Development of a triage tool for neurodevelopmental risk in children aged 30 months.
SSLM plus SDQ at 30 months spots later language and mental-health disorders well, but expect two false positives for every true case.
01Research in Context
What this study did
Sim et al. (2015) tested a two-part triage tool for 30-month-old toddlers. They gave parents the SSLM language checklist and the SDQ behavior scale. One year later they checked which children had language, psychiatric, or global developmental disorders.
The goal was a quick screen that any clinic or community nurse could use to spot kids who need full assessment.
What they found
The SSLM plus SDQ correctly flagged most later disorders. The area-under-the-curve scores ranged from 0.82 to 0.98, showing strong predictive power.
The catch: about two-thirds of the children who screened positive did not actually have a disorder when checked later.
How this fits with other research
Dudley et al. (2019) created a picture-based screener for low-literacy families and also found good accuracy. Both studies show you can triage risk without long tests.
Dietz et al. (2006) screened babies at 14-15 months with the ESAT and still caught ASD cases. Starting earlier is possible, but Fiona’s 30-month window gives stronger predictions.
Pandey et al. (2008) saw the M-CHAT miss more cases at 18 months than at 24-30 months. This supports waiting until the 30-month mark that Fiona used.
Tsai et al. (2012) reported near-perfect accuracy with a 15-item parent form in Taiwan. Their small case-control design may explain the rosier numbers compared with Fiona’s larger community sample.
Why it matters
If you run toddler clinics, keep the SSLM and SDQ in your intake folder. A positive screen is your cue to refer, but plan to explain to families that most positives are false alarms. Use the 30-month sweet spot—earlier screens catch less, and waiting longer delays services.
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02At a glance
03Original abstract
Neurodevelopmental and neuropsychiatric disorders in young children predict educational, health and social problems. Early identification may significantly reduce this burden but relevant tools largely lack validation. We aimed to develop and evaluate the predictive validity of a simple screening tool for neurodevelopmental problems in a community sample of 30 month old children. A sample of children was selected from a community cohort screened at 30 months by health visitors using the Sure Start Language Measure (SSLM) and the Strengths and Difficulties Questionnaire (SDQ) in 2011. Predictive validity was assessed by comparing screening results with detailed psychometric data from the same sample 1-2 years later. Screening performance using different thresholds was explored using Receiver Operating Characteristic (ROC) with ROC area under the curve (AUC) and bootstrapping techniques. The SSLM predicted both language disorder identified by the New Reynell Developmental Language Scales (NRDLS) at follow-up (AUC 0.905) and global developmental delay assessed by the Griffiths Mental Development Scales (AUC 0.983). The SDQ administered at 30 months predicted psychiatric disorders identified by the Development and Wellbeing Assessment (DAWBA) at follow-up (AUC 0.821). Using optimal cut-offs for the SDQ and SSLM at 30 months, both tools together had sensitivity 87%; specificity 64%; positive predictive value 31%; and negative predictive value 97% in the prediction of any kind of neurodevelopmental problem 1-2 years later. The combined measure reported here is not yet sufficient as a stand-alone population screening tool for neurodevelopmental disorders. The SSLM and SDQ did however show promise in identifying preschool children at risk of ongoing language, psychiatric disorders and global developmental delay 1-2 years later but with fairly high false positive rates. Given that current developmental risk prediction in resource-poor settings is little better than random assignment, the SDQ and SSLM may aid clinical judgement when used as interim triage tools for practitioners with no specialist knowledge, in the context of longitudinal follow-up arrangements.
Research in developmental disabilities, 2015 · doi:10.1016/j.ridd.2015.07.017