babies have increased Neuro-developmental morbidity amongst such babies still persist. Through this study we aim to establish a risk stratification tool and predict neurodevelopmental delay at 1 year of age. Materials and Methods : A total number of 77 babies were enrolled in the study after fulfilment of inclusion and exclusion criteria. Follow up till 1 year of age of corrected gestational age was done. Development assessment was done through Child Development Centre (CDC) grading, Amile-Tison Angle, Developmental Observation Card, Trivandrum Developmental Screening Chart and development quotient. Vision and Hearing Assessment was also done. Conclusion : Neuro-developmental outcome prediction at 1 year of age is inadequate and proper long term follow p is needed. Overall preterm babies needing extensive resuscitation and 5 minute APGAR <6 had much poor neurological outcome.
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Abstract This essay analyzes the Brazilian laws, public policies, and programs for the promotion of child development, focusing on initiatives aimed at identifying developmental delays. Since 1984, the legislation about early childhood has included child development as part of the Brazilian childcare agenda. However, screening and developmental assessment were not considered among the most important actions aimed at childcare. It is necessary to formulate official instruments or scales and implement interventions for the detection of developmental disorders, delays, and risk conditions to reach more children and promptly identify their potential developmental delays.
Resumen Este ensayo analiza las leyes, políticas públicas y programas brasileños para la promoción del desarrollo infantil, centrándose en iniciativas destinadas a identificar retrasos en el desarrollo. Desde 1984, la legislación sobre la primera infancia ha incluido el desarrollo infantil como parte de la agenda brasileña de cuidado infantil. Sin embargo, la vigilancia y la evaluación del desarrollo no han ocupado un lugar destacado como una de las acciones más importantes dirigidas al cuidado infantil. Es necesario formular instrumentos o escalas oficiales, e implementar intervenciones para la detección de trastornos del desarrollo, retrasos y condiciones de riesgo que permitan llegar a más infantes, así como la identificación temprana de retrasos en el desarrollo.
Resumo Esse ensaio analisa as leis, políticas públicas e programas brasileiros de promoção do desenvolvimento infantil, com foco em iniciativas que visam identificar atrasos no desenvolvimento. Desde 1984, a legislação da primeira infância inclui o desenvolvimento infantil como parte da agenda brasileira de atenção à população infantil. No entanto, a vigilância e a avaliação do desenvolvimento não ocuparam uma posição importante como uma das ações voltadas para o cuidado da criança. É necessário criar instrumentos ou escalas oficiais e implementar intervenções para a detecção de transtornos do desenvolvimento, atrasos e condições de risco que possibilitem chegar a mais crianças e a identificação precoce de atrasos no desenvolvimento.
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Child Care , Health Policy , Brazil , Delivery of Health CareABSTRACT
Background: To assess the growth and neurodevelopmental outcome of all newborn discharged from the NICU of Netaji Subhash Chandra Bose Medical College, Jabalpur on follow up for 6 months.Methods: Prospective observational cohort study of 200 high risk newborn discharged from NICU. Babies were called for follow up at 1 month, 2 months, 4 month and 6 months of corrected age and detailed information was taken regarding NICU stay and morbidity with the help of data available from discharge card. Anthropometric parameters like weight, length, and head circumference were noted.' Suitable screening tests like denver's developmental screening test for Indian infants (DDSTII) for NDD (neurodevelopmental delay) and Amiel Tison scoring for tone assessment was done.Results: Among the 200 NICU graduates chosen, 40 lost during follow up. The neurodevelopmental delay in this study was 31.3%. Authors also analysed NDD according to gestational age wise groups. NDD in pre-terms was 39.6%. The developmental delay was more in babies with neonatal sepsis, perinatal asphyxia, prematurity, RDS, NEC etc.Conclusions: The morbidities like severe perinatal asphyxia, hypoglycaemia, seizures, shock, hypoxia, hypothermia, low gestational age have direct association with NDD.
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@#Child development starts from conception until early childhood. It is influenced by antenatal, perinatal as well as early childhood factors. Social and environmental factors also affect child development. The National Childhood Immunisation Programme and Childhood Developmental Screening programme provide crucial touchpoints for primary care practitioners to screen, assess and refer cases of developmental delay. At the same time, good parent-child interaction can be promoted during these visits.
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Child development refers to the continuous but predictably sequential biological, psychological and emotional changes that occur in human beings between birth and the end of adolescence. Developmental surveillance should be incorporated into every child visit. Parents play an important role in the child's developmental assessment. The primary care physician should educate and encourage parents to use the developmental checklist in the health booklet to monitor their child's development. Further evaluation is necessary when developmental delay is identified. This article aimed to highlight the normal child developmental assessment as well as to provide suggestions for screening tools and questions to be used within the primary care setting.
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Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Checklist , Child Development , Developmental Disabilities , Diagnosis , Health Knowledge, Attitudes, Practice , Parent-Child Relations , Parents , Psychology , Physicians, Primary Care , Psychology , Primary Health Care , Professional-Family Relations , SingaporeABSTRACT
Autism spectrum disorder (ASD) is characterised by persistent deficits in social communication and interaction as well as restricted, repetitive patterns of behaviour and interests. Early detection and early intervention programmes improve functional outcomes. Family physicians should screen for ASD opportunistically when children attend clinics for acute issues and during scheduled well-child assessments. Early warning signs of ASD include the lack of social gestures at 12 months, using no meaningful single words at 18 months, and having no interest in other children or no spontaneous two-word phrases at 24 months. Children with suspected ASD should be referred to appropriate specialist centres as early as possible for multidisciplinary assessment and diagnosis.
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Objective To investigate the effects of anesthesia on neurodevelopment of preschool children. Methods A total of 445 children, scheduled to undergo surgery in the Fourth Medical Center of Chinese PLA General Hospital from 1st May 2017 to 1st May 2018, were enrolled and, according to different test purpose, grouped as follows: (1) 120 children (GA group) who underwent surgery before Denver Developmental Screening Test (DDST) were matched to 325 unexposed children (Non-GA group). Meanwhile, 168 children (Naive group) were measured as blank control. (2) According to the number of anesthesia that children had undergone, those in GA group were assigned to three subgroups: single, twice and multiple groups. (3) Subgroup analyses was performed based on the time of cumulative duration of anesthesia exposures (less than 3 and greater than or equal to 3h). Data were collected with a questionnaire to evaluate the children's physical development, DDST results were recorded, and the effects were evaluated of the number of anesthesia and the time of cumulative duration of anesthesia exposures on the DDST results. Results For the children aged 0 to 6 yr, the DDST positive rates in Naive, Non-GA and GA groups were 6.0%, 6.5% and 12.5%, respectively. No significant difference existed in DDST positive rate between Naive group and Non-GA group (P=0.825). Compared with Non-GA group, the DDST positive rate increased in GA group (6.5% vs. 12.5%) with significant difference (P=0.038). Compared among the four domains of DDST separately, statistical difference was found only in terms of personal-social, those in GA group showed poor performance than in Non-GA group (P=0.025). For the children aged less than 3 yr, the DDST positive rates in GA group and Non-GA group were 18.6% and 3.9%, respectively, showing significant differences (P=0.019), but no statistical difference was found on DDST positive rate among the three groups of children aged 3 to 6 yr (P>0.05). In GA group, there was no increase in odds of early developmental vulnerability with increasing frequency of anesthesia exposure (P=0.784). However, the DDST positive rate was significantly higher with longer cumulative duration of anesthesia exposure (≥3h) than that of <3h (18.7% vs. 2.2%, P=0.008). Conclusions Exposure to anesthesia is an increased risk for the later neurodevelopment of preschool children, especially before 3 years old. The time of cumulative duration of anesthesia may be positively correlated to the children's neurodevelopment disabilities.
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PURPOSE: The importance of the neurodevelopmental outcomes of very-low-birth-weight (VLBW) infants has been emphasized as their mortality rate has markedly improved. This study aimed to assess the validity of the Korean Developmental Screening Test (K-DST), a developmental screening tool approved by the Korean Society of Pediatrics, for the timely diagnosis of neurodevelopmental delay in VLBW infants. METHODS: Subjects included VLBW infants enrolled in the Korean Neonatal Network database between January 2012 and December 2014. The collected data were analyzed for sensitivity, specificity, positive predictive value, and negative predictive value (NPV) in the K-DST compared to those in the Bayley Scales of Infant Development-II for VLBW infants. RESULTS: A total of 173 patients were enrolled. Their mean gestational age and mean birth weight were 27.5±2.8 weeks and 980.5±272.1 g, respectively. The frequency of failed psychomotor developmental index (PDI) <85 was similar to that in at least one domain of K-DST <1 standard deviation. Failure in more than one K-DST domain compared with a mental developmental index (MDI) <85 showed a sensitivity and NPV of 73.2% and 75.0%, respectively. Failure in more than one K-DST domain compared with PDI <85 showed a sensitivity and NPV of 60.3% and 71.6%, respectively. Each K-DST domain had a stronger correlation with predicting a failing MDI <85 than a failing PDI <85 (P<0.05). CONCLUSION: K-DST could be a useful screening tool for predicting mental developmental delay in VLBW infants and referring them for neurodevelopmental assessments.
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Humans , Infant , Birth Weight , Diagnosis , Gestational Age , Infant, Very Low Birth Weight , Mass Screening , Mortality , Pediatrics , Sensitivity and Specificity , Weights and MeasuresABSTRACT
PURPOSE: The purpose of this study was to identify the risk factors for developmental delays in preterm infants. METHODS: We studied 151 preterm infants admitted to the neonatal intensive care unit (NICU) at the Hallym University Kangnam Sacred Heart Hospital from January 2013 to November 2016. After discharge, the infants were evaluated by a pediatric neurologist via the developmental screening test K-ASQ:SE II, which consists of five domains: communication (CC), gross motor (GM), fine motor (FM), problem solving (PS), and social-emotional (SE). The subjects were divided into a normal group and an abnormal group (abnormal results on at least one of the five domains). Several variables were compared between the two groups and risk factors for developmental delays were analyzed. RESULTS: Several factors, such as birth weight (BW), gestational age (GA), Apgar score at 1 and 5 min (AS1, AS5), hospital days (HDs), respiratory distress syndrome (RDS), chronic lung diseases, intraventricular hemorrhage (IVH), early sepsis, retinopathy of prematurity (ROP), and history of management of invasive ventilators, dexamethasone, anti-hypotensive, were significantly different between the normal and abnormal groups. BW was a risk factor for developmental delay according to the binary logistic regression analysis. On individual domain analysis, risk factors were lower GA for domains CC and FM, lower AS1 for GM domain, lower BW for PS domain, and longer HDs for SE domain. CONCLUSION: In preterm infants, regular developmental screening especially follow-up observation, is important for early detection of developmental delay, considering the risk factors, such as GA (≤30 weeks), BW (≤1,500 g), low AS1, and long HDs, which may be helpful in the early diagnosis of developmental delay.
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Humans , Infant , Infant, Newborn , Apgar Score , Birth Weight , Dexamethasone , Early Diagnosis , Follow-Up Studies , Gestational Age , Heart , Hemorrhage , Infant, Premature , Intensive Care, Neonatal , Logistic Models , Lung Diseases , Mass Screening , Problem Solving , Retinopathy of Prematurity , Risk Factors , Sepsis , Ventilators, MechanicalABSTRACT
Summary Objective: According to data from the World Health Organization (WHO), anemia is a prevalent health problem that leads to increased morbidity and mortality, especially in preschool children. Anemia is recognized as a major health problem due to its negative effects on the mental and physical development during childhood. The aim of our study was to determine the levels of anemia of children in a kindergarten affiliated to the Directorate of National Education using a non-invasive method, and to investigate the effects of anemia on the physical, mental and neuromotor development of children. Method: The levels of anemia was evaluated by using a non-invasive measurement device. Data collection was performed by means of a questionnaire to evaluate the children's physical development and set Denver Developmental Screening Test II scores. Results: Our findings show that 21% of non-anemic and 15% of anemic children are in the suspected abnormal group according to their DDST II total score. Furthermore, it has been identified that mild anemia has a positive effect on neuromotor development, while overweight and obesity affect neuromotor development in a negative way. Conclusion: According to the results obtained from the study, mild anemia may have a positive effect on the children's neuromotor development, while malnutrition could have a negative impact.
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Humans , Male , Female , Psychomotor Performance/physiology , Body Mass Index , Child Development/physiology , Anemia/complications , Obesity/etiology , Severity of Illness Index , Developmental Disabilities/diagnosis , Anemia/physiopathology , Obesity/physiopathologyABSTRACT
Abstract: With standardized screening tools, research studies have shown that developmental disabilities can be detected reliably and with validity in children as young as 4 months of age by using the instruments such as the Ages and Stages Questionnaire. In this review, we will focus on one tool, the Ages and Stages Questionnaire, to illustrate the usefulness of developmental screening across the globe.
Resumen: Mediante el uso de herramientas de evaluación estandarizada, algunos estudios de investigación han demostrado que discapacidades de desarrollo se pueden detectar con fiabilidad y validez en niños desde los 4 meses de edad mediante el uso de los instrumentos estandarizados como el Ages and Stages Questionnaire (Cuestionario de las Edades y Etapas). Para ilustrar la utilidad de la evaluación del desarrollo infantil a escala global, en este trabajo se revisará la herramienta Ages and Stages Questionnaire.
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Child, Preschool , Humans , Infant , Developmental Disabilities/diagnosis , Mass Screening/methods , Surveys and QuestionnairesABSTRACT
Objective·To investigate the developmental state of infants in early childhood and identify risk factors for their early development in community. Methods·Cluster sampling was conducted to collect data of infants aged 12 months by Denver Developmental Screening Test (DDST) in Shanghai Jing'an District. Logistic analysis was employed to detect factors influencing the intellectual development of infants. Results·A total of 4102 infants were enrolled in the survey. The prevalence for abnormal screening result was 1.0%, while 4.3% for suspicious abnormal result. Logistic analysis revealed that low birth weight (OR=6.24, 95% CI 1.69-22.98, P=0.006), low head circumference (OR=5.22, 95% CI 1.20-22.84, P=0.031), mothers older than 35 years in pregnancy (OR=3.61, 95%CI 1.32-9.84, P=0.012) or history of brain impairment (OR=3.96, 95% CI 1.55-10.10, P=0.003) were the risk factors for abnormal screening result. Spearman rank correlation analysis showed a significant negative relationship between breastfeeding duration and suspicious abnormal screening result (ρ=-0.031, P=0.046). Conclusion·It is essential to draw attention to early developmental screening and interference, especially to infants with mothers older than 35 years in pregnancy, low birth weight, low head circumference or high-risk infants.Breastfeeding is helpful for decreasing detection rate of abnormal result.
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Objective·To investigate the developmental state of infants in early childhood and identify risk factors for their early development in community. Methods·Cluster sampling was conducted to collect data of infants aged 12 months by Denver Developmental Screening Test (DDST) in Shanghai Jing'an District. Logistic analysis was employed to detect factors influencing the intellectual development of infants. Results·A total of 4102 infants were enrolled in the survey. The prevalence for abnormal screening result was 1.0%, while 4.3% for suspicious abnormal result. Logistic analysis revealed that low birth weight (OR=6.24, 95% CI 1.69-22.98, P=0.006), low head circumference (OR=5.22, 95% CI 1.20-22.84, P=0.031), mothers older than 35 years in pregnancy (OR=3.61, 95%CI 1.32-9.84, P=0.012) or history of brain impairment (OR=3.96, 95% CI 1.55-10.10, P=0.003) were the risk factors for abnormal screening result. Spearman rank correlation analysis showed a significant negative relationship between breastfeeding duration and suspicious abnormal screening result (ρ=-0.031, P=0.046). Conclusion·It is essential to draw attention to early developmental screening and interference, especially to infants with mothers older than 35 years in pregnancy, low birth weight, low head circumference or high-risk infants.Breastfeeding is helpful for decreasing detection rate of abnormal result.
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PURPOSE: To evaluate the usefulness of the Korean Developmental Screening Test (K-DST) for infants and children for developmental delay assessment. METHODS: This study was based on retrospective studies of the results of the K-DST, Preschool Receptive-Expressive Language Scale (PRES), Sequenced Language Scale for Infants (SELSI), Childhood Autism Rating Scale (CARS), Modified Checklist for Autism in Toddlers (M-CHAT), electroencephalography, magnetic resonance imaging, and extensive tests conducted in 209 of 1,403 patients, of whom 758 underwent the K-DST at the Korea University Guro Hospital between January 2015 and December 2016 and 645 were referred from local clinics between January 2015 and June 2016. RESULTS: Based on the K-DST results, the male children significantly more frequently required further or follow-up examination than the female children in most test sections, except for gross motor. The male children had notably lower mean scores than the female children. The PRES/SELSI results showed that when more further or follow-up evaluations were required in the K-DST communication section, significantly more problems in language delay or disorder emerged. When further or follow-up evaluation was required in the cognitive section in the CARS/M-CHAT, the possibility of autism increased significantly. A child tended to score low in the CARS test and show autism when further or follow-up evaluation was recommended in the K-DST. CONCLUSION: This study demonstrated the usefulness of the K-DST as a screening test early in the development of infants and children in Korea. Data of normal control groups should be examined to determine the accuracy of this investigation.
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Child , Female , Humans , Infant , Male , Autistic Disorder , Checklist , Electroencephalography , Follow-Up Studies , Growth and Development , Korea , Language Development Disorders , Magnetic Resonance Imaging , Mass Screening , Retrospective StudiesABSTRACT
Objective To know the prevalence rate of iron deficiency anemia and its effect on growth and development among infants under 6 months. Methods A total of 341 infants who were born from July 2011 to June 2012 were enrolled. The information of blood routine examination,growth index,feeding patterns was collected at age of 42 days and 6 months,respectively. Developmental screening test was conducted at age of 6 months. Results The prevalence rate of anemia at 42 days was 37. 54%,and there was no significant difference between males(40. 54%)and females(33. 97%) (P>0. 05). The prevalence rate of iron deficiency anemia at 6 months was 19. 35%,in which 48. 48% were new cases. At age of 42 days,there was no significant difference between different feeding patterns in anemia prevalence( breast feeding:30. 82%,mixed feeding:41. 40%,artificial feeding:47. 37%,P>0. 05). While at age of 6 months,the anemia prevalence of breast feeding group was higher( 38. 20%)than that of the other two groups( mixed feeding:16. 38%;artificial feeding:9. 56%;P<0. 05 ). The rate of developmental quotient below 70 was 11. 76% in the anemia cases whose hemoglobin was continuously low from 42 days to 6 months,which was higher than that of new onset anemia cases (3. 13%)and normal hemoglobin controls(1. 82%)(P<0. 05). Conclusion Continuously low hemoglobin at early age of 42 days to 6 months is potentially harmful to neuropsychological development of infants. Early screening of hemoglobin is urgently needed for intervention of iron deficiency anemia among infants.
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Developmental delays and disorders are not uncommon and affect 10 to 20% of children under the age of 5. Early identification of children with delays allows referral for assessment and appropriate intervention, which can influence the child’s developmental trajectory, allowing optimisation of his potential. The family physician has a very important role to play in monitoring the development of children under his care. He is well placed to do this in a longitudinal sense, as he already has an ongoing relationship with the family, and has many opportunities repeated contact with the child in the first few years of life. Developmental surveillance using the checklists, limit milestones and red flags in the Child Health Booklet is described.
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PURPOSE: Since National Health Screening Program for Infants and Children in Korea started from November, 2007, the need to design a new tool that can timely identify infants and chlildren with possible delayed development has been emphasized. The developmental screening devices currently used in Korea are mostly adapted from foreign tests and could be considered inappropriate for children growing in a different cultural background. Therefore, we assessed the appropriateness of Korean-Ages and Stages Questionnaires (K-ASQ) items in Korean infants and children, as a preliminary study to develop a new developmental screening test tool. METHODS: Data on K-ASQ tests that were performed in multicenters as a National Health Screening Program in Korea were analyzed to measure (1) the item difficulty and norm relevance (2) the goodness of fit for factor structure (3) the sensitivity of item for developmental evaluation. A total of 1,696 subjects, 877 boys (51.7%) and 819 girls (48.3%) were studied and with about 50 boys and 50 girls for each age of months, the sample was relatively evenly distributed. RESULTS: Analysis of K-ASQ data showed that (1) The subjects scored higher when compared to the K-ASQ's original criteria. (2) The suitability of confirmative factor structure was insufficient, especially problem solving [x2=41.063, P<0.01, CFI (Comparative Fit Index)=0.929, TLI (Turker-Lewis index)=0.834, RMSEA (Root Mean Square Error Approximation)=0.152] and personal-social domains (x2=55.208, P<0.01, CFI=0.817, TLI=0.573, RMSEA=0.182). (3) Some questions did not show significant difference in the sensitivity of item for developmental evaluation among monthly age groups. CONCLUSION: According to the analysis of previous K-ASQ data, the appropriateness of the questionnaires is good in general, but some questions of problem-solving and personal social domains are not appropriate. We suggested the development of a new developmental screening test tool, which is suitable for Korean infants and children.
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Child , Female , Humans , Infant , Korea , Mass Screening , Problem Solving , Surveys and QuestionnairesABSTRACT
PURPOSE: As a preliminary study on the development of a new developmental screening tool, this study examined the validity of the Korean Ages and Stages Questionnaires (K-ASQ). METHODS: The clinical sample included a total of 218 Infants and children at 30, 36, 60 months of age, who were diagnosed with developmental disorders. Age- and sex-matched normal controls were selected from a national large-scale K-ASQ database. Sensitivity, specificity, and accuracy were calculated in different age and diagnosis groups, and receiver operating characteristic (ROC) curve analysis was performed as well. In addition, concurrent validity was analyzed for the clinical sample by comparing the K-ASQ with other reference scales. RESULTS: The sensitivity, specificity, and accuracy of the K-ASQ were above fair (0.82-0.96) overall, however they varied depending on age and diagnosis groups. Specifically, the sensitivity at 60 months was relatively low (0.65). Especially, the discrimination sensitivity for the language delay group was poor at 60 months (0.42). ROC analysis showed that the overall discrimination capacity was above fair in all 5 domains [area under the curve (AUC): 0.74-0.98]. However, there were some domains and age groups with relatively poor discrimination capacity. In terms of concurrent validity, the correlations between the K-ASQ domains and reference scale subscales were statistically significant overall, but weak in some domains. CONCLUSION: The overall discrimination capacity and concurrent validity of the K-ASQ were above fair, but there were some domains, age, and diagnosis groups in which the K-ASQ was not successful in identifying potentially developmentally challenged children. These findings suggested the need for the development of a new developmental screening test tool, which is suitable for Korean infants & children.
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Child , Humans , Infant , Diagnosis , Discrimination, Psychological , Language Development Disorders , Mass Screening , Surveys and Questionnaires , ROC Curve , Sensitivity and Specificity , Weights and MeasuresABSTRACT
Uno de los instrumentos más utilizados a nivel internacional en la vigilancia del desarrollo del niño es la segunda versión del Denver Developmental Screening Test (DENVER II), del cual se han hecho evaluaciones y modificaciones en varios países, a partir de la estimación de la edad de presentación de los reactivos, pues constituye la base de su estructura y validez. Objetivo Identificar las edades y secuencias de presentación de los reactivos del Test Denver II en los cuatro primeros años de vida en niños de condición socioeconómica baja de una comunidad del Estado de Morelos, México. Método Se realizaron 2350 evaluaciones a niños de 0 a 48 meses de edad. Mediante un modelo de regresión logística se estimó la edad de presentación de cada reactivo para los percentiles 25, 50, 75 y 90. Se establecieron diferencias con los valores de referencia del instrumento con base en los intervalos de confianza al 95% para el percentil 90. Resultados De los 98 reactivos evaluados, 42 se presentaron con retraso; 23 no mostraron diferencias estadísticas y 33 se lograron antes por los niños del estudio. En las áreas Motor grueso y Personal-social predominaron los retrasos en 19/25 y 11/21 reactivos respectivamente. Por el contrario en Motor Fino-Adaptativo y Lenguaje predominaron los adelantos en 11 de 22 y 16 de 30 reactivos. Conclusiones Existen diferencias en las edades y secuencias de presentación de los reactivos del Test de Denver II en la población estudiada. Se recomienda realizar ajustes antes de implementar su uso en contextos socioculturales específicos.
The Denver Developmental Screening Test (Denver II) is the most used internationally tool for child development surveillance, from which assessments and changes have been made in several countries, from the estimate of the age of presentation of the items, because it constitutes the basis of its structure and validity. Objective To identify the age and sequences acquiring of each item of the Denver-II test during the first four years of life in children of low socioeconomic status from a community of Morelos State, Mexico. Method 2350 assessments were conducted to children from 0 to 48 months of age. A logistic regression model was used to estimate the age of presentation of each item to the centiles 25th, 50th, 75th and 90th. Differences were established with values of reference based on confidence intervals up to 95% for 90th centile. Results Of the 98 items evaluated, 42 were submitted delayed, 23 showed no statistical difference and 33 were acquired in earlier age in children of Morelos. In the Gross Motor and Personal-social areas predominated the delayed with 19/25 and 11/21 items, respectively. By contrast, in Fine Motor-Adaptive and Language predominated the advances, with 11/22 and 16/30 items. Conclusions There are differences in the age and sequence of presentation of the items of the Denver-II test in the population studied. Adjustments are recommended before implementing its use in specific socio-cultural contexts.