Abstract / Summary
Objectives: While child developmental checks are universally recommended, engagement with developmental surveillance programmes is low globally. To address this policy to practice gap, this study examined the diagnostic accuracy of the 'Watch Me Grow' Integrated (WMG-I) digital developmental screening and ongoing surveillance approach.
Design: This sub-study examined diagnostic accuracy of the WMG-I digital approach compared with routine assessment (service as usual (SaU)) in a prospective sample.
Participants, setting and intervention: Parents of 16-to-35-month-old children attending 40 general practices (randomised to WMG-I or SaU) in culturally diverse metropolitan New South Wales and Queensland, Australia, participating in a longitudinal cluster randomised controlled trial. Parents in the WMG-I group completed the WMG-I digital weblink, including a primary screener and automated secondary screener (if concerns were reported). On completion, results and recommendations were transmitted to the parent and general practitioner (GP) allowing discussion and further assessment. This was compared with SaU GP assessment. Once engaged, based on child's date of birth, WMG-I sends automated reminders to take the check again at the next recommended ages, thereby allowing ongoing developmental monitoring/surveillance.
Primary outcome measures: All children with identified concerns and a 10% systematic sample without concerns received a reference standard assessment using the Mullen Scale of Early Learning, Autism Diagnostic Observation Schedule and Vineland Adaptive Behaviour Scale. The primary outcome was diagnostic accuracy of WMG-I compared with SAU on the reference standard assessments.
Results: Of the 655 children in the study at age 2 years, 151 children received reference standard assessment. There was a statistically significant difference in the diagnostic accuracy, with 93.9% sensitivity in the WMG-I group (95% CI 88.1% to 99.7%) and 75.9% (95% CI 57.2% to 94%) in the SaU group (p=0.035); specificity was 71.4% (95% CI 54.7% to 88.1%) and 66.7% (95% CI 44.9% to 88.4%) (p=0.743), respectively.
Conclusions: Universal digital surveillance programmes such as WMG-I can enhance time and service efficiency to accurately identify developmental needs. Leveraging routine primary care contact such as immunisation visits to administer WMG-I digital offers a scalable solution for increasing the uptake of developmental surveillance at a population level internationally.