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

Valdemar Landgren; Zohar Raanan Soltis; Emma Svensson; Michail Theodosiou; Magnus Landgren; Rajna Knez

doi:10.2147/NDT.S367196

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

Neuropsychiatr Dis Treat. 2022 Nov 3:18:2559-2574. doi: 10.2147/NDT.S367196. eCollection 2022.

Authors

Valdemar Landgren^{1

2}, Zohar Raanan Soltis¹, Emma Svensson³, Michail Theodosiou^{2

4}, Magnus Landgren², Rajna Knez^{2

5}

Affiliations

¹ Department of Psychiatry, Skaraborg Hospital, Skövde, Sweden.
² Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³ Department of Child Psychiatry, Skaraborg Hospital, Skövde, Sweden.
⁴ School Health Services, City of Gothenburg, Gothenburg, Sweden.
⁵ Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden.

Abstract

Purpose: Determine the prevalence of symptoms of neurodevelopmental problems (NDPs) with a semi-structured review of fourth grade students' medical records, its interrater agreement and validity as compared with clinical assessment.

Methods: A school-based sample of 11-year-old children provided child health care (CHC) records and school health care (SHC) records. A pediatric neurologist, child psychiatrist and an adult psychiatrist scored the records, with the "Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations-Questionnaire" (ESSENCE-Q, 12 items scored 0-2, summary score range 0-24). Agreement was measured with model-based kappa and intraclass correlation coefficient (ICC). Ratings were validated against a multidisciplinary assessment involving a physician, psychologist, teacher- and parental behavioral rating scales rendering a clinical global impression severity rating (CGI-S, range 1-7) of NDPs.

Results: Out of 223 participants, medical charts were available from 201, of whom 169 were rated by all three raters. Kappa agreement was moderate/strong (~0.8) for 7 of the 12 questionnaire items. Measured with the ICC, concordance in the summary score was good for agreement (~0.8) and excellent (~0.9) for consistency. Test-retest reliability was excellent (ICC = ~0.9). Area under the curve for the ESSENCE-Q in predicting clinical-level problems (CGI ≥4) was ~80% for all three raters, albeit with differing optimal cutoffs.

Conclusion: Using the ESSENCE-Q as a template, NDPs appear to be common in medical records, are identified reliably, and predict clinical-level concern. Medical records screening may facilitate a structured review of medical records in work-ups or be applied in conjunction with other screening measures for neurodevelopmental disorders. However, differences in calibration currently preclude defining a universal cutoff for using the ESSENCE-Q for medical records screening.

Keywords: ESSENCE; abnormal development; child health; medical records; neurodevelopmental disorders.

Grants and funding

Funding was provided by grants from Research and Development of Region Västra Götaland (VGSKAS-931754) and the research fund at Skaraborg Hospital (VGSKAS-967692, VGSKAS-939541).