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. 2019 Sep;40(7):511-518.
doi: 10.1097/DBP.0000000000000695.

Quantitative Evaluation of Content and Age Concordance Across Developmental Milestone Checklists

Carol L Wilkinson  1 , M Jackson Wilkinson, Jennifer Lucarelli  2 , Jason M Fogler  1 , Ronald E Becker  1 , Noelle Huntington  3
Affiliations

Quantitative Evaluation of Content and Age Concordance Across Developmental Milestone Checklists

Carol L Wilkinson et al. J Dev Behav Pediatr. 2019 Sep.

Abstract

Objective: Clinicians and caregivers rely on milestone checklists as tools for tracking a child's development. In addition, medical students and residents use milestone checklists to learn about normal child development. However, there are multiple published milestone checklists that vary qualitatively in structure and content, hindering their effective use in developmental surveillance and medical education. This project systematically evaluated the consistency and variability between commonly used milestone checklists.

Methods: A team of child psychologists and developmental pediatricians reviewed a total of 1094 milestones derived from 4 published checklists (2 developed for providers, 2 developed for caregivers) to create a comprehensive set of 728 discrete developmental observations, with each observation mapped to corresponding milestones. This observation-milestone relational database was then used to determine the degree of content overlap and milestone age range concordance across milestone checklists.

Results: Of the 728 discrete developmental observations, 40 (5.5%) were mapped to milestones in all 4 milestone checklists, and an additional 90 (12.4%) were mapped to 3 checklists. Among these 40 "universal" observations, most (42.5%) were in the motor domain. Of those 130 observations mapped to milestones in at least 3 of the 4 checklists, 26.9% (35/130) were mapped to milestones that were discordant in their associated age range.

Conclusion: Four commonly used developmental milestone checklists were found to have limited overlap in content, and those that overlapped were inconsistent in their associated age ranges. The resulting observation-milestone relational database could be used to further validate age estimates of milestones and facilitate milestone surveillance through the electronic health record.

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Conflict of interest statement

Financial Disclosure: All authors have indicated they have no financial relationships relevant to this article to disclose.

Conflict of Interest: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:
1A – An example visualization of analysis determining age concordance among all four systems for a single observation. Solid lines represent paths finding successful agreement between milestones, while dashed lines show attempted but failed paths. Colored blocks show the target age at which the observation is represented by a milestone in the correspondingly- colored system. In an effort to be permissive, the analysis determines the final level of agreement based on the highest number of concordant systems. Figure 1B – An example visualization of analysis showing age concordance among three systems for a single observation.
Figure 2:
Figure 2:. Histograms of age distribution for milestones.
A: A total of 160 milestones were associated with the 40 universal observations found in all 4 systems. 130 of those milestones represent skills between 0 and 36 months of age. B: A total of 418 milestones were associated with the 130 observations found in at least 3 of the 4 systems. 322 of those milestones represent skills between 0 and 36 months of age.
See this image and copyright information in PMC

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