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1、Ages and Stages Questionnaire at 3Years for Predicting IQ at 56 Years幼儿3岁时的发育情况（年龄和发育阶段问卷结果）能预测其5-6岁时的IQ,PEDIATRICS Volume 139, number 4 , X 20XX IF:6.476Yao xing,20XX-X-X,Contens,BackgroundObjectivesMethodsResultsDiscussionStrengths and limitationsConclusionsImplications,Abbreviations,ASQ: Ages & S
2、tages Questionnaires（年龄与发育阶段问卷）CI: Confidence Interval（可信区间）EDEN: Etude des Determinants Pre-et Post-natals du Developpement de lEnfant（伊甸园队列）IQR: Interquartile Range（四分位数间距）ROC: Receiver Operating Characteristic（受试者/接受者工作特征）SDQ: Strengths and Difficulties Questionnaire（长处与困难问卷）WPPSI-III: Wechsler P
3、reschool and Primary Scale of IntelligenceThird Edition（韦氏学龄前儿童智力量表，第3版）,EDEN: Etude des Determinants Pre-et Post-natals du Developpement de lEnfant,The EDEN motherchild cohort study aims to examine prenatal and postnatal determinants of child development, growth, and health.Participants were recrui
4、ted 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 speakers or readers, or plans to move out of the study region in the next 3 years.,Background,1. The identif
5、ication 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 designed to be used in primary care for firstline clinical screening of infant and preschool child developmen
6、t.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 children born preterm showed that the 36-month ASQ predicted school difficulties at age 5.5.There is a gap in kn
7、owledge about the predictive value of early ASQ scores for later cognitive functioning, such as IQ, in the general pediatric population.,Objectives,1. To investigate the predictive value of the 36-month ASQ score for IQ at age 5 to 6 years in a large population-based cohort study.2. To search for ot
8、her 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 between the 36-month ASQ score and later IQ.,Methods,1.Measures of child development,2.1 36-Month ASQ Scor
9、e (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（适应能力）.US norms are available for each domain, and any domain screened 2 SDs below the mean is considere
10、d a positive screening. This study used the sum or the 5 domain scores, producing a score between 0 and 300.,1.Measures of child development,2.2 IQ With the Wechsler Preschool and Primary Scale of IntelligenceThird Edition at Age 5 to 6 YearsWhen the child was 5 to 6 years old, cognitive assessment
11、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 3 years old, mothers filled out a questionnaire reporting sociodemographic status for the family and
12、 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,2.Factors included in the analysis,1. Childs characteristics: gender; whether the child was a firs
13、tborn 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 educational level, occupation, and depressive symptoms assessed with the Center for Epidemiologic Studie
14、sDepression 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 analysis were first compared with the other children in the EDEN cohort who were not included.2. Results
15、 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 linking low IQ (85) and ASQ score was used to determine the optimal cutoff value for the ASQ score.4. A 3
16、-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.The mean 36-month ASQ score was 270 30,with a median of 280 (IQR 260290). IQ was measured at a mean age
17、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 associated with ASQ score.,1. Characteristics of the Study population(and compared with children in the E
18、DEN 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 occupational levels than children included.,2.,IQ at age 5 to 6 years according to 36-month ASQ score(R
19、OC 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 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
20、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 account,单变量,多变量,The risks of low IQ was significantly higher inchildren with an ASQ score 270 and
21、 a maternal educational level at high school or below.,Discussion,1. The prevalence of low IQ wasprobably underestimated in the study.,A prevalence of 16% could have been expected, considering the distribution of IQ (mean = 100, SD =15). The prevalence in this study was 7.3%, which was also in the l
22、ower 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 reported in several previous studies, total ASQ scores provide a global evaluation of a chi
23、lds 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 researchers found that in the general population the use of ASQ total score could be r
24、ecommended 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 early interventions designed to help the child achieve his or her full developmental
25、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 abilities at age 3 were taken into account.Interventions conducted between age 3 and
26、 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 child development throughout early childhood.,Children whose mothers had no occupat
27、ional 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 various aspects of sociocultural and economic background.,Strengths,1.Large sample s
28、ize(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 were blinded to the ASQ score.,Limitations,1.The IQ at 5 to 6 years itself also h
29、as 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 included had a lower socioeconomic background than c
30、hildren included.5.Mothers in the cohort had a higher educational level than those in the overall French population.,Conclusions,1.Results suggest that the 36-month ASQ score could be useful in predicting the risk of having an IQ 85 at age 5 to 6 years. 2.The ASQ scores sensitivity is 0.77 0.11, wit
31、h 0.68 0.03 specificity for a cutoff value of 270. 3.At a given ASQ level, socioeconomic background affects childrens development between age 3 years and age 5 to 6 years and should be taken into account when interpreting the ASQ score as a predictive tool.,Implications,学习1.选调查工具之前要对其进行详尽的了解，包括界值的确定
32、，没有常模的情况下可以借助用ROC曲线；2.任何调查都存在抽样误差，在已有数据中选取部分作为研究对象时可以将研究对象和韦纳入研究的对象进行比较，为结果的解释提供部分依据；3.大样本研究方便研究多个因素，但事先应确定好相关的影响因素和潜在的影响因素；4.在无法准确获取认知能力测量结果的情况下，可以使用其他指标比如total IQ来替代,完善1.统计分析的检验水准可以根据研究数据进行调整，但不能过大，否则会增加犯类错误的概率；2.文章对行为因素研究较少，尤其是儿童3岁至5-6岁期间父母的行为干预内容，如早期刺激、家庭教养等；3.IQ并不适合作为一项长期指标，我们可以借鉴此研究设计横断面研究,Thanks for listening,
