TY - JOUR
T1 - Identifying at-risk children for early intervention services
T2 - Lessons from the infant health and development program
AU - Kirby, Russell S.
AU - Swanson, Mark E.
AU - Kelleher, Kelly J.
AU - Bradley, Robert H.
AU - Casey, Patrick H.
N1 - Funding Information:
Supported by grants from the Robert Wood Johnson Foundation to the Department of Pediatrics, Stanford University; The Frank Porter Graham Child Development Center, University of North Carolina; and the eight participating universities. Additional support was provided to the Department of Pediatrics, Stanford University, from the Pew Charitable Trusts; from the Bureau of Maternal and Child Health and Resources Development, Health Resources Services Administration, U.S. Public Health Service, Department of Health and Human Services (grant No. MCJ-060515); and from the Stanford Center for the Study of Families, Children, and Youth. Presented in part at the meeting of the Southern Society for Pediatric Research, New Orleans, La., Jan. 29-31, 1992. Submitted for publication Oct. 5, 1992; accepted Dec. 16, 1992. Reprint requests: Russell S. Kirby, PhD, MS, Department of Pediatrics/CARE Slot 512, University of Arkansas for Medical Sciences, 4301 W. Markham St. Little Rock, AR 72205. Copyright 9 1993 by Mosby-Year Book, Inc. 0022-3476/93/$1.00 + .10 9/20/45046
PY - 1993/5
Y1 - 1993/5
N2 - A U. S. law mandates early intervention services for infants and young children who have, or are at risk for, developmental problems. Participating states must develop definitions for identifying infants and young children at risk for developmental problems. To assess the sensitivity, specificity, and positive predictive value of some commonly identified risk factors, we examined the definitions proposed by five states. Data on risk factors and 36-month developmental outcomes were obtained from follow-up participants in the infant Health and Development Program, a multisite, collaborative prospective intervention program involving 985 low birth weight preterm infants. Few individual risk factors proposed by these states were associated with poor developmental outcomes. Characteristics with positive predictive values greater than 30% were highly specific but tended to involve few cases. Risk factors with positive predictive values greater than 50%, such as hypothyroidism, occurred infrequently (<6%) in this sample. When state definitions for at-risk children were examined in composite, each definition ylelded a positive predictive value of 25% to 35%, with poor specificities ranging from 12% to 40%. These data on low birth weight infants have implications for the design and funding of population-based early intervention programs, and suggest that more careful clinical and longitudinal research is necessary before appropriate definitions can be promulgated for ideniifying childre in need of early, intervention services.
AB - A U. S. law mandates early intervention services for infants and young children who have, or are at risk for, developmental problems. Participating states must develop definitions for identifying infants and young children at risk for developmental problems. To assess the sensitivity, specificity, and positive predictive value of some commonly identified risk factors, we examined the definitions proposed by five states. Data on risk factors and 36-month developmental outcomes were obtained from follow-up participants in the infant Health and Development Program, a multisite, collaborative prospective intervention program involving 985 low birth weight preterm infants. Few individual risk factors proposed by these states were associated with poor developmental outcomes. Characteristics with positive predictive values greater than 30% were highly specific but tended to involve few cases. Risk factors with positive predictive values greater than 50%, such as hypothyroidism, occurred infrequently (<6%) in this sample. When state definitions for at-risk children were examined in composite, each definition ylelded a positive predictive value of 25% to 35%, with poor specificities ranging from 12% to 40%. These data on low birth weight infants have implications for the design and funding of population-based early intervention programs, and suggest that more careful clinical and longitudinal research is necessary before appropriate definitions can be promulgated for ideniifying childre in need of early, intervention services.
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U2 - 10.1016/S0022-3476(06)80004-1
DO - 10.1016/S0022-3476(06)80004-1
M3 - Article
C2 - 7684440
AN - SCOPUS:0027238424
SN - 0022-3476
VL - 122
SP - 680
EP - 686
JO - The Journal of Pediatrics
JF - The Journal of Pediatrics
IS - 5
ER -