Methodological Challenges in Child Neurodevelopmental Assessment Lisa Thompson, RN, FNP, PhD School of Nursing University of California, San Francisco
Neurodevelopmental Impairment (NDI) • Disturbances in cognition, behavior, language development, motor skills and emotional regulation • Higher rates of NDI in preterm infants and IUGR infants • Higher rates of NDIs in LMICs • 80% of children with NDIs in LMICs • Mild impairment, if recognized early enough, can be reversible with intervention
Etiology of NDIs • Pregnancy: Congenital infections, congenital hypothyroidism, congenital anomalies, maternal nutrition, environmental insults • Delivery: Birth trauma, birth asphyxia, neonatal sepsis, jaundice • Infancy: Protein-Energy Malnutrition, Micronutrient (Iodine, Vitamin A, Zinc, Iron) deficiency, , environmental insults
• Poverty
Approaches • Home-based screening questionnaires • Observer-rated child assessments • Age of assessment – Hard to detect at very young ages (esp. speech, cognition, behavior) – Important to detect and intervene at very young ages
• Training intensity • Professional vs. non-professional
Screening Instruments • Bayley Infant Neurodevelopment Screener (BINS) • Clinical Adaptive Test/Clinical Auditory Milestone Scale (CAT/CLAMS) • Denver Developmental Screening Test • Ages and Stages Questionnaire • Developmental Screening Questionnaire (Khan, et al. 2011, Child) • 10 Questions (Zaman, et. al 1990, IJE)
Developmental Screening Questionnaire (DSQ) • Child < 2 years of age • Administered to mothers • 1 question for eight functional domains is asked: gross motor, fine motor, vision; hearing, cognition, socialization, behavior and speech
• Yes on any question is “screen +” refer
DSQ, 14 month old 14 mo.
Fine motor
Can stand , hold on, from sitting position and can cruise around furniture Can grasp object, e.g., biscuit, puffed rice with fingers
DSQ-114
Vision
Can see small objects, e.g., an M&M
DSQ_115
Hearing
Can hear (i.e. turns towards sound, or responds to call from out of sight) DSQ-116
Cognition
DSQ-117
Socialization
Demonstrates affection on request / Plays pat-a-cake or waves bye-bye on request Responds when spoken to
Behavior
Responsive to surroundings and sleeps well
DSQ-119
Speech
Vocalizes imitative or meaningless words (e.g., mom, dad)
DSQ-120
Gross motor
DSQ-113
DSQ-118
Ten Questions Tool • > 2 years of age • Yes on any question is “screen +” refer
Zaman, et. al 1990, IJE
Considerations for screening questionnaires • • • •
Mother’s education Maternal depression/mental health Social acceptability Gender: over-reporting in boys; underreporting in girls
Child Assessment/Ability Instruments • (Brazelton) Neonatal Behavioral Assessment Scale (NBAS): 28 behavioral items and 18 primitive reflexes
• Network Neurobehavioral Scale (NNNS): 115 items
• Malawi Developmental Assessment Tool (MDAT): 136 items (gross & fine motor, language and social)
• Rapid Neurodevelopmental Assessment (RNDA) • Bayley Scale of Infant Development, III: 325 items, receptive communication, expressive communication, fine motor, gross motor and cognitive, 1-42 months
Considerations for direct child assessment • • • • • • • •
Alertness Optimal performance Examiner facilitation/engagement Endurance Familiarity with objects/past opportunities Stranger anxiety/shyness Cultural factors Engagement in active playing-learning activities
MDAT
Rapid Neurodevelopmental Assessment (RNDA)
Khan NZ, Muslima H, Begum D, et al. Validation of rapid neurodevelopmental assessment instrument for under -two-year-old children in Bangladesh. Pediatrics. Apr;125(4):e755-762.
Study purpose Purpose Train project staff to assess infant neurodevelopment Assess inter-rater reliability and concurrent validity between RNDA and Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) Assess validity based on chronic malnutrition (stunting)
RNDA • 27 items • 9 domains: primitive reflexes, gross and fine motor development, vision, hearing, speech, cognition, behavior and seizures in children
