PEDS Tools^® for Research Projects

Outcome Studies

The PEDS:DM^® Assessment Level, is especially useful for clinical/educational/outcome studies because it provides:

• age-equivalent scores in all developmental/behavioral/mental health domains;
• a way to compare a child’s performance to others of the same age,
• when repeated, offers information about changes in children’s performance over time,
• indicates when performance is falling into a high risk level,
• offers a continuous outcome variable for which numerous statistical techniques can be used (far more so than do binary cutoff scores).
• can be administered in mail-out form, by interview, or hands-on with children

The ability of the PEDS:DM^® Screening or PEDS:DM^® Assessment Level to be completed in large part by parent-report (e.g.,through mail-outs or in waiting rooms prior to an encounter) and without much professional assistance--given its 2nd grade reading level-- makes it an inexpensive way to measure outcomes in multiple domains.

Nevertheless, the PEDS:DM^® can also be administered directly to children. Some grantors/reviewers for scholarly research/journal publication prefer researchers to compare information gathered by parent report (e.g., medical history, psychosocial risk factors, behavioral challenges) to direct measurement of children’s developmental outcomes.

*Note: The PEDS:DM^® can be used in survey/telephone/interview studies, most especially when children are 3 ½ years and younger. At older ages, the PEDS:DM^® requires parents (or professionals) to elicit skills from their children (e.g., names colors, letters, copy shapes, etc). So, if older children are included, we are happy to work with you on how best to measure older children (e.g., rewording items, mailing questions in advance so that families can try them with their children, etc.). Please contact us as needed.

Introducing Parents’ Evaluation of Development Status – Revised (PEDS-R^®)

PEDS^® is being revised as PEDS-Revised^® (PEDS-R^®) to improve the ability of all parents to raise concerns – not only in the domains PEDS^® currently probes: expressive/receptive language, gross/fine motor, behavior, self-help, school and social skills, but also in global/cognitive and other issues including psychosocial challenges and health problems. PEDS^® depended on parents to spontaneously share their worries without prompting. Parents with limited education and/or difficulty speaking English tended not to volunteer concerns about global/cognitive and other/health issues.

To address this challenge, PEDS-R^® adds two questions that prompt for global/cognitive and health concerns. PEDS-R^® is based on decades of research on Survey PEDS^® (Glascoe, 2013) plus 20 years of research on PEDS^® - an interview protocol used by the National Institutes of Health and the Centers for Disease Control and Prevention to determine disability prevalence and how well health care providers meet families’ needs (CDC, 2021).

PEDS-R^® versus Survey PEDS^®

Although Survey PEDS^® within the CDC/NIH Interviews renders risk frequencies (low, moderate, high) that are comparable to PEDS-R^®, Survey PEDS^® involves only multiple-choice questions and does not elicit parents’ actual comments. This makes Survey PEDS^® less than useful for encounters in health care, education, psychology, social work, etc.

PEDS-R^®, in contrast, elicits parents’ verbatim concerns that are crucial for quality care. For example, it is not enough to know that parents are worried about behavior. Clinicians need to know precisely what issue to address in order to tailor developmental-behavioral guidance and make targeted referral decisions when indicated (e.g., how to help with tantrums versus biting versus repetitive play or self-stimulation that is often apparent when children have autism spectrum disorders).

Current research using data from PEDS Online^® as deployed in 63 clinics across 10 US States, compared PEDS^® to PEDS-R^® on a sample of 1499 children averaging 29 months of age: N =302 were administered PEDS-R^® and N = 1197 were administered PEDS^®. Parents were mostly Spanish-speaking and the two groups had comparable psychosocial risk levels (only 53% had completed high school; 27% met federal poverty criteria). The 302 families completing PEDS-R^® were more likely to mention global/cognitive or other/health concerns (7% versus 2%). Both groups had elevated developmental-behavioral/mental health risk levels (26% versus 25%) as is expected when psychosocial risk is high. Nevertheless, professionals took concerns more seriously when parents completed PEDS-R^®, i.e., clinicians were 3 ½ times more likely to also administer the PEDS:DM^® and M-CHAT-R. Higher rates of cognitive and health concerns in the PEDS-R^® group improved prediction of moderate to high-risk performance on other measures. [OR = 3.6, 95%CI (1.7 – 7.6)] (Chen et al, 2019).

Thus PEDS-R^® helps:

• parents better express the full range of their worries.
• providers respond with additional screens, in keeping with AAP recommendations (Lipkin, Macias et al, 2020).
• maintain PEDS^® existing sensitivity and specificity, i.e., does not lead to excess referrals
• improve alignment with and prediction of problematic results across other screens

PEDS-R^® for PEDS Online^® Users

PEDS-R^® is available within PEDS Online^® in Spanish and Chinese. PEDS-R^® in English will be added in late summer 2021. Within PEDS Online^®, PEDS-R^® continues to provide information on types of concerns, Paths and thus indicators of risk, as well as recommendations about optimal next steps.

PEDS Online^® also includes the option of administering PEDS-R^® along with PEDS^®: Developmental Milestones (PEDS:DM^®) and the M-CHAT-R. Most providers (up to 90% in some US States) use both PEDS Tools^® along with an occasional M-CHAT-R, in compliance with AAP Policy. (Lipkin, Macias et al, 2020).

PEDS-R^® has been translated into many other languages following a careful vetting process as prescribed by the International Test Commission (2021). For more information view our research on PEDS-R^® in translation as used across the US and in other nations.

Digital copies of translations are provided freely to PEDS Online^® users. To request translations please contact us.

Professionals can use our translations alongside PEDS Online^®. There are several ways to work well with families who do not speak or read the languages on our site: English, Spanish or Chinese:

• Please obtain our official translations first. If we do not have the translation you need, please contact us.
• If confident that parents have adequate literacy for both reading and writing, print out the appropriate translation for families to complete while waiting for their appointment.
• Provide the appropriate translation to an in-person interpreters for administration by interview
• In the absence of someone in your clinic/service who speaks parents’ language of choice, send a digital copy of our translations to a service such as LanguageLine Solutions (LanguageLine.com)

PEDS-R^® in Print is now available!

Changes to the PEDS-R^® Response Form include two extra questions extending to the back side of the page, along with:

• recording prior results
• identifying PEDS-R^® paths and risk levels
• specifying action steps taken
• which billing/procedure codes were used (along with how to best bill/code for reimbursement)

The PEDS-R^® Response Form ensures that children’s records include clear evidence that PEDS-R^® was administered and scored, results specified, and that plans (e.g., advice, types of referrals) are indicated.

Additional Support

See Identifying and Addressing Developmental and Behavioral Problems: A Practical Guide for Medical and Non-medical Professionals, Trainees, Researchers and Advocates. (Glascoe et al 2013) for comprehensive advice on helping families with next steps, delivering difficult news, finding development-behavioral promotion information in many languages, making effective referrals, training, national and international initiatives, etc.

References

• Glascoe FP. Collaborating with Parents: Using Parents’ Evaluation of Developmental Status (PEDS^®) to Detect and Address Developmental and Behavioral Problems. 2nd Edition. Nolensville, TN: PEDSTest.com, LLC; 2013.
• Centers for Disease Control and Prevention. National Health Interview Survey.
• Chen V, Gellasch P, Glascoe FP. Improving Detection of Mental Health, Behavioral, & Developmental Delays/Disorders (MBDD) in Children of Hispanic, Limited-English Proficient (LEP) Families. Presentation to the Pediatric Academic Societies, May, 2019.
• Glascoe FP, Marks KP, Poon JK, Macias MM (eds). Identifying and Addressing Developmental and Behavioral Problems: A Practical Guide for Medical and Non-medical Professionals, Trainees, Researchers and Advocates. Nolensville, Tennessee: PEDStest.com, 2013.
• International Test Commission. ITC Guidelines for Translating and Adapting Tests.
• Lipkin PH, Macias MM and Council on Children with Disabilities, Section on Developmental and Behavioral Pediatrics. Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics. 2020, 145 (1) e20193449;

A Case Example of Outcomes Research Using PEDS Online^®: 211LA Warm Line