Hatakenaka Yuhei, Hachiya Koutaro, Ikezoe Shino, Åsberg Johnels Jakob, Gillberg Christopher
Facuty of Humanities and Social Sciences, University of the Ryukyus, Nishihara, Okinawa, Japan.
Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Gothenburg, Sweden.
Neuropsychiatr Dis Treat. 2022 Oct 19;18:2405-2420. doi: 10.2147/NDT.S377534. eCollection 2022.
We investigated to what extent early motor development problems predict a future diagnosis of neurodevelopmental disorders (NDDs)/Early Symptomatic Syndromes Eliciting Neurodevelopmental Examinations (ESSENCE) by using a Bayesian network model (BN).
Subjects were the children who had participated in the 18- and 36-month checkups in two cities in Japan between April 2014 and March 2015. Their motor development data at the 4-, 10- and 18-month-checkups were collected with ethical consideration. The diagnosis was confirmed at the age of six, after regular assessment in all developmental areas at a neurodevelopmental clinic. The accuracy of prediction of NDD based on posterior probabilities determined using the BN was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The posterior probability (the optimal cut-off value) yielding the maximum Youden Index (sensitivity + specificity - 1) is determined with the ROC curve, and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and utility index (UI) were computed.
BN models showed associations between early motor items and developmental coordination disorders, borderline intelligence/intellectual disability, and speech and language disorder. The ROC curve for any NDD had an AUC of 0.735. The posterior probability with the maximal Youden Index was 0.138; at the optimal cut-off value, the sensitivity, specificity, PPV, NPV, UI+, and UI- were 0.619, 0.761, 0.250, 0.940, 0.155 and 0.715, respectively.
We utilized a novel approach in detailing the associations between certain early motor problems and specific NDDs. We showed that the presence of motor development problems early in development increases the probability of a future diagnosis of any NDD. Still, the sensitivity of early motor development problems as a screening tool was not high enough to be the sole instrument for detecting NDDs. The need for a broad, holistic ESSENCE perspective when looking at the course of motor development problems was stressed.
我们使用贝叶斯网络模型（BN）研究早期运动发育问题在多大程度上能够预测未来神经发育障碍（NDDs）/引发神经发育检查的早期症状综合征（ESSENCE）的诊断。
研究对象为2014年4月至2015年3月期间在日本两个城市参加18个月和36个月检查的儿童。在遵循伦理原则的情况下收集了他们在4个月、10个月和18个月检查时的运动发育数据。在神经发育诊所对所有发育领域进行常规评估后，于6岁时确诊。基于使用BN确定的后验概率对NDD进行预测的准确性，通过受试者操作特征（ROC）曲线下面积（AUC）进行评估。通过ROC曲线确定产生最大约登指数（敏感度 + 特异度 - 1）的后验概率（最佳截断值），并计算敏感度、特异度、阳性预测值（PPV）、阴性预测值（NPV）和效用指数（UI）。
BN模型显示早期运动项目与发育协调障碍、边缘智力/智力残疾以及言语和语言障碍之间存在关联。任何NDD的ROC曲线的AUC为0.735。具有最大约登指数的后验概率为0.138；在最佳截断值时，敏感度、特异度、PPV、NPV、UI + 和UI - 分别为0.619、0.761、0.250、0.940、0.155和0.715。
我们采用了一种新颖的方法来详细阐述某些早期运动问题与特定NDDs之间的关联。我们表明，发育早期存在运动发育问题会增加未来诊断任何NDD的可能性。然而，早期运动发育问题作为筛查工具的敏感度不够高，不足以成为检测NDDs的唯一手段。强调了在观察运动发育问题过程时需要从广泛、整体的ESSENCE角度出发。
