The Ages and Stages Questionnaire and Neurodevelopmental Impairment in Two-Year-Old Preterm-Born Children

Jorien M Kerstjens, Ard Nijhuis, Christian V Hulzebos, Deirdre E van Imhoff, Aleid G van Wassenaer-Leemhuis, Ingrid C van Haastert, Enrico Lopriore, Titia Katgert, Renate M Swarte, Richard A van Lingen, Twan L Mulder, Céleste R Laarman, Katerina Steiner, Peter H Dijk, Jorien M Kerstjens, Ard Nijhuis, Christian V Hulzebos, Deirdre E van Imhoff, Aleid G van Wassenaer-Leemhuis, Ingrid C van Haastert, Enrico Lopriore, Titia Katgert, Renate M Swarte, Richard A van Lingen, Twan L Mulder, Céleste R Laarman, Katerina Steiner, Peter H Dijk

Abstract

Objective: To test the ability of the Ages and Stages Questionnaire, Third Edition (ASQ3) to help identify or exclude neurodevelopmental impairment (NDI) in very preterm-born children at the corrected age of two.

Methods: We studied the test results of 224 children, born at <32 postmenstrual weeks, who had scores on ASQ3 and Bayley Scales of Infant and Toddler Development, Third Edition (BSIDIII) and neurological examination at 22-26 months' corrected age. We defined NDI as a score of <70 on the cognitive--or motor composite scale of BSIDIII, or impairment on neurological examination or audiovisual screening. We compared NDI with abnormal ASQ3 scores, i.e., < -2SDs on any domain, and with ASQ3 total scores. To correct for possible overestimation of BSIDIII, we also analyzed the adjusted BSIDIII thresholds for NDI, i.e., scores <80 and <85.

Results: We found 61 (27%) children with abnormal ASQ3 scores, and 10 (4.5%) children who had NDI with original BSIDIII thresholds (<70). Twelve children had NDI at BSIDIII thresholds at <80, and 15 had <85. None of the 163 (73%) children who passed ASQ3 had NDI. The sensitivity of ASQ3 to detect NDI was excellent (100%), its specificity was acceptable (76%), and its negative predictive value (NPV) was 100%. Sensitivity and NPV remained high with the adjusted BSIDIII thresholds.

Conclusion: The Ages and Stages Questionnaire is a simple, valid and cost-effective screening tool to help identify and exclude NDI in very preterm-born children at the corrected age of two years.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exists.

Figures

Fig 1. Flowchart with numbers of eligible…
Fig 1. Flowchart with numbers of eligible and included children.
ASQ3; Ages and Stages Questionnaire, Third Edition, time window 22–26 months corrected age. BSIDIII: Bayley Scales of Infant and Toddler Development, Third Edition, time window 21–30 months corrected age. NDI: Neurodevelopmental Impairment: BSIDIII cognitive score or composite motor score

Fig 2. Correlation between BSIDIII combined cognitive…

Fig 2. Correlation between BSIDIII combined cognitive and composite motor scores and ASQ3 total scores.

Fig 2. Correlation between BSIDIII combined cognitive and composite motor scores and ASQ3 total scores.
R square is 0.417, p

Fig 3. ROC curve for NDI with…

Fig 3. ROC curve for NDI with BSIDIII threshold

Area…

Fig 3. ROC curve for NDI with BSIDIII threshold
Area under the curve 96% p

Fig 4. ASQ3 total scores for children…

Fig 4. ASQ3 total scores for children with No NDI and children with NDI.

NDI…

Fig 4. ASQ3 total scores for children with No NDI and children with NDI.
NDI with BSID threshold set at p< 0.0001
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References
    1. Council on Children With Disabilities. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. Pediatrics 2006;118(1):405–420. - PubMed
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This work was funded by The Netherlands Organization for Health Research and Development (ZonMw) Cost-Effectiveness Program: 94507407. The authors received no other specific funding for this work.
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Fig 2. Correlation between BSIDIII combined cognitive…
Fig 2. Correlation between BSIDIII combined cognitive and composite motor scores and ASQ3 total scores.
R square is 0.417, p

Fig 3. ROC curve for NDI with…

Fig 3. ROC curve for NDI with BSIDIII threshold

Area…

Fig 3. ROC curve for NDI with BSIDIII threshold
Area under the curve 96% p

Fig 4. ASQ3 total scores for children…

Fig 4. ASQ3 total scores for children with No NDI and children with NDI.

NDI…

Fig 4. ASQ3 total scores for children with No NDI and children with NDI.
NDI with BSID threshold set at p< 0.0001
Similar articles
Cited by
References
    1. Council on Children With Disabilities. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. Pediatrics 2006;118(1):405–420. - PubMed
    1. Nordhov SM, Rønning JA, Dahl LB, Ulvund SE, Tunby J, Kaaresen PI. Early intervention improves cognitive outcomes for preterm infants: randomized controlled trial. Pediatrics 2010;126(5):e1088–94. 10.1542/peds.2010-0778 - DOI - PubMed
    1. Nordhov SM, Rønning JA, Ulvund SE, Dahl LB, Kaaresen PI. Early intervention improves behavioral outcomes for preterm infants: randomized controlled trial. Pediatrics 2012;129(1):e9–e16. 10.1542/peds.2011-0248 - DOI - PubMed
    1. Bayley Scales of Infant and Toddler Development, third edition San Antonio, TX,USA: Harcourt Assessment, Inc., 2006.
    1. Bayley Scales of Infant Development. 3rd edition: Administration Manual http://www.pediatricapta.org/events/ACP/2012/handouts/pedsfwdcampbell2/B....
Show all 32 references
Publication types
MeSH terms
Related information
Grant support
This work was funded by The Netherlands Organization for Health Research and Development (ZonMw) Cost-Effectiveness Program: 94507407. The authors received no other specific funding for this work.
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Fig 3. ROC curve for NDI with…
Fig 3. ROC curve for NDI with BSIDIII threshold
Area under the curve 96% p

Fig 4. ASQ3 total scores for children…

Fig 4. ASQ3 total scores for children with No NDI and children with NDI.

NDI…

Fig 4. ASQ3 total scores for children with No NDI and children with NDI.
NDI with BSID threshold set at p< 0.0001
Fig 4. ASQ3 total scores for children…
Fig 4. ASQ3 total scores for children with No NDI and children with NDI.
NDI with BSID threshold set at p< 0.0001

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