Article Text

Download PDFPDF
Comparison of parent or caregiver-completed development screening tools with Bayley Scales of Infant Development: a systematic review and meta-analysis
  1. Haribalakrishna Balasubramanian1,
  2. Javed Ahmed2,
  3. Anitha Ananthan3,
  4. Lakshmi Srinivasan4,
  5. Diwakar Mohan5
  1. 1Department of Neonatology, Surya Hospitals, Mumbai, Maharashtra, India
  2. 2Department of Neonatology, McMaster Childrens Hospital and McMaster University, Hamilton, Ontario, Canada
  3. 3Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
  4. 4Department of Pediatrics, The Childrens Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  5. 5Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Haribalakrishna Balasubramanian, Neonatology, Surya Hospitals, Mumbai, Maharashtra 400002, India; drhari{at}


Background Parent/caregiver-completed developmental testing (PCDT) is integral to developmental care in children; however, there is limited information on its accuracy. In this systematic review, we compared the diagnostic accuracy of PCDT with concurrently administered Bayley Scales of Infant Development for detection of developmental delay (DD) in children below 4 years of age.

Methods We searched databases PubMed, Embase, CINAHL, PsycINFO and Google Scholar until November 2023. Bivariate and multiple thresholds summary receiver operating characteristics were used to obtain the summary sensitivity and specificity with 95% CIs. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used for risk of bias assessment.

Results A total of 38 studies (31 in the meta-analysis) were included. Ages and Stages Questionnaire (ASQ) and Parent Report of Children’s Abilities-Revised (PARCA-R) were the most commonly evaluated PCDTs. ASQ score >2 SD below the mean had an overall sensitivity of 0.72 (0.6, 0.82) and 0.63 (0.50, 0.75) at a median specificity of 0.89 (0.82, 0.94) and 0.81 (0.76, 0.86) for diagnosing moderate to severe DD and severe DD, respectively. PARCA- R had an overall sensitivity of 0.69 (0.51, 0.83) at median specificity of 0.75 (0.64, 0.83) for predicting severe DD. Participant selection bias and partial verification bias were found in over 50% of the studies. The certainty of evidence was low for the studied outcomes.

Conclusions The most commonly studied parental tools, ASQ and PARCA-R, have moderate to low sensitivity and moderate specificity for detecting DD in young children. High risk of bias and heterogeneity in the available data can potentially impact the interpretation of our results.

PROSPERO registration number CRD42021268629.

  • Child Development
  • Infant Development
  • Paediatrics

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

View Full Text


  • X @anitha

  • Contributors HB conceptualised the study, carried out the data analysis and drafted the first version of the paper. JA and AA conducted literature search and data curation and critically reviewed the manuscript. LS and DM provided supervision during this process and critically reviewed the manuscript. All authors approved the final version of this manuscript. HB is responsible for the overall content as the guarantor of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.