Berkoff Molly Curtin, Leslie Laurel K, Stahmer Aubyn C
Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
J Dev Behav Pediatr. 2006 Aug;27(4):310-8.
Underidentification of developmental delays among young children involved with child welfare/child protective services (CW) is problematic. Caregivers of young children involved with CW may help increase identification of young children with developmental delays, but the accuracy of caregiver identification in this population and whether this varies by caregiver type is not known. This study uses data from the National Survey of Child and Adolescent Well-Being to determine if (1) caregivers of young children involved with CW accurately identify children with developmental delays and (2) foster caregivers are better able to identify developmental delays compared with other caregivers. Close to half the children had a delay in language, cognitive, and/or adaptive behavior (45%). Overall sensitivity for caregiver identification was 35% (95% confidence interval [CI]: 29%, 41%); specificity was 84% (95% CI: 80%, 87%). After controlling for certain child and caregiver characteristics, in-home caregivers had 0.15 times the odds of identifying a child with a developmental delay compared with foster caregivers (95% CI 0.1, 0.4). Results suggest that caregiver identification of developmental delays is specific but not sensitive, and that foster caregivers were more likely to identify a child with a developmental delay compared with in-home caregivers. Policy implications include improving educational programs regarding child development and developmental services for foster, kinship, as well as in-home caregivers in the hopes of increasing sensitivity of caregiver identification of developmental delays for the population of young children involved with CW.
在涉及儿童福利/儿童保护服务（CW）的幼儿中，发育迟缓未被充分识别是个问题。涉及CW的幼儿的照顾者可能有助于提高对发育迟缓幼儿的识别率，但在这一人群中照顾者识别的准确性以及这是否因照顾者类型而异尚不清楚。本研究使用来自全国儿童和青少年幸福调查的数据，以确定：（1）涉及CW的幼儿的照顾者能否准确识别出发育迟缓的儿童；（2）与其他照顾者相比，寄养照顾者是否更有能力识别出发育迟缓。近一半的儿童存在语言、认知和/或适应性行为方面的延迟（45%）。照顾者识别的总体敏感度为35%（95%置信区间[CI]：29%，41%）；特异度为84%（95%CI：80%，87%）。在控制了某些儿童和照顾者特征后，与寄养照顾者相比，家庭照顾者识别出发育迟缓儿童的几率为其0.15倍（95%CI 0.1，0.4）。结果表明，照顾者对发育迟缓的识别具有特异性但不敏感，并且与家庭照顾者相比，寄养照顾者更有可能识别出发育迟缓的儿童。政策影响包括改进关于儿童发育的教育项目以及为寄养、亲属关系照顾者和家庭照顾者提供发育服务，以期提高涉及CW的幼儿群体中照顾者对发育迟缓识别的敏感度。
