Screening de Desarrollo Psicomotor en la Consulta Pedi�trica: Implementaci�n de una prueba basada en el auto reporte de los padres
Experience using ASQ- online at Clinica Alemana:
Bringing assessments closer during the pandemic
Luisa Schonhaut B., Paula Rojas B., Iván Armijo R, Leonardo Cabrera, Roberto Boisier Clínica Alemana -Universidad Del Desarrollo
AAP 2006- 2020 STATEMENT
Developmental surveillance at every well-child preventive care
9, 18, 24-30 months Concerns raised during surveillance 4- to 5 years
Standardized developmental screening tests.
Quest.
+ -
Diagnostic Development assessment al surveillance
American Academy of Pediatrics. Pediatrics. 2006;118. Lipkin PH et al.. Pediatrics. 2020;145.
Developmental Screening and Surveillance in Chile
Public Health System
- 8 months: EDDP
- 18 months: EEDP
- 3 years: TEPSI
- Abreviated survey guide
- Local screening tests
- Needs of trained professionals.
- TADI: under the local validation process
Private Health System
- Pediatric care providers often not used Standardized developmental screening tests.
- Developmental surveillance
- In risk groups we apply Bayley Tests
- Low accuracy of pediatric care providers in identification of developmental-behavioral problems in children.
Sheldrick C. Pediatrics 2011
Validity and reliability of ASQ: the studies in Chile
Reliability
Validity
Feasibility
Applicability
Schonhaut L et al. Pediatrics 2013;131(5):e1468-74. Armijo I. et al. Early Hum Dev. 2015;91(12):671–6 Schonhaut L, et al. Early Hum Dev. 2020;141:6–11.
ASQ paper-pencil use issues:
- Personal initiative
- Printed version needed
- Sometimes nobody checks results
- At the outpatient office: qualitative evaluation
- Hard to keep and follow data and records.
SCREENPED PROJECT
Children’s development monitoring system
ASQ-online
To analyze the reliability and acceptability of the ASQ-Online
Objectives in Spanish in children of medium-high socioeconomic level.
Cross-sectional study
May 2020 to July 2022
Methodology
Children born or followed up at Clínica Alemana
Ages at recruitment: 0 to 30 months
Evaluation of your child's development
El desarrollo ocurre con la edad y hay ciertas conductas, capacidades, tipos de pensamiento y emociones que aparecen en distintos momentos de la infancia. Estos momentos o hitos del desarrollo sirven para evaluar si un niño o niña está creciendo y desarrollándose a la misma velocidad a la que lo hacen la mayoría de los niños/as de su edad.
Communication Assessment
| COMUNICACIÓN | |||
|---|---|---|---|
| 1. Si Ud. llama a su bebé cuando el lactante no lo/la puede ver, ¿voltea la cabeza en la dirección de su voz? | Si | Aveces | Todavia no restablecer el valor |
| 2. Cuando escucha un ruido fuerte, ¿su bebé voltea a ver de dónde viene? | Si | Aveces | Todavia no restablecer el valor |
| 3. Si Ud. imita los sonidos que hace su bebé, ¿ella los repite? | Si | Aveces | Todavia no restablecer el valor |
| 4. ¿Hace su bebé sonidos como "da", "ga", "ka", y "ba"? | Si | Aveces | Todavia no restablecer el valor |
| 5. ¿Responde su bebé a los diferentes tonos de su voz y deja de hacer la actividad que lo tiene entretenido, al menos por un momento, cuando Ud. le dice "no-no"? | Si | Aveces | Todavia no restablecer el valor |
Results of the Evaluation
- Comunicación: Acorde a lo esperado
- Socio - Individual: Acorde a lo esperado
Parent's Survey Satisfaction with ASQ-ONLINE
This questionnaire was easy to understand. The questions are appropriate to the age of the child. The way the questions are structured makes it easy to understand. The drawings and examples are useful to answer the questions. Recommends the use of the digital questionnaire. How the results are delivered is friendly and easy to understand. The questionnaire allows understanding of the advances in the development of the child.
Analysis
- Alpha Cronbach Reliability
- Pearson’s correlation coefficient
- Means comparison with USA validation
- Distribution
- A previous study in Chile paper-pencil comparison
- Stability Correlation between different ages
- Acceptability Satisfaction survey for parents
Results
- 865 children
- 1933 evaluations
Sample:
| Male | 413 |
|---|---|
| Female | 452 |
| 1 test per child | 320 |
| 2 test per child | 238 |
| 3 test per child | 141 |
| 4 test per child | 116 |
| 5 test per child | 44 |
| Parents with university studies | 94% |
Means and SD Comparison
The scores of the studied sample were similar to those reported in the U.S., except for gross motor at 8 months and communication at 18 and 24 months, which was significantly lower in the ASQ-Online 2022 sample.
Reliability: Alpha Cronbach
In the global analysis, alpha Cronbach of 0.74 and 0.81: acceptable-good internal consistency.
Stability: Ages Correlation
The correlation between the different ages was positive and significant on the overall score and for most of the domains. The lowest correlations were obtained at 4 months comparing with the other ages (due sample size effect?)
Developmental Delay Risk Prevalency
- The prevalence of children at risk of developmental delay, defined as at least 1 domain in the risk zone in at least 1 evaluation, was 26% and 7% for 2 or more domains.
Clinical Implementation: Children with 2 or More Domains Under the Risk Zone
- 1 domain at risk zone
- Pediatric assessment
- Follow Up
- Next questionnaire
- Neurodevelopmental and behavioral program
Developmental Pathways
- Trajectories in each domain were stable and within normal ranges.
- Infants with low gestational age, low Apgar score, male sex, and a mother with depression symptoms may be at risk of developing lower developmental pathways, especially within the communication domain.
Conclusions
The scores obtained in the ASQ-online, the validation of the ASQ in the USA and the validation in pencil modality in Chile in 2015 are similar. The ASQ-online is feasible to apply and represents a great contribution to children's health supervision, especially in such a delicate moment, as confinement due to the COVID-19 pandemic. High acceptability among parents.
Next Steps
Implement other questionnaires that include more aspects to be evaluated, such as well-being and socio-emotional development.