Jane Squires

Impact of implementing developmental screening at 12 and 24 months in a pediatric practice

OBJECTIVES. The purpose of this study was to investigate the effectiveness and costs of incorporating a parent-completed developmental screening tool, the Ages and Stages Questionnaire, into the 12- and 24-month well-child visits under “real-world” conditions, using a combined in-office and mail-back data collection protocol. METHODS. A convenience sample of 1428 caregivers and children presenting for their 12- or 24-month well-child visit between April 2005 and March 2006 participated. Children with identified delays or disorders were excluded. Board-certified pediatricians (n = 18) and nurse practitioners (n = 2) acted as secondary participants. Pediatricians were blinded to Ages and Stages Questionnaire results when completing the Pediatric Developmental Impression. Patients with delayed Ages and Stages Questionnaire or Pediatric Developmental Impression results were referred for additional evaluation. RESULTS. Referral rates increased by 224%. Pediatrician referral on the basis of the Pediatric Developmental Impression was predicted significantly by suspected communication delay and gross motor delay. The Ages and Stages Questionnaire and Pediatric Developmental Impression results differed significantly, with overall agreement of 81.8%. Of Ages and Stages Questionnaire–delayed cases, 67.5% were not detected by pediatricians. Of the 78 patients referred on the basis of combined Ages and Stages Questionnaire and Pediatric Developmental Impression results, 53 would not have been referred on the basis of Pediatric Developmental Impression results alone; 37 patients qualified for special services, and 44 were scheduled for additional developmental monitoring. The rate of Ages and Stages Questionnaire return by caregivers/parents was 54%. CONCLUSIONS. Referral rates increased dramatically, with the greatest increase at 12 months. Although patients with pediatrician referrals were likely to qualify for services (96%), physician referrals accounted for only 42% of total referrals, which highlights the need for pediatric developmental screening. The 54% Ages and Stages Questionnaire return rate, although acceptable under study conditions, calls for alternative implementation strategies.

The Role of Parental Report in the Screening and Assessment of Young Children

This paper reviews research focusing on the role of parental report in screening and assessment of young children. Specific issues discussed include the relationship between parent report and the childs tested performance, variables that may affect parent-professional agreement, the effect of such disagreement on the usefulness of parent report, and how and when parent report should be used. We discuss the role of parent report in screening, assessment, and program planning. We make specific recommendations for the systematic use of parent report in early intervention efforts.

Cross-cultural adaptation of a pre-school screening instrument: comparison of Korean and US populations

BACKGROUND Accurate and efficient developmental screening measures are critical for early identification of developmental problems; however, few reliable and valid tests are available in Korea as well as other countries outside the USA. The Ages and Stages Questionnaires (ASQ) was chosen for study with young children in Korea. METHODS The ASQ was translated into Korean and necessary cross-cultural adaptations were made. The translated version was then distributed and completed by 3220 parents of young children between the ages of 4 months and 5 years. Reliability was studied including domain correlations, internal consistency, and performance of identification cut-off scores for the Korean population. Rasch analyses including tests of Differential Item Functioning, contrasting Korean and US samples were also performed. RESULTS In general, internal consistency of the Korean ASQ was high, with overall correlations 0.75 for communication, 0.85 for gross motor, 0.74 for fine motor, 0.72 for problem solving, and 0.65 for personal-social. Validity, including concurrent validity, also had strong evidence. Mean scores of children on the Korean translation of the ASQ and the US normative sample were generally similar. Rasch analyses indicated the majority of items functioned similarly across the Korean sample. CONCLUSIONS In general, the ASQ was translated with cultural appropriateness in mind and functioned as a valid and reliable parent-completed screening test to assist in early identification of young children with developmental delays. Further research is needed to confirm these results with a larger and more diverse Korean sample.

Genetic and epigenetic characteristics of ICSI children

The outcome of pregnancy and the developmental wellbeing of children conceived from 12,866 consecutive intracytoplasmic sperm injection (ICSI) cycles was assessed. A total of 3277 couples delivered 5891 neonates. There was a higher than normal incidence of de-novo chromosomal abnormalities in a small sample of ICSI offspring. Controlling for maternal age showed that the incidence of low birth weight and gestational length were comparable with the naturally conceived counterpart. Rates of malformation in ICSI offspring ranged from 3.5 to 6.2%. At 3 years of age (n = 811), the proportion of children at risk for developmental delays was 10.4% in ICSI and 10.7% in IVF singletons. However, high order gestations were characterized by 19.4% of the children having compromised development. Epigenetic analysis of assisted reproductive technique conceptuses found minor imprinted gene expression imbalances. ICSI offspring presented with genetic defects that were inherited or arose de novo. Obstetric and neonatal outcomes of singleton pregnancies appeared to be dependent upon maternal age. ICSI and IVF appeared to exert a negative effect on the wellbeing of offspring mainly because of the association with multiple gestations. All assisted reproduction procedures should be monitored for the eventual effect of environmental aggressors on offspring epigenesis.

Parent-completed developmental questionnaires: Effectiveness with low and middle income parents

The Ages & Stages Questionnaires (ASQ) are a series of parent-completed questionnaires designed to screen the developmental performance of children from 4 through 48 months of age. This study examined the use of the ASQ with parents from low and middle income backgrounds. Ninety-six parents completed the ASQ on their child from 4 through 30 months. Percent agreement between questionnaires completed by parents in the low income sample (N= 54) and a professionally-administered standardized assessment ranged from .80–.91 (X = .85); percent agreement for questionnaires completed by parents in the middle income sample (N = 42) ranged from .85–.93 (X = .89). In this longitudinal study, both middle and low income parents appeared able to complete developmental questionnaires with reasonable accuracy.

Risk for maternal depression and child aggression in Early Head Start families: A test of ecological models

Current literature indicates that risk for maternal depression is substantial in low-income families. A large body of research also indicates that when mothers are depressed, children are at risk for a number of developmental difficulties. While mutual influence between child and parental difficulties has been noted, few studies examine risk factors for both depression and child aggression within ecological models. The present cross-site study examined the unique and additive contributions of contextual factors, including SES and family functioning, on maternal depression and child aggression in Early Head Start families. A multiethnic sample of parents and their children, between the ages of 12 and 43 months, participated in this study. Families came from five Early Head Start programs across the United States, representing both urban and rural areas. Structural equation models (SEM) demonstrate mutual links between depression and aggression, mediated at least in part by ecological factors. SEM indicated that 36.4% of the variance in child aggression is accounted for in a model linking aggressive behavior to parent depression, stress, and couple-level functioning, as well as other family interaction variables. A second model focusing on maternal depression revealed that 44.5% of the variance in maternal depression was accounted for through family factors, including couple-related support and satisfaction and parenting stress. In this second model, child aggression was indirectly linked to maternal depression. These data have important implications for programs serving at-risk families.

The Effectiveness of Parental Screening of At-Risk Infants The Infant Monitoring Questionnaires

This study examined the validity, reliability, and cost of a parent-completed screening system called the Infant Monitoring Questionnaires. This system relies on parents to complete developmental questionnaires on their at-risk infants at specific time intervals. The present work replicated and extended a previous study of the questionnaires. The primary analyses included determining (a) the agreement between the infants classification based on the parent-completed questionnaire and a criterion measure (e.g., Bayley Scales of Infant Development, Stanford-Binet Intelligence Test, Revised Gesell Developmental Schedules); (b) interobserver and test-retest reliability of the questionnaires; and (c) the cost of the questionnaire system. The results indicated that percentage agreement between classifications of infants made using the standardized tests and the questionnaires was high, ranging from 86% to 91%. Underscreening rates were low, ranging from zero to 6%; overscreening rates were also low, ranging from 3% to 11%. Interobserver and test-retest agreement were very high. At a cost of about

Adaptation of the 36-Month Ages and Stages Questionnaire in Taiwan: Results From a Preliminary Study

2.50 per questionnaire, the screening system provides an economical and flexible means of screening at-risk infants while at the same time involving parents in the assessment process.

Validity and Reliability of a Curriculum-Based Assessment Approach to Determine Eligibility for Part C Services

Identification of children with developmental disabilities is the first critical step in providing early intervention services. Currently, only 20% of Taiwanese children who could potentially benefit from early intervention have been identified. One possible reason for this low identification rate is the lack of a culturally appropriate, developmental screening instrument for Taiwanese children. A multi-pronged pilot study was conducted to explore the reliability and validity of scores using a Chinese translation of the 36-month version of the Ages and Stages Questionnaire (ASQ) with a sample of Taiwanese children. Results indicated that the translated Chinese version of the 36-month ASQ demonstrates initial cultural appropriateness, and reliability and validity of scores when used with a sample of 3-year-old Taiwanese children. The potential viability of the 36-month ASQ as a developmental screening instrument to identify Taiwanese children in need of early intervention services and the need for further validation research are discussed.

Mental Health Screening in Young Children

Traditional standardized, norm-referenced assessments are used most often to determine childrens eligibility for specialized services. These traditional tests have at least two drawbacks: (a) test items and activities often do not reflect childrens functional repertoires; and (b) outcomes are difficult to link directly to goal development, intervention, and evaluation. A promising alternative is the use of an assessment approach that reflects childrens functional repertoires in familiar environments (i.e., authentic), and directly connects outcomes to programmatic efforts (i.e., linked). This study investigated the validity and reliability of an authentic and linked alternative assessment. Sixty-eight toddlers, with and without disabilities, were given traditional and alternative eligibility assessments. Results suggest the potential for using alternative assessment for determining eligibility for early intervention services.