RESEARCH ON PEDS: Parents Evaluation of Developmental Status

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RESEARCH ON PEDSParents Evaluation of
Developmental Status

• Frances Page Glascoe
• Adjunct Professor of Pediatrics
• Vanderbilt University
• www.pedstest.com
• www.forepath.org

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Your teacher wishes me to delineate those
watershed occasions in your life that have led
you to become,slowly and inexorably,a loose
cannon.
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Developmental/Behavioral Tasks of Health
Supervision Visits

• developmental promotion
• behavioral guidance and patient education
• developmental/behavioral screening
• observation/monitoring
• reassurance
• referral

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Reasons for limited use of screening tests at
well visits
screening tests take too long many are
difficult to administer children may not
cooperate reimbursement is limited not all
developmental/behavioral issues are
addressed lack of familiarity with referral
resources
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Detection rates without screening tests
70 of children with developmental
disabilities not identified (Palfrey et al. J
PEDS. 1994111651-655) 80 of children with
mental health problems not
identified (Lavigne et al. Pediatr.
199391649655)
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Looking Good
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Sample questions to parents that dont work well

• Do you think he has any problems..?
• Do you have any worries about her development?

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First Question
Please tell me any concerns about your
childs learning, development, and behavior.
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Additional Questions Do you have concerns about
how your child 2 .is talking or making speech
sounds? 3 . understands what you say? 4uses
his or her hands and fingers to do things?
5uses his or her arms and legs? 6behaves?
7gets along with others? 8is learning to do
things for himself/herself? 9.is learning
preschool or school skills? 10. Do you have any
other concerns?
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Sample Parent Responses
He cant talk plain Hes mean She wont get
dressed or do nothing for herself Hes slow
and behind and cant do what other kids can
She wont mind me I used to be worried but I
think hes doing better
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Reliability
Test-retest 88 consistency over time in
parents concerns Inter-rater 88 agreement
in categorization of concerns given two
different raters. Coding agreement 83,
weighted kappa .74
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Subjects and Sites
4 cross-validation studies on 971
subjects nationally representative
sample varied settings public health,
community practices, day care, schools,
etc.
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Subjects N 771
Child Subjects
Parent Subjects
ages 0 - 8 64 white 22 African American 14
Hispanic/Other 26 low SES 4 enrolled in S.E.

80 mothers 18 lt H.S. education 5
Spanish- speaking
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Sites
Middle Tennessee N 363 Tampa, FL
N 112 Plymouth, MA N 114 Denver,
CO N 68 Carson City, NV N
114
teaching hospitals N 134 private
practices N 123 day care
centers/public schools N 289 unenrolled
N 229
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Procedures
Parents completed PEDS in writing or by
interview Either a second psychological
examiner blinded to parents concerns, or the
same examiner, blinded to the potential
significance of parents concerns,
administered the concurrent battery
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Procedures II
771 children were administered a dx battery
(IQ, language, academic, motor) scores
categorized into SE eligibility logistic
regression used to identify concerns predictive
of developmental status
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Initial Results
130 were eligible for special education
24 had been previously identified 641 were not
eligible and performed in the broad range
of average on all measures
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Predictive Concerns by Childrens Ages
0 - 1 1/2 yrs global/cognitive, expressive
language, social, medical/other 1 1/2 - 3
yrs above (except social) receptive
language 3 - 4 1/2 yrs above (except
social) receptive language
gross motor 4 1/2 - 8 yrs above
(except social) receptive language
gross motor fine motor
school
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ACCURACY ACROSS AGE RANGES
AGE SENSITIVITY SPECIFICITY
N N 0 - 1 1/2 yrs 3/4 75 66/82 80
1 1/2 - 3 yrs 27/34 79 117/149 79 3 - 4 1/2
yrs 26/35 74 118/165 72 4 1/2 - 8 yrs
42/57 74 172/245 70 TOTAL 98/130 75 473/641 74
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Do Parental Characteristics Affect Their
Concerns?
No differences in accuracy on the basis of
parents level of education or parenting
experience Almost all parents derive concerns
by comparing their children to others Educated
parents, especially dads, 21 times as likely to
raise concerns spontaneously. Children whose
parents discussed concerns were 40 times more
likely to be enrolled in special education
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Evidence-Based Decisions
when and where to refer when to screen and type
of screen needed when to offer developmental
promotion when to provide behavioral
guidance when to observe vigilantly when
reassurance and routine monitoring are sufficient
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Multiple Predictive Concerns 52 Disabled OR
11.4 16 Below Average
Single Predictive Concern 29 17 OR
7.6
Nonpredictive Concerns 7 13 OR 1.3
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20
23
3
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No predictive concerns but communication
barriers 19 0R 4.6 35
No Concerns 5 11 OR 1.0
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Screening in Response to Multiple Predictive
Concerns
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DIAGNOSIS
NO YES
Multiple concerns (N 27) but passed
Brigance/BDIST, or no significant concerns
Multiple concerns and failed Brigance/BDIST (N
36), or single significant concern
435 76
prior
Sensitivity 47/76 62
74 Specificity 335/435 77 73
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Referral Accuracy Multiple Predictive
Concerns
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79 (19/24) of those needing speech-language
evaluations had parents with two or more
concerns about receptive language, self-help,
school or social skills
71 (15/21) of those needing psychological/ educa
tional testing had parents with one or fewer
such concerns
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Screening in the Presence of a Single
Predictive Concern or Communication Barrier
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DIAGNOSIS
NO YES
no concerns or single concern or communication
barrier and passed Brigance Screen
multiple concerns, or single concern/communication
barrier but child failed Brigance Screen
352 56
prior
Sensitivity 41/56 73
75 Specificity 280/352 80 74
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What of those who fail screening but arent
eligible for special education?
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DIAGNOSIS
NO YES
no concerns or single concern or communication
barrier and passed Brigance Screen
multiple concerns, or single concern/communication
barrier but child failed Brigance Screen
These children tended to perform below average in
IQ, academics, and/or languagethe better
predictors of school success
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Developmental Screening in Response to
NonPredictive Concerns or No Concerns
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DIAGNOSIS
NO YES
no concerns or nonsignificant concerns and passed
Brigance/BDIST Screens
multiple concerns, single concern/communication
barrier or no/nonsignificant concerns and failed
Brigance/BDIST
435 76
prior
Sensitivity 65/76 85
74 Specificity 246/435 56 73
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Behavioral Screening in the Presence of
No or Nonpredictive Concerns
gt4 1/2 yrs. lt 4 1/2 yrs
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1 1/2 SDs above mean
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NO YES
NO YES
NO
Nonpredictive Concerns
YES
137 19
124 15
13/15 87 98/124 79
Sensitivity 13/19 68 Specificity
91/137 66
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Evidence-Based Decisions
when and where to refer when to screen and type
of screen needed when to offer developmental
promotion when to provide behavioral
guidance when to observe vigilantly when
reassurance and routine monitoring are sufficient
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Rationale for Electronic PEDS
Empower parents Ensure consistency in scoring
and administration Enhance test availability in
multiple languages and locations Enable
tailoring for local resources Create an
electronic database for research and quality
improvement Give immediate access to patient
education information
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Electronic PEDS

• www.forepath.org
• Web accessible PEDS for
• Licensed PEDS users
• Self-selected parents
• PEDS scoring Web service for EMR/EHR and other
  electronic systems

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Directions for Future Research
Do parents become more accurate when administered
PEDS over time? Does the addition of professional
judgment improve accuracy? Can PEDS detect school
problems in older children, autism, CP, etc.
? Frances.P.Glascoe_at_Vanderbilt.edu
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