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Predictive validity of the Infant Toddler Checklist in primary care at the 18-month visit and school readiness at 4 to 6 years

  • Kimberly M. Nurse
    Affiliations
    Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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  • Magdalena Janus
    Affiliations
    Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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  • Catherine S. Birken
    Affiliations
    Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada

    Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Charles D.G. Keown-Stoneman
    Affiliations
    The HUB Health Research Solutions, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada

    Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;
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  • Jessica A. Omand
    Affiliations
    Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
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  • Jonathon L. Maguire
    Affiliations
    Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
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  • Caroline Reid-Westoby
    Affiliations
    Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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  • Eric Duku
    Affiliations
    Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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  • Muhammad Mamdani
    Affiliations
    Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;

    Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada

    Unity Health Toronto, Toronto, Ontario, Canada

    Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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  • Mark S. Tremblay
    Affiliations
    Healthy Active Living and Obesity Research, CHEO Research Institute, Ottawa, Ontario, Canada
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  • Patricia C. Parkin
    Affiliations
    Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada

    Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Cornelia M. Borkhoff
    Correspondence
    Corresponding author: Dr. Cornelia M. Borkhoff, PhD, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay St, Toronto, ON, Canada M5G 0A4, 416-813-7654
    Affiliations
    Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
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  • on behalf of the
    Affiliations
    See Acknowledgements
Published:September 16, 2022DOI:https://doi.org/10.1016/j.acap.2022.09.004

      Abstract

      Objective

      The American Academy of Pediatrics recommends developmental surveillance and screening in early childhood in primary care. The 18-month visit may be an ideal time for identification of children with delays in language and communication, or symptoms of autism spectrum disorder (ASD). Little is known about the predictive validity of developmental screening tools administered at 18 months. Our objective was to examine the predictive validity of the Infant Toddler Checklist (ITC) at the 18-month health supervision visit, using school readiness at kindergarten age as the criterion measure.

      Methods

      We designed a prospective cohort study, recruiting in primary care in Toronto, Canada. Parents completed the ITC at the 18-month visit. Teachers completed the Early Development Instrument (EDI) when the children were in Kindergarten, age 4-6 years.We calculated screening test properties with 95% confidence intervals (CIs). We used multivariable logistic and linear regression analyses adjusted for important covariates.

      Results

      Of 293 children (mean age 18 months), 30 (10.2%) had a positive ITC including: concern for speech delay (n=11, 3.8%), concern for other communication delay (n=13, 4.4%), and concern for both (n=6, 2.0%). At follow-up (mean age 5 years), 54 (18.4%) had overall EDI vulnerability, 19 (6.5%) had vulnerability on the 2 EDI communication domains. The ITC sensitivity ranged from 11%-32%, specificity from 91%-96%, false positive rates from 4%-9%, PPV from 16%-35%, NPV from 83%-95%. A positive ITC screen and ITC concern for speech delay were associated with lower scores in EDI communication skills and general knowledge (β= −1.08; 95% CI: −2.10, −0.17; β= −2.35; 95% CI: −3.63, −1.32) and EDI language and cognitive development (β= −0.62; 95% CI: −1.25, −0.18; β= −1.22; 95% CI: −2.11, −0.58).

      Conclusions

      The ITC demonstrated high specificity suggesting that most children with a negative ITC screen will demonstrate school readiness at 4-6 years, and low false positive rates, minimizing over-diagnosis. The ITC had low sensitivity highlighting the importance of ongoing developmental surveillance and screening.

      Keywords

      Abbreviations:

      ADHD (Attention-Deficit/Hyperactivity Disorder), ASD (Autism Spectrum Disorder), CI (Confidence Interval), EDI (Early Development Instrument), FN (false negative), FP (false positive), ITC (Infant Toddler Checklist), NPV (negative predictive value), OR (odds ratio), PPV (positive predictive value), SD (Standard Deviation), TARGet Kids! (The Applied Research Group for Kids), TN (true negative), TP (true positive)
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