Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov 3:18:2559-2574.
doi: 10.2147/NDT.S367196. eCollection 2022.

The ESSENCE-Questionnaire in Medical Records Screening for Neurodevelopmental Symptoms/Problems: Utility and Clinical Validity

Valdemar Landgren  1   2 , Zohar Raanan Soltis  1 , Emma Svensson  3 , Michail Theodosiou  2   4 , Magnus Landgren  2 , Rajna Knez  2   5
Affiliations

The ESSENCE-Questionnaire in Medical Records Screening for Neurodevelopmental Symptoms/Problems: Utility and Clinical Validity

Valdemar Landgren et al. Neuropsychiatr Dis Treat. .

Abstract

Purpose: Determine the prevalence of symptoms of neurodevelopmental problems (NDPs) with a semi-structured review of fourth grade students' medical records, its interrater agreement and validity as compared with clinical assessment.

Methods: A school-based sample of 11-year-old children provided child health care (CHC) records and school health care (SHC) records. A pediatric neurologist, child psychiatrist and an adult psychiatrist scored the records, with the "Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations-Questionnaire" (ESSENCE-Q, 12 items scored 0-2, summary score range 0-24). Agreement was measured with model-based kappa and intraclass correlation coefficient (ICC). Ratings were validated against a multidisciplinary assessment involving a physician, psychologist, teacher- and parental behavioral rating scales rendering a clinical global impression severity rating (CGI-S, range 1-7) of NDPs.

Results: Out of 223 participants, medical charts were available from 201, of whom 169 were rated by all three raters. Kappa agreement was moderate/strong (~0.8) for 7 of the 12 questionnaire items. Measured with the ICC, concordance in the summary score was good for agreement (~0.8) and excellent (~0.9) for consistency. Test-retest reliability was excellent (ICC = ~0.9). Area under the curve for the ESSENCE-Q in predicting clinical-level problems (CGI ≥4) was ~80% for all three raters, albeit with differing optimal cutoffs.

Conclusion: Using the ESSENCE-Q as a template, NDPs appear to be common in medical records, are identified reliably, and predict clinical-level concern. Medical records screening may facilitate a structured review of medical records in work-ups or be applied in conjunction with other screening measures for neurodevelopmental disorders. However, differences in calibration currently preclude defining a universal cutoff for using the ESSENCE-Q for medical records screening.

Keywords: ESSENCE; abnormal development; child health; medical records; neurodevelopmental disorders.

PubMed Disclaimer

Conflict of interest statement

Dr Magnus Landgren reports grants from Research and Development of Region Västra Götaland, grants from Fund at Skaraborg Hospital, during the conduct of the study. The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Overview of participants and measures used in the study.
Figure 2
Figure 2
Distributions of ESSENCE-Q summary scores by rater and record source.
Figure 3
Figure 3
(A–C) Proportions of responses by rater and ESSENCE-Q item in CHC records (A), SHC records (B) and CHC+SHC records (C).
Figure 4
Figure 4
Interrater agreement in scoring the ESSENCE-Q from CHC records (A), SHC records (B) and CHC+SHC records (C).
Figure 5
Figure 5
Correlation plot of ESSENCE-Q (range 0–24) rating and Clinical Global Impression – Severity (range 1–7) for the three raters. (A) Child psychiatrist (n=175), (B) child neurologist (n=176), (C) adult psychiatrist (n=190).
Figure 6
Figure 6
Receiver operating characteristic curves of the classification accuracy of the ESSENCE-Q in detecting clinically impairing neurodevelopmental problems (a Clinical Global Impression-Severity rating of 4–7) for the three raters. (A) Child psychiatrist (n=176), (B) child neurologist (n=176), (C) adult psychiatrist (n=190).
See this image and copyright information in PMC

References

    1. Spitzer RL. Psychiatric diagnosis: are clinicians still necessary? Compr Psychiatry. 1983;24(5):399–411. doi:10.1016/0010-440X(83)90032-9 - DOI - PubMed
    1. Gillberg C. The ESSENCE in child psychiatry: early symptomatic syndromes eliciting neurodevelopmental clinical examinations. Res Dev Disabil. 2010;31(6):1543–1551. doi:10.1016/j.ridd.2010.06.002 - DOI - PubMed
    1. Mulligan A, Anney RJL, O’Regan M, et al. Autism symptoms in attention-deficit/hyperactivity disorder: a familial trait which correlates with conduct, oppositional defiant, language and motor disorders. J Autism Dev Disord. 2009;39(2):210–211. doi:10.1007/s10803-008-0640-0 - DOI - PubMed
    1. Cross-Disorder Group of the Psychiatric Genomics Consortium. Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs. Nat Genet. 2013;45(9):984–994. doi:10.1038/ng.2711 - DOI - PMC - PubMed
    1. Pettersson E, Anckarsäter H, Gillberg C, Lichtenstein P. Different neurodevelopmental symptoms have a common genetic etiology. J Child Psychol Psychiatry. 2013;54(12):1356–1365. doi:10.1111/jcpp.12113 - DOI - PubMed