Development and validity of the “Red flag developmental screening checklist”

Abstract

The aim of this pilot study was to develop an indigenous, simple developmental screening tool based on red flags, for administration to Indian children at routine immunization visits and to determine its validity. A 44 items-checklist was designed by listing milestones based on the red flags for the age- groups 3.5-4.5months, 9-12months, 18-20months and 24-26months, in 6 domains- GrossMotor, Fine-Motor, Language, Social, Vision, Hearing. This checklist was administered and difficulties experienced by parents in comprehension were recorded. Then the child underwent evaluation by a developmental expert that included administration of Developmental Profile II and neurodevelopmental assessment. The validity of checklist for detecting developmental delay was calculated. The RFDSC was administered to 102 subjects (29 aged 3.5-4.5months, 32 aged 9- 12months, 26 aged 18-20months, 15 aged 24-26months). 43% were screening test positive (RFDSC fail). The average time taken for its administration was 2.37 minutes (SD=0.62). 32% mothers faced problems in comprehension of certain questions. The RFDSC was found to be a fairly valid screening tool (sensitivity 63%; specificity 87%). The RFDSC was maximally valid for the age-group 3.5- 4.5months with a sensitivity of 88% and a specificity of 90%. However, the sensitivity of the checklist for the age-groups 18-20months and 24-26months was less than 50% with a specificity of 100%. The checklist developed is parent-report based, quick to administer, easily comprehensible, having easy scoring pattern and interpretation. The checklist can be a valid screening tool for the evaluation of development in children coming for immunization in the age-groups 3.5- 4.5months and 9-12monţhs. The ultimate goal is incorporating the administration of this checklist as a part of National Immunization Program so as to facilitate early identification and intervention in developmentally delayed children.