Psychometric properties of the Rapid Neurodevelopmental Assessment in detecting social- emotional problems during routine child developmental monitoring in primary healthcare

Psychometric properties of the Rapid Neurodevelopmental Assessment in detecting social- emotional problems during routine child developmental monitoring in primary healthcare | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychometric properties of the Rapid Neurodevelopmental Assessment in detecting social- emotional problems during routine child developmental monitoring in primary healthcare Tia Campbell, Dianne C. Shanley, Marjad Page, Theresa McDonald, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4652892/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Apr, 2025 Read the published version in BMC Primary Care → Version 1 posted 4 You are reading this latest preprint version Abstract Background The global prevalence of social-emotional problems in children and adolescents is nearly double in First Nations populations compared to non-First Nations, highlighting health inequities due to the impact of colonisation. Addressing this requires culturally responsive social-emotional screening in primary health, enhanced by a simple, psychometrically sound tool. The Rapid Neurodevelopmental Assessment, Australian Edition (RNDA:Australia), is user-friendly, incorporates child observations and parental input, and can be used by primary healthcare providers. This study evaluated the RNDA:Australia’s performance in screening social-emotional problems during routine health checks with First Nations children. Methods Working with an Aboriginal Community Controlled Health Organisation in Australia, children (60% male, 92% identifying as First Nations) aged 3 to 16 years ( M = 8.40, SD = 3.33) and a caregiver participated in this study as part of a health check. The convergence with, and accuracy of, children’s scores derived from single-item measures of seven social-emotional problems on the RNDA:Australia was compared to their corresponding multi-item scores from the parent-report Behavior Assessment System for Children 3rd Edition (BASC-3). Results Each of the single-items measures on the RNDA:Australia were significantly correlated with the corresponding multi-item construct on the BASC-3, except for anxiety. The total accuracy of the RNDA:Australia relative to the BASC-3 was 58 to 81%, with high sensitivity for four of the seven items: hyperactivity (90%), attention problems (87%), externalising problems (82%) and behaviour symptoms index (88%). Sensitivity of the remaining items ranged from 14–71% and specificity ranged from 29–88%. The measure showed an average positive predictive value of 50% and negative predictive value of 75%. Conclusions The single-item measures within the RNDA:Australia’s behaviour domain showed good convergent validity relative to the BASC-3. Most items had acceptable accuracy, comparable with similar screening measures. These findings further support the RNDA:Australia’s integration into First Nations’ child health checks, allowing for a rapid, holistic assessment of child development to improve health equity. First Nations children adolescents primary healthcare social-emotional problems screening RNDA psychometric Introduction The estimated global prevalence of social-emotional problems (i.e., issues that affect mood, thinking, and behaviour such as depression, anxiety, and neurodevelopmental disorders) affecting children and adolescents is approximately 14% 1 , with the prevalence more than doubling in First Nations populations world-wide, such as in Canada (33%), Australia (30%), New Zealand (30%), and America (20%) 2 . Such discrepancies in prevalence rates, like broader health inequities in First Nations populations, are rooted in the ongoing consequences of colonisation (e.g., displacement from land, loss of cultural continuity, oppression, and exploitation of marginalised groups). Colonisation has significantly influenced the social determinants of health, or the conditions in which people are born, grow, live, and work, such as socioeconomic status (SES), education, environment, employment, and access to healthcare 3 . These social determinants disproportionately affect marginalised communities and perpetuate a cycle of inequity, further cementing stark differences in health outcomes among certain populations 4 . The effects of colonisation on First Nations populations worldwide are profound and enduring, with particular evidence of the impact on social determinants of health 5 . One example is poverty, which is the primary driver of numerous health disparities among First Nations communities and is a direct result of the dispossession of First Nations peoples from their lands and resources by colonial powers. This disruption of traditional ways of life, policies of displacement, and racial segregation of First Nations peoples led to education disparities, economic disenfranchisement and loss of self-determination for many First Nations groups. These social determinants, in addition to systemic discrimination of First Nations people, and geographic isolation perpetuate cycles of inequity that persist today 6 . Efforts to address these disparities must prioritise the provision of culturally responsive healthcare, screening, and support strategies by professionals that understand the unique needs and perspectives of First Nations communities 2 . In Australia, annual health checks conducted by Aboriginal Health Workers/Practitioners (AHW/Ps) play a crucial role in bridging the current healthcare gap. AHW/Ps are ideally placed to conduct such health checks given their invaluable knowledge and understanding of the unique needs, cultural nuances, and historical contexts of Australia’s First Nations communities 7 . The effectiveness of health screening, specifically as it relates to child development and social-emotional wellbeing, can be significantly enhanced through the utilisation of culturally acceptable and psychometrically sound tools. Most psychometrically sound tools assessing child development require administration by qualified specialists, are expensive, and difficult to access in primary healthcare 8 . This contributes to health system inequities by creating assessment and treatment bottlenecks, especially in rural and remote regions, where there is a high turnover of specialists 9,10,11 and access to developmental assessment services and allied health support is limited 7 . Concerns also extend to the appropriateness of these tools for children from families of lower SES, a significant demographic in rural and remote communities 12 , given that the most popular tools for developmental screening and assessment were developed in the USA or Britain and validated on samples of urban children from families of high SES. However, there is an opportunity to address the limitations of current screening tools available to the primary healthcare sector with a relatively new measure, the Rapid Neurodevelopmental Assessment, Australian Edition (RNDA:Australia) 13 . The Rapid Neurodevelopmental Assessment The RNDA is a cost-effective, observational, and functional assessment of neurodevelopmental impairment across ten domains (primitive reflexes, gross motor, fine motor, vision, speech/expressive language, hearing, cognition, behaviour, self-care, and seizures) for children from birth to 16 years. The behaviour domain includes single-item measures for various social-emotional problems, including anxiety, atypicality, and attention. A recent editorial 14 identified multiple advantages of single-item measures in psychological research, emphasising their efficiency and utility, especially in time-restricted conditions and with more vulnerable populations. Originally developed in Bangladesh and validated specifically for use in low-income countries 15,16,17, the RNDA has been modified to better suit the Australian context and digitised to increase accessibility and ease of use. The RNDA:Australia provides valuable information about the type and severity of symptoms and can be completed by a broad range of healthcare practitioners. Further, administration and scoring of the RNDA:Australia takes an average of 30 minutes, whereas a comprehensive assessment of social-emotional problems by a physician and/or a psychologist would take approximately three hours or more 17 . Such comprehensive assessments often include clinician observations, interviews, and the scoring and interpretation of caregiver-completed measures such as the Behavior Assessment System for Children 3rd Edition (BASC-3) 18 . This laborious, and often expensive, process places undue burden on the family and society at large given the bottlenecks it creates in assessment and access to early intervention. While the current body of research on the original RNDA has shown promising interrater reliability and concurrent validity, these studies were undertaken in Bangladesh and Guatemala, with evidence of the measure’s utility in Australia still emerging. Furthermore, the original RNDA has previously shown acceptable sensitivity (70–83%) and moderate specificity (57–84%), but only as it relates to the identification of intellectual impairment 17,19 . The accuracy of the RNDA:Australia as a tool to identify social-emotional problems, such as emotional, behavioural, and other neurodevelopmental problems is yet to be demonstrated. The RNDA:Australia not only overcomes the limitations of commonly used measures, particularly in resource-limited communities, it also offers valuable insights into the type and intensity of symptoms, making it a strong candidate for integration into annual health check protocols in primary healthcare in place of other popular screeners. The social-emotional wellbeing section of the RNDA:Australia relies on single-item screeners, which if valid, provides a very economical and efficient addition to triage protocols. Uncovering evidence of the RNDA:Australia’s accuracy in identifying social-emotional problems in a sample of Australian First Nations children and adolescents further strengthens the case for its integration into routine developmental monitoring during health checks for First Nations children. Study aims The aims of this study were to evaluate the concurrent validity and the accuracy of healthcare providers responses to the RNDA:Australia across seven social-emotional problem constructs. The RNDA:Australia included single items for each construct, which are assessed based on observations of child (aged 3 to 16 years) and parent information. The reference test was the Behavior Assessment System for Children 3rd Edition (BASC-3) completed by a caregiver. It is hypothesised that: ( 1 ) the single- RNDA:Australia items used to assess social-emotional problems will be significantly correlated with the comparable multi-item composite score derived from the BASC-3 (see Table 1 ); ( 2 ) the RNDA:Australia will show acceptable accuracy (≥ 80% sensitivity and specificity) in identifying children who have scored above the clinical cut off (i.e., T- score 65 or above) on comparable scales on the BASC-3, as well as moderate positive predictive value (PPV) and high negative predictive value (NPV) in line with expectations for screening measures 20 . Methods Study setting and participants This project was undertaken in partnership with an Aboriginal Community Controlled Health Organisation (ACCHO), which has a catchment area spanning approximately 640,000 km 2 , one of the largest covered by a single ACCHO in Queensland, Australia. Ethical clearance was granted by the Griffith University Human Research Ethics Committee (2022/362) and permission from the committee representing the local Traditional Owners of the Land was granted. The focal participants were 84 children (60% male, 92% First Nations) who underwent a health check between 2019 and 2022, and had their development screened using both the RNDA:Australia and the BASC-3. Children were aged 3 to 16 years ( M = 8.40, SD = 3.33). Of the participants where the administrator of the RNDA:Australia was documented, 87% were completed by healthcare workers who identify as First Nations, 5% by a general practitioner who identifies as First Nations, and 5% by a speech pathologist. Caregivers who answered questions for the RNDA:Australia and completed the BASC-3 attended the health check appointment with the child and were biological mothers ( n = 40; 48%), other family members (i.e., siblings, grandparents, aunties/uncles; n = 26; 31%), or foster mothers ( n = 9; 11%). Most children reported identifying with more than one Nation group, with 24% of participants identifying as Kalkadoon, 21% Waanyi, and 12% Waliwarra. All families were from a “very remote” region, as classified by the Modified Monash (MM) Model (MM 7 = very remote) 21 . During the data collection period, there were 90 children that had undergone a health check. However, one participant was excluded because they were younger than 24 months and had been screened using different RNDA:Australia items than all other participants. Another five participants were excluded due to missing scores on individual items on the RNDA:Australia, which were required for the analyses in this study. Measures The Behavior Assessment System for Children 3rd Edition (BASC-3). For the current study, the BASC-3 Parent Rating Scale (PRS) was used as the reference measure. The BASC-3 was designed for assessing behavioural and emotional problems in children and adolescents and has three forms: preschool (2-5yrs), child (6-11yrs), and adolescent (12-21yrs). With an estimated administration time of 20 minutes, the BASC-3 has over 170 items that are descriptions of observable positive or negative behaviours. The caregiver responds to each item with Never (0 points), Sometimes (1 point), Often (2 points), or Almost always (3 points). Items are summed according to the scale to which they belong, yielding a raw score, which is then converted to a normative T score. Higher scores indicate more problems. The current study utilised gender-specific norms. T scores are computed for 4 content scales and 15 subscales, including hyperactivity, anxiety, and emotional self-control, as well as composite scores for externalising problems (hyperactivity + aggression + conduct problems) and a behavioural symptoms index (attention problems + atypicality + withdrawal). Table 1 outlines the 11 BASC-3 subscales that align with the RNDA:Australia behaviour domain items relevant to this study. The BASC-3 has been shown to have strong psychometric properties, with high internal consistency and test-retest reliability (α = ≥ .80) and excellent sensitivity (.95 − .97) and specificity (.79 − .80) 22 . Additionally, while the BASC-3 relies on a USA normative sample, Tan and colleagues 23 found evidence to support its cross-cultural validity among Australian children. To assess convergence, t-scores were used in correlational analyses. For calculations of sensitivity, specificity, total accuracy, positive predictive value, and negative predictive value, BASC-3 scores were dichotomized using a cut-off score of 1.5 standard deviations from the mean (1 = 65 or greater t-score, 2 = 65 or lower t-score). A cut off score of 1.5 standard deviations from the mean was selected as this is a common cut point for categorising children and adolescents at-risk for psychological and behavioural problems on a range of assessment instruments 24 . RNDA:Australia Due to normative developmental changes in children, the RNDA:Australia has 31 age-specific screening forms. Each form has screening questions for neurodevelopment across nine domains (gross & fine motor, vision, hearing, speech, cognition, behaviour, self-care & seizures). The current study examined the eight items within the behaviour domain, which are designed to be single-item measures of eight developmental and social-emotional problems. Some of these items were combined to create two additional subscales correspondent to the BASC-3 (i.e., externalising problems & behavioural symptoms index; see Table 1 ). Items are brief and draw attention to both strengths and weaknesses in social-emotional functioning. When reading the items to a caregiver, providers can flexibly adapt the wording of items according to the standards outlined in the manual. Scores for each of the single-item measures within the behaviour domain are based on caregiver report to the healthcare provider (caregiver recall) and provider-observation during the assessment. For children under 5 years, individual items are scored as No concern (i.e., no impact on functioning; 0), Mild concern (i.e., minor limitations on functioning; 0.5), Moderate concern (i.e., mild to severe functional limitations; 1), or Severe concern (i.e., symptoms result in marked limitation in social, peer group, or occupational functioning and difficulty in management by family; 2). For children over 5 years, items are scored as No concern ( 1 ) or Impairment ( 2 ). There are some items relating to social-emotional problems that remain consistent across all age ranges (e.g., withdrawal, atypicality, attention problems), and some that emerge from age 5 (e.g., aggression, conduct problems). For correlational analyses to assess convergence, the nominal data was used. However, given the different scoring mechanisms across the age ranges, to run cross-tabulations for calculation of accuracy, scores for participants under 5 years were dichotomised and all scores were reverse coded where a score of 1 = Impairment and 2 = No impairment . Table 1 outlines how each of the relevant RNDA:Australia items align with subscales measuring corresponding constructs on the BASC-3. Table 1 Alignment of RNDA:Australia behaviour domain items with constructs on the BASC-3 BASC Subscale RNDA:Australia Item & Age Hyperactivity • Hyperactive (5 + years) Aggression • Acts very aggressively towards other people (5 + years) • Acts very aggressively towards other people (fights/bullies; 10 + years) Conduct problems • Steals/lies/cheats (10 + years) Externalising problems • Sum of items endorsed (hyperactive + aggression + conduct problems; correlational analysis) • Endorsement of 1 or more of the above (accuracy analyses) Attention problems • Good attention to tasks (< 5 years) • Inattentive (5 + years) Atypicality • No restricted, repetitive, stereotypic behaviour, interest and activity (< 5 years) • Shows odd/unusual behaviour (5 + years) Withdrawal • Sociable (< 5 years) • Acts extremely withdrawn and shy (5 + years) Behavioural Symptoms Index (BSI) • Sum of items endorsed (attention + atypicality + withdrawal; correlational analysis) • Endorsement of 1 or more of the above (accuracy analyses) Anxiety • Extreme fear (5 + years) Emotional Self-control • Temper tantrums (5 + years) Data collection tools and procedure The health check comprised of several components, including: ( 1 ) demographic details; ( 2 ) cultural connections; ( 3 ) prenatal, developmental, educational, medical, and social history; ( 4 ) developmental screening utilising the RNDA:Australia; ( 5 ) clinical observations (vitals); ( 6 ) body systems review and physical examination (for detailed description of the health check see 7 ). The Aboriginal Health Workers/Practitioners (AHW/Ps) completed components 1–5 and a general medical practitioner completed component 6. Where concerns were raised by a caregiver during the health check or flagged by the RNDA:Australia, the AHW/Ps administered the BASC-3 at a follow-up session with the caregiver, which was then entered and scored digitally using a secure cloud-based scoring system. Families where no concerns were raised during the health check, but who agreed to be contacted for future research, were contacted by phone and asked to complete the BASC-3 over the phone with a university research assistant. Data were entered into a REDCap database 25 developed in partnership with the ACCHO staff members. Health providers were blind to the purpose of this study. Only relevant demographic data, RNDA:Australia scores, and BASC-3 scores were used in the current study. Participants who had completed multiple health checks between 2019 and 2022 were only included in the study once, with the RNDA:Australia and BASC-3 data administered closest in time selected for inclusion. Statistical Analyses Point-biserial correlations ( r pb) were used to draw conclusions about the concurrent validity (convergence) of the RNDA:Australia screening scores (nominal data) compared to the BASC-3 subscale scores (t-scores). Cross-tabulation of dichotomous indicators derived from the RNDA:Australia and BASC-3 results was used to produce the sensitivity, specificity, PPV, NPV, prevalence, and total accuracy of the RNDA:Australia with the BASC-3 used as the reference measure. Results As outlined in Table 2 , correlations between the RNDA:Australia and BASC-3 scores were statistically significant, except for anxiety. Table 2 Correlations between the RNDA:Australia and the BASC-3 for constructs of interest BASC-3 subscale RNDA:Aus item RNDA:Aus coding r pb N (%) Hyperactivity Hyperactive 1 = hyperactive 2 = not hyperactive − .56** 69 (82%) Aggression Acts very aggressively towards other people 1 = aggressive 2 = not aggressive − .46** 70 (83%) Conduct problems Steals/lies/cheats 1 = conduct problems 2 = no conduct problems − .39* 26 (31%) Externalising Hyperactive + aggression + conduct problems 0 = no problems 1 = 1 problem 2 = 2 problems 3 = 3 problems .52** 70 (83%) Attention problems Inattentive 1 = inattentive 2 = not inattentive − .39** 83 (99%) Atypicality Shows odd/unusual behaviour 1 = atypical 2 = typical − .25* 83 (99%) Withdrawal Acts extremely withdrawn and shy 1 = withdrawn 2 = not withdrawn − .27* 84 (100%) Behavioural symptoms index (BSI) Attention problems + atypicality + withdrawal 0 = no problems 1 = 1 problem 2 = 2 problems 3 = 3 problems .35** 84 (100%) Anxiety Extreme fear 1 = extreme fear 2 = no extreme fear − .08 67 (80%) Emotional self-control Temper tantrums 1 = temper tantrums 2 = no temper tantrums − .52*** 70 (83%) * p < . 05, ** p < . 01, *** p < . 001. BASC-3 = Behavior Assessment System for Children 3rd Edition, RNDA:Aus = Rapid Neurodevelopmental Assessment: Australia Table 3 outlines the sensitivity, specificity, total accuracy, prevalence (as indicated by the BASC-3), PPV, and NPV, of the RNDA:Australia when compared to the BASC-3 on each of the corresponding constructs. The sensitivity of the RNDA:Australia ranged from 14 to 90% and the specificity ranged from 24 to 94%. The PPV ranges from 7 to 79% and the NPV ranges from 63 to 90%. Table 3 Percentage values for assessing the accuracy of the RNDA:Australia when compared to the BASC-3 BASC-3 subscale (1 = Clinical, 2 = Not) RNDA:Aus construct (1 = Problem, 2 = Not) Sensitivity, % Specificity, % Total Accuracy, % PPV, % NPV, % Prevalence n (%) as indicated by BASC-3 Hyperactivity Hyperactivity 90 67 77 67 90 30 (43) Aggression Aggression 53 85 68 79 63 36 (51) Conduct problems Conduct problems 44 88 81 67 75 9 ( 35 ) Externalising problems Endorse 1 or more (hyperactivity, aggression, conduct problems) 82 43 61 56 73 33 (47) Attention problems Attention problems 87 53 69 61 83 38 (46) Atypicality Atypicality 56 73 66 59 71 34 (41) Withdrawal Withdrawal 58 74 69 50 80 26 ( 31 ) Behavioral Symptoms Index Endorse 1 or more (attention, atypicality, withdrawal) 88 29 58 55 71 42 (50) Anxiety Extreme fear 14 78 72 7 89 7 ( 10 ) Emotional self-control Temper tantrums 71 71 71 52 85 21 ( 30 ) * p < . 05, ** p < . 01, *** p < . 001, BASC-3 = Behavior Assessment System for Children 3rd Edition, RNDA:Aus = Rapid Neurodevelopmental Assessment: Australia, PPV = positive predictive value, NPV = negative predictive value. Discussion The RNDA:Australia behaviour domain contains a set of single items designed to screen for a range of childhood social-emotional problems. The use of single items makes the measure a time and cost-effective way to identify strengths, impairments, and need for further assessment and intervention. The use of single-item measures within the RNDA:Australia, if valid, to screen for social-emotional problems in primary healthcare is advantageous in terms of time-efficiency and clinical utility, especially in rural and remote First Nations’ communities where turnover of specialists, and demand for screening is high. Allen and colleagues 14 argue that single-item measures are acceptable when constructs are unidimensional, clearly defined, and narrow in scope, stating that face validity and convergent validity are two of the common ways to validate such measures. The current study aimed to validate single-item measures on the RNDA:Australia against multi-item reliable and valid subscales on the BASC-3. Statistically significant correlations were found for all single-item measures on the RNDA:Australia, except for anxiety, suggesting that all other items are accurately capturing the desired constructs. These results provide strong evidence that each item within the behaviour domain, except for anxiety, can be considered valid as stand-alone measures. Additionally, these findings validate that the RNDA:Australia can be used as intended, where the individual social-emotional items reveal strengths and impairments in social-emotional functioning, while the total score for the behaviour domain provides insights about the severity of these impairments 13,26 . These findings extend previous research by Khan and colleagues 15,16,17 and Muslima and colleagues 19 and provides further evidence of the convergent validity of the RNDA:Australia behaviour domain when screening for social-emotional problems within Australian First Nation’s children. The weak correlation of the anxiety construct might be attributed to the limited number of participants who endorsed anxiety on the BASC-3. The prevalence of anxiety in the current sample was unusually low at 10%, where the prevalence rate of anxiety for Australia’s First Nations population is approximately 17% 27 . Further, the anxiety-related item (i.e., “does the child have any extreme fears?”) on the RNDA:Australia could be interpreted as referencing only extreme fears or phobias rather than screening for more generalised symptoms of anxiety. The wording “extreme fears” might be too severe and not well associated with anxiety across cultures. For First Nation populations, fear stems from deep-seated traumas such as the Stolen Generation, genocide, and displacement from land and traditional ways of life by colonial powers. While anxiety is a common experience, fear encompasses a distinct set of thoughts and emotions shaped by these profound historical and personal tragedies. Revision of this item may be required to ensure it more accurately captures the construct of anxiety whilst also being culturally appropriate. Words such as worried, concerned, nervous, or uneasy would potentially be better understood by caregivers and more clearly recognised in children. The total accuracy of the RNDA:Australia across social-emotional constructs ranged from 58 to 81%. In community screening programs, where resources are often limited and the goal is to identify at-risk children, higher sensitivity is often prioritised to ensure that no child with social-emotional problems is missed 28 . The RNDA:Australia social-emotional items demonstrated high sensitivity across the constructs of hyperactivity (90%), externalising problems (82%), attention problems (87%), and the behavioural symptoms index (88%) and high specificity for aggression (85%) and conduct problems (88%). Interestingly, other screeners, such as the Ages and Stages Questionnaire (ASQ-3) 29 and the Parents’ Evaluation of Developmental Status: Developmental Milestones 30 , utilise multi-item subscales to assess the same constructs as the stand-alone items on the RNDA:Australia and have comparable sensitivity (i.e., 86% and 83% respectively). On the whole, the sensitivity and specificity values of the social-emotional items on the RNDA:Australia are comparable to other commonly used measures. A systematic review 31 identified related instruments often described in literature and detailed the pooled sensitivity and specificity values for the Pediatric Screening Checklist (Se = 72%, Sp = 88%), Strengths and Difficulties Questionnaire (SDQ; Se = 65%, Sp = 76%), Child Behavior Checklist (Se = 63%, Sp = 84%), Ages and Stages Questionnaire: Social-Emotional (Se = 73%, Sp = 88%), and Brief Infant-Toddler Social Emotional Assessment (Se = 80%, Sp = 82%). Consistent findings were uncovered in another meta-analysis 32 for ADHD symptoms assessed by the SDQ (Se = 59%, Sp = 79%) and the Achenbach System of Empirically Based Assessment (ASEBA) DSM-IV ADHD subscale (Se = 75%, Sp = 81%) and Attention Problems subscale (Se = 73%, Sp = 77%). These reviews corroborate that it is not uncommon for such measures to have higher specificity, despite higher sensitivity being preferred for screening measures. The sample size could have had an effect on the sensitivity and specificity values. Bujang and Adnan 33 utilised PASS software to calculate the minimum sample size required for finding sensitivity and specificity of screening tools. The minimum sample size proposed to find high sensitivity is 163 participants with 49 of these having the disease (prevalence = 30%, power = 0.81). The minimum sample size for finding adequate specificity was 70 with 21 of these having the disease (prevalence = 30%, power = 0.81). Thus, sensitivity may have been more affected by sample size than specificity in the current study. When averaged across all items, the RNDA:Australia showed moderate positive predictive value (PPV) and high negative predictive value (NPV). The moderate PPV indicates that slightly over 50% of the children identified as having a social-emotional problem by the RNDA:Australia were accurately classified. The high NPV suggests the RNDA:Australia accurately identified cases as having no concerns approximately 75% of the time. It is generally desirable for a screening measure to exhibit a higher NPV than PPV, as it indicates better accuracy in ruling out individuals with no problems, thus reducing the risk of false negatives and overlooking children who do have social-emotional problems. These findings further support the RNDA:Australia’s proficiency in correctly ruling out those without social-emotional problems, aligning with the desired criteria for screening measures. A strength of this article was its remote, First Nations sample. Having data from First Nations communities is important because these communities have often been excluded from validity studies 34 . Such evidence is most often generated within dominant culture samples from populated areas and applied to other regions assuming generalisability. This can inadvertently impose incorrect evidence on these communities, perpetuating health inequities 34 . This sample represents a rare demonstration of validity within this population. This was a critical and purposeful decision given that one of the intended purposes of the RNDA:Australia was to be used to improve access to equitable healthcare for these communities. To ensure effective use of the tool for this purpose, validity must be established within these regions. There are challenges inherent in collecting samples from remote regions, and indeed the small sample size which limited the statistical power was a limitation of this sample. Another strength of this study was the single-item nature of the RNDA:Australia, which allowed for the most culturally responsive approach to administration. Culturally responsive administration requires flexibility, whereby those delivering the tool can have the capacity to use wording that places the respondent at ease. This approach was requested by Aboriginal Health Workers/Practitioners (AHW/Ps), who wanted the flexibility to adjust wording within a yarn 35 , which from their perspective would result in a more valid and accurate response. A defining feature of culturally appropriate administration is how the tool is administered. In the current study, the RNDA:Australia was administered predominantly by AHW/Ps, local people who knew the families in community, and were able to easily administer these single-item questions to families in culturally-responsive ways. While the RNDA:Australia’s accuracy requires further validation with additional and larger numbers of children, this study provides evidence that the use of the single-item measures on the RNDA:Australia yield moderate sensitivity and specificity compared to multi-item measures. This seems to be a beneficial trade-off for increased efficiency, utility, and flexibility needed for culturally-responsive administration. Valid single-item social-emotional measures within the RNDA:Australia result in an accessible, quick and easy to administer tool suitable for large-scale screening during routine developmental monitoring in primary healthcare settings. When trained to a standard, AHWP/s, frontline healthcare providers, and other non-specialists can use this tool to reduce barriers to accessing specialist care and start a local support journey, contributing to more equitable healthcare for all. List of abbreviations RNDA:Australia - Rapid Neurodevelopmental Assessment, Australian Edition BASC-3 - Behavior Assessment System for Children 3 rd Edition PPV - Positive predictive value NPV - Negative predictive value SES - Socioeconomic status AHW/Ps - Aboriginal Health Workers/Practitioners ACCHO - Aboriginal Community Controlled Health Organisation ASQ-3 - Ages and Stages Questionnaire PEDS:DM - Parents’ Evaluation of Developmental Status: Developmental Milestones Declarations Ethical approval and consent to participate This study was conducted in accordance with the NHMRC National Statement on Ethical Conduct in Human Research and the NHMRC Ethical conduct in research with Aboriginal and Torres Strait Islander Peoples and communities. Ethical clearance was granted by the Griffith University Human Research Ethics Committee (2022/362) and permission from the committee representing the local Traditional Owners of the Land was granted. Written informed consent was obtained from all study participants. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available due to privacy and ethical considerations. The data contains sensitive personal information of participants from a small remote community and sharing de-identified data publicly risks violating participant confidentiality agreements and Human Research Ethics Committee (HREC) requirements. Interested researchers can reasonably request further information about the study’s methodology and analyses from the corresponding author, Tia Campbell, at [email protected] . Competing interests The authors declare that they have no competing interests. Funding This project was supported by a grant from the Australian Government Department of Health, Drug and Alcohol Program (H1617G038). Funding was provided to establish new diagnostic services and train health professionals within geographic locations that about FASD. The funding body played no role in the design of the study, in the collection, analysis, and interpretation of data, or in the writing of manuscripts. Author’s contributions TC conceptualised the research questions, categorised and cleaned data into a usable format, conducted all data analyses, interpreted results, and prepared the manuscript. DS and EH designed the study, assisted with statistical analyses and interpretation of results, and contributed to writing the manuscript. MP and TM were involved in study design, data collection, and providing cultural supervision and clinical oversight. MZG assisted with conceptualisation of research questions, interpretation of results and providing feedback on manuscript drafts. MH and JW assisted with data collection. All authors read and approved the final manuscript. Acknowledgements We would like to acknowledge the many contributors to this project, without whom this project would not have been possible. We are extremely grateful for the gracious support and feedback given by community members and the professionals working to support them. In particular, we would like to thank Aunty Joan Marshall and Aunty Karen West for their leadership and guidance on this project and within the community. We thank our Community Advisory Group members who willingly provided their perspectives and experiences to guide the conceptualisation and implementation of this project. We thank the children and families, who have bravely travelled on their journey and allowed us to share their path. We would also like to thank our remote health practitioners who started the journey to think differently about how to support child development so that more children could receive care close to home. Specifically, Aunty Shirley Dawson, Kara Rudken, Michelle Parker-Tomlin, Vanessa McDonald, Veronica Sammon, and John Bathern. This project would not have been possible without Sarah Horton’s fantastic management and organisation. Finally, we thank our hardworking research team, which includes Codi White, Wei Liu, Doug Shelton, Natasha Reid and Heidi Webster. References Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual Research Review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015. 10.1111/jcpp.12381 . Lopez-Carmen V, McCalman J, Benveniste T, Askew D, Spurling G, Langham E, et al. Working together to improve the mental health of indigenous children: A systematic review. CYSR. 2019. 10.1016/j.childyouth.2019.104408 . Smylie J, Kirst M, McShane K, Firestone M, Wolfe S, O’Campo P. Understanding the role of Indigenous community participation in Indigenous prenatal and infant-toddler health promotion programs in Canada: A realist review. Soc Sci Med. 2016. 10.1016/j.socscimed.2015.12.019 . Macedo DM, Smithers LG, Roberts RM, Paradies Y, Jamieson LM. Effects of racism on the socio-emotional wellbeing of Aboriginal Australian children. Int J Equity Health. 2019. 10.1186/s12939-019-1036-9 . World Health Organisation. Indigenous Peoples and tackling health inequities summary report. 2002. https://cdn.who.int/media/docs/default-source/documents/gender/revindigenous-peoples-summary-02092213.pdf?sfvrsn=554f3ee3_3 . Accessed 15 Mar 2024. Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. 2015. https://www.aihw.gov.au/getmedia/a5aa4dee-ee6d-4328-ad23-e05df01918b5/18175-chapter1.pdf.aspx . Accessed 15 Mar 2024. Reid N, Page M, McDonald T, Hawkins E, Liu W, Webster H, et al. Integrating cultural considerations and developmental screening into an Australian First Nations child health check. Aust J Prim Health. 2022. /10.1071/PY20300 . Australian Psychological Society. Ethical guidelines for psychological assessment and the use of psychological tests. 2007. https://psychology.org.au/for-members/resource-finder/resources/ethics/ethical-guidelines-psychological-assessment-tests . Accessed 31 March 2024. Vitrikas K, Savard D, Bucaj M. Developmental delay: When and how to screen. AFP. 2017;96:1. Australian Institute of Health and Welfare, Rural. & Remote health, Profile of Rural and Remote Australians - Australian Institute of Health and Welfare. 2019. https://www.aihw.gov.au/reports/rural-remote-australians/rural-remote-health/contents/profile-of-rural-and-remote-australians . Accessed 10 Mar 2024. Ciccia AH, Roizen N, Garvey M, Bielefeld R, Short EJ. Identification of neurodevelopmental disabilities in underserved children using telehealth (INvesT): Clinical trial study design. Contemp Clin Trials. 2015. 10.1016/j.cct.2015.10.004 . Australian Bureau of Statistics. Socio-economic advantage and disadvantaged. In: Census of population and housing: Reflecting Australia. 2016. https://www.abs.gov.au/ausstats/ [email protected] /Lookup/by%20Subject/2071.0~2016~Main%20Features~Socio-Economic%20Advantage%20and%20Disadvantage~123 . Accessed 31 March 2024. Hawkins E, Shanley DC, Khan Z, Muslima H. Rapid Neurodevelopmental Assessment: Australian Edition Administration and Scoring Manual. 2024. Unpublished manuscript. Allen MS, Iliescu D, Greiff S. Single Item Measures in Psychological Science. EJPA. 2022. 10.1027/1015-5759/a000699 . Khan NZ, Muslima H, Begum D, Shilpi AB, Akhter S, Bilkis K, Begum N, Parveen M, Ferdous S, Morshed R, Batra M. Validation of rapid neurodevelopmental assessment instrument for under-two-year-old children in Bangladesh. Pediatrics. 2010. 10.1542/peds.2008-3471 . Khan NZ, Muslima H, Shilpi AB, Begum D, Parveen M, Akter N, Ferdous S, Nahar K, McConachie H, Darmstadt GL. Validation of rapid neurodevelopmental assessment for 2-to 5-year-old children in Bangladesh. Pediatrics. 2013. 10.1542/peds.2011-2421 . Khan NZ, Muslima H, El Arifeen S, McConachie H, Shilpi AB, Ferdous S, Darmstadt GL. Validation of a rapid neurodevelopmental assessment tool for 5 to 9 year-old children in Bangladesh. J Pediatr. 2014. 10.1016/j.jpeds.2013.12.037 . Reynolds CR, Kamphaus RW. Behavior assessment system for children. 3rd ed. Bloomington, MN: Pearson; 2015. Muslima H, Khan NZ, Shilpi AB, Begum D, Parveen M, McConachie H, Darmstadt GL. Validation of a rapid neurodevelopmental assessment tool for 10-to 16‐year‐old young adolescents in Bangladesh. Child Care Health Dev. 2016. 10.1111/cch.12362 . Glascoe FP. Screening for developmental and behavioral problems. Dev Disabil Res Rev. 2005. 10.1002/mrdd.20068 . Australian Government Department of Health and Aged Care. Modified Monash Model. 2019. https://www.health.gov.au/topics/rural-health-workforce/classifications/mmm#:~:text=The%20model%20measures%20remoteness%20and,in%20rural%20and%20remote%20areas . Accessed 24 Mar 2024. Zhou X, Reynolds C, Kamphaus RW. Diagnostic utility of Behavior Assessment System for Children-3 for children and adolescents with autism. Appl Neuropsychol Child. 2021. 10.1080/21622965.2021.1929232 . Tan ATS, Kraska J, Bell K, Costello S. Confirmatory factor analyses of the Behavior Assessment System for Children – Third Edition among an Australian sample. Educ Dev Psychol. 2021. 10.1080/20590776.2021.190718 . Brown-Jacobsen AM, Wallace DP, Whiteside SPH, Multimethod. Multi-informant agreement, and positive predictive value in the identification of child anxiety disorders using the SCAS and ADIS-C. Assessment. 2010; 10.1177/1073191110375792 . Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009. 10.1016/j.jbi.2008.08.010 . Khan NZ, Muslima H. Rapid Neurodevelopmental Assessment of Children (RNDA): Technical manual. Bangladesh Protibondhi Foundation; 2017. Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander Health Survey. 2019. https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/national-aboriginal-and-torres-strait-islander-health-survey/latest-release . Accessed 21 Feb 2024. Kovacs S, Sharp C. Criterion validity of the Strengths and Difficulties Questionnaire (SDQ) with inpatient adolescents. Psychiatry Res. 2014. 10.1016/j.psychres . Squires J, Bricker D, Ages. Stages Questionnaires®, Third Edition (ASQ®-3): A Parent-Completed Child Monitoring System. Baltimore: Paul H. Brookes Publishing Co., Inc; 2009. Glascoe FP, Robertshaw NS, Woods SK. PEDS: Developmental Milestones professionals’ manual. 3rd ed. Nolensville, TN: PEDSTest.com, LLC; 2009. Lavigne JV, Meyers KM, Feldman M. Systematic review: Classification accuracy of behavioral screening measures for use in integrated primary care settings. J Pediatr Psychol. 2016. 10.1093/jpepsy/jsw049 . Mulraney M, Arrondo G, Musullulu H, Iturmendi-Sabater I, Cortese S, Westwood SJ, et al. Systematic review and meta-analysis: Screening tools for Attention-Deficit/Hyperactivity Disorder in children and adolescents. JAACAP. 2021. 10.1016/j.jaac.2021.11.031 . Bujang MA. Requirements for minimum sample size for sensitivity and specificity analysis. JCDR. 2016. 10.7860/JCDR/2016/18129.8744 . Brownson RC, Kumanyika SK, Kreuter MW, Haire-Joshu D. Implementation science should give higher priority to health equity. Implement Sci. 2021. 10.1186/s13012-021-01097-0 . Miller L, Shanley DC, Page M, Webster H, Liu W, Reid N, et al. Preventing drift through continued co-design with a First Nations community: refining the prototype of a tiered FASD assessment. IJERPH. 2022. 10.3390/ijerph191811226 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 11 Apr, 2025 Read the published version in BMC Primary Care → Version 1 posted Editorial decision: Revision requested 05 Jul, 2024 Editor assigned by journal 03 Jul, 2024 Submission checks completed at journal 03 Jul, 2024 First submitted to journal 28 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4652892","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":322993077,"identity":"2c477002-6f9b-4ba3-b900-31f22bee31ec","order_by":0,"name":"Tia Campbell","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABOElEQVRIie2QMUvEMBTHXwgkyxPXDgf3FTqdHgr9Ku2ii4pSuOmGlEJcenVV/BLecvOVQN2cDypaEZwcCsJR5DhM63EWLzoL9gchyT/58V4C0NLyF6Gr2QYaTAsA5GEiqhDr0AB+KUQklzrA1AvCXxVoKKraYeqScB0acDjNoRxOTnZ4INT++0MHGT1/PpP3HeDhxIKh2myM2SRKM78fJUIdxz4iI0F4JV9Q1xtYkBoUsCmwzLuZeVqJXHS6QRBuSd2kddSzgBkUXlBYauXxSai+VuoqtdJ91crSoKBNiayq6OdD2VQs7FlEbioKT5NRXL3FE8lIfCrXeKeQ4YG/68WH3xV+cTvOy3mmf0wleblwHWQ8f8OBcra5Gs+K+Z7po6d6uPWKyEbMYJ0bWR0tfr7R0tLS8n/5AGrpbzsbAZTIAAAAAElFTkSuQmCC","orcid":"","institution":"Griffith University","correspondingAuthor":true,"prefix":"","firstName":"Tia","middleName":"","lastName":"Campbell","suffix":""},{"id":322993081,"identity":"4f214509-4c34-4945-9ada-d5db809db200","order_by":1,"name":"Dianne C. Shanley","email":"","orcid":"","institution":"Griffith University","correspondingAuthor":false,"prefix":"","firstName":"Dianne","middleName":"C.","lastName":"Shanley","suffix":""},{"id":322993082,"identity":"2cdbe89e-3d11-473a-af58-28030b650d0a","order_by":2,"name":"Marjad Page","email":"","orcid":"","institution":"Menzies Health Institute of Queensland","correspondingAuthor":false,"prefix":"","firstName":"Marjad","middleName":"","lastName":"Page","suffix":""},{"id":322993083,"identity":"9264c9af-6a9a-489c-95f6-2f354040709f","order_by":3,"name":"Theresa McDonald","email":"","orcid":"","institution":"North West Hospital and Health Service","correspondingAuthor":false,"prefix":"","firstName":"Theresa","middleName":"","lastName":"McDonald","suffix":""},{"id":322993084,"identity":"46e87560-d385-41cd-b59e-91d60b027c6b","order_by":4,"name":"Melanie Zimmer-Gembeck","email":"","orcid":"","institution":"Griffith University","correspondingAuthor":false,"prefix":"","firstName":"Melanie","middleName":"","lastName":"Zimmer-Gembeck","suffix":""},{"id":322993085,"identity":"825e7cb9-05ac-45cb-8c10-b81333d5b04d","order_by":5,"name":"Megan Hess","email":"","orcid":"","institution":"Griffith University","correspondingAuthor":false,"prefix":"","firstName":"Megan","middleName":"","lastName":"Hess","suffix":""},{"id":322993086,"identity":"81baed96-bc9d-4a24-90db-d76b3557d849","order_by":6,"name":"Jodie Watney","email":"","orcid":"","institution":"Griffith University","correspondingAuthor":false,"prefix":"","firstName":"Jodie","middleName":"","lastName":"Watney","suffix":""},{"id":322993087,"identity":"ca5b8990-80d9-4da3-9c6d-98b47083d917","order_by":7,"name":"Erinn Hawkins","email":"","orcid":"","institution":"Griffith University","correspondingAuthor":false,"prefix":"","firstName":"Erinn","middleName":"","lastName":"Hawkins","suffix":""}],"badges":[],"createdAt":"2024-06-28 07:34:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4652892/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4652892/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12875-025-02807-z","type":"published","date":"2025-04-11T16:05:14+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":80558579,"identity":"738278ff-8540-4790-8f60-492867a21903","added_by":"auto","created_at":"2025-04-14 16:14:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":835821,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4652892/v1/8ade478a-7da5-4e72-a7c8-10e47030010e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychometric properties of the Rapid Neurodevelopmental Assessment in detecting social- emotional problems during routine child developmental monitoring in primary healthcare","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe estimated global prevalence of social-emotional problems (i.e., issues that affect mood, thinking, and behaviour such as depression, anxiety, and neurodevelopmental disorders) affecting children and adolescents is approximately 14%\u003csup\u003e1\u003c/sup\u003e, with the prevalence more than doubling in First Nations populations world-wide, such as in Canada (33%), Australia (30%), New Zealand (30%), and America (20%)\u003csup\u003e2\u003c/sup\u003e. Such discrepancies in prevalence rates, like broader health inequities in First Nations populations, are rooted in the ongoing consequences of colonisation (e.g., displacement from land, loss of cultural continuity, oppression, and exploitation of marginalised groups). Colonisation has significantly influenced the social determinants of health, or the conditions in which people are born, grow, live, and work, such as socioeconomic status (SES), education, environment, employment, and access to healthcare\u003csup\u003e3\u003c/sup\u003e. These social determinants disproportionately affect marginalised communities and perpetuate a cycle of inequity, further cementing stark differences in health outcomes among certain populations\u003csup\u003e4\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe effects of colonisation on First Nations populations worldwide are profound and enduring, with particular evidence of the impact on social determinants of health\u003csup\u003e5\u003c/sup\u003e. One example is poverty, which is the primary driver of numerous health disparities among First Nations communities and is a direct result of the dispossession of First Nations peoples from their lands and resources by colonial powers. This disruption of traditional ways of life, policies of displacement, and racial segregation of First Nations peoples led to education disparities, economic disenfranchisement and loss of self-determination for many First Nations groups. These social determinants, in addition to systemic discrimination of First Nations people, and geographic isolation perpetuate cycles of inequity that persist today\u003csup\u003e6\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eEfforts to address these disparities must prioritise the provision of culturally responsive healthcare, screening, and support strategies by professionals that understand the unique needs and perspectives of First Nations communities\u003csup\u003e2\u003c/sup\u003e. In Australia, annual health checks conducted by Aboriginal Health Workers/Practitioners (AHW/Ps) play a crucial role in bridging the current healthcare gap. AHW/Ps are ideally placed to conduct such health checks given their invaluable knowledge and understanding of the unique needs, cultural nuances, and historical contexts of Australia\u0026rsquo;s First Nations communities\u003csup\u003e7\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe effectiveness of health screening, specifically as it relates to child development and social-emotional wellbeing, can be significantly enhanced through the utilisation of culturally acceptable and psychometrically sound tools. Most psychometrically sound tools assessing child development require administration by qualified specialists, are expensive, and difficult to access in primary healthcare\u003csup\u003e8\u003c/sup\u003e. This contributes to health system inequities by creating assessment and treatment bottlenecks, especially in rural and remote regions, where there is a high turnover of specialists\u003csup\u003e9,10,11\u003c/sup\u003e and access to developmental assessment services and allied health support is limited\u003csup\u003e7\u003c/sup\u003e. Concerns also extend to the appropriateness of these tools for children from families of lower SES, a significant demographic in rural and remote communities\u003csup\u003e12\u003c/sup\u003e, given that the most popular tools for developmental screening and assessment were developed in the USA or Britain and validated on samples of urban children from families of high SES. However, there is an opportunity to address the limitations of current screening tools available to the primary healthcare sector with a relatively new measure, the Rapid Neurodevelopmental Assessment, Australian Edition (RNDA:Australia)\u003csup\u003e13\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eThe Rapid Neurodevelopmental Assessment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe RNDA is a cost-effective, observational, and functional assessment of neurodevelopmental impairment across ten domains (primitive reflexes, gross motor, fine motor, vision, speech/expressive language, hearing, cognition, behaviour, self-care, and seizures) for children from birth to 16 years. The behaviour domain includes single-item measures for various social-emotional problems, including anxiety, atypicality, and attention. A recent editorial\u003csup\u003e14\u003c/sup\u003e identified multiple advantages of single-item measures in psychological research, emphasising their efficiency and utility, especially in time-restricted conditions and with more vulnerable populations.\u003c/p\u003e\u003cp\u003eOriginally developed in Bangladesh and validated specifically for use in low-income countries\u003csup\u003e15,16,17,\u003c/sup\u003e the RNDA has been modified to better suit the Australian context and digitised to increase accessibility and ease of use. The RNDA:Australia provides valuable information about the type and severity of symptoms and can be completed by a broad range of healthcare practitioners. Further, administration and scoring of the RNDA:Australia takes an average of 30 minutes, whereas a comprehensive assessment of social-emotional problems by a physician and/or a psychologist would take approximately three hours or more\u003csup\u003e17\u003c/sup\u003e. Such comprehensive assessments often include clinician observations, interviews, and the scoring and interpretation of caregiver-completed measures such as the Behavior Assessment System for Children 3rd Edition (BASC-3)\u003csup\u003e18\u003c/sup\u003e. This laborious, and often expensive, process places undue burden on the family and society at large given the bottlenecks it creates in assessment and access to early intervention.\u003c/p\u003e\u003cp\u003eWhile the current body of research on the original RNDA has shown promising interrater reliability and concurrent validity, these studies were undertaken in Bangladesh and Guatemala, with evidence of the measure\u0026rsquo;s utility in Australia still emerging. Furthermore, the original RNDA has previously shown acceptable sensitivity (70\u0026ndash;83%) and moderate specificity (57\u0026ndash;84%), but only as it relates to the identification of intellectual impairment\u003csup\u003e17,19\u003c/sup\u003e. The accuracy of the RNDA:Australia as a tool to identify social-emotional problems, such as emotional, behavioural, and other neurodevelopmental problems is yet to be demonstrated.\u003c/p\u003e\u003cp\u003eThe RNDA:Australia not only overcomes the limitations of commonly used measures, particularly in resource-limited communities, it also offers valuable insights into the type and intensity of symptoms, making it a strong candidate for integration into annual health check protocols in primary healthcare in place of other popular screeners. The social-emotional wellbeing section of the RNDA:Australia relies on single-item screeners, which if valid, provides a very economical and efficient addition to triage protocols. Uncovering evidence of the RNDA:Australia\u0026rsquo;s accuracy in identifying social-emotional problems in a sample of Australian First Nations children and adolescents further strengthens the case for its integration into routine developmental monitoring during health checks for First Nations children.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy aims\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe aims of this study were to evaluate the concurrent validity and the accuracy of healthcare providers responses to the RNDA:Australia across seven social-emotional problem constructs. The RNDA:Australia included single items for each construct, which are assessed based on observations of child (aged 3 to 16 years) and parent information. The reference test was the Behavior Assessment System for Children 3rd Edition (BASC-3) completed by a caregiver. It is hypothesised that: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) the single- RNDA:Australia items used to assess social-emotional problems will be significantly correlated with the comparable multi-item composite score derived from the BASC-3 (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e); (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) the RNDA:Australia will show acceptable accuracy (\u0026ge;\u0026thinsp;80% sensitivity and specificity) in identifying children who have scored above the clinical cut off (i.e., T- score 65 or above) on comparable scales on the BASC-3, as well as moderate positive predictive value (PPV) and high negative predictive value (NPV) in line with expectations for screening measures\u003csup\u003e20\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eStudy setting and participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis project was undertaken in partnership with an Aboriginal Community Controlled Health Organisation (ACCHO), which has a catchment area spanning approximately 640,000 km\u003csup\u003e2\u003c/sup\u003e, one of the largest covered by a single ACCHO in Queensland, Australia. Ethical clearance was granted by the Griffith University Human Research Ethics Committee (2022/362) and permission from the committee representing the local Traditional Owners of the Land was granted.\u003c/p\u003e\u003cp\u003eThe focal participants were 84 children (60% male, 92% First Nations) who underwent a health check between 2019 and 2022, and had their development screened using both the RNDA:Australia and the BASC-3. Children were aged 3 to 16 years (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.40, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.33). Of the participants where the administrator of the RNDA:Australia was documented, 87% were completed by healthcare workers who identify as First Nations, 5% by a general practitioner who identifies as First Nations, and 5% by a speech pathologist. Caregivers who answered questions for the RNDA:Australia and completed the BASC-3 attended the health check appointment with the child and were biological mothers (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;40; 48%), other family members (i.e., siblings, grandparents, aunties/uncles; \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;26; 31%), or foster mothers (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9; 11%). Most children reported identifying with more than one Nation group, with 24% of participants identifying as Kalkadoon, 21% Waanyi, and 12% Waliwarra. All families were from a \u0026ldquo;very remote\u0026rdquo; region, as classified by the Modified Monash (MM) Model (MM 7\u0026thinsp;=\u0026thinsp;very remote)\u003csup\u003e21\u003c/sup\u003e. During the data collection period, there were 90 children that had undergone a health check. However, one participant was excluded because they were younger than 24 months and had been screened using different RNDA:Australia items than all other participants. Another five participants were excluded due to missing scores on individual items on the RNDA:Australia, which were required for the analyses in this study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasures\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eThe Behavior Assessment System for Children 3rd Edition (BASC-3).\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFor the current study, the BASC-3 Parent Rating Scale (PRS) was used as the reference measure. The BASC-3 was designed for assessing behavioural and emotional problems in children and adolescents and has three forms: preschool (2-5yrs), child (6-11yrs), and adolescent (12-21yrs). With an estimated administration time of 20 minutes, the BASC-3 has over 170 items that are descriptions of observable positive or negative behaviours. The caregiver responds to each item with \u003cem\u003eNever\u003c/em\u003e (0 points), \u003cem\u003eSometimes\u003c/em\u003e (1 point), \u003cem\u003eOften\u003c/em\u003e (2 points), or \u003cem\u003eAlmost always\u003c/em\u003e (3 points). Items are summed according to the scale to which they belong, yielding a raw score, which is then converted to a normative T score. Higher scores indicate more problems. The current study utilised gender-specific norms. T scores are computed for 4 content scales and 15 subscales, including hyperactivity, anxiety, and emotional self-control, as well as composite scores for externalising problems (hyperactivity\u0026thinsp;+\u0026thinsp;aggression\u0026thinsp;+\u0026thinsp;conduct problems) and a behavioural symptoms index (attention problems\u0026thinsp;+\u0026thinsp;atypicality\u0026thinsp;+\u0026thinsp;withdrawal). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e outlines the 11 BASC-3 subscales that align with the RNDA:Australia behaviour domain items relevant to this study. The BASC-3 has been shown to have strong psychometric properties, with high internal consistency and test-retest reliability (α = \u0026ge; .80) and excellent sensitivity (.95 \u0026minus;\u0026thinsp;.97) and specificity (.79 \u0026minus;\u0026thinsp;.80)\u003csup\u003e22\u003c/sup\u003e. Additionally, while the BASC-3 relies on a USA normative sample, Tan and colleagues\u003csup\u003e23\u003c/sup\u003e found evidence to support its cross-cultural validity among Australian children.\u003c/p\u003e\u003cp\u003eTo assess convergence, t-scores were used in correlational analyses. For calculations of sensitivity, specificity, total accuracy, positive predictive value, and negative predictive value, BASC-3 scores were dichotomized using a cut-off score of 1.5 standard deviations from the mean (1\u0026thinsp;=\u0026thinsp;65 or greater t-score, 2\u0026thinsp;=\u0026thinsp;65 or lower t-score). A cut off score of 1.5 standard deviations from the mean was selected as this is a common cut point for categorising children and adolescents at-risk for psychological and behavioural problems on a range of assessment instruments\u003csup\u003e24\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRNDA:Australia\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDue to normative developmental changes in children, the RNDA:Australia has 31 age-specific screening forms. Each form has screening questions for neurodevelopment across nine domains (gross \u0026amp; fine motor, vision, hearing, speech, cognition, behaviour, self-care \u0026amp; seizures). The current study examined the eight items within the behaviour domain, which are designed to be single-item measures of eight developmental and social-emotional problems. Some of these items were combined to create two additional subscales correspondent to the BASC-3 (i.e., externalising problems \u0026amp; behavioural symptoms index; see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Items are brief and draw attention to both strengths and weaknesses in social-emotional functioning. When reading the items to a caregiver, providers can flexibly adapt the wording of items according to the standards outlined in the manual.\u003c/p\u003e\u003cp\u003eScores for each of the single-item measures within the behaviour domain are based on caregiver report to the healthcare provider (caregiver recall) and provider-observation during the assessment. For children under 5 years, individual items are scored as \u003cem\u003eNo concern\u003c/em\u003e (i.e., no impact on functioning; 0), \u003cem\u003eMild concern\u003c/em\u003e (i.e., minor limitations on functioning; 0.5), \u003cem\u003eModerate concern\u003c/em\u003e (i.e., mild to severe functional limitations; 1), or \u003cem\u003eSevere concern\u003c/em\u003e (i.e., symptoms result in marked limitation in social, peer group, or occupational functioning and difficulty in management by family; 2). For children over 5 years, items are scored as \u003cem\u003eNo concern\u003c/em\u003e (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) or \u003cem\u003eImpairment\u003c/em\u003e (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). There are some items relating to social-emotional problems that remain consistent across all age ranges (e.g., withdrawal, atypicality, attention problems), and some that emerge from age 5 (e.g., aggression, conduct problems). For correlational analyses to assess convergence, the nominal data was used. However, given the different scoring mechanisms across the age ranges, to run cross-tabulations for calculation of accuracy, scores for participants under 5 years were dichotomised and all scores were reverse coded where a score of 1\u0026thinsp;=\u0026thinsp;\u003cem\u003eImpairment\u003c/em\u003e and 2\u0026thinsp;=\u0026thinsp;\u003cem\u003eNo impairment\u003c/em\u003e. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e outlines how each of the relevant RNDA:Australia items align with subscales measuring corresponding constructs on the BASC-3.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eAlignment of RNDA:Australia behaviour domain items with constructs on the BASC-3\u003c/span\u003e\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eBASC Subscale\u003c/span\u003e\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eRNDA:Australia Item \u0026amp; Age\u003c/span\u003e\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHyperactivity\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; Hyperactive (5\u0026thinsp;+\u0026thinsp;years)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAggression\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; Acts very aggressively towards other people (5\u0026thinsp;+\u0026thinsp;years)\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; Acts very aggressively towards other people (fights/bullies; 10\u0026thinsp;+\u0026thinsp;years)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eConduct problems\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; Steals/lies/cheats (10\u0026thinsp;+\u0026thinsp;years)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eExternalising problems\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; Sum of items endorsed (hyperactive\u0026thinsp;+\u0026thinsp;aggression\u0026thinsp;+\u0026thinsp;conduct problems; correlational analysis)\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; Endorsement of 1 or more of the above (accuracy analyses)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAttention problems\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; Good attention to tasks (\u0026lt;\u0026thinsp;5 years)\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; Inattentive (5\u0026thinsp;+\u0026thinsp;years)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAtypicality\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; No restricted, repetitive, stereotypic behaviour, interest and activity (\u0026lt;\u0026thinsp;5 years)\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; Shows odd/unusual behaviour (5\u0026thinsp;+\u0026thinsp;years)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eWithdrawal\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; Sociable (\u0026lt;\u0026thinsp;5 years)\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; Acts extremely withdrawn and shy (5\u0026thinsp;+\u0026thinsp;years)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eBehavioural Symptoms Index (BSI)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; Sum of items endorsed (attention\u0026thinsp;+\u0026thinsp;atypicality\u0026thinsp;+\u0026thinsp;withdrawal; correlational analysis)\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; Endorsement of 1 or more of the above (accuracy analyses)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAnxiety\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; Extreme fear (5\u0026thinsp;+\u0026thinsp;years)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eEmotional Self-control\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026bull; Temper tantrums (5\u0026thinsp;+\u0026thinsp;years)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e\n\u003cp\u003e\u003cb\u003eData collection tools and procedure\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe health check comprised of several components, including: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) demographic details; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) cultural connections; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) prenatal, developmental, educational, medical, and social history; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) developmental screening utilising the RNDA:Australia; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) clinical observations (vitals); (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) body systems review and physical examination (for detailed description of the health check see\u003csup\u003e7\u003c/sup\u003e). The Aboriginal Health Workers/Practitioners (AHW/Ps) completed components 1\u0026ndash;5 and a general medical practitioner completed component 6. Where concerns were raised by a caregiver during the health check or flagged by the RNDA:Australia, the AHW/Ps administered the BASC-3 at a follow-up session with the caregiver, which was then entered and scored digitally using a secure cloud-based scoring system. Families where no concerns were raised during the health check, but who agreed to be contacted for future research, were contacted by phone and asked to complete the BASC-3 over the phone with a university research assistant. Data were entered into a REDCap database\u003csup\u003e25\u003c/sup\u003e developed in partnership with the ACCHO staff members. Health providers were blind to the purpose of this study. Only relevant demographic data, RNDA:Australia scores, and BASC-3 scores were used in the current study. Participants who had completed multiple health checks between 2019 and 2022 were only included in the study once, with the RNDA:Australia and BASC-3 data administered closest in time selected for inclusion.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatistical Analyses\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePoint-biserial correlations (\u003cem\u003er\u003c/em\u003e\u003csub\u003epb)\u003c/sub\u003e were used to draw conclusions about the concurrent validity (convergence) of the RNDA:Australia screening scores (nominal data) compared to the BASC-3 subscale scores (t-scores). Cross-tabulation of dichotomous indicators derived from the RNDA:Australia and BASC-3 results was used to produce the sensitivity, specificity, PPV, NPV, prevalence, and total accuracy of the RNDA:Australia with the BASC-3 used as the reference measure.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAs outlined in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, correlations between the RNDA:Australia and BASC-3 scores were statistically significant, except for anxiety.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eCorrelations between the RNDA:Australia and the BASC-3 for constructs of interest\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBASC-3 subscale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRNDA:Aus item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRNDA:Aus coding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003csub\u003epb\u003c/sub\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperactivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHyperactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;hyperactive\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;not hyperactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.56**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69 (82%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAggression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eActs very aggressively towards other people\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;aggressive\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;not aggressive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.46**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (83%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConduct problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSteals/lies/cheats\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;conduct problems\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;no conduct problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.39*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (31%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExternalising\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHyperactive +\u003c/p\u003e \u003cp\u003eaggression +\u003c/p\u003e \u003cp\u003econduct problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;=\u0026thinsp;no problems\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;1 problem\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;2 problems\u003c/p\u003e \u003cp\u003e3\u0026thinsp;=\u0026thinsp;3 problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.52**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (83%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttention problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInattentive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;inattentive\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;not inattentive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.39**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e83 (99%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtypicality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShows odd/unusual behaviour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;atypical\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;typical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.25*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e83 (99%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithdrawal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eActs extremely withdrawn and shy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;withdrawn\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;not withdrawn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.27*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBehavioural symptoms index (BSI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAttention problems\u0026thinsp;+\u0026thinsp;atypicality +\u003c/p\u003e \u003cp\u003ewithdrawal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;=\u0026thinsp;no problems\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;1 problem\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;2 problems\u003c/p\u003e \u003cp\u003e3\u0026thinsp;=\u0026thinsp;3 problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.35**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtreme fear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;extreme fear\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;no extreme fear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67 (80%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional self-control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTemper tantrums\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;temper tantrums\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;no temper tantrums\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.52***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (83%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* \u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;.\u003c/em\u003e05, \u003cem\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;.\u003c/em\u003e01, \u003cem\u003e*** p\u0026thinsp;\u0026lt;\u0026thinsp;.\u003c/em\u003e001. \u003cem\u003eBASC-3\u0026thinsp;=\u0026thinsp;Behavior Assessment System for Children 3rd Edition, RNDA:Aus\u0026thinsp;=\u0026thinsp;Rapid Neurodevelopmental Assessment: Australia\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e outlines the sensitivity, specificity, total accuracy, prevalence (as indicated by the BASC-3), PPV, and NPV, of the RNDA:Australia when compared to the BASC-3 on each of the corresponding constructs. The sensitivity of the RNDA:Australia ranged from 14 to 90% and the specificity ranged from 24 to 94%. The PPV ranges from 7 to 79% and the NPV ranges from 63 to 90%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003ePercentage values for assessing the accuracy of the RNDA:Australia when compared to the BASC-3\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBASC-3 subscale\u003c/p\u003e \u003cp\u003e(1\u0026thinsp;=\u0026thinsp;Clinical, 2\u0026thinsp;=\u0026thinsp;Not)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRNDA:Aus construct\u003c/p\u003e \u003cp\u003e(1\u0026thinsp;=\u0026thinsp;Problem, 2\u0026thinsp;=\u0026thinsp;Not)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSensitivity, %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpecificity, %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal Accuracy, %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePPV, %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNPV, %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePrevalence\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e (%) as indicated by BASC-3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperactivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHyperactivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30 (43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAggression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAggression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e36 (51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConduct problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConduct problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9 (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExternalising problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEndorse 1 or more (hyperactivity, aggression, conduct problems)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33 (47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttention problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAttention problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e38 (46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtypicality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAtypicality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e34 (41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithdrawal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWithdrawal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e26 (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBehavioral Symptoms Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEndorse 1 or more (attention, atypicality, withdrawal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtreme fear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional self-control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTemper tantrums\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21 (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e* \u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;.\u003c/em\u003e05, \u003cem\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;.\u003c/em\u003e01, \u003cem\u003e*** p\u0026thinsp;\u0026lt;\u0026thinsp;.\u003c/em\u003e001, \u003cem\u003eBASC-3\u0026thinsp;=\u0026thinsp;Behavior Assessment System for Children 3rd Edition, RNDA:Aus\u0026thinsp;=\u0026thinsp;Rapid Neurodevelopmental Assessment: Australia, PPV\u0026thinsp;=\u0026thinsp;positive predictive value, NPV\u0026thinsp;=\u0026thinsp;negative predictive value.\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe RNDA:Australia behaviour domain contains a set of single items designed to screen for a range of childhood social-emotional problems. The use of single items makes the measure a time and cost-effective way to identify strengths, impairments, and need for further assessment and intervention. The use of single-item measures within the RNDA:Australia, if valid, to screen for social-emotional problems in primary healthcare is advantageous in terms of time-efficiency and clinical utility, especially in rural and remote First Nations\u0026rsquo; communities where turnover of specialists, and demand for screening is high. Allen and colleagues\u003csup\u003e14\u003c/sup\u003e argue that single-item measures are acceptable when constructs are unidimensional, clearly defined, and narrow in scope, stating that face validity and convergent validity are two of the common ways to validate such measures. The current study aimed to validate single-item measures on the RNDA:Australia against multi-item reliable and valid subscales on the BASC-3. Statistically significant correlations were found for all single-item measures on the RNDA:Australia, except for anxiety, suggesting that all other items are accurately capturing the desired constructs. These results provide strong evidence that each item within the behaviour domain, except for anxiety, can be considered valid as stand-alone measures. Additionally, these findings validate that the RNDA:Australia can be used as intended, where the individual social-emotional items reveal strengths and impairments in social-emotional functioning, while the total score for the behaviour domain provides insights about the severity of these impairments\u003csup\u003e13,26\u003c/sup\u003e. These findings extend previous research by Khan and colleagues\u003csup\u003e15,16,17\u003c/sup\u003e and Muslima and colleagues\u003csup\u003e19\u003c/sup\u003e and provides further evidence of the convergent validity of the RNDA:Australia behaviour domain when screening for social-emotional problems within Australian First Nation\u0026rsquo;s children.\u003c/p\u003e \u003cp\u003eThe weak correlation of the anxiety construct might be attributed to the limited number of participants who endorsed anxiety on the BASC-3. The prevalence of anxiety in the current sample was unusually low at 10%, where the prevalence rate of anxiety for Australia\u0026rsquo;s First Nations population is approximately 17%\u003csup\u003e27\u003c/sup\u003e. Further, the anxiety-related item (i.e., \u0026ldquo;does the child have any extreme fears?\u0026rdquo;) on the RNDA:Australia could be interpreted as referencing only extreme fears or phobias rather than screening for more generalised symptoms of anxiety. The wording \u0026ldquo;extreme fears\u0026rdquo; might be too severe and not well associated with anxiety across cultures. For First Nation populations, fear stems from deep-seated traumas such as the Stolen Generation, genocide, and displacement from land and traditional ways of life by colonial powers. While anxiety is a common experience, fear encompasses a distinct set of thoughts and emotions shaped by these profound historical and personal tragedies. Revision of this item may be required to ensure it more accurately captures the construct of anxiety whilst also being culturally appropriate. Words such as worried, concerned, nervous, or uneasy would potentially be better understood by caregivers and more clearly recognised in children.\u003c/p\u003e \u003cp\u003eThe total accuracy of the RNDA:Australia across social-emotional constructs ranged from 58 to 81%. In community screening programs, where resources are often limited and the goal is to identify at-risk children, higher sensitivity is often prioritised to ensure that no child with social-emotional problems is missed\u003csup\u003e28\u003c/sup\u003e. The RNDA:Australia social-emotional items demonstrated high sensitivity across the constructs of hyperactivity (90%), externalising problems (82%), attention problems (87%), and the behavioural symptoms index (88%) and high specificity for aggression (85%) and conduct problems (88%). Interestingly, other screeners, such as the Ages and Stages Questionnaire (ASQ-3)\u003csup\u003e29\u003c/sup\u003e and the Parents\u0026rsquo; Evaluation of Developmental Status: Developmental Milestones\u003csup\u003e30\u003c/sup\u003e, utilise multi-item subscales to assess the same constructs as the stand-alone items on the RNDA:Australia and have comparable sensitivity (i.e., 86% and 83% respectively).\u003c/p\u003e \u003cp\u003eOn the whole, the sensitivity and specificity values of the social-emotional items on the RNDA:Australia are comparable to other commonly used measures. A systematic review\u003csup\u003e31\u003c/sup\u003e identified related instruments often described in literature and detailed the pooled sensitivity and specificity values for the Pediatric Screening Checklist (Se\u0026thinsp;=\u0026thinsp;72%, Sp\u0026thinsp;=\u0026thinsp;88%), Strengths and Difficulties Questionnaire (SDQ; Se\u0026thinsp;=\u0026thinsp;65%, Sp\u0026thinsp;=\u0026thinsp;76%), Child Behavior Checklist (Se\u0026thinsp;=\u0026thinsp;63%, Sp\u0026thinsp;=\u0026thinsp;84%), Ages and Stages Questionnaire: Social-Emotional (Se\u0026thinsp;=\u0026thinsp;73%, Sp\u0026thinsp;=\u0026thinsp;88%), and Brief Infant-Toddler Social Emotional Assessment (Se\u0026thinsp;=\u0026thinsp;80%, Sp\u0026thinsp;=\u0026thinsp;82%). Consistent findings were uncovered in another meta-analysis\u003csup\u003e32\u003c/sup\u003e for ADHD symptoms assessed by the SDQ (Se\u0026thinsp;=\u0026thinsp;59%, Sp\u0026thinsp;=\u0026thinsp;79%) and the Achenbach System of Empirically Based Assessment (ASEBA) DSM-IV ADHD subscale (Se\u0026thinsp;=\u0026thinsp;75%, Sp\u0026thinsp;=\u0026thinsp;81%) and Attention Problems subscale (Se\u0026thinsp;=\u0026thinsp;73%, Sp\u0026thinsp;=\u0026thinsp;77%). These reviews corroborate that it is not uncommon for such measures to have higher specificity, despite higher sensitivity being preferred for screening measures.\u003c/p\u003e \u003cp\u003eThe sample size could have had an effect on the sensitivity and specificity values. Bujang and Adnan\u003csup\u003e33\u003c/sup\u003e utilised PASS software to calculate the minimum sample size required for finding sensitivity and specificity of screening tools. The minimum sample size proposed to find high sensitivity is 163 participants with 49 of these having the disease (prevalence\u0026thinsp;=\u0026thinsp;30%, power\u0026thinsp;=\u0026thinsp;0.81). The minimum sample size for finding adequate specificity was 70 with 21 of these having the disease (prevalence\u0026thinsp;=\u0026thinsp;30%, power\u0026thinsp;=\u0026thinsp;0.81). Thus, sensitivity may have been more affected by sample size than specificity in the current study.\u003c/p\u003e \u003cp\u003eWhen averaged across all items, the RNDA:Australia showed moderate positive predictive value (PPV) and high negative predictive value (NPV). The moderate PPV indicates that slightly over 50% of the children identified as having a social-emotional problem by the RNDA:Australia were accurately classified. The high NPV suggests the RNDA:Australia accurately identified cases as having no concerns approximately 75% of the time. It is generally desirable for a screening measure to exhibit a higher NPV than PPV, as it indicates better accuracy in ruling out individuals with no problems, thus reducing the risk of false negatives and overlooking children who do have social-emotional problems. These findings further support the RNDA:Australia\u0026rsquo;s proficiency in correctly ruling out those without social-emotional problems, aligning with the desired criteria for screening measures.\u003c/p\u003e \u003cp\u003eA strength of this article was its remote, First Nations sample. Having data from First Nations communities is important because these communities have often been excluded from validity studies\u003csup\u003e34\u003c/sup\u003e. Such evidence is most often generated within dominant culture samples from populated areas and applied to other regions assuming generalisability. This can inadvertently impose incorrect evidence on these communities, perpetuating health inequities\u003csup\u003e34\u003c/sup\u003e. This sample represents a rare demonstration of validity within this population. This was a critical and purposeful decision given that one of the intended purposes of the RNDA:Australia was to be used to improve access to equitable healthcare for these communities. To ensure effective use of the tool for this purpose, validity must be established within these regions. There are challenges inherent in collecting samples from remote regions, and indeed the small sample size which limited the statistical power was a limitation of this sample.\u003c/p\u003e \u003cp\u003eAnother strength of this study was the single-item nature of the RNDA:Australia, which allowed for the most culturally responsive approach to administration. Culturally responsive administration requires flexibility, whereby those delivering the tool can have the capacity to use wording that places the respondent at ease. This approach was requested by Aboriginal Health Workers/Practitioners (AHW/Ps), who wanted the flexibility to adjust wording within a yarn\u003csup\u003e35\u003c/sup\u003e, which from their perspective would result in a more valid and accurate response. A defining feature of culturally appropriate administration is how the tool is administered. In the current study, the RNDA:Australia was administered predominantly by AHW/Ps, local people who knew the families in community, and were able to easily administer these single-item questions to families in culturally-responsive ways.\u003c/p\u003e \u003cp\u003eWhile the RNDA:Australia\u0026rsquo;s accuracy requires further validation with additional and larger numbers of children, this study provides evidence that the use of the single-item measures on the RNDA:Australia yield moderate sensitivity and specificity compared to multi-item measures. This seems to be a beneficial trade-off for increased efficiency, utility, and flexibility needed for culturally-responsive administration. Valid single-item social-emotional measures within the RNDA:Australia result in an accessible, quick and easy to administer tool suitable for large-scale screening during routine developmental monitoring in primary healthcare settings. When trained to a standard, AHWP/s, frontline healthcare providers, and other non-specialists can use this tool to reduce barriers to accessing specialist care and start a local support journey, contributing to more equitable healthcare for all.\u003c/p\u003e"},{"header":"List of abbreviations","content":"\u003cul\u003e\n \u003cli\u003eRNDA:Australia - Rapid Neurodevelopmental Assessment, Australian Edition\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBASC-3 - Behavior Assessment System for Children 3\u003csup\u003erd\u003c/sup\u003e Edition\u003c/li\u003e\n \u003cli\u003ePPV - Positive predictive value\u003c/li\u003e\n \u003cli\u003eNPV - Negative predictive value\u003c/li\u003e\n \u003cli\u003eSES - Socioeconomic status\u003c/li\u003e\n \u003cli\u003eAHW/Ps - Aboriginal Health Workers/Practitioners\u003c/li\u003e\n \u003cli\u003eACCHO - Aboriginal Community Controlled Health Organisation\u003c/li\u003e\n \u003cli\u003eASQ-3 - Ages and Stages Questionnaire\u003c/li\u003e\n \u003cli\u003ePEDS:DM - Parents\u0026rsquo; Evaluation of Developmental Status: Developmental Milestones\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the NHMRC National Statement on Ethical Conduct in Human Research and the NHMRC Ethical conduct in research with Aboriginal and Torres Strait Islander Peoples and communities. Ethical clearance was granted by the Griffith University Human Research Ethics Committee (2022/362) and permission from the committee representing the local Traditional Owners of the Land was granted. Written informed consent was obtained from all study participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to privacy and ethical considerations. The data contains sensitive personal information of participants from a small remote community and sharing de-identified data publicly risks violating participant confidentiality agreements and Human Research Ethics Committee (HREC) requirements. Interested researchers can reasonably request further information about the study\u0026rsquo;s methodology and analyses from the corresponding author, Tia Campbell, at [email protected].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was supported by a grant from the Australian Government Department of Health, Drug and Alcohol Program (H1617G038). Funding was provided to establish new diagnostic services and train health professionals within geographic locations that about FASD. The funding body played no role in the design of the study, in the collection, analysis, and interpretation of data, or in the writing of manuscripts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTC\u0026nbsp;conceptualised the research questions, categorised and cleaned data into a usable format, conducted all data analyses, interpreted results, and prepared the manuscript. DS and EH designed the study, assisted with statistical analyses and interpretation of results, and contributed to writing the manuscript. MP and TM were involved in study design, data collection, and providing cultural supervision and clinical oversight. MZG assisted with conceptualisation of research questions, interpretation of results and providing feedback on manuscript drafts. MH and JW assisted with data collection.\u0026nbsp;All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge the many contributors to this project, without whom this project would not have been possible. We are extremely grateful for the gracious support and feedback given by community members and the professionals working to support them. In particular, we would like to thank Aunty Joan Marshall and Aunty Karen West for their leadership and guidance on this project and within the community. We thank our Community Advisory Group members who willingly provided their perspectives and experiences to guide the conceptualisation and implementation of this project. We thank the children and families, who have bravely travelled on their journey and allowed us to share their path. We would also like to thank our remote health practitioners who started the journey to think differently about how to support child development so that more children could receive care close to home. Specifically, Aunty Shirley Dawson, Kara Rudken, Michelle Parker-Tomlin, Vanessa McDonald, Veronica Sammon, and John Bathern. This project would not have been possible without Sarah Horton\u0026rsquo;s fantastic management and organisation. Finally, we thank our hardworking research team, which includes Codi White, Wei Liu, Doug Shelton, Natasha Reid and Heidi Webster.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePolanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual Research Review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jcpp.12381\u003c/span\u003e\u003cspan address=\"10.1111/jcpp.12381\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLopez-Carmen V, McCalman J, Benveniste T, Askew D, Spurling G, Langham E, et al. Working together to improve the mental health of indigenous children: A systematic review. CYSR. 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.childyouth.2019.104408\u003c/span\u003e\u003cspan address=\"10.1016/j.childyouth.2019.104408\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmylie J, Kirst M, McShane K, Firestone M, Wolfe S, O\u0026rsquo;Campo P. Understanding the role of Indigenous community participation in Indigenous prenatal and infant-toddler health promotion programs in Canada: A realist review. Soc Sci Med. 2016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.socscimed.2015.12.019\u003c/span\u003e\u003cspan address=\"10.1016/j.socscimed.2015.12.019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacedo DM, Smithers LG, Roberts RM, Paradies Y, Jamieson LM. Effects of racism on the socio-emotional wellbeing of Aboriginal Australian children. Int J Equity Health. 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12939-019-1036-9\u003c/span\u003e\u003cspan address=\"10.1186/s12939-019-1036-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organisation. Indigenous Peoples and tackling health inequities summary report. 2002. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://cdn.who.int/media/docs/default-source/documents/gender/revindigenous-peoples-summary-02092213.pdf?sfvrsn=554f3ee3_3\u003c/span\u003e\u003cspan address=\"https://cdn.who.int/media/docs/default-source/documents/gender/revindigenous-peoples-summary-02092213.pdf?sfvrsn=554f3ee3_3\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 15 Mar 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Institute of Health and Welfare. The health and welfare of Australia\u0026rsquo;s Aboriginal and Torres Strait Islander peoples. 2015. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aihw.gov.au/getmedia/a5aa4dee-ee6d-4328-ad23-e05df01918b5/18175-chapter1.pdf.aspx\u003c/span\u003e\u003cspan address=\"https://www.aihw.gov.au/getmedia/a5aa4dee-ee6d-4328-ad23-e05df01918b5/18175-chapter1.pdf.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 15 Mar 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReid N, Page M, McDonald T, Hawkins E, Liu W, Webster H, et al. Integrating cultural considerations and developmental screening into an Australian First Nations child health check. Aust J Prim Health. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e/10.1071/PY20300\u003c/span\u003e\u003cspan address=\"/10.1071/PY20300\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Psychological Society. Ethical guidelines for psychological assessment and the use of psychological tests. 2007. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://psychology.org.au/for-members/resource-finder/resources/ethics/ethical-guidelines-psychological-assessment-tests\u003c/span\u003e\u003cspan address=\"https://psychology.org.au/for-members/resource-finder/resources/ethics/ethical-guidelines-psychological-assessment-tests\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 31 March 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVitrikas K, Savard D, Bucaj M. Developmental delay: When and how to screen. AFP. 2017;96:1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Institute of Health and Welfare, Rural. \u0026amp; Remote health, Profile of Rural and Remote Australians - Australian Institute of Health and Welfare. 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aihw.gov.au/reports/rural-remote-australians/rural-remote-health/contents/profile-of-rural-and-remote-australians\u003c/span\u003e\u003cspan address=\"https://www.aihw.gov.au/reports/rural-remote-australians/rural-remote-health/contents/profile-of-rural-and-remote-australians\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 10 Mar 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCiccia AH, Roizen N, Garvey M, Bielefeld R, Short EJ. Identification of neurodevelopmental disabilities in underserved children using telehealth (INvesT): Clinical trial study design. Contemp Clin Trials. 2015. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.cct.2015.10.004\u003c/span\u003e\u003cspan address=\"10.1016/j.cct.2015.10.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Bureau of Statistics. Socio-economic advantage and disadvantaged. In: Census of population and housing: Reflecting Australia. 2016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/2071.0~2016~Main%20Features~Socio-Economic%20Advantage%20and%20Disadvantage~123\u003c/span\u003e\u003cspan address=\"https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/2071.0~2016~Main%20Features~Socio-Economic%20Advantage%20and%20Disadvantage~123\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 31 March 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHawkins E, Shanley DC, Khan Z, Muslima H. Rapid Neurodevelopmental Assessment: Australian Edition Administration and Scoring Manual. 2024. Unpublished manuscript.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllen MS, Iliescu D, Greiff S. Single Item Measures in Psychological Science. EJPA. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1027/1015-5759/a000699\u003c/span\u003e\u003cspan address=\"10.1027/1015-5759/a000699\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan NZ, Muslima H, Begum D, Shilpi AB, Akhter S, Bilkis K, Begum N, Parveen M, Ferdous S, Morshed R, Batra M. Validation of rapid neurodevelopmental assessment instrument for under-two-year-old children in Bangladesh. Pediatrics. 2010. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/peds.2008-3471\u003c/span\u003e\u003cspan address=\"10.1542/peds.2008-3471\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan NZ, Muslima H, Shilpi AB, Begum D, Parveen M, Akter N, Ferdous S, Nahar K, McConachie H, Darmstadt GL. Validation of rapid neurodevelopmental assessment for 2-to 5-year-old children in Bangladesh. Pediatrics. 2013. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/peds.2011-2421\u003c/span\u003e\u003cspan address=\"10.1542/peds.2011-2421\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan NZ, Muslima H, El Arifeen S, McConachie H, Shilpi AB, Ferdous S, Darmstadt GL. Validation of a rapid neurodevelopmental assessment tool for 5 to 9 year-old children in Bangladesh. J Pediatr. 2014. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpeds.2013.12.037\u003c/span\u003e\u003cspan address=\"10.1016/j.jpeds.2013.12.037\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReynolds CR, Kamphaus RW. Behavior assessment system for children. 3rd ed. Bloomington, MN: Pearson; 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuslima H, Khan NZ, Shilpi AB, Begum D, Parveen M, McConachie H, Darmstadt GL. Validation of a rapid neurodevelopmental assessment tool for 10-to 16‐year‐old young adolescents in Bangladesh. Child Care Health Dev. 2016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/cch.12362\u003c/span\u003e\u003cspan address=\"10.1111/cch.12362\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlascoe FP. Screening for developmental and behavioral problems. Dev Disabil Res Rev. 2005. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/mrdd.20068\u003c/span\u003e\u003cspan address=\"10.1002/mrdd.20068\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Government Department of Health and Aged Care. Modified Monash Model. 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.health.gov.au/topics/rural-health-workforce/classifications/mmm#:~:text=The%20model%20measures%20remoteness%20and,in%20rural%20and%20remote%20areas\u003c/span\u003e\u003cspan address=\"https://www.health.gov.au/topics/rural-health-workforce/classifications/mmm#:~:text=The%20model%20measures%20remoteness%20and,in%20rural%20and%20remote%20areas\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 24 Mar 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou X, Reynolds C, Kamphaus RW. Diagnostic utility of Behavior Assessment System for Children-3 for children and adolescents with autism. Appl Neuropsychol Child. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/21622965.2021.1929232\u003c/span\u003e\u003cspan address=\"10.1080/21622965.2021.1929232\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTan ATS, Kraska J, Bell K, Costello S. Confirmatory factor analyses of the Behavior Assessment System for Children \u0026ndash; Third Edition among an Australian sample. Educ Dev Psychol. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/20590776.2021.190718\u003c/span\u003e\u003cspan address=\"10.1080/20590776.2021.190718\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrown-Jacobsen AM, Wallace DP, Whiteside SPH, Multimethod. Multi-informant agreement, and positive predictive value in the identification of child anxiety disorders using the SCAS and ADIS-C. Assessment. 2010; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1073191110375792\u003c/span\u003e\u003cspan address=\"10.1177/1073191110375792\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)\u0026mdash;a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jbi.2008.08.010\u003c/span\u003e\u003cspan address=\"10.1016/j.jbi.2008.08.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan NZ, Muslima H. Rapid Neurodevelopmental Assessment of Children (RNDA): Technical manual. Bangladesh Protibondhi Foundation; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Bureau of Statistics. National Aboriginal and Torres Strait Islander Health Survey. 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/national-aboriginal-and-torres-strait-islander-health-survey/latest-release\u003c/span\u003e\u003cspan address=\"https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/national-aboriginal-and-torres-strait-islander-health-survey/latest-release\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 21 Feb 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKovacs S, Sharp C. Criterion validity of the Strengths and Difficulties Questionnaire (SDQ) with inpatient adolescents. Psychiatry Res. 2014. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.psychres\u003c/span\u003e\u003cspan address=\"10.1016/j.psychres\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSquires J, Bricker D, Ages. Stages Questionnaires\u0026reg;, Third Edition (ASQ\u0026reg;-3): A Parent-Completed Child Monitoring System. Baltimore: Paul H. Brookes Publishing Co., Inc; 2009.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlascoe FP, Robertshaw NS, Woods SK. PEDS: Developmental Milestones professionals\u0026rsquo; manual. 3rd ed. Nolensville, TN: PEDSTest.com, LLC; 2009.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLavigne JV, Meyers KM, Feldman M. Systematic review: Classification accuracy of behavioral screening measures for use in integrated primary care settings. J Pediatr Psychol. 2016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/jpepsy/jsw049\u003c/span\u003e\u003cspan address=\"10.1093/jpepsy/jsw049\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMulraney M, Arrondo G, Musullulu H, Iturmendi-Sabater I, Cortese S, Westwood SJ, et al. Systematic review and meta-analysis: Screening tools for Attention-Deficit/Hyperactivity Disorder in children and adolescents. JAACAP. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jaac.2021.11.031\u003c/span\u003e\u003cspan address=\"10.1016/j.jaac.2021.11.031\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBujang MA. Requirements for minimum sample size for sensitivity and specificity analysis. JCDR. 2016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7860/JCDR/2016/18129.8744\u003c/span\u003e\u003cspan address=\"10.7860/JCDR/2016/18129.8744\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrownson RC, Kumanyika SK, Kreuter MW, Haire-Joshu D. Implementation science should give higher priority to health equity. Implement Sci. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13012-021-01097-0\u003c/span\u003e\u003cspan address=\"10.1186/s13012-021-01097-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiller L, Shanley DC, Page M, Webster H, Liu W, Reid N, et al. Preventing drift through continued co-design with a First Nations community: refining the prototype of a tiered FASD assessment. IJERPH. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph191811226\u003c/span\u003e\u003cspan address=\"10.3390/ijerph191811226\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"First Nations, children, adolescents, primary, healthcare, social-emotional problems, screening, RNDA, psychometric","lastPublishedDoi":"10.21203/rs.3.rs-4652892/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4652892/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe global prevalence of social-emotional problems in children and adolescents is nearly double in First Nations populations compared to non-First Nations, highlighting health inequities due to the impact of colonisation. Addressing this requires culturally responsive social-emotional screening in primary health, enhanced by a simple, psychometrically sound tool. The Rapid Neurodevelopmental Assessment, Australian Edition (RNDA:Australia), is user-friendly, incorporates child observations and parental input, and can be used by primary healthcare providers. This study evaluated the RNDA:Australia\u0026rsquo;s performance in screening social-emotional problems during routine health checks with First Nations children.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWorking with an Aboriginal Community Controlled Health Organisation in Australia, children (60% male, 92% identifying as First Nations) aged 3 to 16 years (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.40, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.33) and a caregiver participated in this study as part of a health check. The convergence with, and accuracy of, children\u0026rsquo;s scores derived from single-item measures of seven social-emotional problems on the RNDA:Australia was compared to their corresponding multi-item scores from the parent-report Behavior Assessment System for Children 3rd Edition (BASC-3).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eEach of the single-items measures on the RNDA:Australia were significantly correlated with the corresponding multi-item construct on the BASC-3, except for anxiety. The total accuracy of the RNDA:Australia relative to the BASC-3 was 58 to 81%, with high sensitivity for four of the seven items: hyperactivity (90%), attention problems (87%), externalising problems (82%) and behaviour symptoms index (88%). Sensitivity of the remaining items ranged from 14\u0026ndash;71% and specificity ranged from 29\u0026ndash;88%. The measure showed an average positive predictive value of 50% and negative predictive value of 75%.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe single-item measures within the RNDA:Australia\u0026rsquo;s behaviour domain showed good convergent validity relative to the BASC-3. Most items had acceptable accuracy, comparable with similar screening measures. These findings further support the RNDA:Australia\u0026rsquo;s integration into First Nations\u0026rsquo; child health checks, allowing for a rapid, holistic assessment of child development to improve health equity.\u003c/p\u003e","manuscriptTitle":"Psychometric properties of the Rapid Neurodevelopmental Assessment in detecting social- emotional problems during routine child developmental monitoring in primary healthcare","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-25 08:52:55","doi":"10.21203/rs.3.rs-4652892/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-05T06:24:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-03T06:33:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-03T06:31:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2024-06-28T07:32:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c466d722-5df1-4b1e-8189-eefc0e45fb2a","owner":[],"postedDate":"July 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-14T16:08:45+00:00","versionOfRecord":{"articleIdentity":"rs-4652892","link":"https://doi.org/10.1186/s12875-025-02807-z","journal":{"identity":"bmc-primary-care","isVorOnly":false,"title":"BMC Primary Care"},"publishedOn":"2025-04-11 16:05:14","publishedOnDateReadable":"April 11th, 2025"},"versionCreatedAt":"2024-07-25 08:52:55","video":"","vorDoi":"10.1186/s12875-025-02807-z","vorDoiUrl":"https://doi.org/10.1186/s12875-025-02807-z","workflowStages":[]},"version":"v1","identity":"rs-4652892","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4652892","identity":"rs-4652892","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}