# 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.