ORIGINAL ARTICLE Developmental evaluation at age 4: Validity of an Italian parental questionnaire Anna Maria Dall’Oglio, 1 Barbara Rossiello, 1 Maria Franca Coletti, 1 Maria Cristina Caselli, 5 Lucilla Ravà, 3 Vincenzo di Ciommo, 3 Marcello Orzalesi, 2 Patrizia Giannantoni 4 and Patrizio Pasqualetti 4 1 Unit of Clinical Psychology and Neuropsychology, Child Neuropsychiatry, 2 Neonatal Intensive Care Unit, 3 Unit of Epidemiology, IRCCS Paediatric Hospital Bambino Gesù, 4 AFaR Fatebenefratelli Hospital, Isola Tiberina and 5 Institute of Cognitive Sciences and Technologies, CNR, Rome, Italy Aim: To validate an Italian parental questionnaire designed to evaluate the neuropsychological and behavioural developmental status of 4-year-olds and identify children in need of further evaluation. Methods: The questionnaire (Questionario per la valutazione dello Sviluppo di bambini a 4 anni – Genitori (QS4-G) ) consisted of 93 questions divided into 10 areas: language, visual-motor abilities, memory/attention, fine and gross motor and self-help abilities, lateralisation, social skills, stress, sleep, alimentation and evacuation. It was distributed to 263 parents of 4-year-olds: 94 healthy preterm (gestational age <33 weeks and/or <1500 g, without major neurosensory damage); 44 children with developmental disorders and 125 children with typical development. Cognitive and neuropsychological evaluations were performed using standardised tests. Results: The internal consistency of the areas was adequate (Cronbach’s alpha: 0.69–0.79). The correlation coefficients (r = |0.30|–|0.68|) with standardised tests (Griffiths, Vineland and neuropsychological tests) indicated a good concurrent validity. The receiver operating characteristic curve, for predicting a Griffiths Quotient less than 81, showed an area under the curve of 0.90 and a high diagnostic and discriminatory capacity (sensitivity of 0.88 and specificity of 0.84) for the optimal cut-off (value 48.4). Conclusion: The QS4-G seems to be a valid tool for identifying 4-year-old children at risk for low or borderline cognitive development and/or problematic behaviour who need a complete assessment. It can describe individual neuropsychological profiles. QS4-G is not a diagnostic tool. It is useful for outcome studies in preterm children and in other pathologies. It could also be useful for preschooler prevention programmes. Key words: neuropsychological profiles; parent-report measures; preschool evaluation. Introduction Developmental status in children is best evaluated through direct observation. However, this requires a number of resources and can be time-consuming. For this reason, indirect observation through questionnaires and interviews is often used, given that these tools are both rapid and easy to apply and can be adopted for large-scale screening of neuropsychological disorders, with further evaluations limited to specific cases. 1 Parental questionnaires can be used to identify children at risk for developmental disorders 1–6 and to evaluate those already diagnosed with a genetic, endocrinological, cardiac or neuro- logical pathology. 3,7–9 They can also be used for follow-up sur- veillance programmes and outcome studies 8,9 for children already known to be at risk for neuropsychological disorders (e.g. children with perinatal problems and preterm children). With specific regard to preterm newborns, parental question- naires have often been used to identify children with delays in cognitive and language development. 1,10–14 Some questionnaires/interviews 4–7 explore a wide range of developmental abilities, including motor, language, cognitive, social and adaptive abilities (i.e. ages & stages questionnaires [ASQ], child development inventory [CDI], parent’s evaluation of developmental status [PEDS]), whereas others explore only a few specific cognitive and neuropsychological aspects 15,16 , emo- tional and behavioural development 17–19 , or adaptive and self- help skills 20 . The majority of the above-mentioned questionnaires origi- nated in English, and translated versions 21 require a preliminary cross-linguistic and cross-cultural validation. Moreover, some of Key Points 1 The validity of a new Italian parental questionnaire for devel- opmental evaluation was demonstrated on a sample of 263 children at 4 years of age: 94 healthy preterms, 44 with devel- opmental disorders and 125 with typical development. 2 The questionnaire is divided into 10 neuropsychological and behavioural areas, each of which showed good internal con- sistency (Cronbach’s alpha) and a good concurrent validity with standardised tests that measure the same area. 3 Using a cut-off of 48.4, the QS4-G identified both children with developmental disorders and those at risk for low or with bor- derline cognitive development and/or problematic behaviour (Griffiths Scale score <81). Thus, it could be used by clinicians to identify preschool children in need of further evaluation. Correspondence: Anna Maria Dall’Oglio, Unit of Clinical Psychology and Neuropsychology, Child Neuropsychiatry, IRCCS Paediatric Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165 Rome, Italy. Fax: +39 06 68592450; email: amdalloglio@opbg.net Accepted for publication 6 January 2010. doi:10.1111/j.1440-1754.2010.01748.x Journal of Paediatrics and Child Health 46 (2010) 419–426 © 2010 The Authors Journal compilation © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians) 419