Background: A simple screening tool is essential for priority setting and operating activities in communities.
Objective: The present study aimed to identify the implications of a family protective-risk index (FPRI) for
screening cognitive development of children aged 13-15 years.
Material and Method: The cross-sectional survey among 319 children aged 13-15 years old was conducted in
one district. The cognitive development was measured by TONI version 3. Studied family factors consisted of
parents’ education, parents’ occupation, sufficiency of family income, family relationships, stressful life events
in the family, family type, and quality of child care. The protective characteristic of each factor was given one
point and the risk was given zero point. FPRI was constructed in three models. The FPRI 1 was the cumulative
effects of nine family factors mentioned above. The FPRI 2 was the cumulative effects of seven family factors that
were significantly associated with cognitive development in the present study by Chi-square test: parents’
education, parents’ occupation, family relationship, stressful life events and family type. The FPRI 3 was
constructed from 4 family factors that were significantly associated with cognitive development by logistic
regression analysis: mother’s education, mother’s occupation, family relationship and stressful life events. The
sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were applied to
identify the optimal cut off point of prediction.
Results: The present results showed that 52% of the sample had an intellectual level lower than 90. The FPRI
1 at 6 or 7 scores and the FPRI 2 at 4 or 5 scores yielded the same phenomena, high sensitivity but moderate
specificity, PPV and NPV. The FPRI 3 at 2 scores gave high PPV and moderate for the rest. The FPRI 3 at 3
scores gave high sensitivity and NPV, moderate PPV and low specificity. Among three indices, the FPRI 3 was
found to be the best index as its Receiver Operating Characteristic (ROC) curve was furthest into the top left
corner.
Conclusion: The FPRI 3 at 3 scores can be used as a preliminary screening tool for health personnel to
identity families at risk of having children with slow cognitive development and then, provide urgent support
and help.

Keywords: Family protective-risk index, Cognitive development, Children aged 13-15 years