title: Development of a triage tool for neurodevelopmental risk in children aged 30 months.
abstract: Neurodevelopmental and neuropsychiatric disorders in young children predict educational, health and social problems. Early identification may significantly reduce this burden but relevant tools largely lack validation. We aimed to develop and evaluate the predictive validity of a simple screening tool for neurodevelopmental problems in a community sample of 30 month old children. A sample of children was selected from a community cohort screened at 30 months by health visitors using the Sure Start Language Measure (SSLM) and the Strengths and Difficulties Questionnaire (SDQ) in 2011. Predictive validity was assessed by comparing screening results with detailed psychometric data from the same sample 1-2 years later. Screening performance using different thresholds was explored using Receiver Operating Characteristic (ROC) with ROC area under the curve (AUC) and bootstrapping techniques. The SSLM predicted both language disorder identified by the New Reynell Developmental Language Scales (NRDLS) at follow-up (AUC 0.905) and global developmental delay assessed by the Griffiths Mental Development Scales (AUC 0.983). The SDQ administered at 30 months predicted psychiatric disorders identified by the Development and Wellbeing Assessment (DAWBA) at follow-up (AUC 0.821). Using optimal cut-offs for the SDQ and SSLM at 30 months, both tools together had sensitivity 87%; specificity 64%; positive predictive value 31%; and negative predictive value 97% in the prediction of any kind of neurodevelopmental problem 1-2 years later. The combined measure reported here is not yet sufficient as a stand-alone population screening tool for neurodevelopmental disorders. The SSLM and SDQ did however show promise in identifying preschool children at risk of ongoing language, psychiatric disorders and global developmental delay 1-2 years later but with fairly high false positive rates. Given that current developmental risk prediction in resource-poor settings is little better than random assignment, the SDQ and SSLM may aid clinical judgement when used as interim triage tools for practitioners with no specialist knowledge, in the context of longitudinal follow-up arrangements.
authors.affiliation: Centre for Rural Health, University of Aberdeen, Centre for Health Sciences, Old Perth Rd, Inverness IV2 3JH, Scotland, UK. Electronic address: fiona.sim@glasgow.ac.uk.
authors.forename: Fiona
authors.initials: F
authors.lastname: Sim
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, Boyd Orr Building, Glasgow G12 8QQ, Scotland, UK. Electronic address: Caroline.Haig@glasgow.ac.uk.
authors.forename: Caroline
authors.initials: C
authors.lastname: Haig
authors.affiliation: Public Health, NHS Ayrshire & Arran, UK. Electronic address: john.o'dowd@aapct.scot.nhs.uk.
authors.forename: John
authors.initials: J
authors.lastname: O'Dowd
authors.affiliation: Institute of Health and Wellbeing, College of Medical, Veterinary and Health Sciences, University of Glasgow, Caledonia House, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, Scotland, UK. Electronic address: lucy.thompson@abdn.ac.uk.
authors.forename: Lucy
authors.initials: L
authors.lastname: Thompson
authors.affiliation: Communication & Language Sciences, University of Newcastle, Newcastle, UK. Electronic address: James.Law@newcastle.ac.uk.
authors.forename: James
authors.initials: J
authors.lastname: Law
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, Boyd Orr Building, Glasgow G12 8QQ, Scotland, UK. Electronic address: Alex.Mcconnachie@glasgow.ac.uk.
authors.forename: Alex
authors.initials: A
authors.lastname: McConnachie
authors.affiliation: Gillberg Neuropsychiatry Centre, University of Gothenburg, Sweden. Electronic address: christopher.gillberg@pediat.gu.se.
authors.forename: Christopher
authors.initials: C
authors.lastname: Gillberg
authors.affiliation: Centre for Rural Health, University of Aberdeen, Centre for Health Sciences, Old Perth Rd, Inverness IV2 3JH, Scotland, UK. Electronic address: p.wilson@abdn.ac.uk.
authors.forename: Philip
authors.initials: P
authors.lastname: Wilson
mesh_terms: D001010:Anxiety, Separation / Q000175:diagnosis; D019540:Area Under Curve; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis; D000067877:Autism Spectrum Disorder / Q000175:diagnosis; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006948:Hyperkinesis / Q000175:diagnosis; D007805:Language Development Disorders / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening; D001523:Mental Disorders / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011594:Psychometrics; D012372:ROC Curve; D019962:Reactive Attachment Disorder / Q000175:diagnosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014218:Triage / Q000379:methods*
keywords: ESSENCE; Language delay; Neurodevelopment; Neuropsychiatry; Paediatrics; Primary care; Screening