Validation of an instrument to screen for developmental problems in children younger than 5 years old in Uruguay
DOI:
https://doi.org/10.29193/RMU.36.1.4Keywords:
CHILD DEVELOPMENT, VALIDATION, SCREENING TEST, EVALUATION OF CHILD DEVELOPMENTAbstract
Introduction: early detection of developmental problems in children enables the application of timely interventions that improve prognosis and reduce disabilities. To that end, the application of sensitive, simple and low-cost screening procedures is required, what led to the creation of the “National Guidelines for the Surveillance of Early Childhood Development (under 5 years old children)” (GNVD V2). Use of these guidelines relies on awareness of psychometric properties a well as fixed rates and variables.
Objective: concurrent validation of GNVD V2 with Battelle Developmental Inventory, Fourth Edition.
Method: we conducted a transversal, observational study in a representative sample of children between 1 month and 5 years old from different schools in Montevideo. Subsequently, results from the application of GNVD V2 were compared to the Battelle Developmental Inventory, Fourth Edition. Sensitivity, specificity and predictive positive and negative values of the GNVD V2 were calculated for the different cut-off points. The clinical benefit if its application was estimated by means of likelihood ratios. A psychometric analysis was performed.
Results: validation was done with 341 children. No failure occurring in any of the behaviors to the left of the four areas corresponding to age represents 77% sensitivity, 65% specificity, 42% positive predictive value and 89% negative predictive value. Given such cut-off point, LR+ is 2.2 and LR- is 0.35, and the likelihood of there being a disorder when not passing the test is 1.6 and 0.26 when passing it.
Conclusions: GNVD V2 has the right psychometric properties and fixed rates that are similar to globally validated tests that allow for it to be recommended as the national screening instrument.
References
(1) WHO, UNICEF, World Bank Group. Advancing early childhood development: from science to scale. An executive summary for The Lancet’s Series. Lancet 2016. Disponible en: https://www.thelancet.com/pb-assets/Lancet/stories/series/ecd/Lancet_ECD_Executive_Summary.pdf (Consulta: 17 diciembre 2017).
(2) Irwin LG, Siddiqi A, Hertzman C. Desarrollo de la primera infancia: un potente ecualizador. Informe Final. Vancouver: HELP, 2007:82p. Disponible en: http://www.who.int/social_determinants/publications/early_child_dev_ecdkn_es.pdf (Consulta: 24 marzo 2018).
(3) Center on the Developing Child at Harvard University. From best practices to breakthrough impacts: a science-based approach to building a more promising future for young children and families. Cambridge, MA: Center on the Developing Child, 2016. Disponible en: https://pediatriesociale.fondationdrjulien.org/wp-content/uploads/2016/07/cdc_rapport_complet_2016.pdf (Consulta: 27 marzo 2018).
(4) Funaro R. Poco dinero para los más pequeños. (Blog: Ideas que cuentan, octubre 2015). Disponible en: https://blogs.iadb.org/Ideasquecuentan/2015/10/28/poco-dinero-para-los-mas-pequenos/ (Consulta: 16 diciembre 2018).
(5) Heckman JJ. Invest in early childhood development: reduce deficits, strengthen the economy. Disponible en: https://heckmanequation.org/assets/2013/07/F_HeckmanDeficitPieceCUSTOM-Generic_052714-3-1.pdf (Consulta: 27 diciembre 2017).
(6) Uruguay. Instituto Nacional de Estadística. Salud, nutrición y desarrollo en la primera infancia en Uruguay: primeros resultados de la ENDIS. Grupo de Estudios de Familia. Montevideo: INE, UdelaR, OPP, MSP, MIDES, 2015. Disponible en: http://www.ine.gub.uy/documents/10181/35704/SALUD%2C+NUTRICI%C3%93N+Y+DESARROLLO+EN+LA+PRIMERA+INFANCIA+EN+URUGUAY+PRIMEROS+RESULTADOS+DE+LA+ENDIS/7be3f504-ebb9-4427-bb5d-cb4d9f242a7b (Consulta: 8 diciembre 2018).
(7) Uruguay. Ministerio de Salud Pública. Objetivos Sanitarios Nacionales 2020. Disponible en: https://www.paho.org/uru/index.php?option=com_docman&view=download&alias=531-objetivossanitarios-web2017&category_slug=publicaciones-comunicacion&Itemid=307 (Consulta: 24 marzo 2019).
(8) Palfrey JS, Singer JD, Walker DK, Butler JA. Early identification of children’s special needs: a study in five metropolitan communities. J Pediatr 1987; 111(5):651-9.
(9) Blackman JA. Developmental screening infants, toddlers, and preschoolers. En: Levine MD, Carey WB, Crocker AC. En: Developmental Behavioral Pediatrics. 2a ed. Philadelphia, PA: WB Saunders, 1992:617-23.
(10) Blackman JA, Healy A, Ruppert ES. Participation by pediatricians in early intervention: impetus from Public Law 99-457. Pediatrics 1992; 89(1):98-102.
(11) Bennett F, Guralnick M. Effectiveness of developmental intervention in the first five years of life. Pediatr Clin North Am 1991; 38:1513-28.
(12) Committee on practice and ambulatory medicine, Bright futures periodicity Schedule workgroup. 2017 Recommendations for preventive pediatric health care. Pediatrics 2017; 139(4):e20170254.
(13) Weitzman C, Wegner L; Section on developmental and behavioral pediatrics, Committee on psychosocial aspects of child and family health, Council on early childhood and Society for Developmental Behavioral Pediatrics. Promoting optimal development: screening for behavioral and emotional problems. Pediatrics 2015; 135(2):384-95.
(14) Wilson JM, Jungner G. Principles and practice of screening for disease. Geneva: World Health Organization, 1968. (Public health papers, 34).
(15) Lansdown RG, Goldstein H, Shah PM, Orley JH, Di G, Kaul KK, et al. Culturally appropriate measures for monitoring child development at family and community level: a WHO collaborative study. Bull World Health Organ 1996; 74:283-90.
(16) Colombia. Ministerio de Salud. Escala abreviada de desarrollo. Manual de instrucciones. Bogotá: Guadalupe, 1991.
(17) Mokkink LB, Prinsen CA, Bouter LM, de Vet HC, Terwee CB. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Braz J Phys Ther 2016; 20(2):105-13. Disponible en: http://www.redalyc.org/articulo.oa?id=235046202001 (Consulta: 8 agosto 2017).
(18) Streiner DL, Norman GR, Cairney J. Health measurement scales: a practical guide to their development and use. 4 ed. Oxford: Oxford University, 2008.
(19) Newborg J. Battelle Developmental Inventory. 2ª ed. (Normative update BDI-2 NU). Itasca, IL: Riverside, 2005.
(20) Calvo JJ, coord, Borrás V, Cabella W, Carrasco P, De los Campos H, Koolhaas M. Atlas sociodemográfico y de la desigualdad del Uruguay. Las necesidades básicas insatisfechas a partir de los Censos 2011. Montevideo: Trilce, 2013: 78 p.
(21) Romo-Pardo B, Liendo-Vallejos S, Vargas-López G, Rizzioli-Córdoba A, Buenrostro-Márquez G. Pruebas de tamizaje de neurodesarrollo global para niños menores de 5 años de edad validadas en Estados Unidos y Latinoamérica: revisión sistemática y análisis comparativo. Bol Med Hosp Infant Mex 2012; 69(6):450-62.
(22) Schonhaut L, Salinas P, Armijo I, Schonstedt M, Álvarez J, Manríquez M. Validación de un cuestionario autoadministrado para la evaluación del desarrollo psicomotor. Rev Chil Pediatr 2009; 80(6):513-9.
(23) Cochrane AL, Holland WW. Validation of screening procedures. Br Med Bull 1971; 27(1):3-8.
(24) Hall DMB, ed. Health for all children: a programme for child health surveillance. Oxford: Oxford University, 1989.
(25) DSM IV. Manual diagnóstico y estadístico de los trastornos mentales. 4 ed. Barcelona: Masson, 1995.
(26) Shonkoff JP, Garner AS. The lifelong effects of early childhood adversity and toxic stress. Pediatrics 2011; 129(1):e232-46.
(27) Rydz D, Srour M, Oskoui M, Marget N, Shiller M, Birnbaum R, et al. Screening for developmental delay in the setting of a community pediatric clinic: a prospective assessment of parent-report questionnaires. Pediatrics 2006; 118(4):e1178-86.
(28) Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. Pediatrics 2006; 118(1):405-20.
(29) Silva Fuente-Alba C, Molina Villagra M. Likelihood ratio (razón de verosimilitud): definición y aplicación en Radiología. Rev Argent Radiol 2017; 8(3):204-8.
(2) Irwin LG, Siddiqi A, Hertzman C. Desarrollo de la primera infancia: un potente ecualizador. Informe Final. Vancouver: HELP, 2007:82p. Disponible en: http://www.who.int/social_determinants/publications/early_child_dev_ecdkn_es.pdf (Consulta: 24 marzo 2018).
(3) Center on the Developing Child at Harvard University. From best practices to breakthrough impacts: a science-based approach to building a more promising future for young children and families. Cambridge, MA: Center on the Developing Child, 2016. Disponible en: https://pediatriesociale.fondationdrjulien.org/wp-content/uploads/2016/07/cdc_rapport_complet_2016.pdf (Consulta: 27 marzo 2018).
(4) Funaro R. Poco dinero para los más pequeños. (Blog: Ideas que cuentan, octubre 2015). Disponible en: https://blogs.iadb.org/Ideasquecuentan/2015/10/28/poco-dinero-para-los-mas-pequenos/ (Consulta: 16 diciembre 2018).
(5) Heckman JJ. Invest in early childhood development: reduce deficits, strengthen the economy. Disponible en: https://heckmanequation.org/assets/2013/07/F_HeckmanDeficitPieceCUSTOM-Generic_052714-3-1.pdf (Consulta: 27 diciembre 2017).
(6) Uruguay. Instituto Nacional de Estadística. Salud, nutrición y desarrollo en la primera infancia en Uruguay: primeros resultados de la ENDIS. Grupo de Estudios de Familia. Montevideo: INE, UdelaR, OPP, MSP, MIDES, 2015. Disponible en: http://www.ine.gub.uy/documents/10181/35704/SALUD%2C+NUTRICI%C3%93N+Y+DESARROLLO+EN+LA+PRIMERA+INFANCIA+EN+URUGUAY+PRIMEROS+RESULTADOS+DE+LA+ENDIS/7be3f504-ebb9-4427-bb5d-cb4d9f242a7b (Consulta: 8 diciembre 2018).
(7) Uruguay. Ministerio de Salud Pública. Objetivos Sanitarios Nacionales 2020. Disponible en: https://www.paho.org/uru/index.php?option=com_docman&view=download&alias=531-objetivossanitarios-web2017&category_slug=publicaciones-comunicacion&Itemid=307 (Consulta: 24 marzo 2019).
(8) Palfrey JS, Singer JD, Walker DK, Butler JA. Early identification of children’s special needs: a study in five metropolitan communities. J Pediatr 1987; 111(5):651-9.
(9) Blackman JA. Developmental screening infants, toddlers, and preschoolers. En: Levine MD, Carey WB, Crocker AC. En: Developmental Behavioral Pediatrics. 2a ed. Philadelphia, PA: WB Saunders, 1992:617-23.
(10) Blackman JA, Healy A, Ruppert ES. Participation by pediatricians in early intervention: impetus from Public Law 99-457. Pediatrics 1992; 89(1):98-102.
(11) Bennett F, Guralnick M. Effectiveness of developmental intervention in the first five years of life. Pediatr Clin North Am 1991; 38:1513-28.
(12) Committee on practice and ambulatory medicine, Bright futures periodicity Schedule workgroup. 2017 Recommendations for preventive pediatric health care. Pediatrics 2017; 139(4):e20170254.
(13) Weitzman C, Wegner L; Section on developmental and behavioral pediatrics, Committee on psychosocial aspects of child and family health, Council on early childhood and Society for Developmental Behavioral Pediatrics. Promoting optimal development: screening for behavioral and emotional problems. Pediatrics 2015; 135(2):384-95.
(14) Wilson JM, Jungner G. Principles and practice of screening for disease. Geneva: World Health Organization, 1968. (Public health papers, 34).
(15) Lansdown RG, Goldstein H, Shah PM, Orley JH, Di G, Kaul KK, et al. Culturally appropriate measures for monitoring child development at family and community level: a WHO collaborative study. Bull World Health Organ 1996; 74:283-90.
(16) Colombia. Ministerio de Salud. Escala abreviada de desarrollo. Manual de instrucciones. Bogotá: Guadalupe, 1991.
(17) Mokkink LB, Prinsen CA, Bouter LM, de Vet HC, Terwee CB. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Braz J Phys Ther 2016; 20(2):105-13. Disponible en: http://www.redalyc.org/articulo.oa?id=235046202001 (Consulta: 8 agosto 2017).
(18) Streiner DL, Norman GR, Cairney J. Health measurement scales: a practical guide to their development and use. 4 ed. Oxford: Oxford University, 2008.
(19) Newborg J. Battelle Developmental Inventory. 2ª ed. (Normative update BDI-2 NU). Itasca, IL: Riverside, 2005.
(20) Calvo JJ, coord, Borrás V, Cabella W, Carrasco P, De los Campos H, Koolhaas M. Atlas sociodemográfico y de la desigualdad del Uruguay. Las necesidades básicas insatisfechas a partir de los Censos 2011. Montevideo: Trilce, 2013: 78 p.
(21) Romo-Pardo B, Liendo-Vallejos S, Vargas-López G, Rizzioli-Córdoba A, Buenrostro-Márquez G. Pruebas de tamizaje de neurodesarrollo global para niños menores de 5 años de edad validadas en Estados Unidos y Latinoamérica: revisión sistemática y análisis comparativo. Bol Med Hosp Infant Mex 2012; 69(6):450-62.
(22) Schonhaut L, Salinas P, Armijo I, Schonstedt M, Álvarez J, Manríquez M. Validación de un cuestionario autoadministrado para la evaluación del desarrollo psicomotor. Rev Chil Pediatr 2009; 80(6):513-9.
(23) Cochrane AL, Holland WW. Validation of screening procedures. Br Med Bull 1971; 27(1):3-8.
(24) Hall DMB, ed. Health for all children: a programme for child health surveillance. Oxford: Oxford University, 1989.
(25) DSM IV. Manual diagnóstico y estadístico de los trastornos mentales. 4 ed. Barcelona: Masson, 1995.
(26) Shonkoff JP, Garner AS. The lifelong effects of early childhood adversity and toxic stress. Pediatrics 2011; 129(1):e232-46.
(27) Rydz D, Srour M, Oskoui M, Marget N, Shiller M, Birnbaum R, et al. Screening for developmental delay in the setting of a community pediatric clinic: a prospective assessment of parent-report questionnaires. Pediatrics 2006; 118(4):e1178-86.
(28) Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. Pediatrics 2006; 118(1):405-20.
(29) Silva Fuente-Alba C, Molina Villagra M. Likelihood ratio (razón de verosimilitud): definición y aplicación en Radiología. Rev Argent Radiol 2017; 8(3):204-8.
Downloads
Published
2020-03-31
How to Cite
1.
Giachetto Larraz G, Santoro Ferrero A, Pérez Roca MM, Massa Mandagaran FF. Validation of an instrument to screen for developmental problems in children younger than 5 years old in Uruguay. Rev. Méd. Urug. [Internet]. 2020 Mar. 31 [cited 2024 Dec. 22];36(1):28-3. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/495
Issue
Section
Original Articles
