title: Implications of family protective-risk index for screening cognitive development of children aged 13-15 years.
abstract: BACKGROUND
  A simple screening tool is essential for priority setting and operating activities in communities.
  
  
  OBJECTIVE
  The present study aimed to identify the implications of a family protective-risk index (FPRI) for screening cognitive development of children aged 13-15 years.
  
  
  METHODS
  The cross-sectional survey among 319 children aged 13-15 years old was conducted in one district. The cognitive development was measured by TONI version 3. Studied family factors consisted of parents' education, parents' occupation, sufficiency of family income, family relationships, stressful life events in the family, family type, and quality of child care. The protective characteristic of each factor was given one point and the risk was given zero point. FPRI was constructed in three models. The FPRI 1 was the cumulative effects of nine family factors mentioned above. The FPRI 2 was the cumulative effects of seven family factors that were significantly associated with cognitive development in the present study by Chi-square test: parents' education, parents' occupation, family relationship, stressful life events and family type. The FPRI 3 was constructed from 4 family factors that were significantly associated with cognitive development by logistic regression analysis: mother's education, mother's occupation, family relationship and stressful life events. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were applied to identify the optimal cut off point of prediction.
  
  
  RESULTS
  The present results showed that 52% of the sample had an intellectual level lower than 90. The FPRI 1 at 6 or 7 scores and the FPRI 2 at 4 or 5 scores yielded the same phenomena, high sensitivity but moderate specificity, PPV and NPV The FPRI 3 at 2 scores gave high PPV and moderate for the rest. The FPRI 3 at 3 scores gave high sensitivity and NPV moderate PPV and low specificity. Among three indices, the FPRI 3 was found to be the best index as its Receiver Operating Characteristic (ROC) curve was furthest into the top left corner.
  
  
  CONCLUSIONS
  The FPRI 3 at 3 scores can be used as a preliminary screening tool for health personnel to identity families at risk of having children with slow cognitive development and then, provide urgent support and help.
authors.affiliation: ASEAN Institute for Health Development, Mahidol University, Salaya Campus, Phutthamonthon 4 Rd, Phutthamonthon District, Nakhon Pathom 73170, Thailand.
authors.forename: Sirikul
authors.initials: S
authors.lastname: Isaranurug
authors.forename: Sumalee
authors.initials: S
authors.lastname: Klinman
authors.forename: Jiraporn
authors.initials: J
authors.lastname: Chompikul
authors.forename: Sutham
authors.initials: S
authors.lastname: Nantamongkolchai
authors.forename: Ratanothai
authors.initials: R
authors.lastname: Plubrukan
mesh_terms: D000293:Adolescent; D041923:Adolescent Development; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005192:Family Health; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013785:Thailand