Early Childhood Developmental-Behavioral Screening in Scandinavia & the USA

Authors

Kevin P. Marks MD FAAP
Pediatrician at PeaceHealth Medical Group, Eugene, Oregon; Clinical Assistant Professor, OHSU School of Medicine, Division of General Pediatrics

Nina Madsen Sjö, MSc PhD
Child neuropsychologist, Region Hovedstaden, DanmarkPerson og familietjenester

Philip Wilson DPhil FRCPCH FRCGP
Centre for Research & Education in General Practice, University of Copenhagen; Centre for Rural Health, University of Aberdeen, UK

Our Systematic Review

AIM

The aim of this systematic review was to investigate screening practices with the Ages and Stage Questions Assessment (ASQ) and the Ages and Stage Questions: Social-Economic ASQ-SE in the USA and Scandinavia and to identify practical lessons and research opportunities.

METHOD

The review was performed for ASD- and ASD2-related studies in children from birth to 18 years. From nine databases and 188 references (published from 1988 to 2018), 127 articles were included and categorized using Covidence online software. The Critical Appraisal Skills Programme Checklists were used before data synthesis.

RESULTS

US studies primarily use the ASQADISSE to detect delay in and at stress interventions. US studies also use the ASQADISSE to monitor intervention interruptions. Scenario studies community use the ASQADISSE to monitor developed behavioural differences in intervention-based cohorts. Pre-visit interviews are used to assess the impact of intervention. When referrals are indicated, systematise care coordination with intervention.

INTERPRETATION

PRACTICAL Implementation lessons are reviewed. Research opportunities include investigating and measuring the ASIQ ARSSEQ's overall features; Denmark, Norway, and Swedish transmissions are available but up-to-date norming and validation studies are not yet available. The results of these studies are needed to investigate outcomes in screened versus unscreened cohorts.

Objectives

1. How do different developed countries (the United States, Denmark, Norway and Sweden) use the same two parent-centered, developmental behavioral screening tools, the Ages & Stages Questionnaire (ASQ) and ASQ:Social-Emotional (ASQ:SE) in children from birth through five years?

Previous reviews involving the ASQ and ASQ:SE

• The ASQ and ASQ:SE are "common denominator tools" already being used in Scandinavian and US populations.
• A systematic review was published about the ASQ’s psychometric properties at 2 to 2.5 years (Velikonjaja et al, 2016).
• They span the birth through 5-year age range.
• They only take 10 to 20 minutes for parents to complete.
• A narrative review was published about the use of the ASQ in low & middle-income countries or LMICs (Small, HixSmall, VargasBaron, Marks 2018, Developmental Medicine & Child Neurology, in press).

Why focus on the ASQ & ASQ:SE?

• They use parent-report items which allow for "teachable moments" where the process of screening encourages parents to spend "special time" playing with their child.
• The ASQ and ASQ:SE are "common denominator tools".
• Focusing the review on a broadband developmental and social-emotional screen allows for a more consistent comparison of the lessons learned and research opportunities throughout Scandinavia and the USA.

Systematic Review: Use of the ASQ & ASQ:SE between Scandinavia & the USA

• Summary: From 9 databases and 1689 references (published from 1988 to 2018), 127 articles were included and categorized using Covidence online software for systematic reviews.
• The Critical Appraisal Skills Programme (CASP) Checklists were used before data synthesis for all articles that applied to universal ASQ and/or ASQ:SE screening in general or at-risk populations.

Inclusion Criteria

1. For articles using the ASQ, all 5 developmental domains (communication, gross motor, fine motor, problem solving, and personal-social) needed to be reported to maintain consistency with the ASQ User Guide’s reported psychometric and feasibility properties.
2. Articles using other abbreviated versions of the ASQ (e.g., using less than 6 items per domain) and/or ASQ:SE were excluded because abbreviated versions are assumed to be psychometrically unsound.
3. The correct age interval ASQ and/or ASQ:SE needed to be used.

Excluded Studies

• Articles needed to report or discuss empirical data related to the ASQ and/or ASQ:SE.
• Wrong country (Not DK, SE, N, or USA)
• Duplicate articles
• Mixed countries (target & outside countries)

Comparative Lessons Learned

• Unsurprisingly, the USA has the highest number of overall studies (N=90) and highest number of psychometric studies (N=14) for the ASQ & ASQ:SE.
• Most US studies support the ASQ & ASQ:SE as being well standardized, accurate, reliable, low cost & feasible for use in a busy office setting.
• The ASQ and ASQ:SE’s overall section is being routinely ignored by researchers in both the USA and Scandinavia.

Scandinavian Lessons Learned

• In Scandinavia, the ASQ & ASQ:SE has primarily been used to track/monitor developmental behavioral (DB) outcomes over time after a child has had an environmental exposure or a specific intervention.
• Few Scandinavian studies are using the ASQ and/or ASQ:SE for its original purpose—i.e., early detection of developmental delays and social-emotional problems in a general or at risk population.

Conclusion

• The study findings highlight the importance of identifying social-emotional problems at an early age and taking gender differences and custody arrangements into account.
• General populations: pediatrician impressions (surveillance without the use of the ASQ and/or ASQ:SE) fails to identify & refer the large majority of children with suspected developmental delays.