TY - JOUR
T1 - Sex-Specific Developmental Scales for Surveillance
AU - Sudry, Tamar
AU - Amit, Guy
AU - Zimmerman, Deena R.
AU - Tsadok, Meytal Avgil
AU - Baruch, Ravit
AU - Yardeni, Hadar
AU - Akiva, Pinchas
AU - Moshe, Dror Ben
AU - Bachmat, Eitan
AU - Sadaka, Yair
N1 - Publisher Copyright: Copyright © 2024 by the American Academy of Pediatrics.
PY - 2024/4/1
Y1 - 2024/4/1
N2 - BACKGROUND: Developmental surveillance, conducted routinely worldwide, is fundamental for early detection of children at risk for developmental delay. We aimed to explore sex-related difference in attainment rates of developmental milestones and to evaluate the clinical need for separate sex-specific scales. METHODS: This is a cross-sectional, natiowide retrospective study, utilizing data from a national child surveillance program of ~1000 maternal child health clinics. The main cohort, used for constructing sex-specific developmental scales, included all children born between January 2014 to September 2020, who visited maternal child health clinics from birth to 6 years of age (n 5 839 574). Children with abnormal developmental potential were excluded (n 5 195 616). A validation cohort included all visits between 2020 and 2021 (n 5 309 181). The sex-differences in normative attainment age of 59 developmental milestones from 4 domains were evaluated. The milestones with a significant gap between males and females were identified, and the projected error rates when conducting unified versus sex-specific surveillance were calculated. RESULTS: A new sex-specific developmental scale was constructed. In total, females preceded males in most milestones of all developmental domains, mainly at older ages. Conducting routine developmental surveillance using a unified scale, compared with sex-specific scales, resulted in potential missing of females at risk for developmental delay (19.3% of failed assessments) and over-diagnosis of males not requiring further evaluation (5.9% of failed assessments). CONCLUSIONS: There are sex-related differences in the normative attainment rates of developmental milestones, indicating possible distortion of the currently used unified scales. These findings suggest that using sex-specific scales may improve the accuracy of early childhood developmental surveillance.
AB - BACKGROUND: Developmental surveillance, conducted routinely worldwide, is fundamental for early detection of children at risk for developmental delay. We aimed to explore sex-related difference in attainment rates of developmental milestones and to evaluate the clinical need for separate sex-specific scales. METHODS: This is a cross-sectional, natiowide retrospective study, utilizing data from a national child surveillance program of ~1000 maternal child health clinics. The main cohort, used for constructing sex-specific developmental scales, included all children born between January 2014 to September 2020, who visited maternal child health clinics from birth to 6 years of age (n 5 839 574). Children with abnormal developmental potential were excluded (n 5 195 616). A validation cohort included all visits between 2020 and 2021 (n 5 309 181). The sex-differences in normative attainment age of 59 developmental milestones from 4 domains were evaluated. The milestones with a significant gap between males and females were identified, and the projected error rates when conducting unified versus sex-specific surveillance were calculated. RESULTS: A new sex-specific developmental scale was constructed. In total, females preceded males in most milestones of all developmental domains, mainly at older ages. Conducting routine developmental surveillance using a unified scale, compared with sex-specific scales, resulted in potential missing of females at risk for developmental delay (19.3% of failed assessments) and over-diagnosis of males not requiring further evaluation (5.9% of failed assessments). CONCLUSIONS: There are sex-related differences in the normative attainment rates of developmental milestones, indicating possible distortion of the currently used unified scales. These findings suggest that using sex-specific scales may improve the accuracy of early childhood developmental surveillance.
UR - http://www.scopus.com/inward/record.url?scp=85189478300&partnerID=8YFLogxK
U2 - https://doi.org/10.1542/peds.2023-062483
DO - https://doi.org/10.1542/peds.2023-062483
M3 - Article
C2 - 38545666
SN - 0031-4005
VL - 153
JO - Pediatrics
JF - Pediatrics
IS - 4
M1 - e2023062483
ER -