OBJECTIVE: In analyzing data from a larger study, we noticed significant disagreement between results of 2 commonly used developmental screening tools (Parents’ Evaluation of Developmental Status [PEDS; parent concern questionnaire] and Ages & Stages Questionnaires [ASQ; parent report of developmental skills]) delivered to children at the same visit in primary care. The screens have favorable reported psychometric properties and can be efficient to use in practice; how- ever, there is little comparative information about the relative performance of these tools in primary care. We sought to describe the agreement between the 2 screens in this setting.
METHODS: Parents of 60 children aged 9 to 31 months completed PEDS and ASQ screens at the same visit. Concordance (PEDS and ASQ results agree) and discordance (results differ) for the 2 screens were determined.
RESULTS: The mean age of children was 17.6 months, 77% received Medicaid, and 50% of parents had a high school education or less. Overall, 37% failed the PEDS and 27% failed the ASQ. Thirty-one children passed (52%) both screens; 9 (15%) failed both; and 20 (33%) failed 1 but not the other (13 PEDS and 7 ASQ). Agreement between the 2 screening tests was only fair, statistically no different from agreement by chance.
CONCLUSIONS: There was substantial discordance between PEDS and ASQ developmental screens. Although these are preliminary data, clinicians need to be aware that in implementing revised American Academy of Pediatrics screening guidelines, the choice of screening instrument may affect which children are likely to be identified for additional evaluation.
Comment from Dr. Glascoe: PEDS and the ASQ have very different measurement methods. PEDS identifies, in addition to developmental delays, developmental disorders (meaning children who accomplish milestones on time but…’ something is still clearly wrong’, such as mangled syntax, restricted social interests, etc.). PEDS also identifies mental health and physical health issues, as well as parents’ needs for information and training (e.g., some parental concerns about expressive language are statements such as “I don’t know what a 6 month old should be able to do”. While this automatically places children on a moderate risk path, it also serves as an important alert to clinicians to monitor development carefully and also provide parents critically needed advice on how to promote development).
The ASQ, in contrast, is designed to identify developmental delays. In its 3rd edition, the ASQ also includes prompts encouraging parents to express their perceptions about child-rearing and other issues.
We should not expect the results of each measure to overlap completely. Indeed PEDS calls for use of a measure like the ASQ or PEDS: Developmental Milestones in some 20% of cases-- in order to verify children’s and families needs for developmental and other interventions. The ASQ, in turn, calls for completion of the ASQ: Social-Emotional when children have difficulty on the ASQ.
In any case, both measures pick up nearly 80% of children with various difficulties.
Credits: Pediatrics 2009;124:e640–e647
Laura Sices, MD, MS, Terry Stancin, PhD, H. Lester Kirchner, PhD,c and Howard Bauchner, MD
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