Support for Chapter 4

Measurement Approaches and Options Among Tools

Introduction

Screening and surveillance can often be accomplished with the same measures, i.e., when used over time. Included on this page is the Table of Tools shown in Chapter 4 with live links to publishers. The table includes tools with proven and acceptable levels of accuracy. Costs for time and materials are also shown.

Tools focused on psychosocial risk and resilience, and measures of academic skills and mental health for adolescents are listed in the table. More details about these measures are included in Chapter 9 (focused on appraising school-aged children) and in Chapter 10 (focused on children with risk factors).

Meanwhile, new tools arise and research on existing tools is published frequently. When we receive new information on measures, we will update this web page and the downloadable table. We invite you to send questions and suggestions including new research findings.

Evidence-based measures for Screening/Surveillance

Highlights and selection criteria for the tools shown in the table below, include the following:

  1. Many tools can be used simultaneously for both screening and surveillance. It is rarely necessary to use separate tools for both processes.

  2. The screening tools selected meet standards for screening test construction (described further in Chapter 19). All correctly identify at least 70% of children with disabilities, referred to as sensitivity or co-positivity, while also correctly identifying at least 70% of children without disabilities, referred to as specificity or co-negativity. Over-referral rates (1 - positive predictive value) were not considered due to research showing that over-referred children (those who do poorly on screens but are not found subsequently to have a diagnosis) are those with at least mild delays in areas predictive of school failure, i.e., academic, language skills, along with multiple psychosocial risk factors. Although such children are not eligible for IDEA services, they definitely need referrals to other types of intervention programs such as Head Start, Early Head Start, after-school tutoring, parent-training, etc. See Chapter 10 Chapter 19 for more information on over-referrals.

    All listed measures were standardized on national samples (including ethnic minorities, varying levels of parent education and income, and child gender--all in proportion to their prevalence as identified by the US Census Bureau). All measures are proven to be accurate for English and Spanish-speaking families (and often with other language groups within and outside the US), shown to be reliable in various ways (test-retest, inter-rater, and internal consistency), and all have been validated against a range of diagnostic measures. As a consequence, information on standardization, reliability, and validity is not detailed in this table, although accuracy by age and disability types detected is described (for screening tools).

  3. Three tools used exclusively for surveillance (of psychosocial risk factors and resilience) are included. All were heavily researched and proven to identify variables predictive of successful development or future delays. One (the FPS) has subscales and selected items serve as psychosocial screens (e.g., for parental depression). So, even if we don’t find a developmental or social-emotional delay on a broad-band screen, when psychosocial risk and lack of resilience factors are present, referrals to non-IDEA services are still needed (e.g., social work or parent training).

  4. Selected assessment level tools are also listed. Assessment measures are deployed after a problematic screening result and are used to monitor progress with a high risk group of children. Assessment measures are rarely used in primary care due to their length but instead by referral resources (e.g., IDEA intake) and in NICU follow-up. We include these measures below so that primary care and other providers have information about the measures most likely to be used by the specialists who receive referrals. The assessment level tools described were selected because they can be completed by parent-report and have abundant psychometric support, i.e., validation research supporting the close relationship between subtest results and performance in the same domain on diagnostic measures (e.g., high correlations, or unique performance patterns across various types of disabilities).

  5. Tools are sorted into those that are most feasible in health care versus early childhood or similar settings, where the latter may have more time and, for educational programming purposes, a greater need to observe and directly test children during the process of screening.

  6. Tools are further sorted by their breadth of focus. Broad-band screens measure most or all domains of development, i.e., cognitive/academic, language, motor, self-help) although some do not cover emotional/behavioral/mental health—meaning that when a screen measuring only development is failed, we may need to measure the remaining domains separately.

  7. We also include several condition-specific or narrow-band tools that focus on a single domain of development, behavior/social-emotional or mental health or a specific condition (e.g., autism spectrum disorder). These tools are useful when a broad-band screen indicates a problem, when clinical observation suggests more information is needed, and/or, in the case of autism spectrum disorder, the ages recommended by the AAP. Note that narrow-band tools should never be used as the sole indicator of developmental-behavioral status—they will miss the majority of children with difficulties in other domains because of their limited focus.

  8. Not included are measures such as the Denver-II, DIAL-III, ESP, E-LAP, SWYC, etc. because these fail to meet standards (limited standardization, absent validation, and no proof of accuracy); measures such as the CAT-CLAMS (because they were not standardized on general populations); and/or measures of a single developmental domain (e.g., language or motor), because these are best deployed by specialists. Even so, some worthy tools are not described because they duplicate the shorter measures presented below (e.g., the Conner’s ADHD Rating Scale).

  9. Diagnostic measures are not listed, such as the Vanderbilt Diagnostic ADHD Scales, because such tools should only be used after a broad-band screening test indicates the need for detailed assessment. In the case of ADHD, many conditions (e.g., depression, anxiety, conduct disorders) masquerade as ADHD when in fact the real problem is elsewhere—hence why a broader screen is needed to sort those with problems other than ADHD and direct them to other treatment.

  10. Table Headers

    1. The first column provides publication and contact information, the cost of purchasing a specimen set as of 2015, and the training options available.
    2. The purpose/description column indicates the type of measure [screening, surveillance (or both), versus assessment, and the overall coverage. Also presented are measurement methods (e.g., by parent report, interview, or direct administration). For parent-report tools, the "Description" column includes information about readability for parent report tools and shows grade level reading requirements.
    3. The “Scoring” column indicates the results provided. Although all scores are essentially cutoffs for deciding which children need referring and which do not, screening test results are rendered in various ways with some tests providing a range of results helpful for deciding when to refer, monitor, screen further, advise parents, or reassure.
    4. The “Accuracy” column shows the percentage of patients with and without problems identified correctly, i.e., sensitivity and specificity. These figures are shown first as a range embracing accuracy across age levels (thus describing how well a measure predicts performance on diagnostic measures with younger versus older children). Following this is information on discriminant validity, meaning how well performance on screening tests predicts performance on diagnostic measures (viewed by developmental-behavioral domain and/or by specific conditions studied (e.g., learning disabilities or autism spectrum disorder). Authors/researchers do not always study measures for discriminant validity but when they do, results may take the form of correlations, sensitivity/specificity within a relatively high-risk sample, or sensitivity alone (determined by selecting those children who performed poorly on a screening test and then viewing the types of disabilities they were found to have). Thus a range of data, when available, is included in the Accuracy column.
    5. The “Time Frame/Costs” column shows the time required for scoring, interview (if needed), hands-on administration (if available and preferred) and the price of materials per administration [meaning the cost of purchasing test forms or photocopying (if permissible) at $0.06 cents per page]. 
  11. Information about electronic options is included at the end of the table. Electronic applications can reduce human error via automated scoring, and save time by generating referral letters, providing procedure and billing codes, and aggregating results across patients/clients/students--helpful for program evaluation and quality improvement initiatives. While somewhat more expensive than print, electronic options offer time-savers that offset the costs of hand-scoring, writing referral letters, etc.

  12. A brief description of measures in progress is also provided. These tools are under development but we list them as measures to keep an eye on because their authors are actively working to establish psychometric support and may substantiate them in the future.

Accurate Broad-Band measures for Screening/Surveillance Relying on Information From Parents

Screens for Primary Care
Behavioral and/or Developmental Screens Relying On Information From Parents Age range Purpose and Description Scoring Accuracy Protocol Costs
Scoring Time*, Administration Options and their Time Requirements
Ages & Stages Questionnaires, Third Edition (ASQ-3) (2009) Paul H. Brookes Publishing Co., Inc., P.O. Box 10624, Baltimore, MD 21285.

(800-638-3775) ($275.00)

www.agesandstages.com

Training Options: Presentations and case examples on website, webinars, DVDs for purchase, and live training
Electronic Options: See Table 2E

1 - 66 mos Purpose: Screening and surveillance of developmental milestones. A separate measure, the ASQ:SE-2, is needed to screen for behavioral, social-emotional/mental health issues.

Description: Parents indicate children’s developmental skills on 30 items plus overall concerns. The ASQ has a different form (5-8 pages) for each age interval. Written at the 4th – 6th grade level. Can be used in mass mail-outs for child find programs. Manual contains detailed instructions for organizing child-find programs and includes activity handouts for parents. The ASQ-3 is available in English, Spanish, Somali, Hmong, French, Korean and Norwegian with other translations underway.  Can be administered by parents at home or in waiting rooms [with the aid of a materials kit that can be purchased separately ($295.00) or materials assembled from the list proved in the ASQ manual].

Cutoff scores (set at 1 ½ or 2 SDs below the mean), in 5 developmental domains: Indicates need for referral or monitoring.

Across ages,
Sensitivity: 86%
Specificity: 85%

By domain:
Sensitivity: 83% Specificity: 91%

In discerning disability types
i.e., motor, visual, hearing impairments: Sensitivity: 87%

Protocols:
0.36 - $0.48

Scoring
Time = 2 min

If interview needed:
Time = 12 min.

Parents’ Evaluations of Developmental Status (PEDS)(2013)

PEDSTest.com, LLC, 1013 Austin Court, Nolensville, TN 37135 (615-776-4121) ($42.00)

www.pedstest.com

Training Options: Offers through its website self-training/train-the-trainer support via downloadable slide shows with notes, case examples, pre-post-test questions, FAQs, participant handouts, website discussion list (covering all screens), short videos, with some live training available.

Electronic Options: See Table 2E

Birth to 8 years

Purpose: Screening/surveillance of development/social-emotional/behavior/mental health via parents’ concerns.

Description: 10 questions eliciting parents’ (and providers’) concerns in English, Spanish, Vietnamese, Chinese, Somali and 36 other languages. Items are written at the 4th  grade level (without response options, 2nd grade with). Longitudinal Score and Interpretation Forms, assign risk levels, track decision-making and offer specific guidance on how to address concerns. Provides screening, longitudinal surveillance and triage for developmental as well as behavioral/social-emotional/mental health problems. PEDS is best used in conjunction with the PEDS:DM (below) for compliance with AAP Policy on screening and surveillance. A non-clinical version, Survey PEDS, is used in needs assessment studies such as the National Survey of Child Health.

Identifies levels of risk and decision support, i.e., when to: Refer and what types of referrals are needed; Advise parents; Monitor vigilantly; Screen further (or refer for screening); or Reassure.

Across ages,
Sensitivity: 86%
Specificity: 83%

In discerning disability types
i.e., learning, intellectual, language, mental health, autism spectrum and motor disorders:
Sensitivity: > 80%

Materials: $0.42

Scoring
Time: 1 min

If interview needed:
Time = 2 min

PEDS: Developmental Milestones (Screening Version) (2015) PEDSTest.com, LLC 1013 Austin Court, Nolensville, TN 37135 (615-776-4121) ($299.00)

www.pedstest.com

Training Options: offers through its website self-training/train-the-trainer support via videos, downloadable slide shows with notes, case examples, pre-post-test questions, participant handouts, FAQs, with some live training available. The PEDS:DM manual includes extensive suggestions for training medical students, residents, and nurses.

Electronic Options:
See Table 2E

Birth to 8 years

Purpose: Screening/ surveillance of developmental and social-emotional/mental health milestones

Description: The PEDS:DM consists of 6 – 8 items at each age level. Each item taps a different domain: fine/gross motor, self-help, academics, expressive/receptive language, social-emotional. The PEDS:DM provides screening, triage, and surveillance via a longitudinal score form for tracking milestones progress. Written at the 2nd to 3rd grade level and can be completed by self-report, interview, or administered directly to children. Forms are laminated and completed with a dry erase marker. At each age level, read-aloud stories about age-appropriate parenting assist in developmental-behavioral promotion. Supplemental measures include the M-CHAT, Family Psychosocial Screen, Pictorial PSC-17, the SWILS, the Vanderbilt ADHD scale, and the Brigance Parent-Child Interactions Scale. Best combined with PEDS to ensure compliance with AAP policy. In English, Spanish, Chinese, Portuguese, Arabic, Serbian, Swahili, with other languages in process.

Met/Unmet milestones with cutoffs tied to performance above and below the 16th percentile for each item and its domain.

Across ages,
Sensitivity: 83%;
Specificity: 84%

By domain,
Sensitivity: 3%;
Specificity: 84%

In discerning disability types, i.e., autism spectrum disorder
Sensitivity: 79% - 82%

Materials: $0.06

Scoring
Time: 1 min

If interview needed:
Time = 3 min

If hands-on is preferred:
Time = 5 minutes

Table 2B. Accurate Broad-Band measures for Screening/Surveillance Relying on Direct-Elicitation of Children’s Skills

Hands-on Broad-Band Screens, i.e., requiring skills to be directly elicited from children. Such tools require more time than is usually available in primary care settings (although clinics using a gated screening process and have available a pediatric nurse practitioner or a developmental specialist can often screen in greater depth given a subset of at-risk patients). More commonly, hands-on tools are used in early childhood programs, early intervention intake, NICU follow-up, referral clinic triage, and in research studies when on-going indicators of progress and outcomes are needed.

Developmental Screens Relying On Eliciting Skills Directly From Children Age range Purpose and Description Scoring Accuracy Protocol Costs/
Scoring Time*, Administration Options and their Time Requirements

Brigance Early Childhood Screens-III Curriculum Associates, LLC. (2013)

153 Rangeway Road, N. Billerica, MA, 01862 (800-225-0248) ($867) includes materials kit)

www.Brigance.com

Training Options: live workshops, webcasts, videos, listserv

Electronic Options: See Table 2E

Birth to K -1st grade

Purpose: Screening and surveillance of milestones in most domains

Description: Eight separate forms, one for each 12 month age range. Taps speech-language, motor, readiness and general knowledge at younger ages and also reading and math at older ages. Separate scales measure self-help and social-emotional skills. In the birth – 35 month age range, can be administered by parent interview. Includes longitudinal tracking, progress indicators plus separate psychosocial risk cutoffs for children in Head Start type programs who need “the gift of time” before referral decisions are made. Separate cutoff scores offer indicators for gifted/talented children. In English and Spanish.

Cutoffs, and for progress/outcomes monitoring, age-equivalents and various standard scores are available.

Across ages and disability types, i.e., conditions resulting in eligibility for special education services,

Sensitivity: 91%
Specificity: 86%

Across ages and exceptionality, i.e., gifted/talented,

Sensitivity: 89%
Specificity: 81%

Materials: $1.08

Requires Hands-on or Interview Administration:

Time =15 minutes

Scoring
Time: 3 min

Battelle Developmental Inventory Screening Test –II (BDIST) –2 (2006). Riverside Publishing Company, 8420 Bryn Mawr Avenue, Chicago, Illinois 60631 (800-323-9540) ($405.50 includes materials).

www.riversidepublishing.com

Training Options: live workshops, website FAQs, online training/webcasts

Electronic options: See Table 2E

0 to 8 years

Purpose: Screening and follow-up monitoring of developmental domains.

Description: Uses a combination of direct-elicitation, observation, and parental interview to provide separate scores in adaptive behavior, personal-social, communication, motor, and cognitive domains. Used to decide whether to administer the full BDI-2 (an assessment level tool that takes about 1 ½ - 2 hours to complete and is often used to determine eligibility for early intervention services). Requires trained professionals to administer (e.g., physical/occupational speech-language therapists). Includes helpful links for use by educators to the Hawaii Curriculum and to the BDI-2 Curriculum. In English and Spanish.

cutoffs at 1.0, 1.5, and 2.0 SDs below the mean in each of 5 domains. For outcomes monitoring, age-equivalents, various standard scores and change scores are available.

Across ages: N/A

By disability types, i.e., eligibility for special education services,
Sensitivity: 82%
Specificity: 79% - 84%

Materials: $3.08

Scoring:
Time = 5 minutes
Requires Hands-on Administration with some interview and observation items:
Time = 20 min

PEDS: Developmental Milestones (Assessment Version) (2008) PEDSTest.com, LLC. 1013 Austin Court, Nolensville, TN 37135 (615-776-4121 ($349.00). >www.pedstest.com

Training Options: freely available website videos, downloadable slide shows, case examples, FAQs, audience handouts, some live training available.

Electronic options: See Table 2E

0 – 8 years

Purpose: In depth screening/surveillance plus follow-up/outcomes monitoring. Measures: fine motor, gross motor, expressive language, receptive language, self-help, pre-academics/academics and social-emotional/mental health

Description: Items can be self-administered by parents or hands-on by examiners. Items are written at the 2nd to 3rd grade level. The Assessment Level booklet is reusable with each child and includes a longitudinal score form to track progress. Includes supplementary narrow-band measures (e.g., of mental health, ASD, parent-child interactions, academic measures, psychosocial risk). In English, Spanish, Portuguese, Arabic, Chinese with other translations in progress.

Cutoffs for screening but also age equivalent scores for progress/outcomes tracking

Across ages,
Sensitivity: 83%;
Specificity: 84%

By domain,

Sensitivity: 83%;
Specificity: 84%

In discerning disability types, i.e., autism spectrum disorder, complications of prematurity, motor disorders, etc.

Sensitivity: 80%

Materials: $3.44 (but designed to be reused over time)

Scoring:
Time = 5 minutes

If by Interview:
Time = 10 minutes

Hands-on is preferred:
Time = 15 minutes

Table 2C. Accurate Narrow-Band measures—Adjuncts to Broad-Band Screens That Improve Identification of Specific Conditions and Risk Factors

Narrow-Band Screens. When broad-band tools do not measure all aspects of development such as social-emotional skills, it is necessary to administer narrow-band screens when broad-band screens are failed. Also shown are narrow-band screens addressing other American Academy of Pediatrics’ early detection policies, i.e., measures of psychosocial risk, resilience, and autism spectrum disorder. Note that narrow-band screens do not identify the full range of childhood problems and should never be used without broad-band measures. Some of the narrow-band measures listed below may be too lengthy for primary care but can become a request to referral sources (e.g., the M-CHAT Follow-up Interview).

NARROW-BAND SCREENS
focused on specific Conditions
Age range Purpose and Description Scoring Accuracy Protocol Costs

Scoring Time*, Administration Options and their Time Requirements

Modified Checklist of Autism in Toddlers (M-CHAT-R) (2014)

Freely downloadable in multiple languages along with the Follow-up Interview at www.mchatscreen.comCommercial software vendors must pay a licensing fee.

Training Options: the site contains a guide to the needed follow-up interview for missed items, and houses research papers and reviews on ASD screening.

Electronic options: See Table 2E

18 - 47 mos

Purpose: Screening for autism spectrum disorders

Description: parent report of 20 yes-no questions and written at 4-6th grade reading level. Screens only for Autism Spectrum Disorder and should not be used without a broad-band tool. Downloadable scoring template and .xls files for automated scoring. Requires the MCHAT-R Follow-up Interview if 3 - 7 items are failed and referral if 8 or more failed items. Referral sources can be asked to complete the Follow-up Interview. Available in more than 15 languages. Research is voluminous (and listed/downloadable at www.mchatscreen.com

results in fewer over-referrals to ASD services, meaning that children with other disabilities are less likely to be identified. The measure is available in several languages but the Spanish translation is still in progress. Time time/costs are similar to those of the M-CHAT.

Low-, moderate-, high-risk based on the numbers of failed items

Across ages and by disability, i.e, Autism Spectrum Disorder:
Sensitivity: 91%
Specificity: 96%

Materials: $0.06

Scoring
Time = 2 min

Interview
Time = 5 minutes (excluding follow-up interview)

Brief-Infant-Toddler Social-Emotional Assessment (BITSEA) (2006)

Pearson/Psych Corp, Inc. 19500 Bulverde Road, San Antonio, Texas 78259 (800-627-7271) ($118.90)

www.pearsonclinical.com

Training Options: None Electronic Options: CD-ROM ($339.20)

12 –36 mos

Purpose: Screening and surveillance of milestones in social-emotional and mental health

Description: 42 item parent-report measure (with separate forms if ratings from day care providers are needed). Identifies social-emotional/behavioral problems and delays in competence. Written at the 4th – 6th grade level. Can be followed by the more detailed ITSEA. Available in English, Spanish, French, Dutch, Hebrew, Italian, Russian, Chinese, French and Thai. The longer ITSEA (used when the BITSEA is failed) has a CD-ROM for ease of scoring and also generates reports and referral letters.

Cut-points based on child age and gender show present/absence of problems and competence.

By gender,
Sensitivity: 95%
Specificity: 90%

By disability types: ie.,  internalizing,  externalizing, and autism spectrum disorders,
Sensitivity: 85%
Specificity: 75%

Materials: $0.91 for parent forms, or $1.82 if also using child-care forms

Scoring:
Time = 5 min (unless scoring CD is used)>

If by interview:
Time = 10 minutes

Ages & Stages Questionnaires®: Social-Emotional, Second Edition (ASQ:SE-2™) (2015). Paul H. Brookes Publishing Co., Inc., P.O. Box 10624, Baltimore, MD 21285. (800-638-3775) ($275.00)

www.agesandstages.com

Training Options: Presentations and case examples on website, webinars, DVDs for purchase, and live training

Electronic options: See Table 2E

1 – 72 mos

Purpose: Screening and surveillance of milestones in social-emotional and mental health

 

Description: Companion measure to ASQ-3 and can be administered as a follow-up when the ASQ-3 is failed. ASQ:SE-2 consists of 9 age-specific forms (each 4-6 pages long) with 19-39 items.  Items focus on self-regulation, compliance, communication, adaptive functioning, autonomy, affect, and interaction with people. Readability is 5th – 6th grade. Items related to autism red flags added to 2nd edition. Includes activities sheets for families. In English and Spanish; 1st edition is available in Norwegian.

Single cutoff score indicating when a referral is needed

By age and disability,

 i.e., social-emotional problems,

Sensitivity:

81%.

Specificity:

83%.

Materials : $0.36

Scoring

Time: 2 minutes

 

If by interview:

Time = 10 minutes

 

Screening Tool for Autism in Toddlers (STAT) (2004)

Vanderbilt University
Center for Technology Transfer and Commercialization
1207 17th Avenue South, Suite 105
Nashville, Tennessee  37212 (615-343-2430)
http://stat.vueinnovations.com/ ($500, includes materials kit)

 

Training Options: The price of the measure includes a web-based tutorial or attending live training in order to receive needed certification.

Electronic Options: None

14– 36 mos

Purpose: Screening for autism spectrum disorders

Description: Interactive, play-based tool comprising 12 activities assessing social-communicative behaviors in areas of play, communication, and imitation. Differentiates autism from other developmental disorders. Takes 20 minutes to administer. Direct observation format affords opportunity to identify teaching goals and activities. Requires certification for use. Soon to be available in Spanish.

 

Pass/fail Scores

Across ages,

Sensitivity: 94%
Specificity: 79%

By disability types, i.e., autism spectrum disorder,
Sensitivity: 94%
Specificity: 79%

Scoring time: 1 minute

Materials: $1.00

Administration time: 20 minutes

CSBS: Infant/Toddler Checklist (ITC) (2002)

Paul H. Brookes Publishing Co., Inc., P.O. Box 10624, Baltimore, MD 21285. Phone: (800-638-3775) ($99.95 for scoring CD and manual with freely downloadable protocol)

www.brookespublishing.com

Training Options: live training and research support, downloadable slide shows, abstracts, videos, and references at http://firstwords.fsu.edu

Electronic options: None (apart from the CD-ROM offering automated scoring and saving ~ 7 minutes of time)

6 - 24 mos

Purpose: Screening and surveillance of communicative competence and the detection of language impairment and autism spectrum disorders.

Description: Parents complete the ITC's 24 multiple-choice questions. Examiners verify parents’ answers via brief observation and a Caregiver Questionnaire. Reading level is ~ 5th grade. Can serve as an entry point into the assessment-level, CSBS and an ongoing monitoring tool. In English, Spanish, Slovenian, Chinese, Swedish, German. The First Words website (http://firstwords.fsu.edu) houses research on the ITC and links to the Autism Video Glossary.

Cutoff scores for 3 domains: Communication (efficacy of eye-gaze, emotions and gestures), Expressive (use of sounds and words), and Symbolic (understanding of words and use of objects)

Across ages,

Sensitivity: N/A
Specificity: N/A

By disability types,
i.e., developmental disabilities, autism spectrum disorders:
Sensitivity: 78% Specificity: 84%

Materials: $0.18

Scoring Time: 2 min (with CD-ROM)
If interview needed:
Time = 8 minutes

Family Psychosocial Screen (FPS) (2000)

Included within the AAP Pediatric Intake Form (www.brightfutures.org), laminated within PEDS:Developmental Milestones, and freely downloadable at www.pedstest.com/TheBook/pages/chapter10

Training Options: None

Electronic Options: None

Parent

Purpose: screening and surveillance of family psychosocial risk

 

Description: Included in the Bright Futures Guidelines, the FPS is a two-page measure of psychosocial risk factors associated with developmental problems and is often used for clinic intake. More than four risk factors is associated with developmental delays. The FPS also includes: a) a four item screen for parental history of physical abuse as a child; b) a six item measure of parental substance abuse; c) a four item screen for domestic violence; and d) a three item measure of maternal depression. Can be used along with the Brigance Parent-Child Interaction Scale to view both parenting risk and resilience. Readability is 4th grade. In English and Spanish.

Refer/no refer to available community resources for each of the four screens’ risk factors.

By condition, i.e., parental depression, substance abuse, etc.,

Depression (3 items):

Sensitivity:100% specificity: 88%

Parental Substance Abuse (7 items):

a) alcohol abuse sensitivity: 90%

b) drug abuse

sensitivity: 88%.

Parent history of abusive punishment as a child (4 items):

Sensitivity: 94%

Specificity: 89%

Materials: $0.12

Scoring:

Time = 3 min

If interview needed:

Time = 10 minutes

Brigance Parent-Child Interaction Scale (BPCIS) (2007)

PEDSTest.com, LLC. The BPCIS is included in PEDS:Developmental Milestones and in the Brigance Infant and Toddler Screen. It can be freely downloaded at: http://www.pedstest.com/TheBook/Chapter10

Training Options: None

Electronic Options: None

Birth to 30 mos

Purpose: Surveillance of parenting behaviors associated with resilience versus psychosocial risk

Description: Administered by parent-self report and/or examiner observation, the 18 – 19 multiple choice items tap whether parents read and talk with their child, enjoy talking with their child and perceive him/her as interested in communication, whether parents actively teach their child new things, etc. Certain items are associated with resilience while others are associated with accumulating delays (which start to become visible at  6 months of age and are striking by 12 – 18 months)

Discrete sets of items reflect resilience factors  associated with typical development while others items reflect limited resilience associated with future or current delays

N/A

Materials: $.06

Scoring

Time: 1 minute

If by Interview/

Observation:

Time = 5 mim

Strengths and Difficulties Questionnaire (SDQ) (2014)

 

Freely downloadable in multiple languages

www.sdqinfo.org

Training options: None

Electronic options: None

4 – 17 years

Purpose: Resilience and psychosocial risk for mental health/social-emotional, behavioral skills.

 

Description: 25 items (youth self-report versus parent or teacher report) tapping positive and negative attributes. Generates indicators for conduct problems, hyperactivity, emotional symptoms, peer problems and pro-social behavior. Produces a total strengths versus total difficulties score. Guidance is available on how to aggregate results for epidemiological and needs-assessment studies. Cross-cultural research and translations are abundant and norming studies have been conducted in Great Britain, the United States and otherwise in European countries.

Comparison of factors

N/A

Materials: $0.12

 

Scoring:

Time = 5 min

 

If by Interview:

Time = 5 min

 

Table 2D. Screens for Older Children

SCREENS FOR OLDER CHILDREN. American Academy of Pediatrics’ policies recommend a continued pattern of practice and attention to development and well-being across the well-visit schedule. Because mental health problems often arise when school failure is present, presented are screens for academic skills and mental health including attention deficit hyperactivity disorder.

SCREENS FOR OLDER CHILDREN

Age range

Purpose and Description

Scoring

Accuracy

Protocol Costs/

Scoring Time*, Administration Options and their Time Requirements

Safety Word Inventory and Literacy Screener (SWILS)(2002)

 

From PEDSTest.com, LLC with items courtesy of Curriculum Associates, Inc. The SWILS is included in PEDS:Developmental Milestones (PEDS:DM) and is freely downloadable at: www.pedstest.com/TheBook/Chapter9

 

Training Options: None

 

Electronic Options: None

 

6 – 14 years

Purpose: Screening and surveillance of academic skills

 

Description: Children are asked (by parents or professionals) to read 29 common safety words (e.g., High Voltage, Wait, Poison) aloud. The number of correctly read words is compared to a cutoff score. Results predict performance in math, written language and a range of reading skills. Test content may serve as a springboard to injury prevention counseling and can be used to screen for parental literacy. Because even non-English speakers living in the US need to read safety words in English, the measure is only available in English.

Single cutoff score by age, indicating the need for a referral

Across ages/academic deficits,

Sensitivity: 80%

Specificity: 82%

 

Materials: $0.12

Scoring

Time = 1 min

Requires hands-on administration Time = 7 minutes

Pediatric Symptom Checklist (PSC) and Pictorial PSC (1991)

 

Freely downloadable in multiple languages in its 30 question version at http://www.massgeneral.org/psychiatry/services/psc_home.aspx

 

The Pictorial PSC is useful with low-income Spanish and English speaking families and is included in its 17 item factorable version in PEDS: Developmental Milestones and on www.pedstest.com/TheBook/Chapter9

Training Options: None

 

Electronic Options: web-based application on the authors’ site. See also Table 2E

6 - 18 years

Purpose: Screening and surveillance of emotional/mental health, and conduct. Serves as a necessary prescreen for sorting attention problems from competing conditions.

 

Description: Administered by youth/parent self-report or by interview, the PSC/Pictorial PSC are 35 short statements of problem behaviors capturing various mental health challenges. The PSC-17/Pictorial PSC-17 are 17 item versions producing cutoffs for attentional, internalizing (meaning depression or anxiety) and externalizing problems (conduct, impulsivity, etc.) Readability is ~ 2nd grade. In English, Spanish, Portuguese, Chinese, Dutch, Filippino, French, Somali, and several other languages.

For the PSC, a single refer/nonrefer score, for the PSC-17/Pictorial PSC-17, cutoffs for attention, internalizing, and externalizing factors

PSC/Pictorial PSC-35 by disability, i.e., mental problems of any kind, across numerous studies:

Sensitivity: 88%

Sensitivity: 84%

PSC-17/Pictorial PSC-17 by specific disability, i.e., ADHD, internalizing disorders, externalizing disorders,

Sensitivity: 80%

 

Materials:$.06

 

Scoring

Time = 3 min

 

If by Interview:

Time = 3 min

 

CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) (2009)

 

Freely downloadable from the Center for Adolescent Substance Abuse Research www.ceasar-boston.org

 

Training options: None

 

Electronic options: None  

11 - 21 years

Purpose: To identify substance use (tobacco, alcohol or other drug abuse) in adolescents.

 

Description: Self-/youth-report questionnaire that contains 3 initial screening questions that if failed prompt administration of additional questions. Requires confidential setting. Decision support applied to results indicates whether to advise/monitor or refer. Available in English, Spanish, Chinese, Khmer, Laotian and many other languages.

Advise/Monitor versus refer

 

 

Across ages and by abuse types, Sensitivity: 84%

Specificity: 85%

 

 

Scoring

Time: 1-2 min

Cost: $1.20 - $2.40

Materials (photocopies): $0.12

Total Self-Report: $1.32 - $2.52

 

Interview

Time: 3 min

Cost: $3.60

Materials/

Scoring: $1.32-$2.52

Total Interview: $4.92 - $6.12


Table 2E. Electronic Options in Screening and Surveillance

Electronic Options for Screening and Surveillance with Quality Tools. Electronic screening services eliminate most material costs (unless photocopied paper-pencil forms, usually provided free with licensing, are needed in waiting rooms). The availability of parent portals whereby families can complete screens at home prior to encounters or on waiting room computers can reduce or eliminate materials costs. Electronic applications also remove time requirements for scoring, and the time needed to create referral letters and parent summary reports.

Company Offerings

Training/Support options

Description and Pricing

CHADIS
www.chadis.com

ASQ, M-CHAT, PSC and other measures online for touch-screen, tablet PCs, keyboards, telephony  and parent portal methods). Spanish language applications coming soon.

Downloadable guides, live training at exhibits, and other training services on request.

CHADIS includes decision support for more than 75 both diagnostic and parent/family focused screens, such as the ASQ, the M-CHAT, the Vanderbilt ADHD Diagnostic Rating Scale, and various parent and adolescent depression, substance abuse, domestic violence and other inventories. CHADIS offers a parent portal, an online baby book, integration with existing EHRs, works with a range of equipment/applications, and automatically generates reports. Pricing is via site license and ~ $695 per year per full-time provider. Includes options for MOC, QI credit, and e-learning/CME for clinicians.

PEDS Online www.pedstest.com/online

PEDS, PEDS:DM (Screening Level), PEDS:DM Assessment Level, M-CHAT –R  (for use with keyboards and tablets) in English and Spanish

Slide shows, implementation guides, website FAQs, email/telephone support, online videos. Provides digital files of translations (in 41 languages).

PEDS Online offers PEDS, PEDS: DM, and the M-CHAT for keyboard/tablet applications (if allowing for actual comments from parents). Offers a parent portal (wherein families do not see the results) and HL-7/HPPA/FERPA compliant integration with electronic records. Scoring is automated as are summary reports for parents, referral letters when needed, and dx/procedure codes. In English and Spanish. A unique user database is provided for data export and aggregated views of records to assist QI/MOC efforts. $3.00 - $4.00 per encounter for any/all measure Integrated with several EHRs including EPIC.

Patient Tools www.patienttools.com

(M-CHAT, ASQ, ASQ:SE and other measures online for tablet, i.e., touch-screen PCs)

 

Webcasts/webinars, live support by phone, email

Patient Tools offers the ASQ and ASQ:SE (w/audio options), the PSC, the Vanderbilt ADHD Scales and a wide range of behavioral/mental health measures in multiple languages for adolescents and adults.  A practice-based approach provides access in the office via dedicated Survey Tablet equipment, wireless tablet PCs and kiosk PC; or online from home with results available in the office.  Access fees are $58.00 per month for ongoing hosting, data storage, reporting, custom programming, telephone technical & installation support plus $0.50 per encounter with additional licensing fees for some measures. 

ASQ Online

www.ASQonline.com

 

Online completion and online management for ASQ-3 and ASQ:SE-2 with keyboards and tablet PCs. English and Spanish questionnaires available.

Online tutorials, online manuals and FAQs, live support by phone or email, webinars, and live training

Web-based management system offers automated scoring, reporting, referral tracking, and customizable letters for parents/providers for ASQ-3 and ASQ:SE-2. ASQ Pro is designed for single-site programs ($149.95 annual subscription, plus quarterly billing for screens used) and ASQ Enterprise is designed for multisite programs ($499.95 annual subscription, plus quarterly billing for screens used). Online questionnaire completion available through ASQ Family Access ($349.95 annual subscription) with a secure, customizable website for parent completion of questionnaires. API capability for integrating with EHRs and other online systems.

 

Brigance Early Childhood Screens-III

www. cainc.com

 

Online for keyboards and tablets

Live training, online training, email and phone support, customer suggestion box

This web-based service provides clickable data sheets that automatically calculate chronological age and test scores, including age equivalents, quotients, progress indicators, at-risk cutoff scores, quotients etc.  Aggregated reports and administrative access are available through the online service. $4.00 per child per year.

Battelle Developmental  Inventory Screening Test-2

www.riverpub.com

 

Online via keyboards, PDAs, and/or CD-ROM

Website FAQs, email support, live workshops, webcasts/webinars

Scoring services include report-writing via a web interface, at ~ $476.00 per year, per year plus $84.15 for annual renewal. Mobile phone data management software (priced separately) are also available.