Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
BMJ Paediatr Open. 2022 Jun;6(1). doi: 10.1136/bmjpo-2022-001524.
There is international variation in recommendations regarding developmental screening and growing recognition of the low sensitivity of commonly used developmental screening tools. Our objective was to examine the predictive validity of the Infant Toddler Checklist (ITC) at 18 months to predict a developmental diagnosis at 3-5 years, in a primary care setting.
We designed a prospective cohort study, recruiting in primary care in Toronto, Canada. Parents completed the ITC at the 18-month visit and reported developmental diagnosis at 3-5 years (developmental delay, autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), learning problem). We calculated screening test properties with 95% CIs. We used multivariable logistic regression analyses adjusted for important covariates.
In the final sample (n=488), mean age at screening was 18.5 (SD 1.1) months, and at follow-up was 46.6 (SD 10.0) months. At screening, 46 (9.4%) had a positive ITC. At follow-up, 26 (5.3%) had a developmental diagnosis, including: developmental delay (n=22), ASD (n=4), ADHD (n=1), learning problem (n=1); parents of two children each reported two diagnoses (total of 28 diagnoses). Of four children with a diagnosis of ASD at follow-up, three had a positive ITC at 18 months. The ITC specificity (92%, 95% CI: 89% to 94%) and negative predictive value (96%, 95% CI: 95% to 97%) were high; false positive rate was low (8%, 95% CI: 6% to 11%); sensitivity was low (31%, 95% CI: 14% to 52%). There was a strong association between a positive ITC at 18 months and later developmental diagnosis (adjusted OR 4.48, 95% CI: 1.72 to 11.64; p0.002).
The ITC had high specificity, high negative predictive value, low false positive rate, and identified children with later developmental delay and ASD. The ITC had low sensitivity, similar to other screening tools underscoring the importance of continuous developmental surveillance at all health supervision visits.
发育筛查的建议在国际上存在差异，并且人们越来越认识到常用发育筛查工具的敏感性较低。我们的目的是在初级保健环境中，研究婴儿-幼儿检查表（ITC）在 18 个月时预测 3-5 岁时发育诊断的预测效度。
我们设计了一项前瞻性队列研究，在加拿大多伦多的初级保健机构中进行招募。父母在 18 个月就诊时完成 ITC，并在 3-5 岁时报告发育诊断（发育迟缓、自闭症谱系障碍（ASD）、注意缺陷多动障碍（ADHD）、学习问题）。我们使用 95%置信区间（CI）计算筛查试验的特性。我们使用多变量逻辑回归分析调整了重要协变量。
在最终样本（n=488）中，筛查时的平均年龄为 18.5（SD 1.1）个月，随访时为 46.6（SD 10.0）个月。在筛查时，有 46（9.4%）例 ITC 阳性。在随访时，有 26（5.3%）例有发育诊断，包括：发育迟缓（n=22）、ASD（n=4）、ADHD（n=1）、学习问题（n=1）；有两位儿童的父母各报告了两个诊断（共 28 个诊断）。在随访时有 4 例 ASD 诊断的儿童中，有 3 例在 18 个月时 ITC 阳性。ITC 的特异性（92%，95%CI：89%至 94%）和阴性预测值（96%，95%CI：95%至 97%）均较高；假阳性率较低（8%，95%CI：6%至 11%）；敏感性较低（31%，95%CI：14%至 52%）。18 个月时 ITC 阳性与日后的发育诊断之间存在很强的关联（校正优势比 4.48，95%CI：1.72 至 11.64；p<0.002）。
ITC 特异性高、阴性预测值高、假阳性率低，能识别出日后有发育迟缓或 ASD 的儿童。ITC 的敏感性较低，与其他筛查工具相似，这突出了在所有健康监督就诊时持续进行发育监测的重要性。
