|Year : 2019 | Volume
| Issue : 2 | Page : 89-92
Concurrent validity of the gross motor component of ages and stages questionnaire-3 with the motor scales of Developmental Assessment Scales for Indian Infants (DASII) in risk infants < 6 Months
Deepa C Metgud1, Manisha Bhandankar2, Divya M Madhale1
1 Department of Pediatric Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India
2 Department of Neonatology, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
|Date of Submission||02-Apr-2019|
|Date of Decision||28-May-2019|
|Date of Acceptance||21-Jun-2019|
|Date of Web Publication||23-Dec-2019|
Dr. Divya M Madhale
KAHER Institute of Physiotherapy, Belagavi, Karnataka - 590 010
Source of Support: None, Conflict of Interest: None
Objective: Global developmental delay is the term used when a child lags or has a delay in all the domains of development. Early detection of this delay is a necessity to commence with early intervention. This study aimed to determine the concurrent validity of gross motor component of Ages and Stages Questionnaire-3 (ASQ-3) with the motor scales of Developmental Assessment Scales for Indian Infants (DASII) in risk infants <6 months.
Materials and Methods: This cross-sectional study included risk infants in the age group of 1–6 months (n = 97). They were assessed using the age-appropriate ASQ-3. The parents/caregivers of the children filled in the child-appropriate responses. The children were then assessed using the DASII. The scores of ASQ-3 and DASII were recorded as per the instructions in their respective manuals.
Results: One hundred and fifty infants were screened for eligibility, of which only 97 were eligible according to the study criteria. Fifty-four children failed on the gross motor domain of ASQ-3, whereas sixty children failed on the motor scales of DASII. The overall sensitivity and specificity of the ASQ-3 were found to be 73.80% and 89.83%, respectively. The sensitivity of the ASQ-3 at 2 months was 75% and 66.67% at 4 and 6 months. The specificity of the ASQ-3 at 2, 4, and 6 months was 88%, 90%, and 93.33%, respectively.
Conclusion: ASQ-3 has strong characteristics to detect motor developmental delay in infants at risk for developmental delay.
Keywords: Ages and Stages Questionnaire-3, Developmental Assessment Scales for Indian Infants, Developmental delay, Risk infants
|How to cite this article:|
Metgud DC, Bhandankar M, Madhale DM. Concurrent validity of the gross motor component of ages and stages questionnaire-3 with the motor scales of Developmental Assessment Scales for Indian Infants (DASII) in risk infants < 6 Months. Indian J Phys Ther Res 2019;1:89-92
|How to cite this URL:|
Metgud DC, Bhandankar M, Madhale DM. Concurrent validity of the gross motor component of ages and stages questionnaire-3 with the motor scales of Developmental Assessment Scales for Indian Infants (DASII) in risk infants < 6 Months. Indian J Phys Ther Res [serial online] 2019 [cited 2020 Jan 24];1:89-92. Available from: http://www.ijptr.org/text.asp?2019/1/2/89/273717
| Introduction|| |
Growth and development of a normal infant includes development in all domains, i.e., motor, cognitive, social, behavioral, and emotional. There are great ranges of normal variations in the rate of development. When a child fails to attain these key milestones within the expected age ranges, the child is said to suffer from developmental delay. Global developmental delay is the term used when a child lags or has a delay in all the above-mentioned domains of development. Around 10% of children are estimated to suffer from developmental delay; the incidence being increased with the improved rates of survival of neonates at risk. The WHO statistics affirm that the survival rates of the neonates have improved over the years, but the associated comorbidities suffer negligence.
There are various factors which influence the course of development, and these include the prenatal, perinatal, and postnatal factors. The prenatal factors comprise genetic factors, placental problems, infections and drugs in pregnancy, maternal nutrition, and premature delivery. The perinatal factors comprise hypoxia, malpresentation, hypoxic–ischemic encephalopathy, intraventricular hemorrhage, neonatal seizures, and low birth weight. The postnatal factors encompass illness, infection, nutrition, socioeconomic factors, cultural practices, parental health and attitudes, management of disability, health surveillance, education and opportunities in life. It is the prenatal factors recognized to be dominant in affecting the development of a child. Early intervention forms the basis for treatment of developmental delay; therefore, it becomes utmost important for screening of developmental delay at an earlier age.
According to a systematic review, for distinguishing of developmental and behavioral problems in primary care, it was noted that the deprivation of formal or standard screening program led to insufficient recognition of developmental and behavioral problems. The specificity of a pediatrician to identify developmental and behavioral issues ranged from 69% to 100%, and the sensitivity toward the same ranged from 14% to 54%. The above-stated data clearly indicate that majority of the children with possible developmental delay are missed and therefore may not be intervened.
Early detection and administration of intervention to those at risk for developmental delay is key to prevent or minimize the related risks of prematurity, low birth weight, and other factors responsible for developmental delay. In the absence of a proper program to screen developmental and behavioral problems, the probability of loss of case detection of developmental delay increases. Various screening studies have been conducted using the Ages and Stages Questionnaire (ASQ) but with certain lacunae such as small sample size, language barriers, and limited validation of the ASQ-3 against gold standard tools for assessing developmental delay. The studies previously conducted include other barriers too which comprise limited validation  with a tool meant for Indian children. This barrier is considerable enough due to the versatility of social and cultural differences internationally.
Furthermore, the studies carried out previously focused on higher age groups  for the screening of developmental delay, creating a vacuum in the younger age groups.
Therefore, it necessitates the ASQ-3 to be administered in the younger age groups and validating the same by testing it against a standard tool for Indian infants to assess developmental delay. The aim of the present study was to validate the ASQ-3 in risk infants within the age range of 1–6 months against the Developmental Assessment Scales for Indian Infants (DASII).
| Materials and Methods|| |
One hundred and fifty infants (150) who reported at the high-risk baby clinic of a tertiary care hospital were screened, of which, 97 were eligible according to the study criteria. Ethical clearance was obtained from the Institutional Ethical Committee as the study involved human participants. The criteria for inclusion in this study were infants “at risk” and within the age range of 1–6 months, where “at risk” is the term used to describe children with diverse categories. This terminology refers to children who are in danger of failing to develop physically, medically, or psychologically, and it also encompasses children who are affected by varied economic, environmental and geographical factors.
The study procedure was explained, and a written parental consent was obtained from the parent/guardian of the child. Demographic data including the baseline characteristics such as gestational age, weight, and history of neonatal intensive care unit stay were recorded.
The ASQ-3 was given to the parents who could read and write in English, and the investigator provided help in case of any queries related to the questions in the ASQ-3. For uneducated parents, the investigator asked the questions to the parent and filled in the responses in the ASQ-3. The primary investigator then assessed these infants using the DASII. The raw scores for ASQ-3 and DASII were recorded according to the instructions given in their respective manuals and post calculation, these scores were matched with the cutoff scores.
The ASQ-3 and DASII were the outcome measures used in this study.
The ASQ-3 is a parent-filled questionnaire that may be used as a screening tool for the recognition of developmental delay. The ASQ-3 is a series of thirty parent-filled questionnaire designed to screen the developmental performance of children in the domains of gross motor and fine motor skills, problem-solving skills, and personal–social skills.
The DASII is based on the Bayley Scales of Infant Development (BSID) and is designed for Indian infants. It comprises of the motor and mental scales, with various items being adjusted to the 3%, 50%, and 97% age placements.
| Results|| |
Statistical Packages for the Social Sciences(SSPS) version 23 (IBM Corp., Armonk, New York, USA) was used for the data analysis. [Table 1] shows the characteristics of the study sample.
Out of the 97 children, 54 (55.67%) children failed on the gross motor domain of the ASQ and 60 (61.85%) children failed on the motor scale of the DASII. Majority of the failures were observed in the 2-month age group, on both ASQ and DASII [Table 2] and [Table 3].
|Table 2: Results of Ages and Stages Questionnaire-3 in various age groups|
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|Table 3: Results of Developmental Assessment Scales for Indian Infants in various age groups|
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The sensitivity of the ASQ (motor domain) to detect a developmental delay was 73.80% and the specificity was 89.83%. The positive and negative predictive values were 83.78% and 82.81%, respectively [Table 4]. The sensitivity of the ASQ-3 at 2 months was 75%, and 66.67% at 4 and 6 months. The specificity of the ASQ-3 at 2, 4, and 6 months was 88%, 90%, and 93.33%, respectively.
| Discussion|| |
The present study intended to determine the concurrent validity of motor component of ASQ-3 to detect motor developmental delay in children of lesser age groups, in comparison with the motor scales of the gold standard Indian tool, i.e., DASII. This study shows that ASQ-3 has good test characteristics to identify children with motor delays when compared with a standard tool for Indian infants and can be thereby used for screening of risk infants.
The previous version of the ASQ (ASQ, Second Edition) was validated, and the study included 53 mothers and infants, which was carried out among 24-month-old children. The findings of this study imparted that the ASQ is a valid screening tool for recognition of developmental delay at 24 months of age. The ASQ showed higher sensitivity as well as specificity in relation to the severe delay cut point on the BSID-II than it did in comparison to the other delay cut points. Our study differs from this as it included the revised version of ASQ, i.e., ASQ, Third Edition, and children of lesser age groups.
The Hindi-translated version of the ASQ-3 was compared with the DASII in a study conducted at a tertiary care center in North India. They found that ASQ-3 has strong characteristics to detect development delay in Indian children, especially in high-risk cases. It included children of higher age groups up to 24 ± 1, whereas the present study focused on younger age groups (infants of 1–6 months) so as to detect the developmental delay at an earlier age.
The ASQ-3 has been translated in Thai as well and was compared for its efficiency to detect developmental delays against the Denver Developmental Screening Test II (DDST-II). The study indicated fair-to-moderate agreement between the ASQ-3 Thai and DDST-II, and it was suggested that ASQ-3 Thai can be used clinically with other validated tools.
The translation of ASQ is available even in Chilean version. In a previously conducted study, parents of 1572 children born at term and 324 children at risk for delay in development were included. According to the psychometric outlook, the Ages and Stages Questionnaire - Chilean Version (ASQ-CL) was highly reliable in terms of internal consistency, overtime stability, as well as inter-rater reliability and demonstrated that the qualitative approach used to determine the feasibility of ASQ-CL for use in the regular clinical setup showed good acceptability of the tool.
The psychometric qualities of the ASQ-3 were reported in a study on at risk children. It was found that the ASQ-3 has modest agreement with the Bayley-II and was thereby suggested for standard use in screening low-risk children.
DASII, which is a tool developed for Indian children, was intended for use so as to avoid cultural differences worldwide. The motor subset of the ASQ-3 proved to have good test characteristics to detect motor delays when compared with the motor scales of DASII.
Our study is not devoid of lacunae, and it does have certain limitations. The ASQ-3 has been translated in various languages for better understanding of the tool. Translation of the ASQ-3 in Kannada (regional language) was not considered due to feasibility concerns. All the children who were “at risk” for developmental delays were considered for assessments, and there was no categorization made in terms of high-risk or low-risk groups. Furthermore, the current study aimed at validating only the motor component of ASQ-3 with the motor scales of DASII.
This study thereby concludes that ASQ-3 has good test characteristics and is efficient in detecting motor developmental delays in Indian infants at risk <6 months, with its sensitivity and specificity being 73.80% and 89.83%, respectively.
It is further recommended that ASQ-3 be translated in other regional languages of India for better comprehensibility.
| Conclusion|| |
The current study concludes that the motor component of ASQ-3 has strong characteristics to detect motor developmental delay in risk infants <6 months, with its sensitivity and specificity being 73.80% and 89.83%, respectively.
We would like to thank the parents/caregivers for approval of the participation of their child in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gupte S. The Short Textbook of Paediatrics. 12th
ed. The Health Sciences Publisher, New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd; 2016;38-39.
De Onis M, Garza C, Onyango AW, Martorell R. WHO child growth Standards. In International Symposium, Santiago de Compostela. Int J Paediatr 2003.
Illingworth R. The Normal Child. 10th
ed. New Delhi, India: Elsevier; 2005;175-176.
Sheldrick RC, Merchant S, Perrin EC. Identification of developmental-behavioral problems in primary care: A systematic review. Pediatrics 2011;128:356-63.
Gollenberg AL, Lynch CD, Jackson LW, McGuinness BM, Msall ME. Concurrent validity of the parent-completed ages and stages questionnaires, 2nd
ed. With the Bayley scales of infant development II in a low-risk sample. Child Care Health Dev 2010;36:485-90.
Juneja M, Mohanty M, Jain R, Ramji S. Ages and stages questionnaire as a screening tool for developmental delay in Indian children. Indian Pediatr 2012;49:457-61.
Srinithiwat B, Ularntinon S. Concurrent validity of the ages and amp; stages questionnaires, third edition, Thai-version (ASQ-3 Thai) with the Denver developmental screening test II (DDST-II) in developmental screening of 18, 24, and 30 months old children at queen Sirikit national institute of child health. J Med Assoc Thai 2014;97 Suppl 6:S6-13.
Armijo I, Schonhaut L, Cordero M. Validation of the Chilean version of the ages and stages questionnaire (ASQ-CL) in community health settings. Early Hum Dev 2015;91:671-6.
[Table 1], [Table 2], [Table 3], [Table 4]