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RESEARCH ON PEDS: Parents’ Evaluation of Developmental Status Frances Page Glascoe Adjunct Professor of Pediatrics Vanderbilt University www.pedstest.com.

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Presentation on theme: "RESEARCH ON PEDS: Parents’ Evaluation of Developmental Status Frances Page Glascoe Adjunct Professor of Pediatrics Vanderbilt University www.pedstest.com."— Presentation transcript:

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2 RESEARCH ON PEDS: Parents’ Evaluation of Developmental Status Frances Page Glascoe Adjunct Professor of Pediatrics Vanderbilt University

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4 “Your teacher wishes me to delineate those watershed occasions in your life that have led you to become, slowly and inexorably, a loose cannon.”

5 Developmental/Behavioral Tasks of Health Supervision Visits 4developmental promotion 4behavioral guidance and patient education 4developmental/behavioral screening 4observation/monitoring 4reassurance 4referral

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7 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

8 Detection rates without screening tests 70% of children with developmental disabilities not identified (Palfrey et al. J PEDS. 1994;111: ) 80% of children with mental health problems not identified (Lavigne et al. Pediatr. 1993;91:649=655)

9 “Looking Good”

10 Sample questions to parents that don’t work well Do you think he has any problems…..? Do you have any worries about her development?

11 Please tell me any concerns about your child’s learning, development, and behavior. First Question

12 Additional Questions Do you have concerns about how your child: 2….is talking or making speech sounds? 3…. understands what you say? 4…uses his or her hands and fingers to do things? 5…uses his or her arms and legs? 6… behaves? 7…gets along with others? 8…is learning to do things for himself/herself? 9….is learning preschool or school skills? 10. Do you have any other concerns?

13 Sample Parent Responses He can’t talk plain He’s mean She won’t get dressed or do nothing for herself He’s slow and behind and can’t do what other kids can She won’t mind me I used to be worried but I think he’s doing better

14 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

15 4 cross-validation studies on 971 subjects nationally representative sample varied settings: public health, community practices, day care, schools, etc. Subjects and Sites

16 Subjects N = 771 ages % white 22% African American 14% Hispanic/Other 26% low SES 4% enrolled in S.E. 80% mothers 18% < H.S. education 5% Spanish- speaking Child SubjectsParent Subjects

17 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

18 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

19 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

20 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

21 Predictive Concerns by Children’s Ages /2 yrsglobal/cognitive, expressive language, social, medical/other 1 1/2 - 3 yrsabove (except social) + receptive language /2 yrsabove (except social) + receptive language+ gross motor 4 1/2 - 8 yrsabove (except social) + receptive language+ gross motor +fine motor +school

22 ACCURACY: ACROSS AGE RANGES AGESENSITIVITYSPECIFICITY N%N% /2 yrs 3/47566/ /2 - 3 yrs 27/ / /2 yrs 26/ / /2 - 8 yrs 42/ /24570 TOTAL98/ /64174

23 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 Do Parental Characteristics Affect Their Concerns?

24 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

25 Single Predictive Concern 29% 17% OR = 7.6 Multiple Predictive Concerns 52% Disabled OR = % Below Average No predictive concerns but communication barriers 19% 0R = % Nonpredictive Concerns 7% 13% OR = % 11% 3% 20% 23% No Concerns 5% 11% OR = 1.0

26 Screening in Response to Multiple Predictive Concerns 11% DIAGNOSIS Multiple concerns (N = 27) but passed Brigance/BDIST, or no significant concerns NO YES Multiple concerns and failed Brigance/BDIST (N = 36), or single significant concern Sensitivity 47/76 = 62% 74% Specificity 335/435 = 77% 73% prior

27 Referral Accuracy: Multiple Predictive Concerns 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/ educational testing had parents with one or fewer such concerns 11%

28 Screening in the Presence of a Single Predictive Concern or Communication Barrier 23% 3% DIAGNOSIS no concerns or single concern or communication barrier and passed Brigance Screen NO YES multiple concerns, or single concern/communication barrier but child failed Brigance Screen Sensitivity 41/56 = 73% 75% Specificity 280/352 = 80% 74% prior

29 What of those who fail screening but aren’t eligible for special education? 23% 3% DIAGNOSIS no concerns or single concern or communication barrier and passed Brigance Screen NO YES multiple concerns, or single concern/communication barrier but child failed Brigance Screen These children tended to perform below average in IQ, academics, and/or language—the better predictors of school success

30 Developmental Screening in Response to NonPredictive Concerns or No Concerns DIAGNOSIS no concerns or nonsignificant concerns and passed Brigance/BDIST Screens NO YES multiple concerns, single concern/communication barrier or no/nonsignificant concerns and failed Brigance/BDIST Sensitivity 65/76 = 85% 74% Specificity 246/435 = 56% 73% prior 20% 43%

31 Behavioral Screening in the Presence of No or Nonpredictive Concerns: Nonpredictive Concerns 20% 1 1/2 SDs above mean NO YES Sensitivity 13/19 = 68% Specificity 91/137 = 66% NO YES 43% NO YES 13/15 = 87% 98/124 = 79% >4 1/2 yrs. < 4 1/2 yrs

32 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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35 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

36 Electronic PEDS   Web accessible PEDS for vLicensed PEDS users vSelf-selected parents  PEDS scoring Web service for EMR/EHR and other electronic systems

37 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. ?

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