Development and preliminary testing of the Brief Developmental Assessment: an early recognition tool for children with heart disease
2018
Introduction: Neurodevelopmental abnormalities are common in children with CHD and are the highestpriority
concerns for parents and professionals following cardiac surgery in childhood. There is no additional routine
monitoring of development for children with CHD in the United Kingdom; hence, neurodevelopmental concerns
may be detected late, precluding early referral and intervention. Methods: An early recognition tool – the “Brief
Developmental Assessment” – was developed using quality improvement methodology involving several iterations
and rounds of pilot testing. Our requirements were for a tool covering important developmental domains and
practicable for use within inpatient and outpatient settings by paediatric cardiac health professionals who are nondevelopmental
specialists, without specialised equipment and which involved direct observation, as well as parental
report. Results: Items were included in the tool based on existing developmental measures, covering the domains of
gross and fine motor skills, daily living skills, communication, socialisation, and general understanding. Items were
developed for five age bands – 0–16 weeks, 17–34 weeks, 35–60 weeks, 15 months–2.9 years, and 3–4.9 years – and
the final versions included a traffic light scoring system for identifying children with possible delay in any or all
domains. Preliminary testing indicated excellent inter-rater reliability, an ability to detect children with a diagnosis
known to be associated with developmental delay, and largely acceptable internal reliability. Conclusion: We report the
evolution and preliminary testing of an early recognition tool for assessing the development of children with heart
disease; this was encouraging and sufficiently good to support further validation in a larger study.
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