Objective: This study explored the potential roles and utility of the Parents Evaluation of Developmental Status (PEDS®) to screen children for developmental delays in a Southeast Asian clinical sample of preschool children. The PEDS® is a 10-item questionnaire instrument used in pediatric settings for reporting parents’ concerns for their children’s development, learning, and behavior. Clinicians use it to make decisions about clinical pathways for high-, moderate-, and low-risk categories of concerns, but its utility in cross-cultural contexts has not been well documented.

Methods: Participants in this study were 1806 parents, teachers, and child care workers of preschool children in Singapore. Of these, 47.2% were English speaking, 21.2% were Mandarin Chinese speaking, and 31.6% were Malay speaking. PEDS® was translated into Chinese and Malay for parents using these languages predominantly.

Results: Only parent results were analyzed. The reporting of significant parental concern was considerably higher than US norms and Australian pilot figures when western cutoff scores were applied. When cutoff scores were adjusted, similar patterns of reporting of high, medium, and low risk for disability could be captured.

Conclusions: Parents’ interpretation of the concept of “concern” varies across language and culture. Findings highlight the importance of evaluating a screening tool’s use in local contexts before its widespread implementation to yield clinically meaningful results.

Comment from Frances Page Glascoe: Culture does matter. Quality translations do too. We’ve been working with Dr. Kiing and colleagues since she sent us the above data in 2001, where we mutually concluded that the Mandarin translation was problematic. It isn’t enough to translate and back-translate. Wording has to be tested by providers and parents to make sure it works as intended. In 2005, after much machinating and vetting, we generated a new translation using an alternative Chinese terms for “Do you have concerns…” that was not synonymous with “Do you care…?”. Back-translated, the phrasing for the Chinese translation is “Are you worried….?” Although we know this doesn’t work in English (only about 2% of English speaking parents will respond and we know that rates of problems are much higher than that), the new translation works well with Chinese speaking parents and ensures their rates of “worries” are commensurate with parents speaking other languages. We thank Dr. Kiing, her colleagues and especially Dr. Teck-Hock Toh for working with us on this issue. We’ve also shared the revised translation with researchers using Survey PEDS® within National Survey of Early Childhood Health (NSECH) who found similar problems with their original translation.

Ideally, journal editors/reviewers should ask about the time frame for data collection and if old, should also ask what is known and has been done since then. If such had occurred, this paper would surely not have been published.

So, please also read the subsequent study using better translations of Mandarin by Lim Boon Chuan and colleagues.