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1、Ages and Stages Questionnaire at 3Years for Predicting IQ at 56 Years幼儿幼儿3岁时的发育岁时的发育情况（年龄和发育阶段问卷结果情况（年龄和发育阶段问卷结果）能预测其）能预测其5-6岁时的岁时的IQPEDIATRICS Volume 139, number 4 , April 2017IF:6.476Yao xing,2017-11-07ContensBackgroundObjectivesMethodsResultsDiscussionStrengths and limitationsConclusionsImplicati

2、onsAbbreviations ASQ: Ages & Stages Questionnaires（年龄与发育阶段问卷）（年龄与发育阶段问卷） CI: Confidence Interval（可信区间）（可信区间） EDEN: Etude des Determinants Pre-et Post-natals du Developpement de lEnfant（伊甸园队列）（伊甸园队列） IQR: Interquartile Range（四分位数间距）（四分位数间距） ROC: Receiver Operating Characteristic（受试者（受试者/接受者工作特征）接

3、受者工作特征） SDQ: Strengths and Difficulties Questionnaire（长处与困难问卷）（长处与困难问卷） WPPSI-III: Wechsler Preschool and Primary Scale of IntelligenceThird Edition（韦氏学龄前儿童智力量表，第（韦氏学龄前儿童智力量表，第3版）版）EDEN: Etude des Determinants Pre-et Post-natals du Developpement de lEnfantThe EDEN motherchild cohort study aims to ex

4、amine prenatal and postnatal determinants of child development, growth, and health.Participants were recruited between 2003 and 2006 among pregnant women followed in Poitiers and Nancy university maternities.Exclusion criteria were multiple pregnancies（多胎妊娠）, a known history of diabetes, nonFrench s

5、peakers or readers, or plans to move out of the study region in the next 3 years.Background1. The identification of young children at risk for later suboptimal development is key to the design and implementation of early preventive or interventional strategies.2. Parental report instruments are desi

6、gned to be used in primary care for firstline clinical screening of infant and preschool child development.3. The Ages & Stages Questionnaires (ASQ) are the most commonly used questionnaires to identify young children at risk for developmental delay.4. Previous evidence from a population of chil

7、dren born preterm showed that the 36-month ASQ predicted school difficulties at age 5.5.There is a gap in knowledge about the predictive value of early ASQ scores for later cognitive functioning, such as IQ, in the general pediatric population.Objectives1. To investigate the predictive value of the

8、36-month ASQ score for IQ at age 5 to 6 years in a large population-based cohort study.2. To search for other child, maternal, and family-related factors associated with low IQ once the 36-month ASQ score is taken into account and to determine whether such factors could interact in the relationship

9、between the 36-month ASQ score and later IQ.Methods1.Measures of child development2.1 36-Month ASQ Score (French Second Edition)Parents answer 6 questions in each of 5 domains of development: communication（沟通）, gross motor（粗大动作）, fine motor（精细动作）, problem-solving skills（解决问题能力）, and adaptive skills（

10、适应能力）.US norms are available for each domain, and any domain screened 2 SDs below the mean is considered a positive screening. This study used the sum or the 5 domain scores, producing a score between 0 and 300.1.Measures of child development2.2 IQ With the Wechsler Preschool and Primary Scale of In

11、telligenceThird Edition at Age 5 to 6 YearsWhen the child was 5 to 6 years old, cognitive assessment was performed by trained psychologists.The WPPSI-III includes 7 subtests used to compute a verbal IQ, a performance IQ, and a full-scale IQ. IQ was considered low if it was 85.When the children were

12、3 years old, mothers filled out a questionnaire reporting sociodemographic status for the family and specific data on current maternal health, together with the ASQ. When the children were 5 to 6 years old, a cognitive assessment was conducted by trained psychologists.1.Measures of child development

13、2.Factors included in the analysis 1. Childs characteristics: gender; whether the child was a firstborn child; behavioral problems at age 3, rated via the Strengths and Difficulties Questionnaire (SDQ), and whether the child had started preschool at age 3. 2. Maternal characteristics: maternal educa

14、tional level, occupation, and depressive symptoms assessed with the Center for Epidemiologic StudiesDepression scale. 3. Family characteristics: parents occupation and financial difficulties reported by the parents when the child was 3.3.Statistical analysis 1. Children included in the current analy

15、sis were first compared with the other children in the EDEN cohort who were not included. 2. Results for the 36-month ASQ score and the 5- to 6-year WPPSI-III evaluation were described as means SDs and median with interquartile ranges (IQRs). 3. The receiver operating characteristic (ROC) curve link

16、ing low IQ (85) and ASQ score was used to determine the optimal cutoff value for the ASQ score. 4. A 3-step analysis was then conducted with logistic regression. 5. Statistical analyses were performed in SAS software version 9.3. Results ASQ scores were determined at a mean age of 37.3 0.8 months.Th

17、e mean 36-month ASQ score was 270 30,with a median of 280 (IQR 260290). IQ was measured at a mean age of 67.2 1.8 months. TheMean IQ was 103 13, and 69 children (7.3%) had an IQ 85. All child, maternal, and family factors studied, exceptgender and maternal depressive symptoms, were significantly ass

18、ociated with ASQ score.1. Characteristics of the Study population(and compared with children in the EDEN Cohort but not included in the study)Children not included were more often from Nancy Center, were less often first born, had mothers with lower educational levels, and had parents with lower occ

19、upational levels than children included.2. IQ at age 5 to 6 years according to 36-month ASQ score(ROC curve)The area under the curve was 0.78 (95% confidence interval CI, 0.720.84).即IQ85的幼儿ASQ值小于正常组的概率为0.78。The optimal cutoff value for predicting low IQ was 270(sensitivity was 0.77, specificity was

20、0.68).Positive predictive value was 0.16, the negative predictive value was 0.97（提示3岁时ASQ得分270的幼儿5-6岁时IQ85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 = excellent (A)中 0.80-0.90 = good (B) 0.70-0.80 = fair (C)低 0.60-0.70 = poor (D) 0.50-0.60 = fail (F)3. Factors associated with IQ85 once ASQ is taken into ac

21、count单变量多变量The risks of low IQ was significantly higher inchildren with an ASQ score 270 and a maternal educational level at high school or below.Discussion1. The prevalence of low IQ wasprobably underestimated in the study.A prevalence of 16% could have been expected, considering the distribution o

22、f IQ (mean = 100, SD =15). The prevalence in this study was 7.3%, which was also in the lower range of the prevalence observed in the general pediatric population exhibiting some type of developmental delay or disability before entering school (5%15%).2. The total ASQ score used in the study.As repo

23、rted in several previous studies, total ASQ scores provide a global evaluation of a childs functioning, which seems relevant for predicting later global cognitive functioning.Using the total score instead of the cutoff points by domain（能区） could miss less severe problems restricted to 1 domain.Other

24、 researchers found that in the general population the use of ASQ total score could be recommended because of the low prevalence of difficulties.Using the ASQ at age 3 could lead to decisions to perform more detailed developmental assessments for children with lower scores.The goal would be to set up

25、 early interventions designed to help the child achieve his or her full developmental potential.3. Factors associated with IQ at age 5 to 6 years once ASQ score was taken into account.The objective of this study was to identify the factors still having an impact between age 3 and 5 to 6 years, once

26、abilities at age 3 were taken into account.Interventions conducted between age 3 and 5 to 6 years, such as speech therapy, were not studied.Lower maternal educational level was associated with lower ASQ score. This association underlines the fact that socioeconomic background plays a crucial role in

27、 child development throughout early childhood.Children whose mothers had no occupational activity had a greater risk of low IQ once ASQ score was taken into account and after adjustment for their mothers educational level.It is possible that maternal occupational activity serves as a proxy(代表) for v

28、arious aspects of sociocultural and economic background.Strengths 1.Large sample size(made it possible to study numerous factors).2. The ASQ score was studied in relation to the gold standard evaluation of cognitive ability at age 5 to 6 years(WPPSI-III).3. The psychologists performing the WPPSI-III

29、 were blinded to the ASQ score.Limitations1.The IQ at 5 to 6 years itself also has limits and is not a perfect predictor of longer-term outcomes.2. Only 69 children had an IQ 85,leading to a lack of power for studying associated factors. 3. 959 children were lost to follow-up between birth and age 5 to 6 years.4. Children not include