title: Psychological distress and parent reporting on child health: The case of developmental delay.
abstract: BACKGROUND
  Caregiver-completed screening questionnaires are a common first step in the identification of developmental delay. A caregiver's mood and anxiety level, however, may affect how he or she perceives and reports possible problems.
  
  
  OBJECTIVE
  In this article, we consider the association between caregiver distress and the accuracy of the Ages and Stages Questionnaire (ASQ), a widely-used screen.
  
  
  METHODS
  Our sample includes 857 parent-child dyads drawn from the Psychometric Assessment of the NDDS Study (PANS) and the NDDS Alternate Responses Study (NARS). Parents completed the ASQ and the K6, a brief measure of generalized distress. Children were assessed using the Bayley Scales of Infant and Child Development (BSID). We divided children on BSID result and used logistic regression to examine how distress influenced the ASQ's accuracy in each group.
  
  
  RESULTS
  Of our 857 children, 9% had at least one domain below -2 standard deviations on the BSID, and 17.3% had positive ASQ results. Caregiver distress predicted a positive ASQ substantially and significantly more strongly among BSID-positive children than among others. This translates into slightly reduced ASQ specificity but greatly improved sensitivity among caregivers with higher distress.
  
  
  CONCLUSIONS
  At low to moderate levels of distress, greater distress is associated with greater ASQ accuracy.
authors.affiliation: INfant and Child Health (INCH) Lab, Department of Family Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada. Electronic address: scott.r.veldhuizen@gmail.com.
authors.forename: Scott
authors.initials: S
authors.lastname: Veldhuizen
authors.affiliation: INfant and Child Health (INCH) Lab, Department of Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada. Electronic address: bedardct@mcmaster.ca.
authors.forename: Chloe
authors.initials: C
authors.lastname: Bedard
authors.affiliation: INfant and Child Health (INCH) Lab, Department of Family Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada. Electronic address: rodrigmc@mcmaster.ca.
authors.forename: Christine
authors.initials: C
authors.lastname: Rodriguez
authors.affiliation: INfant and Child Health (INCH) Lab, Department of Family Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada. Electronic address: cairnej@mcmaster.ca.
authors.forename: John
authors.initials: J
authors.lastname: Cairney
mesh_terms: D000328:Adult; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010290:Parents / Q000523:psychology*; D012680:Sensitivity and Specificity; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: ASQ; Developmental screening; Distress; Validation