Evaluating Screening Guidelines for Disruptive Behavior Problems in Young Children: A Systematic Review of the Accuracy of Parents' Concerns

Abstract

The burden of suffering associated with disruptive behavior disorders (DBDs) is considerable and may influence the health outcomes of affected individuals across the life course. There is consensus that secondary prevention strategies which target early manifestations of DBDs in young children, known as disruptive behaviour problems (DBPs), are effective in facilitating early intervention and minimizing this burden of suffering. One example of such a strategy can be found within a current Canadian Paediatric Society practice guideline, which recommends that parents' concerns be used to inform decisions to screen for DBPs in children following the 24-month well-child visit until the age of 5 years (Charach, Bélanger, McLennan & Nixon, 2018). It is prudent to ensure accurate screening decisions within these visits, in effort to maximize the efficacy of screening for DBPs within such a program. A systematic review was conducted to determine whether parents' concerns can provide primary care practitioners (PCPs) with enough information to justify a decision in favour of, or against, screening for DBPs, as is currently recommended. 6 electronic databases (Medline (Ovid), Embase (Ovid), Central (Ovid), CINAHL (EBSCOHost), PsycINFO (Ovid), and Eric (Ovid) and Scopus) were searched for diagnostic test accuracy studies that elicited parents' concerns about their child's behavioral, social and/or emotional development, and that measured the presence of DBPs in children aged 0-5 years. Studies that reported proportions of true positive, false positive, false negative, and true negative outcomes (or outcomes from which these measures could be generated) were included. Risk of Bias in eligible studies was assessed using the QUADAS-2. Results from included studies were synthesized to produce calibrated estimates of the accuracy of parents' concerns in the form of weighted kappa coefficients (Kraemer, 1992). Just one study (Glascoe, MacLean & Stone, 1991) met all eligibility and exclusion criteria. Results from this study indicated that only moderate agreement (k(1,0) = 0.533, [0.501; 0.564]) could be found between the absence of DBPs and the absence of parents' concerns. Similarly, only fair agreement (k(0,0) = 0.255, [0.238;0.272]) could be found between the presence of DBPs and the presence of parents' concerns. These results provide some limited evidence that neither the presence, nor absence, of parents' concerns can provide enough accurate information to PCPs to justify decisions in favour of/against screening. However, the ability of systematic search methods to retrieve a sufficiently large body of homogeneous data relevant to this review's research objectives was limited and revealed a gap in the literature. Future research that seeks to replicate the methods of Glascoe et al. (1991) may facilitate more robust analyses of the accuracy of parents' concerns in this context.