The ten questions screen for childhood disabilities: its uses and limitations in Pakistan.

OBJECTIVE To assess the accuracy of the ten questions screen as a measure of childhood disability for epidemiologic studies in populations lacking resources for professional assessment of children's development and functioning. DESIGN Household survey and screening of children in phase one followed by clinical assessments in phase two. SETTING Karachi, Pakistan. PARTICIPANTS A cluster sample of 6365 children, aged 2 to 9 years, screened using the ten questions and a subsample referred for clinical assessments. MAIN RESULTS Although the sensitivity of the ten questions as a global screen for serious cognitive, motor, and seizure disabilities is high (84-100%), its sensitivity for identifying and distinguishing specific types of disability and for detecting vision, hearing, and mild disabilities, overall, is limited (generally < 80% and as low as 4% for mild vision disability). The predictive value of a positive screening result is also limited-using the ten questions in surveys without clinical confirmation results in overestimation of the prevalence of serious disability by more than 300%. CONCLUSIONS The ten questions screen is not an assessment tool. Its utility lies in its ability to screen or select a fraction of the population at high risk for serious disability. As a screening tool, it allows scarce diagnostic and other professional resources to be efficiently directed toward those at high risk.