經簡化的臺灣兒童發展量表之設計及其臨床試用

Validation of A Simplified Child Developmental Screening Test in Taiwan

本研究所設計的簡易兒童發展量表是針對嬰幼兒發展，作普遍性、全面性的早期評估，以達早期發現、早期介入治療之目的。量表特點為：（一）配合預防接種在滿四、六、九、十二、十八及二十四個月進行篩檢。（二）追蹤發展之內容為粗動作、精細動作、語言溝通、身邊處理及社會性四大領域，內有兩至三個分項，每一追蹤階段共十個分項，以圖片及文字簡潔表達。（三）測試者簡單明確判定'通過'或'不通過'，通過一分項得10分，每一追蹤階段內十個分項，故滿分100分。（四）不需特定的教材或儀器，故將來可普及化。本量表經多次修正，於三種醫療單位試用，追蹤時若有兩個或以上之發展項目'不通過'，且持續到下一追蹤階段，該個案將適當轉介及追蹤。另在每一追蹤階段，測試項目全通過的個案中隨機選取10位，給予中國兒童發展量表(CCDI)測試，並做效度分析。結果為收案302人，完成追蹤272人，完成率90.1%，因異常而轉介者6位，另24位失去聯絡或死亡。得分90分以上者平均佔92.9%；得分80分以下，且落後兩分項在同一大領域的個案，在下一追蹤時甚少得到滿分，落後分項並非同一大領域時，在追蹤時，得滿分的機會並不少見。故建議使用此量表時，需考慮得分多寡與落後項目是否在同一大領域內。個案性別、出生體重、生產方式、照顧者等因素與測試得分做分析，發現在統計上無相關性，顯示此量表適用範圍良好。

Early diagnosis and intervention for infants with developmental delay is necessary and has proved to have beneficial effects in the field of pediatric rehabilitation. In Taiwan, the Denver Developmental Screening Test (DDST) and the Chinese Children Developmental Inventory (CCDI) are not popular, and are used only in certain medical centers, because the former must be performed by specialists or after training and the latter is composed of over 100 items, making it rather complicated. We designed a simple field screening test which are: 1) Allows a evaluation at the 4th, 6th, 9th, 12th, 18 th, and 24th months of age (matching the times of vaccination); 2) Includes four parts, including gross motor, fine motor, prelingustic communication and personal-social behavior skills (10 tested subitems of each age level); 3) Uses only “Pass” or “Fail” for scoring in the two or three sub-items of each part; and 4) Requires neither specific tools nor special training to complete the test. Three different types of health facilities, including medical centers, district hospitals, and clinics were chosen for the evaluation of this test. A total of 302 subjects who were full term babies and had normal birth history were recruited in the first session of assessment of these, 272 (90.1%) were followed up from 4 months to 2 years of age. Most subjects had mild delay in one to three subitems, but none failed more than five of the 10 tested subitems of each age level. The pattern of failed subitems in each tested age level was inconsistent in terms of the four main parts of this test. The inter-rater reliability Kappa value was 0.71 ± 0.30. The validity was high in 13 items among the total 60 items, as compared with CCDI. Not only the number of the failed subitems but also the type were of concern in terms of developmental status of individuals, for those failed subitems which fell under the same category, poor development scoring would be attained in the next evaluation. Our results indicate this new test scale can be used as a screening tool in the community to achieve the aim of early detection and early intervention.