Validity of the ‘Ten Questions’ for Screening Serious Childhood Disability: Results from Urban Bangladesh

Abstract

A survey of 2576 children aged two to nine years was carried out in Dhaka, Bangladesh, as part of a collaborative study to test the validity of a questionnaire (the Ten Questions) for screening severe childhood disabilities in community settings. Approximately 7% of the children were positive on the screen and this rate was slightly higher in boys than girls. The sensitivity, specificity and negative predictive value of the Ten Questions were perfect or nearly perfect for severe and moderate (serious) disabilities. The positive predictive value was only 22% for serious disabilities, but 70% of children classified as false positives were found to have mild disabilities or other conditions (such as ear infections) for which early detection and treatment could be beneficial. No major age or gender differences in the validity of the questionnaire were apparent, but this finding needs additional study and confirmation with studies based on larger samples. In general, the results indicate that the Ten Questions is a valid tool for screening serious disabilities in children and can potentially improve the efficiency of health services by reducing the number of children requiring attention from professionals. Future studies using the Ten Questions should foster greater attention to the dimensions of childhood disability as a public health problem in the less developed world.

Adaptation of the “ten questions” to screen for autism and other neurodevelopmental disorders in Uganda

“…However, in most low-resource settings, administrative databases and medical records are neither widely available nor complete, necessitating different case identification methods than the relatively efficient and inexpensive record-based approaches frequently used in the developed world. An intensive effort was launched in the 1980s to develop and evaluate a method of case identification for children with disabilities as an indicator of health status in countries with scarce resources (Durkin et al, 1991(Durkin et al, , 1994(Durkin et al, , 1995a(Durkin et al, , 1995bShrout and Newman, 1989;Thorburn, 1993;Thorburn and Desai, 1991;Thorburn et al, 1992Thorburn et al, , 1993Zaman et al, 1990). The result was the formulation of a two-stage approach using door-to-door screening with a simple caregiver questionnaire, followed by clinical assessment of children who screen positive.…”

Child disability services in Bangladesh

“…Two important early building blocks for this model were, first, epidemiological surveys using two stages of the Ten Questions screen with carers of children aged 2 to 9 years, followed by expert assessment by a doctor and psychologist. 3 Second, child development teams were formed in a small number of centres around Bangladesh, supported by the expertise of a national Child Development and Neurology Unit at Dhaka Children's Hospital, first established in 1992. 4 These health initiatives were complemented by development of integrated schools and community rehabilitation initiatives, and pictorial manuals of early advice for parents, led by a non-governmental organization, the Bangladesh Protibondhi Foundation.…”

School and Classroom Disabilities Inclusion Guide for Low- and Middle-Income Countries

“…Overall, the TQ has emerged as the predominant measure of child disability in low-and middleincome countries (UNICEF, 2008 (Lorencz & Boivin, 2013), and Bangladesh (Zaman et al, 1990).…”