The predictive value of universal preschool developmental assessment in identifying children with later educational difficulties: A systematic review

Abstract

Background Developmental delay affects substantial proportions of children. It can generally be identified in the pre-school years and can impact on children’s educational outcomes, which in turn may affect outcomes across the life span. High income countries increasingly assess children for developmental delay in the early years, as part of universal child health programmes, however there is little evidence as to which measures best predict later educational outcomes. This systematic review aims to assess results from the current literature on which measures hold the best predictive value, in order to inform the developmental surveillance aspects of universal child health programmes. Methods Systematic review sources: Medline (2000 –current), Embase (2000 –current), PsycInfo (2000 –current) and ERIC (2000 –current). Additional searching of birth cohort studies was undertaken and experts consulted. Eligibility criteria: Included studies were in English from peer reviewed papers or books looking at developmental assessment of preschool children as part of universal child health surveillance programmes or birth cohort studies, with linked results of later educational success/difficulties. The study populations were limited to general populations of children aged 0–5 years in high income countries. Study selection, data extraction and risk of bias assessment were carried out by two independent authors and any disagreement discussed. PROSPERO registration number CRD42018103111. Results Thirteen studies were identified for inclusion in the review. The studies were highly heterogeneous: age of children at first assessment ranged from 1–5 years, and at follow-up from 4–26 years. Type of initial and follow-up assessment also varied. Results indicated that, with the exception of one study, the most highly predictive initial assessments comprised combined measures of children’s developmental progress, such as a screening tool alongside teacher ratings and developmental histories. Other stand-alone measures also performed adequately, the best of these being the Ages and Stages Questionnaire (ASQ). Latency between measures, age of child at initial measurement, size of studies and quality of studies all impacted on the strength of results. Conclusions This review was the first to systematically assess the predictive value of preschool developmental assessment at a population level on later educational outcomes. Results demonstrated consistent associations between relatively poor early child development and later educational difficulties. In general, specificity and Negative Predictive Value are high, suggesting that young children who perform well in developmental assessment are unlikely to go on to develop educational difficulties, however the sensitivity and Positive Predictive Values were generally low, indicating that these assessments would not meet the requirements for a screening test. For surveillance purposes, however, findings suggested that combined measures provided the best results, although these are resource intensive and thus difficult to implement in universal child health programmes. Health service providers may therefore wish to consider using stand-alone measures, which also were shown to provide adequate predictive value, such as the ASQ.

Predictive Validity of Developmental Screening Questionnaires for Identifying Children With Later Cognitive or Educational Difficulties: A Systematic Review

“…This review is in line with the results reported in both the reviews by Cairney et al, ( 33 ) and Sim et al, ( 32 ) that showed a consistent association between different developmental screening assessment tools and later educational performance. They reported better predictive capacity especially when using a parent-reported assessment than direct child assessment.…”

“…In the general population, Sim et al, ( 32 ) demonstrated robust predictive validity of later disorders of language and socioemotional functioning, particularly when parent-report tools were used. In a recent publication, Cairney et al, ( 33 ) analyzed the predictive value of preschool developmental assessment on later educational outcomes in high-income countries, showing a consistent association between relatively poor early child development and later educational difficulties. They report ASQ as having the best correlation despite including only one study using ASQ in their review ( 33 ).…”

“…In a recent publication, Cairney et al, ( 33 ) analyzed the predictive value of preschool developmental assessment on later educational outcomes in high-income countries, showing a consistent association between relatively poor early child development and later educational difficulties. They report ASQ as having the best correlation despite including only one study using ASQ in their review ( 33 ). Although these studies suggest robust predictive ability of the DSQs, none of the published studies analyzed the DSQs as a whole.…”

Predictive validity of the Infant Toddler Checklist in primary care at the 18-month visit and developmental diagnosis at 3–5 years: a prospective cohort study

“…27 30 Factors associated with lower sensitivity include younger age at screening and longer latency from screening to outcome. 30 Therefore, it is not surprising that screening at 18 months resulted in a low sensitivity to predict developmental diagnosis at 3-5 years. This underscores the importance of continuous developmental surveillance at all health supervision visits, as recommended by professional organisations.…”

“…27 Three recent systematic reviews addressed the predictive criterion validity of developmental screening tools; however, of included studies, few examined screening at 18 months or younger, and none included the ITC. [28][29][30] While the ITC may be a promising developmental screening tool for the 18-month visit in primary care, we have identified gaps in evidence regarding its predictive validity. Our objective was to examine the predictive validity of the ITC at the 18-month visit to predict a developmental diagnosis at 3-5 years of age.…”