How PEDS-R® Works

RESEARCH AND PSYCHOMETRIC SUMMARY

Description

PEDS-Revised® (PEDS-R®) is an update to PEDS® that refines its original Paths, enabling professionals to view discrete types of risk, i.e., for developmental delays/disorders (DD), mental health/emotional/behavioral (MEB), or a combination of the two (MEBDD). Thus PEDS-R® divides the original PEDS® Paths into:

  • Path A: High MEBDD Risk
  • Path A: High DD Risk
  • Path B: Moderate MEBDD Risk
  • Path B: Moderate DD Risk
  • Path C: Mild to Moderate MEB Risk
  • Path C: Mild DD Risk
  • Path D/E: Low DD Risk and Low MEB Risk

Standardization

  • PEDS-R® was standardized in English and Spanish on a nationally representative sample of 262,310 North American children, whose ages ranged from birth to 8 years.
  • Families with psychosocial risk factors (e.g., limited education, poverty and non-English- speaking) were as able as those without psychosocial risk factors to raise concerns. Those with psychosocial risk tended to have children with higher DD, MEB and MEBDD risk.
  • Risk rates on PEDS-R® varied considerably by age of child. Children 4 ½ years of age and older had 4 times the risk compared to children less than 18 months of age.
  • The much higher risk rates in older children, compared to prior norming studies, seem due to the adverse impact of the COVID-19 quarantine. Even so, younger children were also affected. For example, MEBDD risk was three times higher for 3-year-olds in 2020 as compared to 2-year-olds in 2019, and 3-year-olds had much higher MEBDD risk in both 2020 and 2021 than in 2018 and 2019.
  • In comparing the performance of boys to girls on PEDS-R®, boys had 1 ½ times the risk for DD, MEB or MEBDD than did girls. Psychosocial risk rates were comparable across gender.
  • In comparing the performance of boys to girls on PEDS-R®, boys had 1 ½ times the risk for DD, MEB or MEBDD than did girls. Psychosocial risk rates were comparable across gender.

Reliability

  • Consistency among PEDS-R® items revealed modest to moderate intercorrelations, i.e., no highly significant correlations reflecting redundancy. This means that each item contributes uniquely to the measure as a whole.
  • Test-retest reliability was 93% for re-administrations within 1 week, and 88% for administrations between 1 week and 4 weeks. Note that PEDS-R® is interactive: When professionals are able to effectively address parents’ concerns, there are often fewer issues raised at the subsequent administration, which lowers test re-test agreement. Thus, results are in keeping with prior reliability studies.
  • Inter-rater reliability was 82% for re-administrations within 1 week and 86% for administrations between 1 week and 4 weeks. Again, because professionals are often able to effectively address concerns, inter-rater reliability is expected to have lower agreement between first and second administrations. In addition, when parents do not speak English, repeat screens often involve a different examiner who is bilingual — also leading to lowered inter-rater agreement.
  • Inter-method reliability compared professional scoring to parent reporting, specifically when parents raised concerns whether they marked “a little” or “concerned”. In only 6% of cases did professionals need to change “not concerned” to “concerned”. The remaining 489 cases were correctly reported by the parents and clinicians completing PEDS-R®. Thus, inter-method agreement was 94% (N = 489/515).
  • Stability. Comparing risk levels on PEDS-R® when rescreening over longer time intervals had 80% agreement for younger children and 82% agreement for older children. Lowered risk levels in subsequent administrations illustrate the effectiveness of interventions including professional advice. As a consequence, improved status was found in 49% of younger children and 30% of older children who were initially at risk. Even so, developmental/mental health risk remains a “moving target”, i.e., risk of developmental and mental health problems increase the older the child.
  • Stability. Comparing risk levels on PEDS-R® when rescreening over longer time intervals had 80% agreement for younger children and 82% agreement for older children. Lowered risk levels in subsequent administrations illustrate the effectiveness of interventions including professional advice. As a consequence, improved status was found in 49% of younger children and 30% of older children who were initially at risk. Even so, developmental/mental health risk remains a “moving target”, i.e., risk of developmental and mental health problems increase the older the child.

Validity

  • Content Validity. PEDS-R®’s content validity derives from questions eliciting parents’ comments in each of well-established developmental-behavioral/mental health domains.
  • Concurrent Validity. PEDS-R® has close associations with comparable subdomains on an assessment level measure.
  • Construct Validity. PEDS-R® factors were closely associated with similar factors on mid- level assessment and diagnostic measures. Social-emotional and behavioral concerns on PEDS-R® were correlated with a range of deficits on in-depth tools – suggesting that when referrals are made, professionals should measure children’s skills across multiple domains.
  • Discriminant validity. Findings from several different studies illustrate that: a) parents’ concerns reflect problems in the same domain on in-depth, milestones-focused measures, b) Risk on PEDS-R® also served as an indicator of other DD/MEBDD risks; and c) there are unique performance patterns on PEDS-R® for various categories of disabilities (e.g., ASD, motor impairment, learning disabilities). Nevertheless, speech language impairment and mental health diagnoses shared the same pattern, confirming prior research: Children with ongoing language disorders are at greater risk of mental health problems.
  • Predictive Validity/Predictive Sensitivity. Among children who eventually received a diagnosis and thus enrolled in IDEA/special education, prior screening with PEDS-R® revealed risk in 82%. PEDS-R® detected problems on average 21 months earlier than age at diagnosis.

Accuracy

  • PEDS-R®’s sensitivity is high, 93%, as is specificity, 92%, especially when applying to Path B: Moderate DD risk results, additional predictors such as M-CHAT-R or PEDS:DM® (screener) results, minority status and child’s age.

Utility

  • Readability. PEDS-R® questions were assessed for readability via different formulas. Response options were omitted because including these can falsely lower indices of reading difficulty/intelligibility:
  • Flesch Reading Ease score: 88.2, i.e., easy to read
  • Gunning Fog: 3.7, i.e. easy to read
  • Flesch-Kincaid Grade Level: 2.9 (high second to early third grade level)
  • The SMOG Index: 2.7 (high second to early third grade level)
  • Automated Readability Index: 1.4, Grade level: 6-8 yrs. old (First and Second graders)
  • Linsear Write Formula: third grade level
  • Administration Time. Answering questions on PEDS-R® takes an average of 2 minutes (range = 1 – 11 minutes). Parents with few or no concerns complete PEDS-R® in 1 – 3 minutes while parents with abundant concerns often require 9 – 11 minutes. If using the PEDS Online® Parent Portal, 0 minutes of professional time are needed. Scoring Time. In print, PEDS-R® takes 2 minutes to score. With PEDS Online®, 0 minutes are required due to automated scoring.
  • Time Required to Write Referral Letters and Take-Home Parent Summaries. A scant minimum of 5 minutes is needed for each of these tasks when using PEDS-R® in print. With PEDS Online®, 0 minutes are needed because referral letters and parent summaries are automatically generated.

Material Costs

  • In print, PEDS-R® costs $1.04 per administration. Unlike past iterations of PEDS®, which had two separate pads of forms plus a separate booklet of directions, PEDS-R® combines all components into a single perforated fold-over protocol. Within are directions for administration, the PEDS-R® questions/space for parents’ comments, Score and Interpretation Forms [including how to incorporate findings from the PEDS:DM® (screener) and M-CHAT-R], and a Current Findings table for documentation of results and selection of recommendations.
  • PEDS Online® costs $4.00 per administration and includes the PEDS:DM® and M-CHAT-R along with automation of scoring, results, referral letters and take-home parent summary report. Reimbursement/Billing. PEDS-R® [as well as the PEDS:DM® (screener) and M-CHAT-R] are eligible for payment from Medicaid/private insurance via the 96110 code (multiplied by 3 if all measures are given). The average reimbursement per screen is $8.00, rendering a substantial profit margin for practices. Integration with Electronic Records. PEDS Online® can be seamlessly and securely integrated with electronic records via an Application Programming Interface (API). Because sophisticated programming skills are needed, professionals wanting integration will need to prompt vendors at the national level to contact us: Amy@pedstest.com Other Benefits and Provisos

Impact/Stakeholder Uptake.

  • Eliciting and addressing parents’ concerns is an essential component of caring for children and their families. Prior studies show that parents much appreciate professional attention to their worries and thus are far more likely to keep future appointments.
  • Professionals find that use of PEDS-R® reduces late-arising concerns. These disruptions leave no time for preparation or for gathering information handouts/brochures about referral resources. The time allotted for encounters is often exceeded, and this results in irritation to other families who must wait longer than expected.
  • When parents’ concerns are elicited, professionals find it easier to deliver difficult news because parents’ worries can be confirmed thus providing motivation to seek intervention.

Compliance with Policy Recommendations.

  • The combination of PEDS-R®, PEDS:DM® (screener) and the M-CHAT-R offer evidence-based compliance with American Academy of Pediatrics’ recommendations to: Elicit and address parents’ concerns, measure milestones and periodically screen for autism spectrum disorder: https://publications.aap.org/pediatrics/article/145/1/e20193449/36971/Promoting-Optimal- Development-Identifying-Infants Compliance for Medicaid Patients. The Centers for Medicare and Medicaid Services (CMS) requires evidence that billable screening tests were administered, scored, interpreted and appropriate action steps taken. To successfully survive a Medicaid audit:
  • The combination of PEDS-R®, PEDS:DM® (screener) and the M-CHAT-R offer evidence-based compliance with American Academy of Pediatrics’ recommendations to: Elicit and address parents’ concerns, measure milestones and periodically screen for autism spectrum disorder: https://publications.aap.org/pediatrics/article/145/1/e20193449/36971/Promoting-Optimal- Development-Identifying-Infants
  • Compliance for Medicaid Patients. The Centers for Medicare and Medicaid Services (CMS) requires evidence that billable screening tests were administered, scored, interpreted and appropriate action steps taken. To successfully survive a Medicaid audit:
  • Compliance for Medicaid Patients. The Centers for Medicare and Medicaid Services (CMS) requires evidence that billable screening tests were administered, scored, interpreted and appropriate action steps taken. To successfully survive a Medicaid audit:

PEDS-R® is printed in English and Spanish. PEDS Online® is offered in English, Spanish and Chinese. These and nearly 65 other translations have been thoroughly vetted and shown to work well. Translations are freely offered to PEDS Online® users and can be licensed by print users. Contact: Translations@pedstestonline.com

Copyright. PEDS-R® is copyrighted. Just because you have acquired a copy of PEDS-R® does not mean you have the right to distribute it freely. It is illegal to photocopy blank protocols, embed any elements of the PEDS-R® into other questionnaires, display on websites, or include in electronic records. Only completed forms may be scanned. Copyright infringement is theft. Copyright infringement is taken seriously and will result in litigation. Infringement also starves future development of PEDS Tools®. See our complete copyright notice on: https://pedstest.com/CopyrightNotice/

The PEDS Tools®’ team who provide customer support, ship materials, facilitate translations, improve its website, create training, and write programming for PEDS Online®, are all parents with children to support. Copyright infringement hurts real people and their families. You can see who we are at https://pedstest.com/about-us/ Copyright Notice.

Posting of copyright-protected PEDS Tools® forms and any copying or reproduction of the form or any use of the form without permission from PEDStest.com, LLC is unlawful and constitutes copyright infringement in violation of the U.S. Copyright Act, 17 U.S.C. § 101 et seq. The PEDS Tools® may only be used in the original form provided through purchase from PEDSTest.com, LLC, and may not be copied or reproduced. Please be aware that the Copyright Act entitles PEDStest.com, LLC to seek statutory damages of as much as $150,000 per act of infringement and its attorneys’ fees in prosecuting its copyright claim.

Further, the original forms include a copyright notification and contact information that may not be omitted. Alteration of the forms in such manner to delete this information constitutes violation of the Digital Millennium Copyright Act, 17 U.S.C. § 1202(b), which states: No person shall, without the authority of the copyright owner or the law, intentionally remove or alter any copyright management information knowing, or, with respect to civil remedies under section 1203, having reasonable grounds to know, that it will induce, enable, facilitate, or conceal an infringement of any right under this title. The damages for violating 17 U.S.C. § 1202 alone range from $2,500 to $25,000 per violation, in addition to any damages for copyright infringement.

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PEDS-R®, PEDS:DM® and MCHAT-R are available online at pedstestonline.com via our PEDS Online® service. PEDS Online® offers instant, automated (error-free!) scoring, generates referral letters, parent summary reports, and diagnostic/procedure codes. There is a free trial available at: pedstestonline.com/trial

The PEDS Tools® can be licensed in 60+ languages outside of those that we print (English & Spanish). Read more about our translations on our Translations page.