Usefulness of parent-completed ASQ for neurodevelopmental screening of preterm children at five years of age

Abstract

Introduction: Preterm children are at greater risk of developmental impairment and require close follow-up for early and optimal medical care. Our goal was to examine use of the parent-completed Ages and Stages Questionnaire (ASQ) as a screening tool for neurodevelopmental disabilities in preterm infants at five years of age.

Patients and methods: A total of 648 preterm children (<35 weeks gestational age) born between 2003 and 2004 and included in the regional Loire Infant Follow-up network were evaluated at five years of age. ASQ was compared with two validated tools (Intelligence Quotient and Global School Adaptation Score) and the impact of maternal education on the accuracy of this questionnaire was assessed.

Results: Overall ASQ scores for predicting full-scale IQ<85 and GSA score produced an area under the receiver operating characteristic curve of 0.73±0.03 and 0.77±0.03, respectively. An ASQ cut-off value of 285 had optimal discriminatory power for identifying children with IQ scores<85 and GSA scores in the first quintile. ASQ values<285 were significantly associated with a higher risk of non-optimal neurologic outcomes (sensitivity of 0.80, specificity of 0.54 for IQ<85). ASQ values>285 were not distinctive for mild delay or normal development. In children with developmental delay, no difference was found when ASQ scores according to maternal education levels were analyzed.

Conclusions: ASQ at five years is a simple and cost-effective tool that can detect severe developmental delay in preterm children regardless of maternal education level, while its capacity to identify children with mild delay appears to be more limited.

Figure 1. Cohort profile.

LIFT: Loire Infant Follow-up Team; ASQ: Ages and Stages Questionnaire; GSA: Global School Adaptation.

Figure 2. Distribution of global ASQ scores, GSA scores and full-scale IQ scores in study population.

Figure 3. Receiver Operating Characteristic curves for predicting full-scale IQ score<85 and GSA score in first quintile based on ASQ values.

Arrows denote optimal cut-off values (ASQ score of 285 for the two curves).

Figure 4. Correlations between global ASQ scores and full-scale IQ scores, and between global ASQ scores and GSA scores.