Objective: To propose and preliminarily assess a model for helping providers select, based on empirical evidence, the optimal in-office developmental/behavioral service to offer families: (1) when to refer patients for diagnostic evaluations; (2) use screening measures to assist with referral decisions; (3) offer patient education; (4) watch vigilantly over time; and (5) when to offer reassurance and routine monitoring. The rationale is that if providers can respond optimally to children’s developmental and behavioral needs, children may be more likely to receive early intervention that can ameliorate or eliminate disabilities. This Is known to reduce the risk of school failure, drop out, criminality, teen child-bearing, and unemployment.
Subjects and Sites: Data from four previously published studies on the relationship between parents’ concerns and children’s developmental/behavioral status was grouped and reanalyzed in order to test optimal decision-making regarding parents’ concerns. Subjects were 771 children between 0 – 8 year of age and their parents who approximated demographic characteristics of the US. Settings included teaching hospitals, private pediatric practices, day care centers and public schools.
Measurement and Procedures: In all four studies, parents’ concerns were elicited by Parents’ Evaluation of Developmental Status (PEDS®) and children were administered a battery of developmental and behavioral tests.
Results: The relationship between PEDS® and concurrent measures revealed five distinct groups of families who either had different types of concerns or children with differing levels of risk. Children at highest risk were those whose parents had multiple of the concerns predictive of disabilities (OR = 20.1, CI = 10.5 – 36.3). Responding with screening tests reduced sensitivity below acceptable levels suggesting that referrals for diagnostic evaluations are the best response. Parents whose children had moderate levels of risk for disabilities were those with either single of the predictive concerns or with communication barriers, defined as incomplete, inconsistent or nonsensical responses on PEDS® (OR ranges 4.4 to 7.6). These groups benefited from screening first to reduce false positives. Nevertheless, children in these groups who passed screening were likely to perform below average in areas critical to school success. This suggests the need for patient education and watchful waiting. Parents whose children had low levels of risk were those with no concerns or concerns nonpredictive of disabilities (OR ranges 1.0 -= 1.3). Screening these groups resulted in an unacceptable loss of specificity which suggests that patient education should be offered to those with nonpredictive concerns and routine monitoring for those with no concerns at all.
Conclusions: – The results suggest that clinicians can make reasonably accurate decisions about which psychosocial services to provide families if these decisions are based on the empirically derived relationship between parents’ concerns and children’s developmental status. Such an approach is not only brief but also offers a three fold improvement over the usual rates of disability detection in pediatric offices.
