Developmental screening in children with CHD: Ages and Stages Questionnaires

Abstract

Objective: Standardized developmental screening tools are important for the evaluation and management of developmental disorders in children with congenital heart disease (CHD). However, psychometric properties and clinical utility of screening tools, such as the Ages and Stages Questionnaires, Third Edition (ASQ-3), have not been examined for the CHD population. We hypothesized the ASQ-3 would be clinically useful for this population. Study Design: ASQ-3 developmental classifications for 163 children with CHD at 6, 12, 24 and/or 36 months of age were compared to those obtained from concurrent developmental testing with the Bayley Scales of Infant and Toddler Development, Third Edition. Results: When ASQ-3 screening failure was defined as ≥ 1 standard deviations below the normative mean, specificity (≥81.9%) and negative predictive value (≥ 81.0%) were high across ASQ-3 areas. Sensitivity was high for gross motor (79.6%), increased with age for communication (35.7%−100%), and generally decreased with age for problem solving (73.1%−50.0%). When ASQ-3 screening failure was defined as ≥ 2 standard deviations below the normative mean, specificity (≥93.6%) and positive predictive value (≥74.5%) were generally high across ASQ-3 areas, but sensitivity was low (31.1%) to fair (62.8%). The ASQ-3 improved accuracy in predicting delays over clinical risk factors alone. Conclusions: The ASQ-3 appears to be a clinically useful tool for screening development in children with CHD, although utility varied based on developmental area and time point. Clinicians are encouraged to refer children scoring ≥ 1 standard deviation below the normative mean on any ASQ-3 area for formal developmental evaluation.

Neuromotor performance in infants before and after early open-heart surgery and risk factors for delayed development at 6 months of age

“…1,22,36,42 Although sensitivity varied across subtests, overall specificity was >93% across all domains. 37 The Ages and Stages Questionnaire is a low-resource developmental surveillance option, which, combined with known clinical risk factors, offers the ability to screen all at-risk infants in the absence of formal developmental follow-up programmes. Given the frequency of low severity delays in this clinical cohort, a higher level of caution should be adopted when interpreting "atrisk" scores, and referral for developmental assessment and evaluation considered for children scoring ⩾1 SD below the mean in any Ages and Stages domain.…”

“…For this study, categories were collapsed to normal (above cut-off) and delayed (close to or below cut-off) owing to the clinical relevance of mild delay in this cohort and consequent low threshold for referral for assessment. 2,36,37 Procedures Neuromotor performance of infants enrolled in the study was assessed at two time points: (1) before cardiac surgery and (2) after cardiac surgery before hospital discharge. Where possible, timing of assessments was standardised to the day before or of surgery, and the day of hospital discharge.…”

Neurodevelopmental evaluation and referral practices in children with congenital heart disease in central South Africa

“…(12,(23)(24)(25)(26) Electronic developmental screening questionnaires could be completed by parents at home and sent on to the practitioner to facilitate remote screening of the child's developmental status. (27) Less than a quarter of practitioners (n=4; 20%) referred at-risk children for formal developmental evaluation, which would include the administration of a comprehensive, standardised developmental test. (2) Children were referred to allied health services (n=15; 75%) and to medical specialists such as a paediatric neurologists or neurodevelopmental paediatricians (n=11; 55%) for formal developmental evaluation.…”

Perbedaan Status Perkembangan dan Pertumbuhan Anak dengan Penyakit Jantung Bawaan Sianotik dan Non-sianotik

“…5 Gangguan perkembangan pada anak dengan PJBdapat dideteksi dengan menggunakan Ages and Stages Questionnaires-3 (ASQ-3) yang memiliki spesifisitas dan sensitivitas yang tinggi (90 dan 80%). 6 Ages and Stages Questionnaires mudah digunakan sehingga kecurigaan terjadinya gangguan perkembangan dapat diketahui lebih awal dan diintervensi lebih cepat pada pasien anak dengan PJB. 6 Bila dibandingkan dengan alat skrining lain yang menggunakan informasi dari orang tua, seperti Denver II, Child Development Review Parent Questionnaires (CDR-PQ) dan Parents Evaluation of Development Status (PEDS), ASQ-3 membutuhkan waktu yang singkat dalam pengerjaan dibandingkan yang lain.…”

“…6 Ages and Stages Questionnaires mudah digunakan sehingga kecurigaan terjadinya gangguan perkembangan dapat diketahui lebih awal dan diintervensi lebih cepat pada pasien anak dengan PJB. 6 Bila dibandingkan dengan alat skrining lain yang menggunakan informasi dari orang tua, seperti Denver II, Child Development Review Parent Questionnaires (CDR-PQ) dan Parents Evaluation of Development Status (PEDS), ASQ-3 membutuhkan waktu yang singkat dalam pengerjaan dibandingkan yang lain. 7 Ages and Stages Questionnaires juga telah digunakan sebagai alat skrining perkembangan oleh The American Academy of Pediatrics (AAP) sejak tahun 2006, 8 tetapi belum di rekomendasikan untuk pasien anak dengan PJB.…”