The Dysphagia Disorder Survey: Validation of an assessment for swallowing and feeding function in developmental disability

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Aim To determine the prevalence of drooling, swallowing, and feeding problems in persons with cerebral palsy (CP) across the lifespan. Method A systematic review was conducted using five different databases (AMED, CINAHL, Embase, MEDLINE, and PubMed). The selection process was completed by two independent researchers and the methodological quality of included studies was assessed using the STROBE and AXIS guidelines. Meta‐analyses were conducted to determine pooled prevalence estimates of drooling, swallowing, and feeding problems with stratified group analyses by type of assessment and Gross Motor Function Classification System level. Results A total of 42 studies were included. Substantial variations in selected outcome measures and variables were observed, and data on adults were limited. Pooled prevalence estimates determined by meta‐analyses were as high as 44.0% (95% confidence interval [CI] 35.6–52.7) for drooling, 50.4% (95% CI 36.0–64.8) for swallowing problems, and 53.5% (95% CI 40.7–65.9) for feeding problems. Group analyses for type of assessments were non‐significant; however, more severely impaired functioning in CP was associated with concomitant problems of increased drooling, swallowing, and feeding. Interpretation Drooling, swallowing, and feeding problems are very common in people with CP. Consequently, they experience increased risks of malnutrition and dehydration, aspiration pneumonia, and poor quality of life. What this paper adds Drooling, swallowing, and feeding problems are very common in persons with cerebral palsy (CP). The prevalence of drooling, swallowing, and feeding problems is 44.0%, 50.4%, and 53.5% respectively. There are limited data on the prevalence of drooling, swallowing, and feeding problems in adults. Higher Gross Motor Function Classification System levels are associated with higher prevalence of drooling, swallowing, and feeding problems. There is increased risk for malnutrition, dehydration, aspiration pneumonia, and poor quality of life in CP.

Section: Discussionmentioning

confidence: 99%

Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta‐analyses

Speyer

Cordier

Kim

et al. 2019

110

“…The Dysphagia Disorders Survey—Pediatric (Part 2) (DDS) was the primary tool to assess feeding outcome, following systematic review and further testing of psychometrics . The DDS (Part 2) assesses eight ingestion functions on a puree, chewable food and fluid . Each ingestion function is rated ‘impaired’/‘not impaired’, with a maximum raw score of 22.…”

Section: Methodsmentioning

confidence: 99%

Parent‐reported indicators for detecting feeding and swallowing difficulties and undernutrition in preschool‐aged children with cerebral palsy

Benfer

Weir

Ware

et al. 2017

“…children identified as having OPD on the SOMA are likely to have ‘true’ OPD); however, the sensitivity, particularly for mild OPD, has not been adequately explored. The DDS was developed primarily in adults with developmental disability and, although it has been validated for children as young as 2 years, there has been inadequate sampling of children of this age . Thus, it is possible the DDS is overdetecting OPD in children with newly established oral sensorimotor systems.…”

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confidence: 99%

Validity and reproducibility of measures of oropharyngeal dysphagia in preschool children with cerebral palsy

Benfer

Weir

Bell

et al. 2014

AIM The aim of the study was to determine the best measure to discriminate between those with oropharyngeal dysphagia (OPD) and those without OPD, among young children with cerebral palsy (CP).METHOD We carried out a cross-sectional population-based study involving 130 children with CP aged between 18 months and 36 months (mean 27.4mo; 81 males, 49 females) classified according to the Gross Motor Function Classification Scale (GMFCS) as level I (n=57), II (n=15), III (n=23), IV (n=12), or V (n=23). Forty children with CP (mean 28.5mo; 21 males,19 females, eight for each GMFCS level) were included in the reproducibility sub-study, and 40 children with typical development (mean 26.2mo; 18 males, 22 females) were included in the validity sub-study. OPD was assessed using the Dysphagia Disorders Survey (DDS), Pre-Speech Assessment Scale (PSAS), and Schedule for Oral Motor Assessment (SOMA). We analysed reproducibility using inter-and intrarater agreement (percentage) and reliability (kappa values and intraclass correlation coefficients). Construct validity was assessed as concordance between measures (SOMA, DDS, and PSAS). In the absence of a criterion standard measure for OPD, prevalence was estimated using latent class variable analysis. Data from the children with typical development were used to propose modified OPD cut-points for discriminative validity.RESULTS All measures had strong agreement (>85%) for inter-and intrarater reliability. The SOMA had the best specificity (100.0%), but lacked sensitivity (53.0%), whereas the DDS and PSAS had high sensitivity (each 100.0%) but lacked specificity (47.1% and 70.6% respectively). OPD prevalence when calculated using the web-based estimation was 65.4%, which was similar to the estimate from the modified cut-points.INTERPRETATION Using the sample of children with typical development and modified cutpoints, OPD prevalence was lower than estimates with standard scoring. We propose using these modified cut-points when administering the DDS, PSAS or SOMA in young children with CP.