Identification of childhood disability in Jamaica: the ten question screen

Abstract

This is the first in a series of papers that report the testing of two instruments for the identification and assessment of childhood disability by community workers (CWs) in Third World countries. It is part of the International Epidemiologic Study on Childhood Disability. The Ten Question Screen (TQ) was used as the main instrument to identify disability in a two stage population-based survey of 5478 children aged 2-9 years in Clarendon, Jamaica. In the second stage, TQ positive and 8% of the screen negative controls were professionally assessed by a doctor and a psychologist using standard criteria based on the main classification system of the ICIDH. Sensitivity of the TQ as a whole varied in different strata of the group and amongst different disabilities, from perfect in girls under 6 years, fits and motor disabilities and for serious disability in all group except boys over 5 years with cognitive disability. Specificity was good but the false positive rate was unacceptably high at 74%. It was concluded, firstly, that the validation of a simple questionnaire of perceptions of behaviour against objective measurements of impairments was perhaps not fair to the TQ. In spite of this, the TQ would be a very useful instrument in collecting disability data or for identifying people in need of rehabilitation help, if a way of reducing false positives could be found.

PIP: Information is lacking on disability in developing countries. This is the first in a series of reports on the testing of 2 instruments to identify and assess childhood disability by community works in developing countries. Specifically, this study tests the validity of the Ten Question Screen (TQ) as a screening instrument to find different levels of motor, hearing, visual, speech, cognitive, and fit-related childhood disabilities by age and sex in Jamaican communities. The TQ was used as the main instrument to identify disability in a 2-stage population-based survey of 5478 children 2-9 years old in Clarendon, Jamaica. TQ sensitivity varied in different strata of the group and among different disabilities, and specificity was good, but the false positive rate was unacceptably high at 74%. Overall, it may be said that it was unfair to use TQ to validate a simple questionnaire of behavioral perceptions against objective measurements of impairments. The TQ would, however, be useful in collecting disability data or for identifying people in need of rehabilitation assistance if false positives could be reduced.