Triagem de atraso de desenvolvimento e de alterações de comportamento: estudo normativo do Survey of Wellbeing of Young Children (SWYC) no contexto brasileiro

Abstract

Introduction: In developing countries, like Brazil, there are few child development assessment tools that are validated, adapted to the local culture, accessible, and viable for use in clinical practice. Hence, it is important to validate and adapt tools that can be used on a large scale in our country. The "Survey of Wellbeing of Young Children (SWYC)" is a North American questionnaire for parents of children aged one to 65 months. The SWYC is divided into three evaluation domains: developmental ("Developmental Milestones" and "Parent's Observations of Social Interactions - POSI"), behavior ("Baby Pediatric Symptom Checklist - BPSC" and "Preschool Pediatric Symptom Checklist - PPSC), and risk factors that affect parents and children's well-being ("Family Questions"). The SWYC is quick and easy to administer, is available free of charge, and shows evidence of validity and reliability, which makes it feasible to use in primary care. Objectives: To conduct the cross-cultural adaptation of the SWYC for Brazilian Portuguese and to do a normative study to identify cut off scores for the detection of developmental delay and behavioral problems in Brazilian children. Methodology: In the first phase of the study, the cross-cultural adaptation of the SWYC for Brazilian Portuguese was carried out, following standard procedures described in the international literature. The second phase encompassed the normative study of the SWYC with Brazilian children, which consisted on an observational cross-sectional study involving 415 children from one to 65 months and their caregivers, recruited in primary care service facilities in the city of Araranguá (SC). The questionnaires were applied through individual interviews with parents/guardians with an average duration of 40 minutes. Firstly, the parents answered a structured questionnaire, created by the researchers, to characterize risk factors and the socioeconomic status of the families. Next, the SWYC was applied and the interview was ended with the Ages & Stages Questionnaires 3rd edition (ASQ-3). The clinimetric properties of the items of the "Developmental Milestones" were analyzed using the Gradual Response Model of the Item Response Theory (IRT), the same measurement model used to develop the original instrument. The manual cut-off points of the "Developmental Milestones" were calculated based on the values and parameters of the item characteristic curve of the IRT model, using the age corresponding to 15% of delay. The construct validity of the BPSC and PPSC was verified by obtaining the values of dimensionality, reliability and convergent validity. The Bifactor model was employed for the PPSC, following the same procedure used in the original version of the SWYC. This model was adjusted for the Brazilian version by means of exploratory and confirmatory factor analysis. Statistical procedures were also performed to adjust the cutoff points for the Brazilian versions of the BPSC and PPSC, considering that the score at or above the 90th percentile for both questionnaires. Results/Discussion: The final version of SWYC adapted to the Brazilian Portuguese is available online since November 2015. The set of items of the "Developmental Milestones" presented adequate adjustment in the factor analysis (Kaiser-Meyer-Olkin; KMO= 0,97), convergent validity (Average Variance Extracted; AVE= 0,73) and internal consistency (Cronbach's Alpha; AC= 0,97). It was also found that the "Developmental Milestones" provides more information in the 10 to 30 months age group. The scores of the American and Brazilian versions diverged for the majority of age groups for the "Developmental Milestones, BPSC, and PPSC. Regarding BPSC, all constructs presented AVE, AC and Composite Reliability (CC) above 0.60 and KMO> 0.50. Regarding the PPSC, it was observed that all measures of quality and validity of the constructs in the Brazilian and the original version were very similar (AVE> 0.27; AC = 0.81; CC = 0.81; Tucker-Lewis Index and Comparative Fit Index> 0.90 and Root Mean Square Error of Approximation <0.10). Conclusion: We conclude that the SWYC questionnaires "Developmental Milestones", BPSC and PPSC have acceptable measurement quality to be used with the Brazilian population. We recommend the use of the Brazilian version cutoff points because they are more adjusted to the local context. The cross-cultural adaptation and normative study of the SWYC can be considered the first step towards the validation of resources for the screening of developmental delay and behavioral disorders for large scale use in Brazil.