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AgesandStagesQuestionnaireat3YearsforPredictingIQat5–6Years幼儿3岁时的发育情况(年龄和发育阶段问卷结果)能预测其5-6岁时的IQPEDIATRICSVolume139,number4,April2017IF:6.476Yaoxing,2017-11-07ContensBackgroundObjectivesMethodsResultsDiscussionStrengthsandlimitationsConclusionsImplicationsAbbreviationsASQ:Ages&StagesQuestionnaires(年龄与发育阶段问卷)CI:ConfidenceInterval(可信区间)EDEN:EtudedesDeterminantsPre-etPost-natalsduDeveloppementdel’Enfant(伊甸园队列)IQR:InterquartileRange(四分位数间距)ROC:ReceiverOperatingCharacteristic(受试者/接受者工作特征)SDQ:StrengthsandDifficultiesQuestionnaire(长处与困难问卷)WPPSI-III:WechslerPreschoolandPrimaryScaleofIntelligence–ThirdEdition(韦氏学龄前儿童智力量表,第3版)EDEN:EtudedesDeterminantsPre-etPost-natalsduDeveloppementdel’EnfantTheEDENmother–childcohortstudyaimstoexamineprenatalandpostnataldeterminantsofchilddevelopment,growth,andhealth.Participantswererecruitedbetween2003and2006amongpregnantwomenfollowedinPoitiersandNancyuniversitymaternities.Exclusioncriteriaweremultiplepregnancies(多胎妊娠),aknownhistoryofdiabetes,non–Frenchspeakersorreaders,orplanstomoveoutofthestudyregioninthenext3years.Background1.Theidentificationofyoungchildrenatriskforlatersuboptimaldevelopmentiskeytothedesignandimplementationofearlypreventiveorinterventionalstrategies.2.Parentalreportinstrumentsaredesignedtobeusedinprimarycareforfirstlineclinicalscreeningofinfantandpreschoolchilddevelopment.3.TheAges&StagesQuestionnaires(ASQ)arethemostcommonlyusedquestionnairestoidentifyyoungchildrenatriskfordevelopmentaldelay.4.Previousevidencefromapopulationofchildrenbornpretermshowedthatthe36-monthASQpredictedschooldifficultiesatage5.5.ThereisagapinknowledgeaboutthepredictivevalueofearlyASQscoresforlatercognitivefunctioning,suchasIQ,inthegeneralpediatricpopulation.Objectives1.Toinvestigatethepredictivevalueofthe36-monthASQscoreforIQatage5to6yearsinalargepopulation-basedcohortstudy.2.Tosearchforotherchild,maternal,andfamily-relatedfactorsassociatedwithlowIQoncethe36-monthASQscoreistakenintoaccountandtodeterminewhethersuchfactorscouldinteractintherelationshipbetweenthe36-monthASQscoreandlaterIQ.Methods1.Measuresofchilddevelopment2.136-MonthASQScore(FrenchSecondEdition)Parentsanswer6questionsineachof5domainsofdevelopment:communication(沟通),grossmotor(粗大动作),finemotor(精细动作),problem-solvingskills(解决问题能力),andadaptiveskills(适应能力).USnormsareavailableforeachdomain,andanydomainscreened2SDsbelowthemeanisconsideredapositivescreening.Thisstudyusedthesumorthe5domainscores,producingascorebetween0and300.1.Measuresofchilddevelopment2.2IQWiththeWechslerPreschoolandPrimaryScaleofIntelligence–ThirdEditionatAge5to6YearsWhenthechildwas5to6yearsold,cognitiveassessmentwasperformedbytrainedpsychologists.TheWPPSI-IIIincludes7subtestsusedtocomputeaverbalIQ,aperformanceIQ,andafull-scaleIQ.IQwasconsideredlowifitwas85.Whenthechildrenwere3yearsold,mothersfilledoutaquestionnairereportingsociodemographicstatusforthefamilyandspecificdataoncurrentmaternalhealth,togetherwiththeASQ.Whenthechildrenwere5to6yearsold,acognitiveassessmentwasconductedbytrainedpsychologists.1.Measuresofchilddevelopment2.Factorsincludedintheanalysis1.Child’scharacteristics:gender;whetherthechildwasafirstbornchild;behavioralproblemsatage3,ratedviatheStrengthsandDifficultiesQuestionnaire(SDQ),andwhetherthechildhadstartedpreschoolatage3.2.Maternalcharacteristics:maternaleducationallevel,occupation,anddepressivesymptomsassessedwiththeCenterforEpidemiologicStudies–Depressionscale.3.Familycharacteristics:parents’occupationandfinancialdifficultiesreportedbytheparentswhenthechildwas3.3.Statisticalanalysis1.ChildrenincludedinthecurrentanalysiswerefirstcomparedwiththeotherchildrenintheEDENcohortwhowerenotincluded.2.Resultsforthe36-monthASQscoreandthe5-to6-yearWPPSI-IIIevaluationweredescribedasmeans±SDsandmedianwithinterquartileranges(IQRs).3.Thereceiveroperatingcharacteristic(ROC)curvelinkinglowIQ(85)andASQscorewasusedtodeterminetheoptimalcutoffvaluefortheASQscore.4.A3-stepanalysiswasthenconductedwithlogisticregression.5.StatisticalanalyseswereperformedinSASsoftwareversion9.3.Results①ASQscoresweredeterminedatameanageof37.3±0.8months.Themean36-monthASQscorewas270±30,withamedianof280(IQR260–290).②IQwasmeasuredatameanageof67.2±1.8months.TheMeanIQwas103±13,and69children(7.3%)hadanIQ85.③Allchild,maternal,andfamilyfactorsstudied,exceptgenderandmaternaldepressivesymptoms,weresignificantlyassociatedwithASQscore.1.CharacteristicsoftheStudypopulation(andcomparedwithchildrenintheEDENCohortbutnotincludedinthestudy)ChildrennotincludedweremoreoftenfromNancyCenter,werelessoftenfirstborn,hadmotherswithlowereducationallevels,andhadparentswithloweroccupationallevelsthanchildrenincluded.2.IQatage5to6yearsaccordingto36-monthASQscore(ROCcurve)Theareaunderthecurvewas0.78(95%confidenceinterval[CI],0.72–0.84).即IQ<85的幼儿ASQ值小于正常组的概率为0.78。TheoptimalcutoffvalueforpredictinglowIQwas270(sensitivitywas0.77,specificitywas0.68).Positivepredictivevaluewas0.16,thenegativepredictivevaluewas0.97(提示3岁时ASQ得分>270的幼儿5-6岁时IQ<85的可能性小)ROC曲线下面积与工具诊断准确度高低高0.90-1.00=exc

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