Maternal estimates of mental age in developmental assessment
http://www.100md.com
《美国医学杂志》
Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Abstract
Objective: To examine the accuracy and clinical utility of maternal estimates of mental age in young children referred for developmental assessment. Methods: Mothers of 100 children aged 16 to 60 months referred for developmental evaluation to psychology services of Department of Pediatrics of a tertiary care teaching hospital were asked to estimate the mental age of their child. Maternal estimates were converted to intelligence quotient (IQ) and were compared to results from developmental tests of cognitive and adaptive behavior functioning which were administered to all children. Results: Maternal estimate IQ was highly correlated with IQ calculated from Developmental Profile II (r=.83, p<.001) and social quotient (SQ) calculated from Vineland Social Maturity Scale (r=.81, p<.001). Maternal estimate IQ was 82% sensitive to cognitive delay and 81% specific in identifying children likely to have normal development. Twenty seven percent of the maternal estimates were within ± 5 IQ points of actual IQ. Mothers were more likely to overestimate their child's functioning. Maternal IQ (Mean=62.1, S.D. =25.8) was significantly higher (t=2.93, p<.004) than the actual IQ (Mean=57.9, S.D.=21.9). Step-wise multiple regression analysis revealed that the child's IQ and SQ explained 10% of the variance (F=6.40, p<.001) in maternal accuracy. The lower the SQ and IQ of the child, more accurate the estimates. Conclusion: Maternal estimates of mental age provide an accurate measure of developmental functioning in young children and may be used as a screening technique to identify a subset of children who need more detailed evaluation
Keywords: Maternal estimates; Mental age; Development assessment
The importance of early diagnosis and treatment of children with developmental disabilities has emerged in recent years as a matter of growing concern among pediatricians. [1],[2],[3] In young children, disabilities often present as delays in the acquisition of expected developmental milestones in speech, cognition, adaptive, fine motor or gross motor development. Early identification combined with early treatment to address delays can improve outcome, enhance function, and reduce the development of secondary behavioral problems. [4],[5],[6]
Pediatricians play a key role in the early identification of children with developmental delays.[7] There is, however, no consensus as to how such early identification can be optimally performed. Some of the commonly used techniques include reviewing developmental milestones with parents, relying on clinical judgment based on history, physical examination, observation, eliciting parental concerns, or administering a formal developmental screening test. [8],[9]
Past research has documented the infrequent use of developmental screening or diagnostic tests by pediatricians.[8], [10],[11] Moreover, when physicians rely on their clinical judgment, their estimates of children's developmental status are often inaccurate. [12],[13] Studies indicate that almost half of the children with developmental disabilities are not identified by their pediatricians.[13],[14] Research conducted in the developed countries has shown that parents' numerical estimates of their child's developmental age is a useful method for detecting developmental delay in young children.[9], [15],[16],[17] For example, Glascoe and Sandler[17] asked parents of 234 children aged 0 to 77 months to estimate their child's overall developmental age. The children were also administered a range of screening and diagnostic measures of intelligence, speech-language and adaptive behavior. The results indicated that overall age-estimate if less than chronological age was 75% sensitive to likely developmental problems, and if equal to or greater than chronological age was 90% specific in identifying children likely to have normal development. The authors found no differences in the accuracy of parents' estimates on the basis of children's age, sex, race, parents' level of education or parenting experience.
The utility of parental estimate of young children's developmental age in identifying children with developmental delay is not known in our country. In the Indian context, an important question is whether parents can estimate a developmental age for their child and how accurate are their estimates. Specifically, the objectives of the study are (i) to investigate the accuracy of maternal estimates of mental age in young children with suspected developmental delay, and (ii) to assess the clinical utility of maternal estimates by evaluating its effectiveness in screening for developmental delay.
Materials and Methods
Subjects comprised of 100 parent-child dyads who were referred for developmental assessment to outpatient psychology services of the Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh. The inclusion criteria for all children were (i) chronological age less than 5 yrs, (ii) the absence of sensory or motor impairment, and (iii) the child being accompanied by the mother who should be the primary caretaker. In all cases, the children had been referred for developmental evaluation because of parental concerns regarding global delay, language delay, behavior problems, and/or hyperactivity. The developmental evaluation represented the first formal developmental assessment for all the children.
Procedure
Before conducting the developmental assessment, each mother was asked to estimate a global estimate of overall developmental status of the child. The mothers were asked "your child is now X years and X months old. Although he/she is X years and X months old, overall do you think his/her mental development is age appropriate, ahead of his/her chronological age or lagging behind. If the mother answered "age appropriate" no further questions were asked. On the other hand, if the mother answered that the child was advanced for age or lagging behind, they were asked to estimate an overall mental age of the child. Parents were encouraged to give their answer in years as well as months. None of the parents had any difficulty in understanding the question or in providing a numerical answer. In case the mother gave a range of ages as an estimate, she was asked to select a single answer that best described her child's mental developmental age. Estimates were converted to maternal estimate intelligence quotient by dividing maternal estimate mental age by the child's chronological age and the product multiplied by 100. After maternal estimates were obtained, each of the children received a comprehensive developmental assessment to determine the child's current level of functioning by a trained person who was blind to the maternal estimate of mental age.
Developmental Assessment
The developmental assessment of each child was done by administering two tests: Developmental profile II[18] and the Indian adaptation of the Vineland Social Maturity Scale[19].
Developmental Profile II
The DP II is a 186 items inventory which assesses the child's developmental status from birth to 9 years. The DP II yields child's developmental age in five domains, namely physical, social, self-help, academic and communication. Each sub-scale yields a developmental age that is subtracted from the chronological age. The resulting "months differential" is compared with a cut off that indicates whether children are advanced, normal, borderline or delayed in their development. The academic sub-scale assesses a range of skills necessary for success in school, including language, cognition, and scholastic accomplishments and the academic age can be converted to an IQ score. The IQ calculated from the academic scale has been found to have moderate to high correlations with conventional measures of intelligence.
Vineland Social Maturity Scale
The VSMS (Malin, 1971) was used as a measure of child's adaptive behavior functioning. The VSMS assesses the child's developmental level in looking after his practical needs and taking responsibility in daily living. The scale yields a social age which can be converted to a social quotient (SQ).
Results
The children's age ranged from 16 to 60 months, with an average age of 42.2 months (S.D.=11.5). All the children were referred for suspected developmental delay by pediatricians. The mean age of the mothers was 28.4 years (S.D. = 4.3) and they had on an average completed 10.9 years of schooling, and 19% mothers had 5 years or less education and 54% had high school and above. The income levels were generally low (Mean = Rs. 6486) and the mean socio-economic status was 3.29 which represented a low middle class family and 42% of the children belonged to very low and lower middle class families table1.
In order to assess the accuracy of maternal estimates, the actual IQ as found on the DP II was correlated with maternal estimate, IQ. A high correlation (r=.83, p<.000) was found between maternal estimate IQ and actual IQ calculated from DP II. High correlation (r=.81, p<.000) was also obtained between maternal estimate IQ and the SQ calculated from the VSMS. Many mother's estimates were close to their child's actual IQ. A little more than one-fourth (27%) of the maternal estimates were within ± 5 IQ points of the actual IQ. The mean absolute error in maternal estimate IQ was 11.84 (S.D. = 9.48). The mean actual IQ was 57.9 (S.D. = 21.93) with a range of 15-112, and the mean maternal IQ was 62.2 (S.D=25.9) and the range was 15-100. The maternal estimate was significantly (t=2.93, p<.004) higher than the actual IQ as mothers were more likely to overestimate their child's functioning. Fifty-two percent of the mothers over estimated their child's cognitive functioning by a mean of 15.5 IQ points. A little more than one-third (37%) of the mothers underestimated their child's functioning by 10.2 IQ points and 11% were exact in estimating their child's IQ.
In order to assess the clinical utility of maternal estimates in detecting children with developmental delay, a 2x2 contingency table was constructed with the maternal estimate as a screening test and the IQ calculated from the DP II as the gold standard table2. The maternal estimate was found to be 82% sensitive to cognitive delay and 81% specific to normal development. The positive predictive value, i.e., the percentage of children with positive screening result (<70 maternal estimate IQ) who actually had cognitive deficits ( < 70 IQ on DP II) was 92.31%. The negative predictive value, i.e, the percentage of children with negative screening ( > 70 maternal estimate IQ) who did not have cognitive deficits ( > 70 IQ on DP II) was 62.85%. The results, therefore, indicate that the maternal estimate IQ is a sensitive measure and would miss only 18% of the children with cognitive deficits.
Several socio-economic and demographic variables including mother's age and education, child's sex, age, and birth order, income and socio-economic status of the household were examined for association with maternal accuracy (error in IQ points in maternal estimate IQ) but none were significant. Stepwise multiple regression was conducted to predict maternal accuracy using demographic, socio-economic, SQ and IQ of the child as predictor variables. Results revealed that the child's SQ and IQ explained 10% of the variance (F=6.40, p<.001) in maternal accuracy. The lower the SQ and IQ of the child, more accurate the estimates and lesser the error. Interestingly, maternal education or age, child's age, sex, or birth order, or socio-economic status of the household did not emerge as significant predictors of maternal accuracy.
Discussion
The study examined the accuracy of maternal estimate IQ and its clinical utility in detecting cognitive delay in young children. The results indicate that, overall, mother's were relatively accurate in estimating their child's developmental age. A little more than half of the mothers estimated within ± 10 IQ points of their child's actual IQ. The correlations between maternal estimate IQ and actual IQ and SQ were relatively high and close to the range of correlations reported in earlier studies.[16], [20],[21],[22]For instance, Pulsifer et al[16] reported a correlation of 0.82 between maternal estimate DQ and actual DQ for children aged 5 to 60 months. Glascoe and Sandler[17] reported correlations ranging from 0.65 to 0.78 between parents' age estimates and actual functioning of the child in 7 developmental domains, i.e. adaptive, personal-social, gross-motor, fine-motor, expressive language, receptive language and academic skills as assessed by Battelle Developmental Inventory Screening test.[23]
In a study from India, Keshvan and Narayanan[21] reported an overall correlation of 0.86 between developmental quotients (DQ) and parental estimates of DQ. The mean absolute error in maternal estimate IQ was approximately 12 which is also consistent with earlier reports and is less than 1 standard deviation on standardized intelligence tests. Overall, mothers were more likely to overestimate the IQ of their child. This tendency to overestimate the child's functioning has also been reported earlier.[16]
Many socio-economic and demographic factors including age and education of mother, sex, age and birth order of child, income and socio-economic status of the household were studied to examine whether there might be a correlation with maternal accuracy of IQ. None of the factors were found to be significantly correlated with maternal accuracy. This result is consistent with some previous studies but inconsistent with others. For example, Keshavan and Narayanan[21] had found that parents who had fewer children and no formal education made more accurate estimates. However, the sample size in Keshavan and Narayanan[21] study was very small (30) and the results were confined to children with less than 70 IQ. The age range of children tested in the study was also very wide and included children upto 15 years. Possibly, these differences account for the different results obtained in their and the present study.
It was, however, found that the child's SQ and actual IQ were significant predictors of maternal accuracy, such that mothers made more accurate estimates when their child had lower cognitive an adaptive behavior functioning. These findings are in line with previous findings, wherein higher correlation (r=.96) between parents' estimate and actual DQ was found for children with DQs less than 50. In contrast, the correlation between parental DQ and actual DQ declined to 0.53 for children with DQs greater than 50.
The maternal estimate IQ showed both high sensitivity and high specificity (82% and 81% respectively) when used as an indicator of developmental delay. Meisels[24] had recommended that screening tests with 80% or more sensitivity and specificity are acceptable as they meet the required standards. The high sensitivity of maternal estimates has been reported in studies from the West and the present study's findings confirm it from a different culture.
It seems then that mothers can provide a single global age-estimate of their child's functioning that has a high level of sensitivity in identifying children with cognitive deficits. Age estimates could be elicited relatively easily and quickly, regardless of the mother's age, education, and socio-economic status. It must, however, be recognized that the overall age estimate provided by mothers did not provide specific information about the child's functioning in different developmental domains for identification of relative strengths and weaknesses. Therefore, global age parental estimates should be viewed as helpful prescreening device for identification of those children who would require more detailed developmental evaluations. Parental estimates are helpful adjuncts to routine assessment and should not be used as an alternate to developmental assessment. More research is needed to confirm and extend these findings using a larger sample and diagnostic developmental tests to determine developmental status.
References
1. Committee on Children with Disabilities. Screening young children for developmental disabilities. Pediatrics 1994; 93: 863-865.
2. Malhi P, Singhi P. Screening young children for delayed development. Indian Pediatr 1999; 36: 569-577.
3. Glascoe FP. Evidence-based approach to developmental and behavioral surveillance using parents' concerns. Child Care Health Dev 2000; 26: 137-149.
4. McCarton CM, Brooks-Gunn J, Wallace IF. Results at age 8 years of early intervention for low-birth -weight premature infants. The Infant Health and Development Program. JAMA 1997; 277: 126-132.
5. Guralnick MJ. Effectiveness of early intervention for vulnerable children: a developmental perspective. Am J Ment Retard 1998; 102: 319-345.
6. Majnemer A. Benefits for early intervention for vulnerable children with developmental disabilities. Semin Pediatr Neurol 1998; 5: 62-69.
7. Squires J, Nickel RE, Eisert D. Early detection of developmental problems: strategies for monitoring young children in the practice setting. J Dev Behav Pediatr 1996; 19; 420-427.
8. Dobos AE, Dworkin PH, Bernstein B. Pediatricians' approach to developmental problems: 15 years later. Am J Dis Child 1992; 146: 484-490.
9. Glascoe FP, Dworkin PH. The role of parents in the detection of developmental and behavioral problems. Pediatrics 1995; 95: 829-839.
10. Blackman JA, Healy A, Ruppert ES. Participation by pediatricians in early identification: impetus from public law 99-457. Pediatrics 1992; 89: 98-102.
11. Sices L, Feudtner C, McLaughlin J, Drotar D, Williams M. How do primary care physicians identify young children with developmental delays A national survey. J Dev Behav Pediatr 2003; 24: 409-417.
12. Bierman JM, Conner A, Vaage M, Honzik MP. Pediatricians assessment of the intelligence of two-year-olds and their mental test scores. Pediatrics 1964; 43: 680-690.
13. Dearlove J, Kearney D. How good is general practice developmental screening Br Med J 1990; 300: 1177-1180.
14. Bowie D, Parry JA. Court come true-for better or for worse. Br Med J 1984; 299: 1322-1324.
15. Tew B, Laurence KM, Samuel P. Parental estimates of the intelligence of their physically handicapped child. Dev Med Child Neurol 1974; 16: 494-500.
16. Pulsifer MB, Hoon AH, Palmer FB, Gopalan R, Capute AJ. Maternal estimates of developmental age in preschool children. J Pediatr 1994; 125: S18-S24.
17. Glascoe FP, Sandler H. Value of parents' estimates of children's developmental ages. J Pediatr 1995; 127: 831-835.
18. Alpern G, Boll T, Shearer M. Developmental Profile II (DP II) Los Angeles, Western Psychological Services, 1986.
19. Malin AJ. Indian adaptation of the Vineland Social Maturity Scale. Lucknow; Indian Psychological Corporation, 1971.
20. Keshavan MS, Narayanan HS. Parental estimation of developmental level. Am J Dis Child 1983; 137: 87-88.
21. Blacher-Dixon J, Simmeonsoon RJ. Consistency and correspondence of mothers' and teachers' assessments of young handicapped children. J Div Early Childhood 1981; 3: 64-71.
22. Coplan J. Parental estimate of child's developmental level in a high risk population level in a high risk population. Am J Dis Child 1982; 136: 101-104.
23. Newborg J, Stock JR, Wnek L. Battelle Developmental Screening Inventory Screening Test. Chicago; Riverside Publishing, 1988.
24. Meisels SJ. Can developmental screening tests identify children who are developmentally at risk Pediatrics 1989; 83: 578-585.(Malhi Prahbhjot, Kashyap )
Abstract
Objective: To examine the accuracy and clinical utility of maternal estimates of mental age in young children referred for developmental assessment. Methods: Mothers of 100 children aged 16 to 60 months referred for developmental evaluation to psychology services of Department of Pediatrics of a tertiary care teaching hospital were asked to estimate the mental age of their child. Maternal estimates were converted to intelligence quotient (IQ) and were compared to results from developmental tests of cognitive and adaptive behavior functioning which were administered to all children. Results: Maternal estimate IQ was highly correlated with IQ calculated from Developmental Profile II (r=.83, p<.001) and social quotient (SQ) calculated from Vineland Social Maturity Scale (r=.81, p<.001). Maternal estimate IQ was 82% sensitive to cognitive delay and 81% specific in identifying children likely to have normal development. Twenty seven percent of the maternal estimates were within ± 5 IQ points of actual IQ. Mothers were more likely to overestimate their child's functioning. Maternal IQ (Mean=62.1, S.D. =25.8) was significantly higher (t=2.93, p<.004) than the actual IQ (Mean=57.9, S.D.=21.9). Step-wise multiple regression analysis revealed that the child's IQ and SQ explained 10% of the variance (F=6.40, p<.001) in maternal accuracy. The lower the SQ and IQ of the child, more accurate the estimates. Conclusion: Maternal estimates of mental age provide an accurate measure of developmental functioning in young children and may be used as a screening technique to identify a subset of children who need more detailed evaluation
Keywords: Maternal estimates; Mental age; Development assessment
The importance of early diagnosis and treatment of children with developmental disabilities has emerged in recent years as a matter of growing concern among pediatricians. [1],[2],[3] In young children, disabilities often present as delays in the acquisition of expected developmental milestones in speech, cognition, adaptive, fine motor or gross motor development. Early identification combined with early treatment to address delays can improve outcome, enhance function, and reduce the development of secondary behavioral problems. [4],[5],[6]
Pediatricians play a key role in the early identification of children with developmental delays.[7] There is, however, no consensus as to how such early identification can be optimally performed. Some of the commonly used techniques include reviewing developmental milestones with parents, relying on clinical judgment based on history, physical examination, observation, eliciting parental concerns, or administering a formal developmental screening test. [8],[9]
Past research has documented the infrequent use of developmental screening or diagnostic tests by pediatricians.[8], [10],[11] Moreover, when physicians rely on their clinical judgment, their estimates of children's developmental status are often inaccurate. [12],[13] Studies indicate that almost half of the children with developmental disabilities are not identified by their pediatricians.[13],[14] Research conducted in the developed countries has shown that parents' numerical estimates of their child's developmental age is a useful method for detecting developmental delay in young children.[9], [15],[16],[17] For example, Glascoe and Sandler[17] asked parents of 234 children aged 0 to 77 months to estimate their child's overall developmental age. The children were also administered a range of screening and diagnostic measures of intelligence, speech-language and adaptive behavior. The results indicated that overall age-estimate if less than chronological age was 75% sensitive to likely developmental problems, and if equal to or greater than chronological age was 90% specific in identifying children likely to have normal development. The authors found no differences in the accuracy of parents' estimates on the basis of children's age, sex, race, parents' level of education or parenting experience.
The utility of parental estimate of young children's developmental age in identifying children with developmental delay is not known in our country. In the Indian context, an important question is whether parents can estimate a developmental age for their child and how accurate are their estimates. Specifically, the objectives of the study are (i) to investigate the accuracy of maternal estimates of mental age in young children with suspected developmental delay, and (ii) to assess the clinical utility of maternal estimates by evaluating its effectiveness in screening for developmental delay.
Materials and Methods
Subjects comprised of 100 parent-child dyads who were referred for developmental assessment to outpatient psychology services of the Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh. The inclusion criteria for all children were (i) chronological age less than 5 yrs, (ii) the absence of sensory or motor impairment, and (iii) the child being accompanied by the mother who should be the primary caretaker. In all cases, the children had been referred for developmental evaluation because of parental concerns regarding global delay, language delay, behavior problems, and/or hyperactivity. The developmental evaluation represented the first formal developmental assessment for all the children.
Procedure
Before conducting the developmental assessment, each mother was asked to estimate a global estimate of overall developmental status of the child. The mothers were asked "your child is now X years and X months old. Although he/she is X years and X months old, overall do you think his/her mental development is age appropriate, ahead of his/her chronological age or lagging behind. If the mother answered "age appropriate" no further questions were asked. On the other hand, if the mother answered that the child was advanced for age or lagging behind, they were asked to estimate an overall mental age of the child. Parents were encouraged to give their answer in years as well as months. None of the parents had any difficulty in understanding the question or in providing a numerical answer. In case the mother gave a range of ages as an estimate, she was asked to select a single answer that best described her child's mental developmental age. Estimates were converted to maternal estimate intelligence quotient by dividing maternal estimate mental age by the child's chronological age and the product multiplied by 100. After maternal estimates were obtained, each of the children received a comprehensive developmental assessment to determine the child's current level of functioning by a trained person who was blind to the maternal estimate of mental age.
Developmental Assessment
The developmental assessment of each child was done by administering two tests: Developmental profile II[18] and the Indian adaptation of the Vineland Social Maturity Scale[19].
Developmental Profile II
The DP II is a 186 items inventory which assesses the child's developmental status from birth to 9 years. The DP II yields child's developmental age in five domains, namely physical, social, self-help, academic and communication. Each sub-scale yields a developmental age that is subtracted from the chronological age. The resulting "months differential" is compared with a cut off that indicates whether children are advanced, normal, borderline or delayed in their development. The academic sub-scale assesses a range of skills necessary for success in school, including language, cognition, and scholastic accomplishments and the academic age can be converted to an IQ score. The IQ calculated from the academic scale has been found to have moderate to high correlations with conventional measures of intelligence.
Vineland Social Maturity Scale
The VSMS (Malin, 1971) was used as a measure of child's adaptive behavior functioning. The VSMS assesses the child's developmental level in looking after his practical needs and taking responsibility in daily living. The scale yields a social age which can be converted to a social quotient (SQ).
Results
The children's age ranged from 16 to 60 months, with an average age of 42.2 months (S.D.=11.5). All the children were referred for suspected developmental delay by pediatricians. The mean age of the mothers was 28.4 years (S.D. = 4.3) and they had on an average completed 10.9 years of schooling, and 19% mothers had 5 years or less education and 54% had high school and above. The income levels were generally low (Mean = Rs. 6486) and the mean socio-economic status was 3.29 which represented a low middle class family and 42% of the children belonged to very low and lower middle class families table1.
In order to assess the accuracy of maternal estimates, the actual IQ as found on the DP II was correlated with maternal estimate, IQ. A high correlation (r=.83, p<.000) was found between maternal estimate IQ and actual IQ calculated from DP II. High correlation (r=.81, p<.000) was also obtained between maternal estimate IQ and the SQ calculated from the VSMS. Many mother's estimates were close to their child's actual IQ. A little more than one-fourth (27%) of the maternal estimates were within ± 5 IQ points of the actual IQ. The mean absolute error in maternal estimate IQ was 11.84 (S.D. = 9.48). The mean actual IQ was 57.9 (S.D. = 21.93) with a range of 15-112, and the mean maternal IQ was 62.2 (S.D=25.9) and the range was 15-100. The maternal estimate was significantly (t=2.93, p<.004) higher than the actual IQ as mothers were more likely to overestimate their child's functioning. Fifty-two percent of the mothers over estimated their child's cognitive functioning by a mean of 15.5 IQ points. A little more than one-third (37%) of the mothers underestimated their child's functioning by 10.2 IQ points and 11% were exact in estimating their child's IQ.
In order to assess the clinical utility of maternal estimates in detecting children with developmental delay, a 2x2 contingency table was constructed with the maternal estimate as a screening test and the IQ calculated from the DP II as the gold standard table2. The maternal estimate was found to be 82% sensitive to cognitive delay and 81% specific to normal development. The positive predictive value, i.e., the percentage of children with positive screening result (<70 maternal estimate IQ) who actually had cognitive deficits ( < 70 IQ on DP II) was 92.31%. The negative predictive value, i.e, the percentage of children with negative screening ( > 70 maternal estimate IQ) who did not have cognitive deficits ( > 70 IQ on DP II) was 62.85%. The results, therefore, indicate that the maternal estimate IQ is a sensitive measure and would miss only 18% of the children with cognitive deficits.
Several socio-economic and demographic variables including mother's age and education, child's sex, age, and birth order, income and socio-economic status of the household were examined for association with maternal accuracy (error in IQ points in maternal estimate IQ) but none were significant. Stepwise multiple regression was conducted to predict maternal accuracy using demographic, socio-economic, SQ and IQ of the child as predictor variables. Results revealed that the child's SQ and IQ explained 10% of the variance (F=6.40, p<.001) in maternal accuracy. The lower the SQ and IQ of the child, more accurate the estimates and lesser the error. Interestingly, maternal education or age, child's age, sex, or birth order, or socio-economic status of the household did not emerge as significant predictors of maternal accuracy.
Discussion
The study examined the accuracy of maternal estimate IQ and its clinical utility in detecting cognitive delay in young children. The results indicate that, overall, mother's were relatively accurate in estimating their child's developmental age. A little more than half of the mothers estimated within ± 10 IQ points of their child's actual IQ. The correlations between maternal estimate IQ and actual IQ and SQ were relatively high and close to the range of correlations reported in earlier studies.[16], [20],[21],[22]For instance, Pulsifer et al[16] reported a correlation of 0.82 between maternal estimate DQ and actual DQ for children aged 5 to 60 months. Glascoe and Sandler[17] reported correlations ranging from 0.65 to 0.78 between parents' age estimates and actual functioning of the child in 7 developmental domains, i.e. adaptive, personal-social, gross-motor, fine-motor, expressive language, receptive language and academic skills as assessed by Battelle Developmental Inventory Screening test.[23]
In a study from India, Keshvan and Narayanan[21] reported an overall correlation of 0.86 between developmental quotients (DQ) and parental estimates of DQ. The mean absolute error in maternal estimate IQ was approximately 12 which is also consistent with earlier reports and is less than 1 standard deviation on standardized intelligence tests. Overall, mothers were more likely to overestimate the IQ of their child. This tendency to overestimate the child's functioning has also been reported earlier.[16]
Many socio-economic and demographic factors including age and education of mother, sex, age and birth order of child, income and socio-economic status of the household were studied to examine whether there might be a correlation with maternal accuracy of IQ. None of the factors were found to be significantly correlated with maternal accuracy. This result is consistent with some previous studies but inconsistent with others. For example, Keshavan and Narayanan[21] had found that parents who had fewer children and no formal education made more accurate estimates. However, the sample size in Keshavan and Narayanan[21] study was very small (30) and the results were confined to children with less than 70 IQ. The age range of children tested in the study was also very wide and included children upto 15 years. Possibly, these differences account for the different results obtained in their and the present study.
It was, however, found that the child's SQ and actual IQ were significant predictors of maternal accuracy, such that mothers made more accurate estimates when their child had lower cognitive an adaptive behavior functioning. These findings are in line with previous findings, wherein higher correlation (r=.96) between parents' estimate and actual DQ was found for children with DQs less than 50. In contrast, the correlation between parental DQ and actual DQ declined to 0.53 for children with DQs greater than 50.
The maternal estimate IQ showed both high sensitivity and high specificity (82% and 81% respectively) when used as an indicator of developmental delay. Meisels[24] had recommended that screening tests with 80% or more sensitivity and specificity are acceptable as they meet the required standards. The high sensitivity of maternal estimates has been reported in studies from the West and the present study's findings confirm it from a different culture.
It seems then that mothers can provide a single global age-estimate of their child's functioning that has a high level of sensitivity in identifying children with cognitive deficits. Age estimates could be elicited relatively easily and quickly, regardless of the mother's age, education, and socio-economic status. It must, however, be recognized that the overall age estimate provided by mothers did not provide specific information about the child's functioning in different developmental domains for identification of relative strengths and weaknesses. Therefore, global age parental estimates should be viewed as helpful prescreening device for identification of those children who would require more detailed developmental evaluations. Parental estimates are helpful adjuncts to routine assessment and should not be used as an alternate to developmental assessment. More research is needed to confirm and extend these findings using a larger sample and diagnostic developmental tests to determine developmental status.
References
1. Committee on Children with Disabilities. Screening young children for developmental disabilities. Pediatrics 1994; 93: 863-865.
2. Malhi P, Singhi P. Screening young children for delayed development. Indian Pediatr 1999; 36: 569-577.
3. Glascoe FP. Evidence-based approach to developmental and behavioral surveillance using parents' concerns. Child Care Health Dev 2000; 26: 137-149.
4. McCarton CM, Brooks-Gunn J, Wallace IF. Results at age 8 years of early intervention for low-birth -weight premature infants. The Infant Health and Development Program. JAMA 1997; 277: 126-132.
5. Guralnick MJ. Effectiveness of early intervention for vulnerable children: a developmental perspective. Am J Ment Retard 1998; 102: 319-345.
6. Majnemer A. Benefits for early intervention for vulnerable children with developmental disabilities. Semin Pediatr Neurol 1998; 5: 62-69.
7. Squires J, Nickel RE, Eisert D. Early detection of developmental problems: strategies for monitoring young children in the practice setting. J Dev Behav Pediatr 1996; 19; 420-427.
8. Dobos AE, Dworkin PH, Bernstein B. Pediatricians' approach to developmental problems: 15 years later. Am J Dis Child 1992; 146: 484-490.
9. Glascoe FP, Dworkin PH. The role of parents in the detection of developmental and behavioral problems. Pediatrics 1995; 95: 829-839.
10. Blackman JA, Healy A, Ruppert ES. Participation by pediatricians in early identification: impetus from public law 99-457. Pediatrics 1992; 89: 98-102.
11. Sices L, Feudtner C, McLaughlin J, Drotar D, Williams M. How do primary care physicians identify young children with developmental delays A national survey. J Dev Behav Pediatr 2003; 24: 409-417.
12. Bierman JM, Conner A, Vaage M, Honzik MP. Pediatricians assessment of the intelligence of two-year-olds and their mental test scores. Pediatrics 1964; 43: 680-690.
13. Dearlove J, Kearney D. How good is general practice developmental screening Br Med J 1990; 300: 1177-1180.
14. Bowie D, Parry JA. Court come true-for better or for worse. Br Med J 1984; 299: 1322-1324.
15. Tew B, Laurence KM, Samuel P. Parental estimates of the intelligence of their physically handicapped child. Dev Med Child Neurol 1974; 16: 494-500.
16. Pulsifer MB, Hoon AH, Palmer FB, Gopalan R, Capute AJ. Maternal estimates of developmental age in preschool children. J Pediatr 1994; 125: S18-S24.
17. Glascoe FP, Sandler H. Value of parents' estimates of children's developmental ages. J Pediatr 1995; 127: 831-835.
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