Simultaneous Technique for Acuity and Readiness Testing (START): further concurrent validation of an aid for developmental surveillance.

Abstract

A brief (8-minute) procedure, now called Simultaneous Technique for Acuity and Readiness Testing or START, has been shown to be efficacious for predicting developmental outcomes and a cost-effective screen for visual acuity. The objective of the two studies reported here was to examine the ability of this procedure to predict concurrent development outcome by using a new simplified scoring system. A prospective design was used. Subjects were screened using START, and then samples were stratified on the basis of developmental screening results (START in study 1 and the revised Denver Developmental Screening Test and a shortened version of the Minnesota Child Development Inventory in study 2) into subsamples (n = 118 and 120) which were administered the standard criterion test (McCarthy Scales of Children's Abilities in one cohort and the Stanford-Binet in the other). Prekindergarten registration for a rural school system in North Carolina. Two county-wide cohorts of preschool children (n = 352 and 362). Results for prediction of the McCarthy outcomes were as follows: sensitivity, 0.76; specificity, 0.99; predictive value, 0.81; underreferral, 1.3%; overreferral, 1.0%; and percent agreement, 98%. Prediction of Stanford-Binet results was as follows: sensitivity, 0.94; specificity, 0.83; predictive value, 0.22; underreferral, 0.3%; overreferral, 16%; and percent agreement, 84%. Most of the overreferrals for the Stanford-Binet were in the clinically important borderline category. These results provide further support for the concurrent validity of START: The results illustrate how routine health procedures can be restructured to obtain clinically useful data on specific child developmental functioning.