The ten questions screen for childhood disabilities: its uses and limitations in Pakistan.

Abstract

Objective -To assess the accuracy of the ten questions screen as a measure ofchildhood disability for epidemiologic studies in populations lacking resources for professional assessment of children's development and functioning. Design -Household survey and screening of children in phase one followed by clinical assessments in phase two. Setting -Karachi, Pakistan. Participants -A cluster sample of 6365 children, aged 2 to 9 years, screened using the ten questions and a subsample referred for clinical assessments. Main results -Although the sensitivity of the ten questions as a global screen for serious cognitive, motor, and seizure disabilities is high (84-100%), its sensitivity for identifying and distinguishing specific types ofdisability and for detecting vision, hearing, and mild disabilities, overall, is limited (generally <80% and as low as 4% for mild vision disability). The predictive value of a positive screening result is also limited -using the ten questions in surveys without clinical confirmation results in overestimation ofthe prevalence ofserious disability by more than 300%. Conclusions -The ten questions screen is not an assessment tool. Its utility lies in its ability to screen or select a fraction of the population at high risk for serious disability. As a screening tool, it allows scarce diagnostic and other professional resources to be efficiently directed toward those at high risk. A study in Dhaka, Bangladesh found that the ten questions screen had excellent sensitivity and high specificity for detecting serious disabilities in 2-9 year old children. It also showed that the validity was comparable for boys and girls, and for older and younger children within the 2-9 year age range.'7 Investigators using the ten questions in Jamaica found that it had excellent sensitivity for serious motor, seizure, speech, vision, and hearing disabilities.'8 Recent comparative analyses of the ten questions screen in three countries (Bangladesh, Jamaica, and Pakistan) found that it had good reliability (alpha and kappa coefficients greater than 0.60) in all three countries as well as acceptable to excellent sensitivity (>80%) for detecting serious cognitive, motor, and seizure disabilities. It was found, however, to have relatively poor sensitivity for serious vision and hearing disorders that had not been identified previously, and it was concluded that the ten questions screen must be supplemented with actual tests of vision and hearing in order to detect these disabilities.'920 The studies in all three countries (Bangladesh, Jamaica, and Pakistan) have also shown that the screen has limited positive predictive value for serious disability (<25%), meaning that most (>75%) children who screen positive do not have a serious disability.1619All previous analyses of the ten questions screen have used a broad orglobal interpretation which considers a screening result to be positive for any disability if at least one question is positive; no correspondence is required between specific questions on the s...

Model for Service Delivery for Developmental Disorders in Low-Income Countries

“…When dialed, the IVR application provided prerecorded voice-responses to the Ten Questions Screen for disability. 14 After each prerecorded question had been read out, the caller was given the choice to select options by pressing a digit. When all 10 questions had been answered, the application used an algorithm to determine the results of the screening and fed it back to the caller.…”

Neurologic outcomes in retinopathy-negative cerebral malaria survivors

“…This questionnaire screens for the presence of neurodevelopmental disabilities. 6 It has been validated in similar geographic and economic contexts for children as young as 2 years old, 7 and shows good (85%) sensitivity in the detection of moderate to severe disabilities in children older than 2 years. Children without developmental abnormalities may screen positive on the Ten Questions Screen due to a history of febrile seizure.…”

A Population-based Study on the Prevalence of Impairment and Disability Among Young Cambodian Children

“…Overall, 15.59% of children aged 2-9 years were estimated to have some impairment and 10.06% of children were estimated to have a disability, of which cognition was by far the most prevalent condition. The prevalence estimate for Cambodia, of 3.22% for children aged 2-9 years with moderate/severe/ profound disabilities, was similar to figures for Jamaica at 2.5% (Thorburn et al, 1992) and Pakistan at 4.4% (Durkin et al, 1995) but lower than that found in Kenya at 6.1% (Mung'ala-Odera et al, 2006).…”

“…The Organisation for Economic Cooperation and Development (OECD, 2007) gives a median percentage for 15 developed countries of 2.63% for children with organic disabilities of compulsory school age, and data from developing countries, e.g. Jamaica at 2.5% (Thorburn et al, 1992) and Pakistan at 4.4% (Durkin et al, 1995) and Kenya at 6.1% (Mung'alaOdera et al, 2006), all show estimates substantially higher than 1%.…”