Purpose: To validate a 2-step infant developmental screening protocol administered by non-physician health professionals.
Subjects: The parents of 213 eligible 4 – 6 month olds were invited to attend one of five community screening clinics in a single county in Minnesota. 66 families participated in the study: 55 chose to attend a screening clinic and follow-up measures were sent (via surface mail, 2 months later, to a random sample of 65 families) of whom 11 returned completed questionnaires. Of infants whose parents attended screening clinics, 92% were white and 68% were grouped as ‘risk- positive’ after histories were taken, which included both biological (prematurity or a history of medical diagnoses in the family) or social-environmental factors (such as a teen mother).
Methods: A modified version of Parents’ Evaluation of Developmental Status (PEDS®) was administered to all parents. PEDS®, a measure eliciting parents’ concerns in all developmental-behavioral domains, was modified by retaining four (of the ten) PEDS® questions: items focused on global/cognitive, expressive language, medical/other, and social emotional issues. Two additional items were added: one that focused on feeding, and a second item requiring parents to estimate their child’s developmental status given multiple choices [Parents were asked if the child was a) more advanced b) the same as or c) less advanced than other infants of the same age]. Parents who attended the screening clinics were also administered the Meade Movement Checklist (MMCL), a 27 item observational scale focused on infant movement and behavior during a series of structured parent-child interactions as the second stage of screening. (www.vickiemeade.com for a fact sheet summarizing all research on the MMCL) Criterion measures included 1SD below the mean one either the mental or motor scales of the Bayley Scales of Infant Development-II and the Movement Assessment of Infants at 6 months and the Ages and Stages Questionnaire plus the Social-Emotional scale at 8 months of age.
Results: Parents attending screening clinics held significantly more concerns than those who did not. Of the former, 61% held concerns about feeding issues. The modified PEDS® was 80% sensitive when compared to the BSID-II results (using 1SD below the mean on either the mental or psychomotor scales) but only 48% specific in identifying infants who needed further evaluation. The MMCL demonstrated 87.5% sensitivity, 91.4% specificity, and 70% positive predictive value compared to the PDI. There was no relationship between screening results at 4 months and the ASQ or ASQ-SE results at 8 months.
Conclusions: Inviting parents to attend community screening clinics and then eliciting parents’ concerns of those who chose to attend helped discern children in need of further screening. Of attendees, most families had children with a range of developmental, behavioral and health problems that were refined by further screening. Since parents actively choose to attend the screening clinics, it is still possible that some parents may have wished to attend but could not for other reasons and therefore their children were missed. Screening 25.8% of a birth cohort identified by parent concerns in step one, resulted in high validity (sensitivity 87.5%; specificity 91.4%) in identifying infants in step two. Combining parent concerns and the MMCL effectively increased PPV to 70%. This two-stage screening process, implemented by nonphysician health professionals provides a valid, new perspective for screening young infants. Future research should carefully focus on parents’ concerns about feeding and gross motor skills. A nuanced taxonomy of such concerns should help facilitate swift detection of children at risk for motor disorders such as cerebral palsy while also discerning which parental concerns reflect typical developmental issues for parents of young children.