New trends in instruments for child development screening in Brazil: a systematic review / Novas tendências em instrumentos para triagem do desenvolvimento infantil no Brasil: uma revisão sistemática

INTRODUCTION: Screening instruments are widely used to monitor child development. The accurate use of standardized tools is an indispensable condition for clinical practice and research aimed at detecting developmental risks and other problems in childrenOBJECTIVE: The objective of this systematic review was to analyze the use of standardized tools for child development screening used in studies with Brazilian childrenMETHODS: Two independent researchers selected references in English and Portuguese from five databases through which they searched for studies that used screening tests to assess the development of Brazilian children. All articles were read to determine the main objective, design, target population, the type of screening test, and the purpose of using the test with Brazilian childrenRESULTS: Among the 27 papers analyzed, most of them was observational studies conducted with children up to six years of age, with the main objective to screen development delays and analyze associations between risks and child development. Four instruments were identified: Denver Developmental Screening Test II, Ages and Stages Questionnaire, Bayley Scales of Infant and Toddler Development Screening Test, and Battelle Developmental Inventory Screening Test. Three of these tests have been validated for use in BrazilCONCLUSION: This review suggests that the screening instruments have been used in research for different purposes, such as in the diagnosis of developmental problems, and sometimes inappropriately. Furthermore, studies to validate measures for screening and assessing the development of Brazilian children are still scarce and, therefore, deserve more attention

INTRODUÇÃO: Instrumentos de triagem são usados para monitoramento do desenvolvimento infantil. O uso acurado de ferramentas padronizadas é condição indispensável para a prática clínica e pesquisas que visam detectar risco de desenvolvimento e problemas em criançasOBJETIVO: O objetivo desta revisão sistemática foi analisar o uso de instrumentos padronizados de triagem do desenvolvimento infantil adotados em estudos com crianças brasileirasMÉTODO: Dois pesquisadores independentes selecionaram em cinco bases de dados referencias em Inglês e Português onde buscaram estudos que usaram testes de triagem para avaliação do desenvolvimento de crianças brasileiras. Todos os artigos foram lidos para analisar o objetivo principal, delineamento, população-alvo, o tipo de teste de triagem e o propósito de uso do teste com crianças brasileirasRESULTADOS: Dentre os 27 artigos analisados, a maioria deles eram estudos observacionais conduzidos com crianças até seis anos de idade com objetivo principal de rastrear atrasos e analisar associações entre riscos e desenvolvimento. Quatro instrumentos foram identificados: Teste de Triagem do Desenvolvimento de Denver II; Ages and Stages Questionnaire; Bayley Scales of Infant and Toddler Development, Screening Test; e Battelle Developmental Inventory Screening Test. Três testes estão sendo validados para uso no BrasilCONCLUSÃO: Esta revisão sugere que os instrumentos de triagem têm sido usados nas pesquisas com diferentes finalidades, por vezes de forma apropriada ou incorreta, como por exemplo para diagnosticar problemas de desenvolvimento. Além disso, os estudos de validação de medidas para triagem e avaliação do desenvolvimento de crianças brasileiras ainda são escassos e, por isso, merecem atenção

Relação entre gênero e desempenho neuropsicomotor de crianças em Belém, Brasil / Relationship between gender and psychomotor performance of children in Belém, Brazil

Resumo Este estudo objetivou analisar o desempenho neuropsicomotor de crianças a partir da realização do Teste de Triagem de Desenvolvimento de Denver II (TTDD-II). Foram avaliadas 318 crianças, com idade entre 36 a 48 meses. Os resultados indicaram que as meninas obtiveram melhor desempenho em três das quatro áreas pesquisadas: Pessoal Social (p < 0,001), Motor Fino (p = 0,020) e Linguagem (p = 0,028). Na área Motor Amplo não foi observada diferença significativa entre os gêneros. Ao se analisar o desempenho das crianças na execução das tarefas previstas no teste, constatou-se diferença significativa nos seguintes itens: na área Pessoal Social, o item mais falho foi "escova os dentes sem ajuda"; na área Motor fino, o item "indica a linha mais longa" apresentou mais falhas; na área da Linguagem, os itens mais falhos foram "conhece 2 adjetivos", "conhece 4 ações" e "compreende 4 preposições"; na área Motor Amplo foi o item mais falho "pula num pé só". A análise dos resultados aponta que padrões socialmente impostos, baseados em diferenças de gênero, podem interferir nos comportamentos neuropsicomotores de crianças. Além disso, conhecer tal perfil de desenvolvimento é de fundamental importância na formulação de políticas públicas e de ações capazes de contribuir para o desenvolvimento infantil.

Abstract This study aimed to analyze the neuropsychomotor performance of children by implementing the Denver Developmental Screening Test-II (DDST-II). We evaluated a sample of 318 children aged 36 to 48 months. Results indicated that girls performed better in three of the four areas analyzed in the test: Personal-Social (p < 0.001), Fine Motor-adaptive (p = 0.020) and Language (p = 0.028). No significant difference was observed between genders in the Gross Motor skills area. Analyzing the performance of children in implementing the tasks expected in the test, we found significant differences in the following items: in the Personal-Social area, the worst-performing item was "Brushes teeth without help"; in the Fine Motor area, the worst-performing item was "shows the longest line"; in the Language area, the worst-performing items were "Knows two adjectives", "Knows four actions" and "Understands four prepositions"; and in the Gross Motor area, the worst-performing item was "Hops on one foot". The results suggest that socially-imposed standards, based on gender differences, may interfere with the neuropsychomotor behavior of children. Furthermore, knowing such development profile is crucial in the formulation of public policies and actions that can contribute to child development.

Confiabilidad de la detección de problemas de desarrollo mediante el semáforo de la prueba de Evaluación del Desarrollo Infantil: ¿es diferente un resultado amarillo de uno rojo? / Reliability for detection of developmental problems using the semaphore from the Child Development Evaluation test: Is a yellow result different from a red result?

Introducción: La prueba Evaluación del Desarrollo Infantil (EDI) es un instrumento de tamizaje de problemas en el desarrollo diseñado y validado en México. La calificación obtenida se expresa como semáforo. Se consideran positivos tanto el resultado amarillo como el rojo, aunque se plantea una intervención diferente para cada uno. El objetivo de este trabajo fue evaluar la capacidad de la prueba EDI para discriminar entre los niños identificados con semáforo amarillo y los identificados con rojo al compararse con el Inventario de Desarrollo de Battelle 2.ª edición (IDB-2) en cuanto al cociente de desarrollo del dominio (CDD). Métodos: El análisis se llevó a cabo utilizando la información obtenida para el estudio de la validación. Se excluyeron los pacientes con resultado normal (verde) en EDI. Se utilizaron 2 puntos de CDD (IDB-2) por dominio: < 90 para incluir normal-bajo y < 80 para diagnóstico de retraso. Se analizó el resultado con base en la correlación del resultado del semáforo de EDI (amarillo o rojo) y el IDB-2, total y por subgrupos de edad. Resultados: Al considerar un CDD < 90 en amarillo, el 86.8% tuvo al menos un dominio afectado, y el 50%, 3 o más dominios, en comparación con el 93.8% y el 78.8% para el resultado en rojo, respectivamente. Hubo diferencias en todos los dominios entre amarillos y rojos (p < 0.001) para el porcentaje de niños con un CDD < 80: cognitivo (36.1 vs. 61.9%); comunicación (27.8 vs. 50.4%); motor (18.1 vs. 39.9%); personal-social (20.1 vs. 28.9%); y adaptativo (6.9 vs. 20.4%). Conclusiones: Los resultados de semáforo (amarillo o rojo) permiten identificar diferente magnitud de los problemas en el desarrollo y apoyan intervenciones diferenciadas.

Background: The Child Development Evaluation (CDE) is a screening tool designed and validated in Mexico for detecting developmental problems. The result is expressed through a semaphore. In the CDE test, both yellow and red results are considered positive, although a different intervention is proposed for each. The aim of this work was to evaluate the reliability of the CDE test to discriminate between children with yellow/red result based on the developmental domain quotient (DDQ) obtained through the Battelle Development Inventory, 2nd edition (in Spanish) (BDI-2). Methods: The information was obtained for the study from the validation. Children with a normal (green) result in the CDE were excluded. Two different cut-off points of the DDQ were used (BDI-2): < 90 to include low average, and developmental delay was considered with a cut-off < 80 per domain. Results were analyzed based on the correlation of the CDE test and each domain from the BDI-2 and by subgroups of age. Results: With a cut-off DDQ <90, 86.8% of tests with yellow result (CDE) indicated at least one domain affected and 50% 3 or more compared with 93.8% and 78.8% for red result, respectively. There were differences in every domain (P < 0.001) for the percent of children with DDQ < 80 between yellow and red result (CDE): cognitive 36.1% vs. 61.9%; communication: 27.8% vs. 50.4%, motor: 18.1% vs. 39.9%; personal-social: 20.1% vs. 28.9%; and adaptive: 6.9% vs. 20.4%. Conclusions: The semaphore result yellow/red allows identifying different magnitudes of delay in developmental domains or subdomains, supporting the recommendation of different interventions for each one.

Child Development Evaluation Test analysis by field improves detection of developmental problems in children

Background: The Child Development Evaluation (CDE) Test is a screening instrument for developmental problems. In the validation study, a sensitivity of 81% and a specificity of 61% were reported, considering a cut-off value for both a total development quotient (TDQ) of 90. Given that the TDQ is obtained by calculation of the five evaluated fields in the Battelle Development Inventory, 2nd edition (BDI-2), it may occur that a child is classified as a false positive (TDQ ≥90) and may have a developmental delay in at least one of the fields (true positive). The objective of this work was to evaluate if the properties of the CDE Test are different when analyzing each field for the probability of a developmental delay. Methods: The information obtained for the study from the validation (Rizzoli-Córdoba, 2013) was analyzed. In the CDE Test, a true positive was considered when the result was yellow or red. A developmental delay was considered per domain with a scale score <80 in the BDI-2. The results were analyzed based on the correlation of what was evaluated between the CDE Test and the BDI-2. Results: For 438 children of 1- to 60-months of age, sensitivity (S) and specificity (Sp) per field were as follows: a) Motor: S=84.3% and Sp=87%; b) Communication: S=79.5% and Sp=79.4%; c) Personal-Social: S=86.9% and Sp=85%; d) Adaptive: S=91.7% and Sp=85.1%; and e) Cognitive: S=83.6% and Sp=88.8%. Conclusions: When analyzing each field separately, better scores for the CDE are observed compared with those reported for the TDQ in both sensitivity and specificity.

ESTIMATING THE AFFECTS OF ACCREDITATION PROCESS ON HIGHER / Шинэ санаа Шинэ нээлт

BACKGROUND Advantages of Accreditation process are assessing the institution as well as its staffs and teachers, involving them into the organization plan, determining a current level of organization, experiencing all the staffs and developing organization. This thesis was chosen to study how the voluntary audits effect development, quality and efficiency of high educational organization and the individual development. OBJECTIVE Accreditation processes to study that how influence on the institution and individual development METHOD Survey has been conducted by cross- sectional study of analytical study and collected materials through quantitative method. Totally 446 participants were provided by questionnaire sheets and 21 sheets of those were excluded due to incomplete, 407 participants involved. Data processing was implemented by interval evaluation and SWOT. RESULTS There are high prevalence of diabetes, cardiovascular diseases, cancer and mental health problem among the general populations. Majority of these conditions appear with other disability types. 66.5% of the persons with disabilities, who are living under poverty line, have chronic conditions. Number of vehicles increased in urban and rural area, high migration from rural area to urban area, high density in central area. Weak city planning, low light in the street, high number of unemployed people, and alcoholism is increased in the country. But the current collected statistics do not satisfy the basic needs of the country. CONCLUSION Comparison of interval evaluation shows that index of the influences for the institution and individual is 3.5:3.6 and it approved the accreditation influences more for the institutional development. SWOT analyzes show that there are possibilities to achieve more opportunities by using institutional and individual advantages and also strategy should be strengthening advantages by using opportunities. Accreditation process affects more for institutional development.

Validación de un instrumento para la detección oportuna de problemas de desarrollo en menores de 5 años en México / Validation of an instrument for early detection of developmental problems in children under 5 years in Mexico

Introducción. En México, no se contaba con una prueba de evaluación del desarrollo infantil con propiedades psicométricas. La prueba de evaluación del desarrollo infantil (EDI) se desarrolló con este fin. El objetivo de este trabajo fue determinar las propiedades psicométricas de la EDI como prueba de tamizaje para los problemas de desarrollo infantil en menores de 5 años. Métodos. Se realizó un estudio transversal que incluyó pacientes menores de 5 años en tres entidades de la República Mexicana: Chihuahua, Yucatán y Distrito Federal. El espectro de la población incluyó niños con factores de riesgo biológico, ambiental y sin riesgo para retraso en el desarrollo. Se excluyeron los pacientes con alteraciones neurológicas evidentes. Se consideró, como prueba diagnóstica, el Inventario de Desarrollo de Battelle-2 en las tres entidades. En el Distrito Federal, adicionalmente, se aplicó Bayley-III. A cada participante se le aplicaron la prueba de tamizaje en dos versiones y la prueba diagnóstica, el mismo día o en un lapso no mayor a una semana. La persona que aplicó la prueba diagnóstica no conocía el resultado de la prueba de tamizaje. Se definió retraso cuando el cociente total de desarrollo resultó menor a 90. Resultados. Se incluyeron, en total, 438 niños menores de 5 años provenientes del Distrito Federal (n =152, 34.7%), Yucatán (n =151, 34.5%) y Chihuahua (n =135, 30.8%). Del total, 43.4% fueron del sexo femenino (n =190). La clasificación por tipo de riesgo fue biológico (n =197, 45%), ambiental (n =137, 31.3%) y sin riesgo (n =104, 23.7%). Se encontró una sensibilidad de 0.81 (IC 95%: 0.75-0.86), especificidad de 0.61 (IC 95%: 0.54-0.67), concordancia 0.70 (IC 95%: 0.66-0.74). La correlación parcial de las áreas del desarrollo entre la prueba de tamizaje y la prueba Bayley III (n =87) ajustada por grupo de edad del tamizaje fue la siguiente: área motor fino 0.468, motor grueso 0.441, lenguaje 0.508, social 0.336 y adaptativo 0.355 (p ≤0.001). Conclusiones. La prueba EDI posee propiedades adecuadas y similares a las pruebas más utilizadas en América.

Background. The ''Evaluación del Desarrollo Infantil'' (EDI) test was developed as an screening tool for the developmental evaluation of Mexican children younger than 5 years old. The objective of this study was to evaluate the psychometric properties of EDI as a screening tool for children with developmental problems. Methods. We carried out a cross-sectional study including patients from urban and rural areas in three locations: Mexico City, Yucatan and Chihuahua. The disease spectrum was defined according to biological risk, environmental risk or without risk for developmental problems. Patients with obvious neurological disabilities or genetic syndromes were excluded. The gold standards were the Battelle Developmental Inventory 2 (in Spanish) and Bayley-III. Each participant had two complete applications of the EDI test (all interrogated and all observed) and the gold standard (Bayley-III only in Mexico City). Developmental delay was defined as a total development quotient <90. Results. The study included 438 children <5 years old. Distribution by site includes Mexico City (n =152, 34.7%), Yucatan (n =151, 34.5%), Chihuahua (n =135, 30.8%); female gender (n =190, 43.4%). Classification by risk includes biological (n =197, 45%), environmental (n =137, 31.3%), without risk (n =104, 23.7%). With BDI-II as the gold standard, the modified version of EDI (interrogated plus observation) has a sensitivity of 0.81 (95% CI: 0.75-0.86), specificity 0.61 (95% CI: 0.54-0.67), and concordance 0.70 (95% CI: 0.66-0.74). The partial correlation between EDI areas and Bayley-III areas (n =87) was adjusted by test group: fine motor 0.468, gross motor 0.441, language 0.508, social 0.336 and adaptive 0.355 (p ≤0.001). Conclusions. The modified version of EDI has similar properties as the various developmental screening tools available in the U.S. or Latin America and could be a good screening tool in Spanish.

El juego del espejo: diferencias entre díadas madre-hijo urbanas y rurales mapuche en Chile / Mirror game: differences between urban and Mapuche rural mother-infant dyads

Body image is a cognitive construction, the precursor of identity, based on the experience with a mirror. The mother and the child use this external device in a complex representational game prior to language. objective: To describe and analyze the mirror-child interaction and mother-child-mirror game to identify the construction of realities and representations in preverbal children by comparing two different populations of the Chilean culture. subjects and Methods: qualitative and quantitative, non-experimental, descriptive and comparative study where categories of interaction between mother and child in the mirror are created and their association with sociodemographic variables are evaluated. 49 Mapuche rural and urban mother-child interaction videos in the presence of a mirror at eating and feeding times are assessed, interactional categories emerged which become the observation instrument used. results: Different ways to play from the child perspective and the mother-child dyad are reported in different degrees of cognitive and relational complexity, significant differences between both populations are observed. Urban children developed integrated games (p 0.0013) and games of four players (p 0.001), while the Mapuche play mostly by themselves (p 0.0014). Infants older than 13 months make more complex games (p 0.026). The parallel (not looking at the mirror) and the dyadic game correlate positively with the rural unmarried Mapuche mother, and if there is a history of alcoholism and depression, they are prompt to play in groups of four. Conclusions: Qbservation categories and stages of relational complexity in front of the mirror emerged, which reflect the cognitive and relational development of children. Differences were observed in the study populations, possibly due to cultural differences. It is suggested to use this study as development diagnosis and monitoring.

La imagen corporal es una construcción cognitiva, precursora de la identidad, basada en la experiencia del espejo. La madre y el niño usan este dispositivo externo en un juego representacional complejo anterior al lenguaje. objetivo: Describir y analizar la interacción niño-espejo, y el juego madre-hijo-espejo, para identificar la construcción de realidades y representaciones en niños pre-verbales comparando dos poblaciones chilenas de diferente cultura. Pacientes y Método: Estudio cualicuantitativo, no experimental, descriptivo y comparativo donde se crean categorías de interacción entre la madre y el niño ante el espejo y se evalúa su asociación con variables sociodemográficas. Se evalúan 49 vídeos de interacciones madre-hijo urbanos y rural-mapuches en presencia de un espejo durante el comer y dar de comer, emergen categorías interaccionales que a su vez constituyen el instrumento de observación utilizado. resultados: Se reconocen formas de juego desde la perspectiva del niño y la diada madre-hijo en distintos grados de complejidad cognitiva y relacional, observándose diferencias significativas entre ambas poblaciones. Los niños urbanos hacen juego integrado (p 0,0013) y juego de a cuatro (p 0,001), mientras los mapuche juegan más solos (p 0,0014). Los > 13 meses hacen juegos más complejos (p 0,026). El juego paralelo (no mirar el espejo) y juego diádico, se correlacionan positivamente con la madre rural mapuche conviviente y si hay antecedentes de alcoholismo y depresión, hacen más juego de a cuatro. Conclusiones: se aportan categorías de observación y estadios de complejidad relacional delante del espejo que dan cuenta del desarrollo cognitivo y relacional del niño. se evidencian diferencias en las poblaciones estudiadas posiblemente por diferencias culturales. se sugiere utilizarlo como diagnóstico y seguimiento del desarrollo.