Dept of Child Development; KK Women's and Children's Hospital Singapore, Singapore.
Psychology and Child & Human Development, Nanyang Technological University National Institute of Education, Singapore.
Pediatr Neonatol. 2024 Jan;65(1):48-54. doi: 10.1016/j.pedneo.2023.03.013. Epub 2023 Jul 18.
With increasing acceptance of universal developmental screening in primary care, it is essential to evaluate the local validity and psychometric properties of commonly used questionnaires like the parent-completed Ages and Stages Questionnaires, 3rd Edition (ASQ-3) in identifying developmental delays. The aim of this study is to assess the convergent validity of the ASQ-3 with the Bayley Scales of Infant Development-3rd edition (Bayley-III) in identifying developmental delay in a low-risk term cohort in Singapore.
ASQ-3 and Bayley-III data was collected prospectively with generation of ASQ-3 cut-off scores using three different criteria: 1-standard deviation (SD) (Criterion-I) or 2-SD (Criterion-II) below the mean, and using a Receiver Operator Curve (ROC) (Criterion-III). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated. Correlations between the ASQ-3 and Bayley-III domains were evaluated using Pearson coefficients.
With all three criteria across different domains ASQ-3 showed high specificity (72-99%) and NPV (69-98%), but lower sensitivity (19-74%) and PPV (11-59%). Criterion-I identified 11-21% of children as "at-risk of developmental delay," and was the most promising criterion measure, with high specificity (82-91%), NPV (69-74%) and overall agreement of 64-71%. Moderate-strong correlations were seen between ASQ-3 Communication and Bayley-III Language scales (r = 0.44-0.59, p < 0.01). The lowest sensitivities were seen in the motor domains.
ASQ-3 is reliable in low-risk settings in identifying typically developing children not at risk of developmental delay, but it has modest sensitivity. Moderate-strong correlations seen in the communication domain are clinically important for early identification of language delay, which is one of the most prevalent areas of early childhood developmental delay.
随着普遍接受在初级保健中进行通用发育筛查，评估常用问卷（如父母完成的年龄和阶段问卷，第 3 版（ASQ-3））在识别发育迟缓方面的当地有效性和心理测量特性至关重要。本研究旨在评估 ASQ-3 在新加坡低危足月队列中与贝利婴幼儿发育量表第 3 版（Bayley-III）的收敛效度，以识别发育迟缓。
前瞻性地收集 ASQ-3 和 Bayley-III 数据，并使用三种不同的标准生成 ASQ-3 截断分数：1 个标准差（SD）（标准-I）或低于平均值 2 个 SD（标准-II），以及使用接收器操作曲线（ROC）（标准-III）。计算灵敏度、特异性、阳性（PPV）和阴性（NPV）预测值。使用 Pearson 系数评估 ASQ-3 和 Bayley-III 域之间的相关性。
在所有三个标准的不同域中，ASQ-3 显示出高特异性（72-99%）和 NPV（69-98%），但灵敏度较低（19-74%）和 PPV（11-59%）。标准-I 确定了 11-21%的儿童为“发育迟缓风险”，是最有前途的标准衡量标准，具有高特异性（82-91%）、NPV（69-74%）和总一致性为 64-71%。ASQ-3 沟通和 Bayley-III 语言量表之间存在中度到强相关性（r=0.44-0.59，p<0.01）。在运动域中，灵敏度最低。
ASQ-3 在低危环境中可靠地识别没有发育迟缓风险的典型发育儿童，但灵敏度适中。在沟通领域中观察到的中度到强相关性对早期识别语言发育迟缓具有重要的临床意义，语言发育迟缓是幼儿发育迟缓最常见的领域之一。
