Purpose: Quality screens are standardized on a sample of children and families whose socio-economic and demographic characteristics represent those of an entire nation (e.g., in the US by creating a normative group that reflects Census Bureau population parameters). Standardization of tests on such a sample defines what is typical performance and, in the case of screening tests, predicted frequencies of referral rates. Should researchers and clinicians working with Medicaid, NICU follow-up, or other at-risk groups expect their referral rates to differ from national norms?

Methods: Referral rates based on national norms for Parents Evaluation of Developmental Status (PEDS^®) (N = 771) were compared to those from a pediatric clinic serving mostly Medicaid patients in Milwaukee, Wisconsin (N = 744), and to 211LA, a warm line serving mostly ethnic minority families (47% Latino and 30% Arican-American) in non-medical crisis (e.g., housing or food instability)(N = 257).

Results: Chi-square comparisons among the three groups revealed that clinics serving families with elevated rates of psychosocial risk (e.g., poverty, less than a high school education, limited English proficiency, etc.) had significantly higher rates of children with problematic performance on PEDS^® (p < .0001). These results are corroborated by other studies of at-risk children administered different screening tests.

Conclusions: The impact of psychosocial risk on development is well known to developmental-behavioral specialists. Helping trainees and generalist pediatricians anticipate increased referral rates when working with at-risk populations is needed. Screening test authors should help by reporting, not only the frequency of problematic performance on nationally representative samples, but also frequencies for various at-risk populations (e.g., children in foster-care, NICU follow-up, etc.).