Parents as key actors to screen early childhood development disorders: Validation of a culturally sensitive, parent-administered screening instrument using Delphi technique.

Abstract

The lack of culturally sensitive screening instruments that can be administered by parents is one of the major barriers to incorporating them in the monitoring of their child's developmental progress and incorporating them in the early identification of early childhood development disorders (ECDDs). The paper presents the methods and outcomes of the validation process using the Delphi technique to develop a culturally congruent instrument appropriate to be used by the parents of infants in the South Indian state of Tamil Nadu to assess their child's developmental progress. A screening tool was developed with 64 statements/items on the red flag signs for children from age 0 to 12 months. A panel of experts then evaluated this instrument and scored each of the items, in two rounds, on 5-point Likert scales evaluating their safety and relative priority. In both the rounds, any item/statement with a median score < 5 or interquartile range > 1 was removed. The validated alpha version of the tool had 45 statements split across infant's age, encompassing a comprehensive range of pediatric development domains including tone, primitive reflex, cognition, gross motor, fine motor, language communication, sensory motor, social, and problem solving. The cultural congruence with the Tamil population, focus on concerning signs of developmental delay, and the inclusion of a few primitive reflexes perceived by the expert panel as safe to be used by the parents/caregivers enhances the practical application of the instrument, in the early detection of ECDD.