Case Studies and Videos
Stephen: Using Parents' Evaluation of Developmental Status (PEDS) and PEDS: Developmental Milestones (PEDS:DM): A Case Study of a 30-month old Child
Stephen Richards (not his real name), age 29 months, received health care from Paragon Pediatrics, a practice implementing the American Academy of Pediatrics’ 2006 policy on developmental screening and surveillance. The practice added a 30 month visit devoted to detecting and addressing developmental and behavioral issues. Clinicians used both PEDS and the PEDS:DM. Mrs Richards filled out a PEDS Response Form while she was in the waiting room. She expressed some concerns about Russell’s behavior and understanding of language.
PEDS:DM forms are laminated and parents mark them with a dry erase marker. Opposite the questions are stories and illustrations to encourage reading aloud. A scoring template is placed over the answers to reveal correct and incorrect responses. Results are marked on the PEDS:DM Growth Chart (see handout) where there is also space for noting specific decisions. On the other side of the PEDS:DM Growth Chart is the PEDS Score and Combined Interpretation Form. Thus a 1 page form remains in the child’s chart to track surveillance and screening activities from 0 to 7– 11 years.
Matty: A case study using PEDS Online in a busy clinic
In this case example, you will see how PEDS Online works in our busy clinics. We describe one of our patients, whose pseudonym is Matty Walds. He was 3 years old when we saw him for the first time (and with no past medical records). You will also see how our differing multi‐satellite clinics implemented the PEDS Online Screening service—including administration options, billing and coding for optimal reimbursement, how we met foreign language challenges, and found resources (both for referrals and for parenting information).
Although the focus in this movie is on health care clinics, the implementation process is relevant to other settings such as day cares, schools, Head Start, foster care, and other types of services.
Roger: Case Study using PEDS
Parents’ Evaluation of Developmental Status (PEDS): An evidence-based method for detecting and addressing developmental and behavioral problems in children
Roger* had regular checkups since birth. During each, his mother had a range of complaints, mostly health-related or behavioral (as shown on both the Score Form and Interpretation Form). These were addressed with medical/nutrition intervention, parent education (including Ferber’s sleep techniques), and eventually in-home behavior therapy to address head-banging, pacing, and tantrums. Developmentally, Roger walked and talked on time and had a fairly substantial vocabulary, however unusual, at 18 months of age. His parents were active in playing with and teaching him.
The PEDS’ Response Form (next page) shows what his mother wrote while waiting for Roger’s two-year check-up.
The PEDS’ Score Form (showing the concerns raised at prior visits as well) revealed 4 concerns predictive of developmental problems and 2 non-predictive concerns.
The Score Form points to Path A on the PEDS Interpretation Form and the need for audiological/speech-language assessment. Roger’s pediatrician. Dr. Louise Hamilton, also followed the American Academy of Neurology’s recommendations for second-stage screening using an autism-specific measure. Lacking time, she requested that the local Early Intervention (EI) program administer the Modified Checklist of Autism in Toddlers (M-CHAT). Dr. Hamilton also followed the AAN’s recommendation for audiological, vision and lead screening, all of which were negative. (As an aside, PEDS online at www.forepath.org also provides the M-CHAT, offers automated scoring, generates a summary for parents and a referral letter for sharing with other professionals).
The early intervention program administered a range of measures and determined that Roger met eligibility criteria for enrollment in early intervention because of a receptive and expressive language delay and social deficits. (Note that it is not necessary to have a diagnosis for enrollment in early intervention). The program also interviewed Roger’s parents to look at family stressors, mental health issues and other external contributors to Roger’s difficulties but felt the family was healthy and coping well under the circumstances of a challenging child. The developmental specialist at the EI program also administered the M-CHAT which was positive and thus indicated the need to see an autism specialist. The EI program explained these results to Roger’s mother and in a letter back to Dr. Hamilton, suggesting that Roger be placed on the waiting list for the autism specialist at a local university while the program continued to work with him and his family.
Rachel: A Case Study using the PEDS:DM Assessment Level
This case example shows use of PEDS, PEDS:DM Screening Level, and the M-CHAT, all used within a primary health care setting. Due to problematic results, this child was referred to her local early intervention program where the PEDS:DM Assessment Level was administered twice, six months apart. You will see some of the PEDS:DM items (for both Screening and Assessment Level), how the Assessment Level is scored, and how the Assessment Level booklets are reused over time with the same child to track progress. Use of PEDS along with the PEDS:DM is called “the Best Approach” because it enables you to know exactly what parents’ concerns are, as well as how to rule those concerns in or out.
Vernon: A Case Study of an 8-month old Child Using the PEDS:DM
Vernon’s mother, Ms. Chavez, completed the PEDS:DM while in the waiting room, just before seeing a public health nurse for his 6 month check-up...