Validation of a questionnaire for the detection of children at
Contents
1. No or I don t know Does not cooperate Both this latter answer and a No answer are afterwards classified as Does not meet expectations Questionnaires 4 and 5 have some simple tests for either the mother or the healthcare personnel to administer to the child recognize colors jump recognize figures or draw The pass or fail criterion of the questionnaire is explained at the end of each form the child is considered to fail if he she does not answer one or two questions whose PRUNAPE 90 percentile or 75 according to the questionnaire is less than the child s age It is not required to adjust the child s age to the gestational age The access to the five questionnaires is open from the e version of this article In all cases both for the questionnaires administered by the healthcare personnel HP as well as those self administered SA the final decision related to the child passing or failing the test should be made by healthcare personnel who is well aware of the Technical Handbook that comes with the CPPP This handbook and the questionnaires can be downloaded from the Acumar health website www acumar gov ar only spanish version Concomitant validation Once questions were reformulated and the design was adjusted the next step was to evaluate how much the questionnaire was able to predict PRUNAPE results The guidelines used were followedto validate the test based on the previous experience2. 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 para Comprender TLC Evaluaci n de la comprensi n de textos Buenos Aires Paid s 2010 Pascucci MC La validaci n de tests de pesquisa En Lejarraga H Desarrollo del ni o en contexto Buenos Aires Paid s 2006 FrankemburgWK vanDoorninckWJ LiddellTN DickNP The Denver Prescreening Developmental Questionnaire PDQ Pediatrics 1976 57 744 53 Frankemburg WK Fandal AW Thornton SM Revision of Denver Pre screening Developmental Questionnaire J Pediatr1987 110 1 653 7 SkellernCY RogersY O CallaghanMJ Aparent completed developmental questionnaire Follow up of ex premature infants J Pediatr Child Health 2001 37 2 125 9 Pool JL Parent completed developmental screening for preschool children A study of concurrent validity and reliability Accessed on July 5 2013 Available at Chen IC Kin CH How effectively do parents discern their children s cognitive deficits at preschool age J Chin Med Assoc2007 70 10 445 50 Coghlan D Kling JS Parents evaluation of developmental status in the Australian day care setting developmental concerns of parents and careers J Paediatr Child Health 2003 39 1 49 54 Pulsifer MB Hoon AH Palmer FB Gopalaw R et al Maternal estimates of developmental age in preschool children J Pediatr1994 125 1 S18 24 Malhi P Kashyap S Maternal estimates of mental age in developmental
3. O E 76 pies juntos por encima de un objeto sin pisarlo 2 El ni o o ni a puede cumplir dos indicaciones seguidas cuando usted se lo 52 NO S pide Por ejemplo tra tus zapatillas y cerr la puerta dame el pan y llam a la abuela o busc tu mochila y sentate a E LI Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 1 5 Validation of a questionnaire for the detection of children at high risk of developmental disorders The PRUNAPE Pre Screening Test 501 N mero de identificaci n uso oficial Formulario 5 Ni os y ni as de 4 a os a 5 a os y 11 meses Para responder lo que sigue USTED tiene que pedirle al ni o o ni a que haga algunas pruebas Si el ni o o ni a no las puede hacer marque NO Si el ni o o ni a no quiere hacerlas marque NO COLABORA 3 Mu strele un color al ni o o ni a y p dale que se ale el que se le parece Si el ni o o ni a puede se alar correctamente dos o m s marque Si 4 Entr guele el l piz al ni o o ni a d le las siguientes indicaciones y si pudo cumplirlas TODAS marque S pon el l piz debajo de la silla pon el l piz delante de mis pies pon el l piz sobre la silla 5 Preg ntele al ni o o ni a Para qu sirve la COCINA y Para qu sirve la HELADERA Si contesta bien cu l es el uso de los dos objetos marque S E
4. 2 Las preguntas a considerar aqui son aquellas cuyo percentil 75 es menor que la edad del ni o o ni a m rquela con una X y luego tilde CUMPLE o NO CUMPLE Preguntas a Pregunta N considerar Percentil 75 1 Oo sma o Cumple No Cumple no sabe no colabora O fo eee EE fo ew o 5 ep 12 O O O O e e 00000000000 na O O El ni o o ni a no pasa el CPPP si la respuesta es NO CUMPLE en dos de las preguntas consideradas 3 RESULTADO FINAL PASA NO pasa administrar PRUNAPE Nombre y apelido del agente de salud interviniente sics s vincsscivecsesavccesssanacesevavcnavavaecesesanacesevenanasecasissesavccssouasncsesadecssesamasos ASAS A Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013
5. 6 El ni o o ni a puede subirse a una r silla sin ayuda 7 El ni o o ni a puede hacer con un l piz una raya o garabato en un papel 8 El ni o o ni a copia a veces lo que usted est haciendo como limpiar algo pasar un trapo barrer 9 El ni o o ni a dice mam a la mam o pap al pap 10 El ni o o ni a puede patear una pelota 11 El ni o o ni a utiliza alguna palabra para pedir lo que quiere por ejemplo 6 agua leche pan galletita aunque no la pronuncie bien Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 201 si El si LI s si si si si B NO NO LI NO NO NO NO NO El a 32 NO S NO S E NO S NO S NO S NO S NO S NO S uso oficial Formulario 3 Ni os y ni as de 18 meses a 2 a os y 5 meses Uso oficial Pauta PRUNAPE N 10 8 72 28 12 43 71 44 2 4 494 Arch Argent Pediatr 2013 111 6 476 483 Original article EOS e amp D t CUESTIONARIO PRUNAPE PRE PESQUISA CPPP PRUEBA NACIONAL DE PESQUISA PRUNAPE UN Ss 6 Direcci n General e de Salud Ambiental hoy acumnar a Autoridad de Cuenca Matanza Riachuelo Form u la rio 3 N mero de identificaci n uso oficial Ni os y ni as de 18 mes
6. osiosocasancenccnanicosracion s WONGPONO ccaciivectsscticsccascisti tesssonacesisicevseessesseiis Marque con una X el nivel educativo alcanzado Primario incompleto C Primario completo Secundario incompleto _ Secundario completo _ Terciario Universitario _ Este formulario tiene preguntas sobre las cosas que hacen los ni os y las ni as Queremos conocer cu les ya puede hacer su ni o o ni a y cu les todav a no Lea cada pregunta y marque con una X lo que corresponda Si tiene dudas marque NO SE 3 Cuando usted sienta al ni o o ni a en el suelo puede sostenerse CON las manos apoyadas sin ayuda Uso oficial Pauta PRUNAPE N ni o o ni a acostado boca El ll E dl arriba puede girar solo y ponerse de costado sin 1 Cuando usted pone al si NO NO SE ayuda 2 Cuando usted llama al si NO NO SE ni o o ni a gla mira 39 si NO NO SE O O 62 Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 Validation of a questionnaire for the detection of children at high risk of developmental disorders The PRUNAPE Pre Screening Test 485 N mero de identificaci n uso oficial 4 Cuando usted pone al ni o o ni a frente al espejo se mira o se sonrie 5 El ni o o ni a puede P agarrar un objeto peque o 4 como un pedacito de pan y con la mano e o 6 El ni
7. 11 meses 3 Formulario CPPP destinado a identificar ni os y ni as a quienes se les debe administrar la Prueba Nacional de Pesquisa PRUNAPE 9 Este formulario debe ser realizado a la madre o persona a cargo bajo consignas dictadas por personal de salud que conozca bien el 3 Manual T cnico www acumar gov ar La decisi n de si el ni o o ni a pasa o no pasa el CPPP ser tomada por el personal de salud seg n las instrucciones del Manual El formulario debe ser administrado con el ni o o ni a presente Fecha de hoy Datos del ni o o ni a Nombre cioociconoioiinsronesnicaronsiio narr Apellido soormirrossiocinesrcas oras acosan IN DOCUMENTOS ieoinicirionicnsinnarnciisriaienints Fecha de nacimiento d a mes a o Merval Meis Edad coins Peso al nacer _ _ ___ Kg Datos de la madre o persona a cargo A E A REO N DOCUMENTO 3 i5cssncntcsanecssesscssansecd ies Direcci n Bi Localidad Tel fono Marque con una X el nivel educativo alcanzado Primario incompleto Primario completo C Secundario incompleto Secundario completo C Terciario Universitario C Este formulario tiene preguntas sobre las cosas que hacen los ni os y las ni as Queremos conocer cu les ya puede hacer su ni o o ni a y cu les todavia no Lea cada pregunta y marque con una X lo que corresponda Si tiene dudas marque NO SE Uso oficial Pauta PRUNAPE N 1 El ni o o ni a puede saltar con los dos si NO NO SE
8. Maternal level of education None 2 Primary 217 Secondary 277 University 31 Birthweight 2500 g or more 249 lt 2500 g lt 1500 g 33 5 Age groups Form 1 6 11 months old 75 Form 2 12 17 months old 73 Form 3 18 29 months old 126 Form 4 30 47 months old 128 Form 5 48 71 months old 131 Ficure 1 Percentage of matches M of each question in the CPPP with the corresponding PRUNAPE milestone C 100 uE ARS oo Yo 80 60 gt 40 20 00 9 gt oo 9 b o o r gt 60 80 PRUNAPE 480 Arch Argent Pediatr 2013 111 6 476 483 Original article these percentages p lt 0 01 Table 3 shows the validation indicators that result if instead of applying the questionnaire low birth weight and very low birth weight are considered the risk criteria of failing the PRUNAPE A very high specificity even higher than that obtained in the CPPP questionnaire and a high PPV are observed DISCUSSION In the present study we were able to validate a simple questionnaire to identify more accurately children who are candidates to the PRUNAPE The lack of significant differences in the validity between the CPPP administration by mothers or the healthcare personnel or among mothers of a different education level makes it a very operational tool in primary care Questionnaire validity is very variable in the bibliography For instance Frankenburg obtained a sensitivity of 0 25 in the one develop
9. ni o o ni a es capaz de ir a buscar un juguete zapatos o alg n objeto conocido Gracias por colaborar Ni os y ni as de 12 a 17 meses Uso oficial Pauta PRUNAPE N si NO NO SE LJ LJ E 70 si NO NO SE 9 si NO NO SE 7 si NO NO SE 27 si NO NO SE O Lads El 10 Lejarraga H y col Archivos Argentinos de Pediatria 2013 Vol 111 N 5 2013 Validation of a questionnaire for the detection of children at high risk of developmental disorders The PRUNAPE Pre Screening Test 491 N mero de identificaci n coco uso oficial Formulario 2 Ni os y ni as de 12 a 17 meses Uso oficial Resultados del CPPP para ser completado por personal de salud 1 La edad del ni o o ni a es mes s dias 2 Las preguntas a considerar aqui son aquellas cuyo percentil 75 es menor que la edad del ni o o ni a marquela con una X y luego tilde CUMPLE o NO CUMPLE Preguntas a No Cumple Pregunta N considerar Percentil 75 Cumple no sabe no colabora o NI CI o fo f e OO O ee O ee 13m17d ee Se Me Ey EE ene Els aE Wey e ee f e o 5 O O El ni o no pasa el CPPP si la respuesta es NO CUMPLE en dos de las preguntas consideradas 3 RESULTADO FINAL PASA NO PASA administrar PRUNAPE Nombre y apellido del agente de salud interviniente ccesesccesessccceeesencecee
10. o 0 e m a Tu l 1 w a fo oo o we o o oof o ema 0 0 e f 0 as A A e Go oe a a o mee o o El Sees el amp LV ee El ni o o ni a no pasa el CPPP si la respuesta es NO CUMPLE en dos de las preguntas consideradas 3 RESULTADO FINAL PASA NO pasal administrar PRUNAPE Nombre y apellido del agente de salud interviniente uocooconooonconannnannonccnonanccnnaroonncnanonnonnonranocononncnnonnnnnscnrnnnoronnccnno nos A A AA A A A A a Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 496 Arch Argent Pediatr 2013 111 6 476 483 Original article PRUEBA NACIONAL DE PESQUISA PRUNAPE Direcci n General ay acumar de Salud Ambiental Autoridad de Cuenca Matanza Riachuelo CUESTIONARIO PRUNAPE PRE PESQUISA CPPP peg 2 rp a Formulario 4 N mero de identificaci n uso oficial Ni os y ni as de 2 a os y 6 meses a 3 a os y 11 meses Uso oficial seg n las instrucciones del Manual El formulario debe ser administrado con el ni o o ni a presente Formulario CPPP destinado a identificar ni os y ni as a quienes se les debe administrar la Prueba Nacional de Pesquisa PRUNAPE Este formulario debe ser realizado a la madre o persona a cargo bajo consignas dictadas por personal de salud que conozca bien el Manual T cnico www acumar gov ar La decisi n de si el ni o
11. o ni a pasa o no pasa el CPPP ser tomada por el personal de salud Fecha de hoy Messi Deia Datos del ni o o ni a NOMIC iiss cineci caus ser rE SVS Apellido lt a Fecha de nacimiento d a mes a o ere Meerrr Datos de la madre o persona a cargo TOO ii a Marque con una X el nivel educativo alcanzado Primario incompleto Primario completo E Secundario incompleto Secundario completo Terciario Universitario _ Este formulario tiene preguntas sobre las cosas que hacen los ni os y las ni as Queremos conocer cu les ya puede hacer su ni o o ni a y cu les todav a no Lea cada pregunta y marque con una X lo que corresponda Si tiene dudas marque NO S 1 Cuando un familliar o amigo llama al ni o o ni a para decirle algo se si NO acerca respondiendo al llamado 2 El ni o o ni a dice oraciones de dos palabras como Vamos mam si NO Nene juega Pap come aunque no las pronuncie bien 3 El ni o o ni a puede tirarle una si NO pelota con las manos a una persona que est cerca 4 El ni o o ni a dej los pa ales durante el dia y adem s le avisa cuando si NO quiere hacer pis C C NO S NO S NO S NO S LI Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 Uso oficial Pauta PRUNAPE N 11 48 73 15 1 4 Validation of a questionnair
12. o o ni a puede mantenerse sentado solo SIN apoyar las manos 7 Cuando el ni o o ni a tiene un objeto o juguete en la mano se resiste a que se lo quiten 8 El ni o o ni a juega a esconderse si usted le tapa la cara con un trapo o una tela 9 El ni o o ni a dice da da da o ta ta ta 10 Cuando el ni o o ni a est sentado en el suelo puede agarrar un objeto o juguete cercano 11 El ni o o ni a dice ma ma ma o pa pa pa 12 El ni o o ni a entiende cuando usted le dice NO Formulario 1 Ni os y ni as de 6 a 11 meses si si NO NO NO NO SE LJ NO S O NO S NO S si si si NO NO NO NO SE NO SE NO SE s NO NO S si NO NO SE Lejarraga H y col Archivos Argentinos de Pediatria 2013 Vol 111 N 5 2013 Uso oficial Pauta PRUNAPE N 3 24 65 4 5 41 64 42 40 486 Arch Argent Pediatr 2013 111 6 476 483 Original article Gas CRA Ly Direcci n General y de Salud Ambiental Ay acumar Autoridad de Cuenca Matanza Riachuelo CUESTIONARIO PRUNAP PRE PESQUISA CPPP PRUEBA NACIONAL DE PESQUISA PRUNAPE Evaluaci n Integral de Salud en Areas de Riesgo Formulario 1 N mero de identificaci n us
13. of older ages It is worth mentioning that when referring to a SP of 0 25 25 of the most severe cases of inapparent developmental disorders are being selected As with the other tests questions for children under 6 months old have not been included so that the questionnaire is more cost effective The low birth weight BW provides such validation results that we consider the PRUNAPE could be administered without the need of administering the questionnaire Ina previous study no significant relationship was found between BW and PRUNAPE results The difference could be due to the fact that this result was the consequence of a logistic regression in which the predictive capacity of the weight adjusted to all the other variables perhaps is weakened One of the variables to which it was adjusted was pathologic pregnancy which is strongly related to the birth weight However in the present study the weight is not adjusted to any other outcome measure and perhaps it is subsuming in itself all the risk factors that overall make BW be associated to PRUNAPE failure in the setting where it was studied In primary care this oversimplification of risk factors is good because the implementation of action guidelines and priorities to administer the test is easier In the past the validation of specific questionnaires developed to detect different types of developmental problems delays in motor development language cognitive dev
14. of validation it was considered reasonable to include 100 children in each of the five questionnaires see below 478 Arch Argent Pediatr 2013 111 6 476 483 Original article therefore a sample of 500 children was estimated but eventually a 10 was added a total of 550 children to make up for possible losses The study consisted of three consecutive steps 1 self administration of the questionnaire by mothers questionnaire CPPP SA 2 administration of the same questionnaire by healthcare professionals psychologist educational psychologist or pediatrician questionnaire CPPP HP 3 administration of the PRUNAPE to the child The procedure was always carried out following the above order A total of 15 professionals participated pediatricians psychologists and educational psychologists who had all been previously trained in the administration of the PRUNAPE The three procedures were blinded each of the three steps was done by a different professional without anyone knowing the result of the other two attempts Each professional had a laptop with electronic versions of the questionnaires and the PRUNAPE so as to be able to record the information in the field A professional of the healthcare team recorded the answers of the CPPP SA questionnaires in paper in the laptops in the same place where the survey was performed In addition to the questions the questionnaire had information about the mothers education co
15. Original article a Division of Environmental Health Direcci n General de Salud Ambiental DGSA Acumar b Hospital Ricardo Guti rrez Buenos Aires Argentina E mail address Horacio Lejarraga M D cursotesisO7 gmail com Conflict of interest None Received 2 2 2013 Accepted 6 19 2013 Arch Argent Pediatr 2013 111 6 476 483 476 Validation of a questionnaire for the detection of children at high risk of developmental disorders The PRUNAPE Pre Screening Test Horacio Lejarraga M D Diana Kelmansky M D Celina Lejarraga M D Gabriela Charr a M D Graciela Salamanco M D Iv n Ins a M D and Fernando Nunes M D ABSTRACT Introduction The administration of the National Screening Test PruebaNacional de Pesquisa PRUNAPE a tool which is effective to screen inapparent developmental disorders in children under 6 years old requires adequate training time spaceand furniture A simple questionnaire to help screen large population groups could be useful to identify children at risk Objective To evaluate the validity of the PRUNAPE pre screening questionnaire cuestionario PRUNAPE pre pesquisa CPPP to identify children at risk of not passing the test Methods Fifty seven PRUNAPE milestones were transformed into questions they were organized in five questionnaires one for each age group between 6 and 71 months old with illustrative pictures The study was performed in Florencio V
16. Primario completo Secundario incompleto C Secundario completo _ Terciario Universitario E Este formulario tiene preguntas sobre las cosas que hacen los ni os y las ni as Queremos conocer cu les ya puede hacer su ni o o ni a y cu les todav a no Lea cada pregunta y marque con una X lo que corresponda Si tiene dudas marque NO S Uso oficial Pauta PRUNAPE N 1 El ni o o ni a habitualmente come solo o si NO NO SE O oO 2 sin su ayuda la mayor parte de la comida aunque sea con la mano 2 El ni o o ni a puede introducir un objeto d d s NO NO S eque o como una piedrita dentro de un 27 peq pi lt a O G C 27 frasco o una botella 3 Cuando usted extiende el brazo para pedirle al ni o o a la ni a que le d el si NO NO SE objeto o juguete que tiene en la mano se lo ofrece aunque no lo suelte 7 Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 1 4 Validation of a questionnaire for the detection of children at high risk of developmental disorders The PRUNAPE Pre Screening Test 493 N mero de identificaci n 4 Cuando usted se lo pide el ni o o ni a es capaz de ir a buscar un juguete zapatos o alg n objeto conocido 5 El ni o o ni a juega con mu ecas haciendo como que les da de comer los peina o los hace dormir O juega con autitos haciendo que cargan nafta estacionan o andan
17. RESULTADO FINAL PASA NO PASA _ Jtacministrar PRUNAPE Nombre y apellido del agente de salud interviniente isa sviis ces vcvnsasn viesssacvessavecnssecessasnseansnedsasseisseaauainsciees Eo RARA TT T EPA E A uu AAA Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 488 Arch Argent Pediatr 2013 111 6 476 483 Original article K LS CS CUESTIONARIO PRUNAPE PRE PESQUISA CPPP gt PRUEBA NACIONAL DE PESQUISA PRUNAPE Ld S SF ES Direccion General fey acu ma r de Salud Ambiental Q aiiis de Ceca Matanza rico Formulario 2 N mero de identificaci n uso oficial Ni os y ni as de 12 a 17 meses Formulario CPPP destinado a identificar ni os y ni as a quienes se les debe administrar la Prueba Nacional de Pesquisa PRUNAPE Este formulario debe ser realizado a la madre o persona a cargo bajo consignas dictadas por personal de salud que conozca bien el Manual T cnico www acumar gov ar La decisi n de si el ni o o ni a pasa o no pasa el CPPP ser tomada por el personal de salud seg n las instrucciones del Manual El formulario debe ser administrado con el ni o o ni a presente Uso oficial Fecha de hoy Datos del ni o o ni a Fecha de nacimiento d a mes a o A A Datos de la madre o persona a cargo Tel fono Marque con una X el nivel educativo alcanzado Prima
18. acLeanWE The importance of parents concerns about their child s development Am J Dis Child 1989 143 8 955 8 McCune YD Richardson MM et al Psychosocial health issues in pediatric practices parents knowledge and concerns Pediatrics 1984 74 2 183 90 Glascoe FP Parents concerns aboutchildren s development prescreening technique or screening tests Pediatrics 1997 99 4 522 8 Glascoe FP Dworkin PH The role of parents in thedetection 31 32 33 Validation of a questionnaire for the detection of children at high risk of developmental disorders The PRUNAPE Pre Screening Test 483 of developmental and behavioral problems Pediatrics 1995 95 6 829 36 Glascoe FP Can clinical judgment detect children with speech language problems Pediatrics 1991 87 3 317 22 Glascoe FP Parents evaluation of developmental status how well do parents concerns identify children with behavioral and emotional problems ClinPediatr Phila 2003 42 2 133 8 Meier JH Screening assessment and intervention for young children at developmental risk En Yjossem TD 34 35 ed Intervention Strategies for high risk infants and young children Baltimore University Park Press USA 1976 Glascoe FP Dworkin PH Obstacles to effective developmental surveillance errors in clinical reasoning J Dev Behav Pediatr 1993 14 5 344 9 Institute of Medicine Neurological psychiatric and developmental disorders Meeting the ch
19. allenge in the developing world National Academic Press Washington DC Disponible http nap edu catalog 10111 html Acceso January 2013 484 Arch Argent Pediatr 2013 111 6 476 483 Original article CUESTIONARIO PRUNAPE PRE PESQUISA CPPP PRUEBA NACIONAL DE PESQUISA PRUNAPE ES Direcci n General de Salud Ambiental Y acu Ma r Autoridad de Cuenca Matanza Riachuelo Formulario 1 Uso oficial N mero de identificaci n ococooco uso oficial Ni os y ni as de 6 a 11 meses Formulario CPPP destinado a identificar ni os y ni as a quienes se les debe administrar la Prueba Nacional de Pesquisa PRUNAPE Este formulario debe ser realizado a la madre o persona a cargo bajo consignas dictadas por personal de salud que conozca bien el Manual T cnico www acumar gov ar La decisi n de si el ni o o ni a pasa o no pasa el CPPP ser tomada por el personal de salud seg n las instrucciones del Manual El formulario debe ser administrado con el ni o o ni a presente Fecha de hoy losas lisa Datos del ni o o ni a dalla nessis sriis ressis arer erii Apellido ooomoooccccnononcnncncnonacinaoos N Documento ccccnnccccononinnncnnananananncnananonnos Fecha de nacimiento d a mes a o A ais Edad ccccecee Peso al nacer _ _ Kg Datos de la madre o persona a cargo NOME onenian ES A aia N Documento A LoCalidad eooicoiic
20. and summoned mothers on an individual basis to participate Once the consent was signed Florencio Varela mothers and their children where driven to Neighborhood Cooperation Centers for the studies to be conducted Assessment of the comprehension of questionnaire texts Forty six mothers whose children were healthy from 6 to 71 months old were interviewed all of them were of a low socio economic level None of them participated in the final validation sample Based on previous experiences mothers were invited to complete the questionnaire and to participate in a focus group meeting according to the corresponding age group their children belonged to The following items were assessed on a qualitative and quantitative basis a comprehension and interpretation of questions by mothers with their children present b usefulness of illustrative pictures c adequacy of questions to prompt yes no answers Questionnaires Five questionnaires were developed one for each age range Fifty seven out of a total of 64 PRUNAPE milestones for children older than 6 months were made 89 of possible questions oriented towards asking about competencies a child can attain Since the seven remaining milestones were rather complex it was not possible to convert them to questions The five questionnaires have the same cover page please refer to electronic version with healthcare information The possible answers to each question are Yes
21. arelaand inthe Health Promotion Unit of Hospital de Nifios Ricardo Guti rrez in the Autonomous City of Buenos Aires In a sample of 533 healthy children and their mothers of a low socio economic level the CPPP was consecutively a self administered by each mother CPPP SA b by healthcare personnel CPPP HP and finally c the PRUNAPE test was administered to each child by qualified professionals Each step was performed by a different professional in a triple blind fashion When choosing the cutoff point the positive predictive value PPV was prioritized to reach the least possible number of false positives Results For the CPPP SA and the CPPP HP the overall results were respectively Cohen s kappa coefficient 0 23 and 0 28 sensitivity 0 41 and 0 42 specificity 0 81 and 0 85 negative predictive value 0 57 and 0 59 and PPV 0 71 and 0 76 Conclusions The CPPP is a valid tool to identify children who most require the PRUNAPE to be administered Key words developmental disorders screening test PRUNAPE pre screening questionnaire child development http dx doi org 10 5546 aap 2013 476 INTRODUCTION The National Screening Test PruebaNacional de Pesquisa PRUNAPE is an effective tool to detect inapparent developmental disorders in children under 6 years old It is duly validated has been recommended by the Committee of Outpatient Pediatrics of the Argentine Society of Pediatrics and is widely u
22. assessment IndianJPediatr2005 72 11 931 4 Novick J Ascertaining deviant behaviour in children J Consul ClinPsychol1966 30 2 30 Harris SR Parents and caregivers perceptions oftheir children s development Dev Med Child Neuroly1994 36 10 918 23 Limbos MM Joyce DP Comparison of the ASQ and PEDS reeningfordevelopmentaldelayinchildrenpresenting for primary care J DevBehavPediatr2011 32 7 499 511 Saleh A A brief screening questionnaire for infant sleep problems validation findings for the internet sample Pediatrics 2003 113 570 5 Allen CW Silone N Williams K Hutchins P Validity of the social communication questionnaire in assessing risk of autism in pre school children with developmental problems Arch Dev Disorders 2007 37 1273 8 Cox JEN Huntington et al Developmental screening and parents written comments an added dimension to the parents s evaluation of developmental status questionnaire Pediatrics 2010 126 Suppl 3 170 6 Glascoe FP Itisnot whatit seems The relationship between parent s concerns and children with global delays ClinPediatr Phila 1994 33 292 6 Glascoe FP Foster EM An economic analysis of developmental detection methods Pediatrics 1997 99 6 830 7 Kiing JS Low PS Chan YH Neihart M Interpreting parents concerns about their children s development with the parents evaluation of developmental status culture matters J DevBehavPediatr2012 33 2 179 83 GlascoeFP AlthemeierWA M
23. caci n Formulario 5 Ni os y ni as de 4 a os a 5 a os y 11 meses En las pr ximas preguntas usted deber pedirle al ni o o ni a que dibuje L ale las consignas Usted NO deber marcar ninguna respuesta Uso oficial 12 P dale al ni o o ni a que copie con el l piz la figura que se muestra debajo Pauta PRUNAPE N 34 _ si ie NO COLABORA zona para dibujar 13 Pidale al ni o o ni a que copie con el l piz la figura que se muestra debajo 37 gs ge NO COLABORA zona para dibujar 14 P dale al ni o o ni a que dibuje una persona una mam un pap un nene o una nena El espacio en blanco que sigue a continuaci n es para que el ni o a haga su dibujo de la figura humana 33 3 partes gs Jr NO COLABORA 36 6 partes Js ee NO COLABORA Gracias por colaborar Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 504 Arch Argent Pediatr 2013 111 6 476 483 Original article TA CUESTIONARIO PRUNAPE PRE PESQUISA CPPP PRUEBA NACIONAL DE PESQUISA PRUNAPE El Se Direccion General fe y acu m a de Salud Ambiental a a ee Formulario 5 N mero de identificaci n uso oficial Ni os y ni as de 4 a os a 5 a os y 11 meses Uso oficial Resultados del CPPP para ser completado por personal de salud 1 La edad del ni o o ni a es meses
24. cancesesseceeeeseneeseessecensaceeeeeecaeeesensaneeseeesaeees EU ois E E TE TA E E EE E E E ET E E ET AT Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 492 Arch Argent Pediatr 2013 111 6 476 483 Original article CUESTIONARIO PRUNAPE PRE PESQUISA CPPP ho PRUEBA NACIONAL DE PESQUISA PRUNAPE ey ao de sanear p Y acUuMar Autoridad de Cuenca Matanza Riachuelo Fo rmu la rio 3 N mero de identificaci n uso oficial Ni os y ni as de 18 meses a 2 a os y 5 meses Formulario CPPP destinado a identificar ni os y ni as a quienes se les debe administrar la Prueba Nacional de Pesquisa PRUNAPE Este formulario debe ser realizado a la madre o persona a cargo bajo consignas dictadas por personal de salud que conozca bien el Manual T cnico www acumar gov ar La decisi n de si el ni o o ni a pasa o no pasa el CPPP ser tomada por el personal de salud seg n las instrucciones del Manual El formulario debe ser administrado con el ni o o ni a presente Uso oficial Fecha de hoy Wessseced rere Datos del ni o o ni a NOMDIO aniston aiaa Apellido acionosiriciciricases sierras N Documento Fecha de nacimiento d a mes a o lista AAA E Peso al nacer _ Datos de la madre o persona a cargo Nombre Apellido N Documento Direcci n Localidad TOCINA siii bassist veassaascatds Marque con una X el nivel educativo alcanzado Primario incompleto
25. cian and the rest of the healthcare personnel should receive more training and education in this field and the present questionnaire is an additional tool to the ones they already have at present It is useful to better identify children who are candidates to be evaluated with the PRUNAPE at a low cost thereby improving the cost effective relationship in the healthcare process supported by studies that prove the validity of the test in the confirmed developmental disorders approach which is consistent with the international trends about the timely detection of developmental disorders The PPV estimates the likelihood that a child has of failing the PRUNAPE if he or she did not pass the questionnaire This enables that the referral to the test is made with the least possible false positive number The pediatrician should know that the PPV since it depends on the prevalence of developmental problems in low prevalence settings as it might happen in a consulting office of children who live in favorable social and economic conditions the PPV of the questionnaire can be lower that the one in this study CONCLUSIONS The questionnaire allows a more accurately identification of children who are candidates to the PRUNAPE The lack of significant differences in the validity between the administration of the questionnaire by mothers or the healthcare personnel or among mothers of a different education level makes it a very operational t
26. de consisted of 533 children and mothers 487 from Florencio Varela The 46 children from Hospital Guti rrez were under 18 months old The age range of the children included in the sample was from 0 50 to 5 99 years matching the selection criterion Seventeen mothers were born in Bolivia 52 in Paraguay and 15 in Peru Mothers without formal education were not able to fill in the self administered questionnaire There was no information about 6 mothers but they knew how to read and write Aiming at determining whether there were any queries with a quite different matching percentage compared to the rest the proportion of those whose result matched or did not match the corresponding PRUNAPE milestone was studied Figure 1 shows matching percentages among questions included in the questionnaires and their corresponding PRUNAPE milestone A question of questionnaire 3 had fewer matches than the rest When removing it there were no remarkable changes in the validation results therefore the decision was made not to remove it Validation Table 2 shows the results of indicators as per the cutoff points selected for each of the five questionnaires in A and PS modalities Nearly all the indicators for CPPP HP questionnaires administered by the healthcare personnel were slightly better than for the CPPP SA questionnaires self administered but this difference was small and non systematic The CPPP SA questionnaire had a low sensitivit
27. e for the detection of children at high risk of developmental disorders The PRUNAPE Pre Screening Test 497 N mero de identificaci n o o ooo uso oficial Formulario 4 Ni os y ni as de 2 a os y 6 meses a 3 a os y 11 meses Uso oficial Pauta PRUNAPE N si NO NO SE 5 El ni o o ni a puede SACARSE alguna Ci oO 0 prenda de ropa sin ayuda buzo pantalon medias zapatillas 13 si NO NO SE 6 El ni o o ni a puede saltar con los dos 46 pies juntos sin caerse o sostenerse si NO NO SE 7 El ni o o ni a intenta cantar o tararear alguna canci n junto con otros C C C 74 ni os y ni as en el jard n o en alg n cumplea os o reuni n s NO NO S 8 El ni o o ni a puede PONERSE alguna prenda de ropa sin ayuda buzo C C C 14 pantal n medias zapatillas si NO NO SE 9 El ni o o ni a dice oraciones largas como por ejemplo vamos a casa d nde est la abuela mam es linda esto es m o 50 si NO NO SE 10 El ni o o ni a puede decir su nombre completo nombre y apellido 49 cuando alguien le pregunta C mo te llam s 9 11 El ni o o ni a puede saltar con los dos 2 s NO Noes pies juntos por encima de un objeto sin L 76 pisarlo Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 2 4 498 Arch A
28. ed to select children to administer the Denver test Although the sensitivity of our questionnaires is not very high in average it is slightly higher than 0 40 This is because cutoff points were selected prioritizing the PPV in terms of having the least possible false positive results Consequently the PPV of our questionnaire is high between 0 63 and 0 90 according to the questionnaire used values that are comparable to the 0 23 of the Denver questionnaire and the ASQ questionnaire of 0 40 in a study and of 0 20 in another one TABLE 2 Validation indicators of each questionnaire type SA self administered and HP healthcare personnel based on the cutoff points selected to be used in primary care Type of administration Questionnaire no Failure criterion MP Kappa Sp S NPV PPV Self administered 1 2 P90 0 67 0 30 0 77 0 53 0 69 0 63 Healthcare personnel 0 67 0 28 0 88 0 38 0 66 0 71 Self administered 2 2 P75 0 66 0 18 0 91 0 25 0 66 0 64 Healthcare personnel 0 66 0 18 0 91 0 25 0 66 0 64 Self administered 3 2 P75 0 59 0 21 0 81 0 41 0 54 0 72 Healthcare personnel 0 56 0 16 0 88 0 29 0 52 0 74 Self administered 4 1 P90 0 58 0 19 0 73 0 52 0 38 0 82 Healthcare personnel 0 66 0 33 0 84 0 58 0 45 0 90 Self administered 5 2 P75 0 63 0 26 0 83 0 43 0 60 0 72 Healthcare personnel 0 72 0 43 0 85 0 58 0 67 0 79 Self administered General 0 63 0 23 0 81 0 43 0 57 0 71 Healthcare personnel 0 65 0 28 0 85 0 42 0 59 0 76 Self admi
29. elopment autism etc was examined by means of instruments based on questions to parents with quite variable results 2 The detection of many developmental problems in pediatricians offices is mainly achieved because of parents concern In this case variability is also wide some studies show that the rate of parents who show concern about any aspect of the development of their children is as high as 90 while others show that it is only 5 Although parents do not remember quite well the ages their children attain developmental milestones they can identify what their children are able or not to do This justifies the use of a questionnaire for parents which additionally is highly cost effective in relation to the results it provides Parents should be listened when they state their concern about the development of their children or when they fill in questionnaires about their development although these perceptions are influenced by the social and economic level language and the education level Parents Opinions expressed either orally during a visit to the office or written in a formal questionnaire contribute to improving the identification of children who are at risk but based on the results of the present study it does not replace the PRUNAPE but it allows to better detect candidates to be tested 29 Child development and related problems will deserve much more attention in the future The pediatri
30. es a 2 a os y 5 meses Uso oficial Pauta PRUNAPE N si NO NO S oO 12 El ni o o ni a puede armar una torre poniendo cuatro juguetes uno sobre otro sin ayuda y sin que se caigan 13 Cuando un familiar o un amigo llama al ni o o ni a para decirle algo si NO N S se acerca respondiendo al llamado C C C 11 an ae z NOS 14 El ni o o ni a dice oraciones de dos palabras como Vamos mam Nene si No 48 juega Pap come aunque no las pronuncie bien 5 15 El ni o o ni a puede tirarle una si NO NO SE Uo A R pelota con las manos a una persona que est cerca Gracias por colaborar 7 col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 Validation of a questionnaire for the detection of children at high risk of developmental disorders The PRUNAPE Pre Screening Test 495 N mero de identificaci n uso oficial Formulario 3 Ni os y ni as de 18 meses a 2 a os y 5 meses Uso oficial Resultados del CPPP para ser completado por personal de salud 1 La edad del ni o o ni a es meS6S dias 2 Las preguntas a considerar aqui son aquellas cuyo percentil 75 es menor que la edad del ni o o ni a marquela con una X y luego tilde CUMPLE o NO CUMPLE Preguntas a No Cumple Pregunta N considerar Percentil 75 Cumple no sabe no colabora o sa
31. isorders The PRUNAPE Pre Screening Test 499 N mero de identificaci n oo uso oficial Formulario 4 Ni os y ni as de 2 a os y 6 meses a 3 a os y 11 meses Uso oficial Resultados del CPPP para ser completado por personal de salud 1 La edad del ni o o ni a es meses dias 2 Las preguntas a considerar aqu son aquellas cuyo percentil 90 es menor que la edad del ni o o ni a marquela con una X y luego tilde CUMPLE o NO CUMPLE Preguntas a No Cumple Pregunta N considerar Percentil 90 Cumple no sabe no colabora O o fo wee oo o oOo Opa pa pao pag pao po pag ojo po o po El ni o o ni a no pasa el CPPP si la respuesta es NO CUMPLE en una de las preguntas consideradas 3 RESULTADO FINAL PASA NO pasal administrar PRUNAPE Nombre y apellido del agente de salud interviniente ccccceessececeeseceeeeeseeeeeesenceetensceeeeseeeseeseseesesaeeesseseaeeeeeeaeeeeeeseeee nn A Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 500 Arch Argent Pediatr 2013 111 6 476 483 Original article O PRUNAPE PRE PESQUISA CPPP PRUEBA NACIONAL DE PESQUISA PRUNAPE Direcci n General de Salud Ambiental ay acu ma r Autoridad de Cuenca Matanza Riachuelo Formu lario 5 N mero de identificaci n uso oficial Ni os y ni as de 4 a os a 5 a os y
32. n uso oficial 8 P dale al ni o o ni a que se pare en un solo pie sin apoyarse Mu strele c mo hacerlo D le dos o tres oportunidades y si puede hacerlo sin caerse marque S 9 P dale al ni o o ni a que salte en un pie varias veces Mu strele c mo hacerlo y si el ni o o ni a puede hacerlo al menos dos veces sin caerse marque Si 10 Pidale al ni o o ni a que camine solo poniendo un pie delante del otro de forma tal que el tal n de un pie toque con la punta del otro en una l nea recta como jugando a pan y queso y si puede dar algunos pasos sin caerse marque Si Mu strele al ni o o ni a c mo hacerlo 11 P dale al ni o o ni a que haga lo mismo pero caminando hacia atr s poniendo un pie detr s del otro de forma tal que la punta de un pie toque con el tal n del otro y si puede dar algunos pasos sin caerse marque S Mu strele al ni o o ni a c mo hacerlo Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 Ni os y ni as de 4 a os a 5 a os y 11 meses NO si NO COLABORA 3 NO si NO COLABORA f NO si NO COLABORA gt t l NO COLABORA om Uso oficial Pauta PRUNAPE N 75 77 78 79 3 5 Validation of a questionnaire for the detection of children at high risk of developmental disorders The PRUNAPE Pre Screening Test 503 N mero de identifi
33. nistered n 531 administered by the healthcare personnel n 533 MP matching percentage kappa Cohen s kappa coefficient Sp specificity S sensitivity NPV negative predictive value PPV positive predictive value Failure criteria 2 P90 the child does not answer two questions whose PRUNAPE 90th percentile is less than the child s age 2 P75 the child does not answer two questions whose PRUNAPE 75th percentile is less than the child s age 1 P90 the child does not meet a milestone whose PRUNAPE 90th percentile is less than the child s age TABLE 3 Percentage of children who fail the PRUNAPE according to birth weight and validity indicators BW Fails Passes MP Kappa Sp S NPV PPV lt 2500 g 33 12 0 51 0 07 0 95 0 13 0 49 0 73 22500 g 249 236 lt 1500 g 5 1 0 48 0 996 0 03 0 47 0 83 21500 g 277 247 MP matching percentage kappa Cohen s kappa coefficient Sp specificity S sensitivity NPV negative predictive value PPV positive predictive value Validation of a questionnaire for the detection of children at high risk of developmental disorders The PRUNAPE Pre Screening Test 481 In China a good reliability was found in parents opinion regarding their children s potential developmental disorders but in Australia Coghland obtained a matching kappa value of 0 40 which statisticians consider quite poor The sensitivity is low in questionnaires 1 and 2 but then it increases in children
34. o oficial Ni os y ni as de 6 a 11 meses Uso oficial Pauta PRUNAPE N 13 Cuando usted cubre un objeto juguete u otra cosa con un pa uelo o tela si NO NO SE 6 el ni o o ni a levanta el pa uelo o la tela para encontrarlo 14 El ni o o ni a puede pararse sosteni ndose de una silla mesa o alg n 66 otro mueble 15 El ni o o ni a camina algunos pasos 67 agarr ndose de alg n mueble m 16 El ni o o ni a puede agarrar un S NO NOS objeto peque o como una miguita de pan 25 a con su dedo pulgar y su dedo indice Gracias por colaborar a H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 Validation of a questionnaire for the detection of children at high risk of developmental disorders The PRUNAPE Pre Screening Test 487 Formulario 1 Ni os y ni as de 6 a 11 meses Uso oficial Resultados del CPPP para ser completado por personal de salud 1 La edad del ni o o ni a es MESES dias 2 Las preguntas a considerar aqui son aquellas cuyo percentil 90 es menor que la edad del ni o o ni a marquela con una X y luego tilde CUMPLE o NO CUMPLE Preguntas a No Cumple Pregunta N considerar Percentil 90 Cumple no sabe no colabora O 16 apajaya apa apa a a apa a paja Ol 11m 26d Ol El ni o o ni a no pasa el CPPP si la respuesta es NO CUMPLE en dos de las preguntas consideradas 3
35. ool in primary care m 482 Arch Argent Pediatr 2013 111 6 476 483 Original article Acknowledgments To Florencio Varela health promoters working at the following institutions Sociedad de Fomento SF 17 de Diciembre in San Nicolas SF of Barrio Parque Cooperativa 20 de Diciembre of Villa Argentina Centro de Integraci nComunitaria Pico de Oro SF of Villa Argentina To the pediatricians and psychologists who participated in this study Maria Jos Coronel Mariel Backman Aldana Caro Eliana Castellanelli Constanza Cinat Liliana Diaz Mercedes Di Noto Roqu Carolina Fabrizi Clarisa G mez Patricia Isabel Hidalgo Paola Leyes Marina Elda L pez Paula Lotes Vanina Paola Romano and Romina Rosbelke To pediatricians working at Hospital Ricardo Guti rrez Paola Czerniuk and Mar a Bel n Fern ndez To DGSA personnel Graciela Blatt B S Mar a Cecilia Pascucci M D Alicia Masautis M D Oscar Farina M D secretaries Andrea Robles Micaela Redlich EsefaniaLandi Florencia Andechaga To Florencio Varela healthauthorities Alejandro Mario Bagato M D H ctor Miret M D Gabriel Bejarano B S and Juan Vieyra To Cristina Galoppo M D and Angela Gentile M D of Hospital Ricardo Guti rrez and to Lorena Cordi M D of Hospital P de Elizalde To Acumar Communication Department Galv n B S Beatriz G mez Cevallos and FacundoBosco To the IT Department Esteban Neme Eng Alejandro G mez Auad and Ariel Tas
36. pasos agarr ndose de alg n mueble 7 El ni o o ni a puede agarrar un objeto F N s NO No S peque o como una miguita de pan con su C C C 25 dedo pulgar y su dedo ndice E oe Ed lt GC Y 8 El ni o o ni a camina de la mano de s NO NO S alguien O O u si 9 El ni o o ni a camina solo si NO NO S O O A i Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 2 4 490 Arch Argent Pediatr 2013 111 6 476 483 Original article 9 aus de Salud Ambiental S O gt A L CUESTIONARIO PRUNAPE PRE PESQUISA CPPP i b gt UW PRUEBA NACIONAL DE PESQUISA PRUNAPE A Q DnR Autoridad de Cuenca Matanza Riachuelo Formulario 2 Direcci n General Y acumar N mero de identificaci n uso oficial 10 El ni o o ni a puede agacharse para recoger un objeto del suelo y volver a pararse solo 11 El ni o o ni a habitualmente come solo sin su ayuda la mayor parte de la comida aunque sea con la mano 12 Cuando usted extiende el brazo para pedirle al ni o o a la ni a que le d el objeto o juguete que tiene en la mano se lo ofrece aunque no lo suelte 13 El ni o o ni a puede introducir un objeto f gt peque o como una piedrita dentro de un frasco de o una botella 3 y 14 Cuando usted se lo pide el
37. rgent Pediatr 2013 111 6 476 483 Original article D CUESTIONARIO PRUNAPE PRE PESQUISA CPPP PRUEBA NACIONAL DE PESQUISA PRUNAPE Direcci n General gt de Salud Ambiental AY acumar Autoridad de Cuenca Matanza Riachuelo Formulario 4 N mero de identificaci n oo o o uso oficial Ni os y ni as de 2 a os y 6 meses a 3 a os y 11 meses Para responder lo que sigue USTED tiene que pedirle al ni o o ni a que haga algunas pruebas Si el ni o o ni a no las puede hacer marque NO Si el ni o o ni a no quiere hacerlas marque NO COLABORA Uso oficial Pauta PRUNAPE N NO COLABORA TOD 12 Se ale usted las figuras de este dibujo y pidale al ni o o ni a que las nombre pregunt ndole ste qui n es Si puede reconocer dos o m s figuras marque S NO COLABORA Sat e 13 Pidale al ni o o ni a que se pare en un solo pie sin apoyarse M estrele c mo debe hacerlo Dele dos o tres oportunidades y si puede hacerlo sin caerse marque S A NO si NO COLABORA 14 Mu strele un color al ni o o ni a y pidale que se ale el que se le parece C C C 17 Si el ni o o ni a puede se alar correctamente dos o m s marque s iGracias por colaborar Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 Validation of a questionnaire for the detection of children at high risk of developmental d
38. rio incompleto Primario completo L Secundario incompleto _ Secundario completo _ Terciario Universitario C Este formulario tiene preguntas sobre las cosas que hacen los ni os y las ni as Queremos conocer cu les ya puede hacer su ni o o ni a y cu les todav a no Lea cada pregunta y marque con una X lo que corresponda Si tiene dudas marque NO S Uso oficial Pauta PRUNAPE N 1 Cuando el ni o o ni a est sentado en el si NO NO SE 64 suelo puede agarrar un objeto o juguete cercano 2 El ni o o ni a dice ma ma ma o pa pa pa E E ml 42 si NO NO SE 3 El ni o o ni a entiende cuando usted le dice NO C 40 4 Cuando usted cubre un objeto juguete otra cosa con un papel o una si NO NO SE tela el ni o o ni a levanta el papel o la tela para encontrarlo 6 Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 1 4 Validation of a questionnaire for the detection of children at high risk of developmental disorders The PRUNAPE Pre Screening Test 489 N mero de identificaci n oo oooooo uso oficial Formulario 2 Ni os y ni as de 12 a 17 meses Uso oficial Pauta PRUNAPE N 5 El ni o o ni a puede pararse s NO NO S O O u i r A 66 sosteni ndose de una silla mesa o alg n otro mueble si NO NO SE LIU O Gs 6 El ni o o ni a camina algunos
39. sed in different settings However its administration requires personnel to be trained available time and adequate space and furniture Considering the social programs that cover a large number of families and children like Plan Nacer it would be appropriate to do a pre screening targeted to mothers or guardians with a simpler method which pre screens children with the highest likelihood of not passing the PRUNAPE test so that the screening process of children who might be candidates to this test and eventually also specific diagnoses and interventions are more cost effective An alternative is to interview parents and ask them at what age their children attained the developmental milestones retrospective questions but this approach has proved not to be so reliable Another more reliable and cost effective approach is the use of simple questionnaires for parents about what the child can do at the time of the interview The objectives of this article are 1 to evaluate the validity of the pre screening PRUNAPE test cuestionario PRUNAPE pre pesquisa CPPP to identify children with the highest risk of not passing the test 2 to evaluate if the validity is different if administered by mothers or by the healthcare personnel and 3 taking into account that low birth weight is related to a higher prevalence of developmental disorders to perform a subset analysis Validation of a questionnaire for the detection of children a
40. sero To DGSA secretaries REFERENCES 1 Lejarraga H Kelmansky D Pascucci MC Salamanco G Prueba Nacional de Pesquisa PRUNAPE Fundaci n Hospital Garrahan 2004 2 Pascucci MC Lejarraga H Kelmansky D Alvarz M et al Validaci n de la Prueba Nacional de Pesquisa PRUNAPE Arch Argent Pediatr2002 100 5 374 85 3 Boggiano E Breitman F Andrade M Sociedad Argentina de Pediatria Comit de Pediatria Ambulatoria Manual de supervisi n de la Salud para ni as ni os y adolescentes La detecci n oportuna de problemas de desarrollo La prueba nacional de Pesquisa PRUNAPE BuenosAires SAP Fundasap 2010 P gs 447 50 4 Robbins LC The accuracy of parental recall of aspects of child rearing practices J AbnormPsychol 1963 66 261 5 Glascoe FP Evidence based approach to developmental and behavioural surveillance using parents s concerns Child Care Health Dev2000 26 2 137 49 6 MinisteriodeSalud Subsecretar a de Programas dePrevenci n yProtecci n de la Salud Evaluaci n del Sistema de Vigilancia Epidemiol gica Buenos Aires Argentina Metodolog a para la construcci n de un cuestionario para el sistema de vigilancia Cap 3 P g 18 2003 7 Lejarraga H Men ndez A Menzano E Fattore MJ et al PRUNAPE Pesquisa de trastornos de desarrollo en el primer nivel de atenci n Arch ArgPediatr 2008 106 2 119 25 8 Abusamra V Ferreres A Raiter A De Beni R et al Test Leer 10 11 12 13 14 15
41. st n bien respuestas como la COCINA sirve para cocinar calentar la comida hacer el mate y la HELADERA sirve para enfriar congelar conservar la comida 6 Sin mostrarle ni ayudarle pidale al ni o o ni a que Si el ni o o ni a se ala tres o cuatro colores correctamente marque S se ale los colores diciendo Mostrame el rojo Mostrame el amarillo Mostrame el azul Mostrame el verde 7 Preg ntele al ni o o ni a C mo te das cuenta cu ndo es de D A y C mo te das cuenta cu ndo es de NOCHE Si contesta bien una de las preguntas o las dos marque S Est n bien respuestas como es de D A porque hay luz voy al jard n est el sol y es de NOCHE porque est oscuro est n las estrellas est la luna me voy a dormir si si si E El si NO NO COLABORA O O O NO NO COLABORA NO NO GOLABORA NO NO GOLABORA NO NO GOLABORA Lejarraga H y col Archivos Argentinos de Pediatr a 2013 Vol 111 N 5 2013 Uso oficial Pauta PRUNAPE N 17 51 54 55 56 2 5 502 Arch Argent Pediatr 2013 111 6 476 483 Original article CUESTIONARIO PRUNAPE PRE PESQUISA CPPP PRUEBA NACIONAL DE PESQUISA PRUNAPE Direcci n General fs acumar de Salud Ambiental re Formulario 5 Ce mi SS N mero de identificaci
42. t high risk of developmental disorders The PRUNAPE Pre Screening Test 477 for children with a birth weight of less than 2500 g to see if this outcome measure can also predict PRUNAPE results MATERIAL AND METHODS The study was conducted from July 2 to August 31 in the Department of Health Protection and Promotion of Hospital de Ni os Ricardo Guti rrez and in community centers of Florencio Varela FV with the participation of its Secretariat of Health Mothers and their children were visited at their homes by health promoters and evaluated in Sociedad de Fomento 17 de Diciembre San Nicol s Cooperaci n de Barrio Parque Villa M nica Cooperativa 20 de Diciembre Villa Argentina and Centro de Integraci n Comunitaria Pico de Oro Preparation of the questionnaire The general recommendations for questionnaires established by the Ministry of Health were followed PRUNAPE milestones were transformed into simple questions for mothers about what the child is able to do avoiding ambiguous questions For instance based on the PRUNAPE milestone sitting unsupported the following question was generated Is the child able to sit alone without the support of his her hands No questions were formulated for children under 6 months old because the prevalence of developmental disorders is low in this age range in relation to older ages Fields of work Community health promoters visited low socio economic households
43. untry of origin the child s date of birth and birth weight Statistical studies The assessment was done with the following indicators used for validations of other tools percent agreement Cohen s kappa coefficient sensitivity specificity negative predictive value NPV and positive predictive value PPV Cutoff points were chosen prioritizing the specificity and the positive predictive value so as to avoid the maximum possible number of false positives and they were the same for both questionnaire modalities SA and HP Validation indicators with a high and a low prevalence of developmental disorders From all the indicators used some are independent of the prevalence o the problem encountered in the field others are not Sensitivity and specificity exclusively depend on the instrument but the predictive value positive and negative depends on the prevalence of the problem For instance if the indicators of three hypothetical samples with different prevalence of children who failed the PRUNAPE with a prevalence of 53 3 99 and 1 1 respectively were estimated for the same instrument i e with the same sensitivity and specificity e g 0 82 and 0 43 respectively positive predictive values would be 0 73 0 996 and 0 03 in this order The greater the prevalence of the problem the higher the predictive value of the tool RESULTS Sample characteristics The final sample Table 1 on which the validation was ma
44. y in the 6 to 29 months age group and was higher in 30 months old children and older Overall the specificity Sp ranged from 0 73 to 0 91 the sensitivity S ranged from 0 25 to 0 53 and the PPV ranged from 0 63 to 0 82 all of these were expected results takinginto account that the sensitivity and the PPV were prioritized In the CPPP HP the Sp S and PPV values ranged from 0 84 to 0 91 0 25 to 0 58 Validation of a questionnaire for the detection of children at high risk of developmental disorders The PRUNAPE Pre Screening Test 479 and 0 64 to 0 90 respectively No significant differences were found in the validation values of the questionnaires among mothers with a primary and secondary education level Birth weight and PRUNAPE In the 530 children whose birth weight BW was available the mean weight was 3281 g SD 580 g ranging from 1100 to 4650 g There was 8 4 of children with a BW lt 2500 g and 1 5 with a BW lt 1500 g Table 3 shows the proportion of children with a birth weight of less than 2500 g and of 1500 g that passed or failed the PRUNAPE Of the children who failed the test 73 3 had a low birth weight and 51 3 had an adequate birth weight There is a significant difference in TABLE 1 Sample characteristics and number of children and mothers studied per questionnaire Total Mothers children 533 Origin Florencio Varela 487 Hospital R Guti rrez 46 Nationality of mothers Argentina 449 Other 84
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