This study developed DESS-C, a caregiver-reported screening scale for digital eye-strain symptoms in children aged 2–8 years, using 533 caregiver–child dyads from Thai schools. Classical item analysis and Rasch modelling reduced a 30-item field version to 27 items. Test–retest reliability and correlation with a reference questionnaire were strong; ROC AUC was 0.91 with a candidate cutoff of 7 or above. DESS-C is a caregiver screening instrument, not an ophthalmic diagnosis or evidence that screen use caused the symptoms.
Key findings
- The 27-item DESS-C met the authors' Rasch-fit criteria and showed no substantial age- or sex-related differential item functioning; person reliability was 0.78 and separation 1.89.
- Test–retest reliability was good (ICC 0.90, 95% CI 0.83–0.94), with high classification agreement (kappa 0.94, p
- Scores correlated strongly with DESCAQ (Spearman rho=0.88, p
- Correlations with PedsQL were small and negative at baseline (rho=-0.29) and six months (rho=-0.25), supporting part of the validity argument but not a causal effect.
- ROC AUC was 0.91 (95% CI 0.88–0.95); a score of 7 or above yielded 92.3% sensitivity and 79.0% specificity. The authors call this a candidate screening threshold, not a diagnostic cutoff.
Why this matters globally
Young children may have difficulty describing screen-related ocular symptoms, leaving a gap for caregiver screening. DESS-C could support consistent referral and research measurement, but cross-country use requires translation, measurement-invariance testing, and validation against comprehensive eye examinations. The study adds a measurement tool; it does not define safe screen time or prove that screen-reduction interventions work.
Thai researcher contribution
Sukritta Jaichomcheun and Wachira Suriyawong are linked to Chiang Mai University's Faculty of Nursing, while Piripat Techakanta is affiliated with Boromarajonani College of Nursing, Nakhon Lampang, Praboromarajchanok Institute. Participants came from Thai schools, and ethics review included the Thai institution, giving Thailand substantive roles in setting, participants, and research personnel.
Limitations to consider
The scale depends on caregiver recall and interpretation, and ages 2–8 span marked developmental differences despite no age DIF in this sample. Recruitment from one Thai province limits generalisability. No comprehensive ophthalmic examination served as the reference; the cutoff of 7 used a symptom-based comparator and is not diagnostic. DESCAQ was originally a self-report instrument for ages 8 and older but was caregiver-completed here, raising shared-method concerns and the need for independent validation. The publisher also labels the article an Early Version subject to editing before the Version of Record.