Vaezghasemi Masoud, Eurenius Eva, Ivarsson Anneli, Richter Sundberg Linda, Silfverdal Sven Arne, Lindkvist Marie
Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Department of Clinical Science, Pediatrics, Umeå University, Umeå, Sweden.
Front Pediatr. 2022 Feb 9;10:756239. doi: 10.3389/fped.2022.756239. eCollection 2022.
Expressions of emotional and behavioral symptoms in preschool age can predict mental health problems in adolescence and adulthood. The Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) has been successful in detecting social and emotional problems in young children in some countries but had not been tested in Sweden. The objective of this study was to determine the optimal cut-off for the ASQ:SE instrument when administered to 3-year-old children in a northern Swedish setting, using the Strengths and Difficulties Questionnaire (SDQ) as the reference.
The ASQ:SE (36-month interval, first edition) was administered at routine 3-year-olds' visits to Child Health Care centers in Region Västerbotten, Sweden. During the study period (September 2017 to March 2018) parents were invited to also fill out the SDQ (2-4 year version). In the final analyses 191 children fulfilled the criteria for inclusion in the study sample. Non-parametric Receiver Operating Characteristic analysis was performed to quantify the discriminatory accuracy of ASQ:SE based on SDQ.
The Pearson correlation between ASQ:SE and SDQ indicated strong correlation between the two instruments. The Receiver Operating Characteristic curve showed good accuracy of ASQ:SE in relation to SDQ. However, our results suggest that the existing ASQ:SE cut-off score of 59 was not optimal in the Swedish context. Changing the cut-off from 59 to 50 would allow us to detect 100% ( = 14) of children with problems according to SDQ, compared to 64% ( = 9) when the cut-off was 59. However, the proportion of false positives would be higher (9% compared to 3%).
The main finding was that for 3-year-olds in Sweden a decreased ASQ:SE cut-off score of 50 would be optimal. This would increase the detection rate of at-risk children according to SDQ (true positive), thus prioritizing sensitivity. Our conclusion is that, although this change would result in more false positives, this would be justifiable.
学龄前儿童的情绪和行为症状表现能够预测其青少年期和成年期的心理健康问题。年龄与发育阶段调查问卷：社会情绪版（ASQ:SE）在一些国家已成功用于检测幼儿的社会和情绪问题，但尚未在瑞典进行测试。本研究的目的是在瑞典北部地区，以长处与困难问卷（SDQ）作为参照标准，确定将ASQ:SE工具应用于3岁儿童时的最佳临界值。
在瑞典韦斯特博滕地区的儿童保健中心，对3岁儿童进行常规访视时使用ASQ:SE（36个月间隔，第一版）。在研究期间（2017年9月至2018年3月），邀请家长同时填写SDQ（2 - 4岁版本）。最终分析纳入了191名符合研究样本纳入标准的儿童。基于SDQ进行非参数ROC分析，以量化ASQ:SE的辨别准确性。
ASQ:SE与SDQ之间的Pearson相关性表明，这两种工具之间存在强相关性。ROC曲线显示ASQ:SE相对于SDQ具有良好的准确性。然而，我们的结果表明，在瑞典背景下，现有的ASQ:SE临界值59并非最佳。将临界值从59改为50，根据SDQ可使我们检测出100%（ = 14）有问题的儿童，而临界值为59时这一比例为64%（ = 9）。然而，假阳性比例会更高（分别为9%和3%）。
主要发现是，对于瑞典的3岁儿童，将ASQ:SE临界值降至50最为合适。这将提高根据SDQ检测高危儿童的比例（真阳性），从而优先考虑敏感性。我们的结论是，尽管这种改变会导致更多假阳性，但这是合理的。
