A study to validate the Ten-Question-Questionnaire + for the detection of moderate to severe neurological disabilities in older Bangladeshi children

Abstract

Purpose

Our study validated the Ten Question Questionnaire (TQQ+) for Bangladeshi children between 10 and 16 years. The TQQ + is a rapid screening tool for disability and was previously validated in children below 9 years of age.

Materials and methods

The study was carried out in Chattogram, Bangladesh. One hundred children aged 10–16 years, 10 with mild or moderate disabilities, 40 with severe disabilities, and 50 children without a disability were identified. Children with disability (n = 50) had previously undergone Wechsler Intelligence Scale-Revised (WISC-R) assessments by psychologists as a reference standard. Each child was evaluated using Rapid Neurodevelopmental Assessment (RNDA) by physicians and TQQ + was administered by researchers. Sensitivities and specificities of TQQ + were evaluated in comparison with RNDA and WISC-R.

Results

The sensitivity of TQQ + was 98% in comparison with either RNDA or WISC-R. The specificity of TQQ was 76.5% compared with RNDA and 78% with WISC-R. TQQ + successfully picked up cognitive (98%) and motor (75%) disabilities as well as behavioural problems (88.9%). Specificity was good to excellent in all other domains. Logistic regression showed that TQQ + could reliably predict disability by RNDA and WISC-R. The area under the Receiver Operating Characteristic Curve (ROC) curve was 0.88 which denoted good diagnostic accuracy of the questionnaire.

Conclusion

The TQQ + is valid for screening disabilities in 10–16 year old Bangladeshi children.

IMPLICATIONS FOR REHABILITATION

• If children with neurodevelopmental disabilities are screened early, the benefit of intervention will be greater.

• TQQ + is an easy to administer and low-cost tool that has been validated internationally.

• The TQQ + is now validated and can be used for children aged 10 to 16 years in Bangladesh.

Keywords:

• TQQ+
• screening instrument
• disability
• low-income country
• child development

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

The authors like to acknowledge Professor. Dr. Naila Zaman Khan, Former Head of the Child Development Center and Neurology Unit, Dhaka Shishu Hospital for her encouragement to work in this field and her advice and training in implementing the RNDA. They also acknowledge Professor Penny Holding for her inspiration in protocol preparation. Special thanks to Dr. Razia Sultana, Pediatrician, Dr. Tofajjal Hossen, Ms. Lutfun Nahar Begum, and Ms. Nazmin-A-Hayat, Child Psychologist, Ms. Pushpita Sen Gupta, Developmental therapist, and other staffs of child development centers of Chattogram Medical College Hospital and Chattogram M…O…Shishu Hospital, all the children enrolled in the study, TQQ + interviewers, and principals of schools from where we enrolled the children.

Disclosure statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Additional information

Funding

This was a sub-study of “Saving Brain: Long-term neurocognitive assessment of children following an episode of severe malaria: The artesunate suppository trial cohort.” This research was sponsored by the University of Oxford. This was funded by Grand Challenges Canada (GCC): Saving Brain Programmes. The Grant number was 0060-03. None of the authors personally had any relevant financial and/or nonfinancial relationships to disclose.