The ESSENCE-Questionnaire for Neurodevelopmental Problems – A Swedish School-Based Validation Study in 11-Year-Old Children

Abstract

Purpose To determine the prevalence of parent-rated developmental concern using the ESSENCE-Q (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations-Questionnaire, 12-items, score range 0–24) and to ascertain the predictive validity and optimal cutoff level of the instrument in a school-based sample of 11-year-old children. Methods In a cross-sectional, school-based study, participants underwent a clinical assessment by a physician and a psychologist, teachers and parents completed the SDQ (Strength and Difficulties Questionnaire), medical health records and national tests were reviewed, and parents independently completed the ESSENCE-Q. In a case-conference outcomes were defined as a) the need for further clinical work-up due to suspected neurodevelopmental problems (NDPs) and b) degree of investigator-rated symptoms/impairment from NDPs on the CGI-S (Clinical Global Impression-Severity instrument, range 1–7, 4–7 defined as clinically symptomatic). Classification and optimal cutoffs of the ESSENCE-Q were determined using ROC (Receiver Operating Characteristic) analysis. Results Out of 343 eligible children, 223 enrolled, of whom 173 (50% of all eligible) had a parent-rated ESSENCE-Q. At least one of the 12 possible concerns was reported by parents of 36% of participants. Overall, in 101 (57%) participants a work-up was warranted, and 64 (37%) were clinically symptomatic from NDPs. The AUC of the ESSENCE-Q in detecting need for work-up was 0.70 (95% confidence interval [CI] 0.63–0.77), and the AUC in detecting clinically symptomatic participants was 0.82 (95% CI 0.76–0.88). ESSENCE-Q ratings correlated positively with CGI-S scores ( r =0.48, p <0.05). A cutoff of ≥3 had the highest accuracy (78%) with a negative predictive value of 82%. Ratings >6 conferred few false positives cases with positive likelihood ratios >10 and positive predictive values of 86% or more. Significance This study of the ESSENCE-Q in 11-year-old children suggests it might be an acceptable instrument for screening of NDPs in children in middle school, optimally in conjunction with other methods.

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

“…As discussed in Landgren et al, the rate of clinically significant problems in this cohort (CGI ≥ 4 in 37%) was higher than expected and may be due to several factors. 18 Selection effects (families experiencing problems may be more prone to participate and those without problems more prone to decline), a more demanding school environment that make “borderline cases” with NDPs clinically impaired, or that studies relying on statistically motivated cutoffs may underestimate the prevalence of NDPs in this age group may be reasons. The AUC of the ESSENCE-Q rated medical records were in the range of ~0.80, which is similar to that of other screening measures for NDDs in this age-group, such as the SDQ.…”

“…The validity of parent-rated ESSENCE-Q in this cohort has been reported previously, where a more detailed methodological description of the clinical assessments can be found. 18 Here, we report on a sub-study examining the usefulness of using the ESSENCE-Q as a template for experts/clinicians in screening medical records for symptoms of NDDs. A flow diagram of participants and measures are provided in Figure 1 .…”

“…As described previously, we therefore rated each participant with the clinical global impression – severity instrument (CGI-S). 18 , 21 The CGI-S reflects the clinician’s impression of degree of impairment with reference to the distribution of the specific condition under study, based on all available information about the participant. In a clinical setting based on our experience, participants with CGI 1–3 would not be referred for work-up in regular health care (child psychiatry), whereas participants with CGI 4–7 would likely have symptoms/impairments warranting clinical attention and likely diagnosis (For a detailed description and examples of the CGI-S rating, see Landgren et al).…”

Neurodevelopmental problems, general health and academic achievements in a school‐based cohort of 11‐year‐old Swedish children

“…None of the schools had pupils attending special education. Using the same cohort, we have previously reported on the validity of the ESSENCE questionnaire for detecting clinically relevant NDPs as rated by parents, or by physicians when screening medical records for detecting clinically relevant NDPs 8,9 …”

“…Using the same cohort, we have previously reported on the validity of the ESSENCE questionnaire for detecting clinically relevant NDPs as rated by parents, or by physicians when screening medical records for detecting clinically relevant NDPs. 8,9 From the 20 classes in eight schools, 348 children were eligible and 223 enrolled in the study, giving a participation rate of 64%. Attrition varied between the two recruited academic years (2018 74% vs. 2019 54% participation), and between schools (range 36%-91%).…”