Predictive validity of the Infant Toddler Checklist in primary care at the 18-month visit and developmental diagnosis at 3-5 years: a prospective cohort study

Cornelia M Borkhoff; Marina Atalla; Imaan Bayoumi; Catherine S Birken; Jonathon L Maguire; Patricia C Parkin

doi:10.1136/bmjpo-2022-001524

Predictive validity of the Infant Toddler Checklist in primary care at the 18-month visit and developmental diagnosis at 3-5 years: a prospective cohort study

BMJ Paediatr Open. 2022 Jun;6(1):e001524. doi: 10.1136/bmjpo-2022-001524.

Authors

Cornelia M Borkhoff¹, Marina Atalla², Imaan Bayoumi³, Catherine S Birken¹, Jonathon L Maguire², Patricia C Parkin⁴

Affiliations

¹ Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
² Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
³ Department of Family Medicine and Centre for Studies in Primary Care, Queen's University, Kingston, Ontario, Canada.
⁴ Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada patricia.parkin@sickkids.ca.

Abstract

Objective: There is international variation in recommendations regarding developmental screening and growing recognition of the low sensitivity of commonly used developmental screening tools. Our objective was to examine the predictive validity of the Infant Toddler Checklist (ITC) at 18 months to predict a developmental diagnosis at 3-5 years, in a primary care setting.

Methods: We designed a prospective cohort study, recruiting in primary care in Toronto, Canada. Parents completed the ITC at the 18-month visit and reported developmental diagnosis at 3-5 years (developmental delay, autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), learning problem). We calculated screening test properties with 95% CIs. We used multivariable logistic regression analyses adjusted for important covariates.

Results: In the final sample (n=488), mean age at screening was 18.5 (SD 1.1) months, and at follow-up was 46.6 (SD 10.0) months. At screening, 46 (9.4%) had a positive ITC. At follow-up, 26 (5.3%) had a developmental diagnosis, including: developmental delay (n=22), ASD (n=4), ADHD (n=1), learning problem (n=1); parents of two children each reported two diagnoses (total of 28 diagnoses). Of four children with a diagnosis of ASD at follow-up, three had a positive ITC at 18 months. The ITC specificity (92%, 95% CI: 89% to 94%) and negative predictive value (96%, 95% CI: 95% to 97%) were high; false positive rate was low (8%, 95% CI: 6% to 11%); sensitivity was low (31%, 95% CI: 14% to 52%). There was a strong association between a positive ITC at 18 months and later developmental diagnosis (adjusted OR 4.48, 95% CI: 1.72 to 11.64; p=0.002).

Conclusion: The ITC had high specificity, high negative predictive value, low false positive rate, and identified children with later developmental delay and ASD. The ITC had low sensitivity, similar to other screening tools underscoring the importance of continuous developmental surveillance at all health supervision visits.

Keywords: health services research.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Attention Deficit Disorder with Hyperactivity* / diagnosis
Autism Spectrum Disorder* / diagnosis
Checklist
Child, Preschool
Humans
Infant
Primary Health Care
Prospective Studies