婴幼儿检查表在18个月访视时的初级保健中的预测效度及4至6岁时的入学准备情况

Predictive Validity of the Infant Toddler Checklist in Primary Care at the 18-month Visit and School Readiness at 4 to 6 Years.

作者信息

Nurse Kimberly M, Janus Magdalena, Birken Catherine S, Keown-Stoneman Charles D G, Omand Jessica A, Maguire Jonathon L, Reid-Westoby Caroline, Duku Eric, Mamdani Muhammad, Tremblay Mark S, Parkin Patricia C, Borkhoff Cornelia M

机构信息

Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto (KM Nurse, CS Birken, JL Maguire, M Mamdani, PC Parkin, and CM Borkhoff), Toronto, Ontario, Canada.

Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University (M Janus, C Reid-Westoby, and E Duku), Hamilton, Ontario, Canada.

出版信息

Acad Pediatr. 2023 Mar;23(2):322-328. doi: 10.1016/j.acap.2022.09.004. Epub 2022 Sep 17.

DOI:10.1016/j.acap.2022.09.004

PMID:36122830

Abstract

OBJECTIVE

The American Academy of Pediatrics recommends developmental surveillance and screening in early childhood in primary care. The 18-month visit may be an ideal time for identification of children with delays in language and communication, or symptoms of autism spectrum disorder (ASD). Little is known about the predictive validity of developmental screening tools administered at 18 months. Our objective was to examine the predictive validity of the Infant Toddler Checklist (ITC) at the 18-month health supervision visit, using school readiness at kindergarten age as the criterion measure.

METHODS

We designed a prospective cohort study, recruiting in primary care in Toronto, Canada. Parents completed the ITC at the 18-month visit. Teachers completed the Early Development Instrument (EDI) when the children were in Kindergarten, age 4-6 years. We calculated screening test properties with 95% confidence intervals (CIs). We used multivariable logistic and linear regression analyses adjusted for important covariates.

RESULTS

Of 293 children (mean age 18 months), 30 (10.2%) had a positive ITC including: concern for speech delay (n = 11, 3.8%), concern for other communication delay (n = 13, 4.4%), and concern for both (n = 6, 2.0%). At follow-up (mean age 5 years), 54 (18.4%) had overall EDI vulnerability, 19 (6.5%) had vulnerability on the 2 EDI communication domains. The ITC sensitivity ranged from 11% to 32%, specificity from 91% to 96%, false positive rates from 4% to 9%, PPV from 16% to 35%, NPV from 83% to 95%. A positive ITC screen and ITC concern for speech delay were associated with lower scores in EDI communication skills and general knowledge (β = -1.08; 95% CI: -2.10, -0.17; β = -2.35; 95% CI: -3.63, -1.32) and EDI language and cognitive development (β = -0.62; 95% CI: -1.25, -0.18; β = -1.22; 95% CI: -2.11, -0.58).

CONCLUSIONS

The ITC demonstrated high specificity suggesting that most children with a negative ITC screen will demonstrate school readiness at 4-6 years, and low false positive rates, minimizing over-diagnosis. The ITC had low sensitivity highlighting the importance of ongoing developmental surveillance and screening.

摘要

目的

美国儿科学会建议在初级保健中对幼儿进行发育监测和筛查。18个月龄的访视可能是识别语言和沟通延迟或自闭症谱系障碍（ASD）症状儿童的理想时机。关于18个月龄时进行的发育筛查工具的预测效度知之甚少。我们的目的是使用幼儿园入学准备情况作为标准测量指标，检验18个月龄健康监督访视时婴幼儿检查表（ITC）的预测效度。

方法

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招募研究对象。家长在18个月龄访视时填写ITC。孩子4至6岁上幼儿园时，教师填写早期发育工具（EDI）。我们计算了筛查测试指标及95%置信区间（CI）。我们使用多变量逻辑回归和线性回归分析，并对重要的协变量进行了校正。

结果

293名儿童（平均年龄18个月）中，30名（10.2%）ITC呈阳性，包括：言语延迟担忧（n = 11，3.8%）、其他沟通延迟担忧（n = 13，4.4%）以及两者皆有担忧（n = 6，2.0%）。随访时（平均年龄5岁），54名（18.4%）儿童总体EDI存在缺陷，19名（6.5%）儿童在EDI的两个沟通领域存在缺陷。ITC的灵敏度在11%至32%之间，特异度在91%至96%之间，假阳性率在4%至9%之间，阳性预测值在16%至35%之间，阴性预测值在83%至95%之间。ITC筛查阳性以及ITC对言语延迟的担忧与EDI沟通技能和常识得分较低相关（β = -1.08；95% CI：-2.10，-0.17；β = -2.35；95% CI：-3.63，-1.32），也与EDI语言和认知发展得分较低相关（β = -0.62；95% CI：-1.25，-0.18；β = -1.22；95% CI：-2.11，-0.58）。