Evaluation of the revised Nipissing District Developmental Screening (NDDS) tool for use in general population samples of infants and children

Abstract

BackgroundThere is widespread interest in identification of developmental delay in the first six years of life. This requires, however, a reliable and valid measure for screening. In Ontario, the 18-month enhanced well-baby visit includes province-wide administration of a parent-reported survey, the Nipissing District Developmental Screening (NDDS) tool, to facilitate early identification of delay. Yet, at present the psychometric properties of the NDDS are largely unknown.Method812 children and their families were recruited from the community. Parents (most often mothers) completed the NDDS. A sub-sample (n = 111) of parents completed the NDDS again within a two-week period to assess test-retest reliability. For children 3 or younger, the criterion measure was the Bayley Scales of Infant Development, 3rd edition; for older children, a battery of other measures was used. All criterion measures were administered by trained assessors. Mild and severe delays were identified based on both published cut-points and on the distribution of raw scores. Sensitivity, specificity, positive and negative predictive values were calculated to assess agreement between tests.ResultsTest-retest reliability was modest (Spearman’s rho = .62, p < 001). Regardless of the age of the child, the definition of delay (mild versus severe), or the cut-point used on the NDDS, sensitivities (from 29 to 68 %) and specificities (from 58 to 88 %) were poor to moderate.ConclusionThe modest test-retest results, coupled with the generally poor observed agreement with criterion measures, suggests the NDDS should not be used on its own for identification of developmental delay in community or population-based settings.

Misclassification due to age grouping in measures of child development

“…Although there are considerable differences between our examination and real validation studies (notably, we considered only a single subscale), age banding may therefore help to explain the often modest agreement reported in comparisons of the BSID-III and ASQ17–20 and of the BSID-III and NDDS 10 11 21. Although sensitivities above 70% have been reported in comparisons between the ASQ and BSID-III, these are often from studies that do not include broad age ranges.…”

“…These 593 subjects are included in the present analysis. Parents of PANS participants were slightly better educated and had slightly higher incomes than the national average 10 11. We received ethical approval from the McMaster University Research Ethics Board and all parents provided informed, written consent.…”

Diagnostic accuracy of developmental screening in primary care at the 18-month health supervision visit: a cross-sectional study

“…The Nipissing District Developmental Screen is not a standardized tool. Recently, Cairney and colleagues 23 evaluated the psychometric properties of the screen with the Bayley Scales of Infant Development (3rd edition). In that study, the Nipissing District Developmental Screen had modest testretest reliability (Spearman ρ = 0.62), low sensitivities ranging from 29% to 68% and specificities ranging from 58% to 88% in the identification of developmental delays.…”

Recommendations on screening for developmental delay

“…40 The Nipissing District Developmental Screen was found to have only moderate test-retest reliability (78% of retests produced the same results). 38 Sensitivity and specificity for children between one month and three years, relative to the Bayley Scales of Infant Development, were poor to moderate, ranging from 29% to 65% and from 63% to 88%, respectively, depending on the age of the child and the cut-point used to define an abnormal test result.…”

“…The task force also reviewed results from a forthcoming study 38 (not included in the systematic review 19 ) that evaluated the diagnostic properties of the Nipissing District Developmental Screen 39 and the Bayley Scales of Infant De velopment, third edition. 40 The Nipissing District Developmental Screen was found to have only moderate test-retest reliability (78% of retests produced the same results).…”