Validez predictiva del Ages and Stages Questionnaire (ASQ®), un cuestionario de cribado del desarrollo psicomotor infantil basado en el reporte de padres o cuidadores principales.

Abstract

Introduction: Parent/caregiver completing developmental screening questionnaires (DSQs) have become increasingly widespread. Worldwide, the most well-known is the Ages and Stages Questionnaire (ASQ), an instrument that has been used in Catalonia and validated in Chile; however, there is a gap in the knowledge of its predictive capacity in the longer term. Objective: To determine the reliability and predictive validity of the ASQ for the screening of developmental difficulties. Methods: Three research studies were carried out. A prospective cohort of 321 children born at the SCIAS - Hospital in Barcelona, in order to evaluate the reliability of the questionnaires administered at 24 months of corrected age and 48 months of chronological age of the ASQ-3 in Spanish and the correlation between both evaluations. A cohort of 227 children seen at Clínica Alemana de Santiago, Chile, to study the predictive validity of the ASQ applied at 8 and 18 months of chronological age in full-term children and corrected age in preterm, or 30 months of chronological age, to detect children who will have cognitive deficits at school. Finally, a systematic review of the literature was carried out to analyze the ability of the ASQ, and other DSQs, to predict low cognitive or academic performance in children of the general population. Results: In Barcelona, it was observed that ASQ is a reliable instrument for psychomotor development screening (Cronbach’s alpha for the global score 0.78/0.79), with a positive and significant correlation between the assessments made at 24 and 48 months. The presence of 2 or more domains in the risk zone at 24 months was predictive of developmental deficit at 48 months (Odds Ratio (OR) =140 [95% CI 14.85;3575.65]). In Chile, the predictive ability of the ASQ to identify children with lower cognitive performance at school was satisfactory (area under the curve (AUC) 0.77 [95% CI 0.65- 0.89]) and comparable with the reference diagnostic test (p=0.58). Considering at least one domain in the risk zone, it presented a 66.7% sensitivity and 71.7% specificity. Finally, through a systematic review of the literature, we identified 8 cohorts evaluated with the ASQ that reported overall “positive” associations between early developmental screening and later cognitive or academic performance, with AUC between 0.66 and 0.87, and OR higher than 3. We observed a mirror effect when reviewing the sensitivity and specificity of the cohorts. The heterogeneity of the studies did not allow meta-analysis or subgroup analysis. Conclusions: The ASQ is reliable and has an adequate correlation and capacity to predict developmental difficulties between two and four years of age in Barcelona. In the longer term, in Chile, it was demonstrated that the assessments performed at 8, 18, or 30 months have an adequate predictive capacity of cognitive difficulties in the school stage. These results were corroborated through a systematic review of the literature. Further studies are needed to determine the impact of different adaptations, sociocultural contexts, biological risk factors, and assessment ages on the predictive ability of the ASQ, such as parent-repot DSQs.

Date of Award	29 Mar 2022
Original language	Spanish
Supervisor	Xavier Demestre Guasch (Director)