Title: Assessing Parent’s Evaluation of Development Status (PEDS) using the California Health Interview Survey (CHIS) 2008 (submitted) May Aydin, Ph.D. Research & Survey Support Manager California Health Interview Survey (CHIS) UCLA Center for Health Policy Research The PEDS was designed as screening tool for parent’s concerns about their child’s development and behavior. Although the instrument has been primarily used in clinically-based settings, more recent applications have been adapted for use in population-based surveillance. The California Health Interview Survey (CHIS) utilizes several age-specific items from the PEDS to assign overall estimates of risk of problematic development for children ages 4 months to 5 years in the California population. In CHIS 2003 and 2005, parents were asked a series of questions about their concerns in several developmental areas. An age-adjusted algorithm was applied to estimate risk distributions across four levels (i.e. no risk, low risk, moderate risk, high risk). Prevalence estimates in 2003 indicate that approximately one-quarter (25.6%) of children in California have high risk of developmental, behavioral or social delays, compared to just under 20% in 2005. Results suggest comparable rates of moderate and low risk in 2003 and 2005. For example, about 17.4% of children had moderate risk for delay in 2003 compared to 17.9% in 2005. Similarly, in 2003, 16.6% of children scored in the low risk range compared to 17.7% in 2005. Finally, 2003 data indicate that 40.7% children have no risk for developmental, behavioral or social delays with slightly higher estimates reported in 2005 at 44.5%. More attention should be given to the application of PEDS in population-based survey efforts. TITLE: Household Language, Parent Developmental Concerns, and Child Risk for Developmental Disorder. 2008, submitted Katharine E. Zuckerman, M.D. Alexy Arauz Boudreau, M.D., M.P.H. Ellen A. Lipstein, M.D. Karen A. Kuhlthau, Ph. D. James M. Perrin, M.D. Center for Child and Adolsecent Health Policy, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA ABSTRACT: Background: Provider elicitation of parent developmental and behavioral [DB] concerns is the foundation of DB surveillance. Language differences may affect whether providers ask about parental concerns. Objectives: To compare children in English versus non-English primary language [PL] households according to child risk for DB disorder and elicitation of parental DB concerns. Design/Methods: Using data from the 2004 National Survey of Children’s Health, we compared 30,618 children aged 0-71 months in English versus non-English PL households, who received preventive care in the previous 12 months. We used logistic regression to test the association of household PL with child risk of DB disorder and parent-reported elicitation of DB concerns at healthcare visits in the previous 12 months. Results: Compared to children in English PL households, children in non-English PL households were equally likely to be at risk for DB disorder (odds ratio [OR] 0.80, 95% confidence limit 0.64-1.02). However, non-English PL households were less likely to report elicitation of DB concerns (OR 0.67 [0.55-0.82]). Elicitation of concerns was also less likely in the subgroup of children at moderate/high risk for DB disorder (OR 0.55 [0.38-0.81]). Households with neither Spanish nor English PL reported less elicitation than households with Spanish PL (OR 0.62 [0.40-0.95]). Conclusion: Although children in non-English PL households had similar risk for DB disorder, their parents were less likely to report elicitation of DB concerns. These findings suggest that language differences may affect the receipt of DB surveillance in children, and that non-Spanish PL families may be at particular risk. Title: Child care problems and employment among families with preschool-aged children with autism in the United States. Pediatrics. 2008 Jul;122(1):e202-8. Montes G, Halterman JS. Children's Institute, Rochester, NY BACKGROUND: The impact of childhood autism on parental employment is largely unknown. OBJECTIVE: The purpose of this work was to describe the child care arrangements of children with autism and to determine whether families of preschool-aged children with autism are more likely to report that child care arrangements affected employment compared with typically developing children and children at high risk for developmental problems. METHODS: Parents of 16282 preschool-aged children were surveyed by the National Survey of Children's Health. An autism spectrum disorder was defined as an affirmative response to the question, "Has a doctor or health professional ever told you that [child] has any of the following conditions? Autism?" There were 82 children with autism spectrum disorder in the sample, and 1955 children at high risk on the basis of the Parent's Evaluation of Developmental Status. We used chi(2) and multivariate logistic regression analyses. RESULTS: Ninety-seven percent of preschool-aged children diagnosed with autism spectrum disorder were cared for in community settings, particularly preschool and Head Start, with only 3% in exclusive parental care. Thirty-nine percent of the parents of children with autism spectrum disorder reported that child care problems had greatly affected their employment decisions, compared with 16% of the children at high risk and 9% of those who were typically developing. In multivariate analyses, families with a child with autism spectrum disorder were 7 times more likely to state that child care problems affected employment than other families, after controlling for household and child covariates. This effect was 3 times larger than the effect of poverty. CONCLUSIONS: Developmental problems and autism spectrum disorder are associated with higher use of child care services and higher probability that child care problems will greatly affect employment. These findings warrant evaluation of the community resources available to families with children with special needs. TITLE: Assessing development in the pediatric office. Pediatrics. 2004 Jun;113(6 Suppl):1926-33. Halfon N, Regalado M, Sareen H, Inkelas M, Reuland CH, Glascoe FP, Olson LM. UCLA Schools of Medicine and Public Health, Los Angeles, California OBJECTIVE: To determine the proportion of children aged 10 to 35 months who were reported ever to have received a developmental assessment (DA) and to examine characteristics of the child, family, and health care setting associated with the receipt of a DA. METHODS: The National Survey of Early Childhood Health, conducted in 2000, is a survey of 2068 parents of children 4 to 35 months of age. Children were classified as having received a DA in response to 2 questions: whether the child's pediatric provider ever told parents that he or she was doing a "developmental assessment" and/or parents recalled explicit components of a DA, such as stacking blocks or throwing a ball. Parent-reported receipt of a DA was assessed in relationship to child and family, health care access, other measures of health care content and process, and measures of quality and satisfaction. RESULTS: Approximately 57% of children 10 to 35 months of age ever received a DA. Forty-two percent of parents recalled ever being told by their child's pediatric provider that a DA was being done. Thirty-nine percent recalled their child's being asked to perform specific tasks routinely included in a DA. Bivariate analysis indicates that receipt of a DA is not associated with child or family sociodemographic characteristics such as maternal education and household income, with the exception of race/ethnicity. Less acculturated Hispanic parents reported a DA more frequently than parents in other racial/ethnic groups (66% vs 56%). A smaller proportion of parents whose children who used community health centers reported their child's ever having received a DA compared with children who use other settings (51% vs 60%). Compared with other children, parents whose child ever received a DA reported more frequently than other parents that the time spent with the child's provider during the last well-child visit was adequate (94% vs 80%). They also reported longer visits (19 minutes vs 16 minutes), higher family-centered care ratings (mean: 71 vs 59), and higher satisfaction with well-child care (8.9 vs 8.4). Receipt of a DA is also associated with the content of developmentally focused anticipatory guidance received. For each health supervision topic analyzed, frequency of discussion is higher for children who ever received a DA. In multivariate analysis, odds of receiving a DA are higher for children with longer visits with the provider (odds ratio: 1.03; 95% confidence interval: 1.01-1.05) and lower for children in community health clinics compared with a private office (odds ratio: 0.61; 95% confidence interval: 0.39-0.96), even accounting for total well-child visits to the pediatric provider. CONCLUSION: Although guidelines endorse the routine provision of DAs, parents of many children do not report receiving DAs. Children who receive assessments are more likely to receive other developmental services, and their parents are more likely to report greater satisfaction with care and rate the interpersonal quality of well-child care more favorably. The substantial number of children who do not receive these routinely recommended services raises important questions about the quality of care received. Measuring the quality of preventive and developmental services for young children: national estimates and patterns of clinicians' performance. Pediatrics. 2004 Jun;113(6 Suppl):1973-83. Bethell C, Reuland CH, Halfon N, Schor EL. Child and Adolescent Health Measurement Initiative, Oregon Health and Science University, Portland, Oregon OBJECTIVE: To generate a national picture of performance in the area of preventive and developmental services for children aged 4 to 35 months using 4 composite quality measures in the areas of 1) anticipatory guidance and parental education, 2) screening for family psychosocial risks, 3) screening for smoking and drug and alcohol use in the home, and 4) provision of family-centered care. METHODS: Data from the National Survey on Early Childhood Health (N = 2068) were used to calculate the 4 composite performance measures, which, taken together, represent 23 topics included in the American Academy of Pediatrics health supervision guidelines. The reliability and degree of redundancy within and across these 4 measures were evaluated. Four methods for scoring these measures were used. Quality scores for subgroups of children were calculated, and logistic regression analysis was performed to examine the association of demographic, health, and health system variables with receiving recommended care. RESULTS: Regardless of the scoring method used, performance is highest in areas of family-centered care and screening for smoking and drug and alcohol use in the home. Performance is lowest in the areas of anticipatory guidance and education and assessment for family psychosocial risks. Using a scoring method that takes into account parent preferences for guidance and beliefs about discussing psychosocial topics, composite quality measure scores ranged from 13.5% to 59.6% of parents of young children receiving recommended care. Overall, 94.0% of parents reported 1 or more unmet needs for parenting guidance, education, and screening by pediatric clinician(s) in 1 or more of the content of care areas evaluated. Uninsured children and children aged 18 to 35 months are disproportionately represented among the 15.3% of children whose parents indicated an unmet need in each of the 4 areas of care. Although the reliability of each composite measure was high, no single item in any composite was highly correlated with the remaining combined items. Performance on any 1 composite measure for a child was only somewhat predictive of performance for the other measures. There are significant variations in performance on the basis of child age, race, insurance status, maternal education, marital status, and parent language as well as other factors. CONCLUSIONS: National results using 4 complementary composite quality measures confirm the need for improving the quality of preventive and developmental services for young children in the United States. The 4 measures identify areas of care and subgroups of children for whom improvements in quality are most needed. The measures provide a parsimonious yet comprehensive assessment across distinct health supervision topics and 4 essential aspects of preventive and developmental services. Until valid measures of outcomes of preventive and developmental services are identified or 1 single process of care measure is shown to be highly predictive of these outcomes, assessing multiple aspects of recommended care will be necessary to assess performance of health care providers or systems of care. Assessing health system provision of well-child care: The Promoting Healthy Development Survey. Pediatrics. 2001 May;107(5):1084-94. Bethell C, Peck C, Schor E. FACCT-The, Portland, Oregon BACKGROUND: Preventive care guidelines for children include parent education and counseling, developmental assessment, and screening for psychosocial and safety risks. Health care providers are in a unique position to identify and follow up on potential problems and to influence parenting knowledge, attitudes, and behavior to ensure the healthy development of young children. Few quality measures are available to assess health care system performance in this important area. OBJECTIVE: To develop a feasible, valid, and reliable methodology for evaluating health care system performance in providing family-centered anticipatory guidance and child and family assessment services on behalf of children from birth through 48 months old. METHODS: The Promoting Healthy Development Survey (PHDS) was developed and tested with a diverse group of families in 3 managed care organizations (n = 1478). A standard mail administration protocol was used, including an informed consent with a waiver of documentation, 2 mailings, a postcard reminder, and telephone reminders. The 36-item parent survey assesses whether health care providers(1) talk with parents about topics recommended in Bright Futures and the American Academy of Pediatrics Guidelines for Health Supervision,(2) provide follow-up for children who may be at risk for developmental problems,(3) and address psychosocial well-being and safety within the family. The PHDS also assesses the degree to which parent's interactions with providers are family-centered, helpful, and facilitate parental confidence. Psychometric, bivariate, and multivariate analyses were conducted to assess the reliability, validity, and patterns of variation in the seven quality measures derived from the PHDS. RESULTS: Psychometric analyses demonstrated that the PHDS quality measure scales have strong construct validity (mean factor loading: 0.69) and internal consistency (mean Cronbach's alpha: 0.80). Parents reporting positive parenting behaviors had significantly higher scores on the anticipatory guidance quality measure compared with parents not reporting positive behaviors. Parents who reported that their questions on specific anticipatory guidance topics were answered were more likely to report higher confidence in related parenting activities (odds ratio [OR]: 5.9, 95% confidence interval [CI]: 3.4-10.2; OR: 8.3, 95% CI: 5-13.8)and were less likely to report concerns about their child's development in related areas compared with parents who reported they wished they had talked more with their child's doctor about these topics (OR: 0.46, 95% CI: 0.29-0.72; OR: 0.58, 95% CI: 0.37-0.89). The 7 PHDS quality measure scores for health plans ranged from 17 to 67 (on a 0-100 scale; where 100 is the best score possible) and varied significantly across health plans. Performance was highest for provision of anticipatory guidance information from health plans and lowest for family psychosocial assessment. Scores for families with Medicaid coverage were significantly higher on 2 of the PHDS measures and significantly lower for 3 measures compared with scores for families with commercial insurance. Age of child, whether child is first- born, parental marital status, education, income, and race were significant predictors for 1 or more of the PHDS quality measures (average R(2) = 0.05). CONCLUSIONS: The PHDS provides a comprehensive, psychometrically valid and reliable assessment of how well health plans and the health care providers working within these plans promote the healthy development of young children. The PHDS seems to differentiate among health care plans and among the different aspects of preventive care provided within a health plan. For the population studied here, there is significant room for improvement in ensuring families and children receive appropriate and family-centered care to promote the healthy development of children between 3 and 48 months old. Because the PHDS is conceptually based on national recommendations for child health supervision, improved performance on the PHDS would indicate greater adherence to these national recommendations and progress toward the achievement of Healthy People 2010 goals. The generalizability of the findings presented in this report are being examined using data collected in 5 statewide Medicaid samples (N = 11 696) and data from the National Survey of Early Childhood Health, which has incorporated most of the PHDS items. The parent-provider relationship: does race/ethnicity concordance or discordance influence parent reports of the receipt of high quality basic pediatric preventive services? J Urban Health. 2005 Dec;82(4):560-74. Epub 2005 Oct 12. Stevens GD, Mistry R, Zuckerman B, Halfon N. Division of Community Health, University of Southern California, Keck School of Medicine, Alhambra, CA Recent research among adults suggests that having a provider of the same race/ethnicity may enhance the quality of health care above and beyond just having any regular source of care. It is not known whether such relationships exist in pediatric care. The purpose of this study is to identify the distribution and methods by which families have a race/ethnicity concordant provider of well-child care and examine whether differences exist in the receipt of basic preventive services (BPS) and family-centered care (FCC) among those with concordant, discordant, and no regular providers. Analyses are stratified by geography to assess whether urban versus nonurban setting moderates these differences. This study uses publicly available data from the 2000 National Survey of Early Childhood Health (NSECH), a nationally representative, cross-sectional telephone survey of parents of children ages 4-35 months (n = 1,996). African Americans and Latinos were more likely than whites to lack a regular provider of well-child care (60.9% and 65.7% vs. 50.6%) and less likely to have a concordant provider (9.8% and 5.7% vs. 38.5%) (P < .001). African Americans with a regular provider were about three times more likely to establish a concordant relationship in urban versus nonurban settings (32.4% vs. 12.5%, P < .01). No statistically significant differences in BPS or FCC were found by concordance versus discordance for any group, a finding that held regardless of geographic setting. White children with no regular provider received better BPS than those with a discordant provider (e.g., excellent BPS of 37.2% vs. 27.1%, P < .05), but children with no regular provider were more likely than those with either concordant or discordant providers to have lower FCC in one (Latinos, whites) or three domains (African Americans). Despite racial/ethnic differences in the likelihood of having a concordant regular provider of well-child care, no disparities were found in BPS or FCC associated with discordance, even after stratification by urban/nonurban setting. Lacking a regular provider was associated with lower FCC versus having either a concordant or discordant provider, suggesting that efforts to improve these aspects of well-child care might focus less on linking children with a race/ethnicity concordant provider and more on social, cultural, and linguistic factors that impact having any regular provider. Prevalence and correlates of high-quality basic pediatric preventive care. Pediatrics. 2004 Dec;114(6):1522-9. Zuckerman B, Stevens GD, Inkelas M, Halfon N. Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts BACKGROUND: The list of recommended pediatric preventive services has grown considerably in the past decade, and clinician variability, clinician distribution, and other correlates of provision of these basic preventive services (BPS) are not known. OBJECTIVE: To describe the proportion of high-quality basic pediatric preventive services, exclusive of immunizations, reported by parents and to identify sociodemographic and health system predictors and health service correlates of provision of these services. STUDY DESIGN: The study used cross-sectional data on 2041 children, 4 to 35 months of age, in the 2000 National Survey of Early Childhood Health. OUTCOME MEASURES: The BPS measure assesses the receipt of (1) developmental assessment, (2) injury prevention counseling, (3) screening for parental smoking, (4) guidance on reading to the child, and (5) guidance on 14 other topics (assessed as a composite score). The BPS scale categorizes the receipt of services as excellent, good, fair, or poor. RESULTS: Most children received excellent (34.9%) or good (31.5%) care, but many received fair (24.9%) or poor (8.7%) care. Sociodemographic and health care factors such as race/ethnicity, insurance, and practice setting were not associated with BPS levels. Higher BPS scores were associated with parental reports of longer well-child visits, more counseling regarding family and community risk factors, lower rates of delayed or missed care, and greater satisfaction. CONCLUSIONS: Two thirds of children receive good or excellent basic preventive care, as determined with this composite, and no disparities according to race/ethnicity, income, or health insurance status of families (which are often found to be associated with health care access) were found. This equitable distribution of high-quality care suggests a high level of clinician professionalism. Duration of visits may be a key factor to improve quality of care. Because of its association with other services, processes, and outcomes of care, the BPS scale may serve as a useful construct for monitoring quality and stimulating efforts to improve national pediatric preventive care. Satisfaction with health care for young children. Pediatrics. 2004 Jun;113(6 Suppl):1965-72. Halfon N, Inkelas M, Mistry R, Olson LM. Department of Community Health Sciences, UCLA School of Public Health, Los Angeles, California, USA. OBJECTIVES: The aims of this study are to 1) assess parent satisfaction with well-child care for their young child and 2) identify how global satisfaction ratings and parent reports on the processes of care vary with child and family characteristics, health care received, and health system factors. METHODS: The National Survey of Early Childhood Health is a telephone survey that used a stratified random-digit-dial sampling design to achieve a nationally representative sample of 2068 children and 4 to 35 months. Parents provided global ratings of satisfaction with their child's well-child visits (range 0-100) and reported their satisfaction with information provided and the time spent with the provider. A subsample of parents whose child has a particular provider for well-child care (n = 930) also reported their likelihood of recommending their provider. RESULTS: The mean global satisfaction rating is 86.9 (standard error: 6.1). Approximately 94% of parents of young children reported information satisfaction, 88% reported time satisfaction, and 79% would recommend their child's provider. Bivariate analysis shows lower satisfaction for uninsured children but few differences associated with insurance type or health care setting. In multivariate analyses including child and family factors and health system factors, Hispanic, Spanish-speaking mothers of young children have lower odds than non-Hispanic white mothers of reporting information (odds ratio [OR]: 0.32; 95% confidence interval [CI]: 0.13-0.79) and time satisfaction (OR: 0.44; 95% CI: 0.21-0.90). Parents of children who experienced missed or delayed care have lower odds of time satisfaction (OR: 0.27; 95% CI: 0.16-0.46) and have lower global satisfaction. Greater length of well-child visits is consistently associated with greater satisfaction on all 4 measures. CONCLUSION: Although most parents reported relatively high levels of satisfaction with well-child care, shorter length of well-child visits and experiencing missed or delayed care are the 2 factors consistently associated with lower satisfaction using each of the measures. Efforts to improve satisfaction ratings might focus on improving the delivery of well-child care and ensuring that parents get the time they need. Parents' discipline of young children: results from the National Survey of Early Childhood Health. Pediatrics. 2004 Jun;113(6 Suppl):1952-8. Regalado M, Sareen H, Inkelas M, Wissow LS, Halfon N. Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. OBJECTIVE: To examine the use and predictors of different discipline practices by parents of very young children using data from the 2000 National Survey of Early Childhood Health (NSECH). METHODS: NSECH is a nationally representative telephone survey of 2068 parents of young children between the ages of 4 and 35 months conducted by the National Center for Health Statistics. The survey includes questions about parents' use of 5 discipline practices: yelling, spanking, time out, toy removal, and explanations. chi2 analyses and logistic multivariate regression were used to examine associations between discipline practices and child, parent, and demographic factors. RESULTS: Among young children aged 19 to 35 months, frequent parental use of discipline strategies ranged from 26% (spanking) to 65% (taking away toy or treat), 67% (yelling), 70% (using time out), and 90% (providing explanations). In multivariate analyses, child age predicts reports of more frequent spanking and yelling, and child developmental risk is associated with increased reports of yelling. Parent frustration predicts frequent use of every discipline practice, including a greater inclination to use aversive practices. Lower parental emotional well-being is associated with reports of frequent yelling and spanking. Black ethnicity and maternal age predict more frequent spanking, and Spanish-speaking parents reported less frequent use of time out and taking away a toy. CONCLUSION: Child age and developmental risk and parents' ethnicity, emotions, and mental health are closely associated with discipline practices in the first 3 years of life. These factors are important for pediatricians to recognize in providing anticipatory guidance about discipline. The following study used our online CATI and administered clinical PEDS Parents comments on PEDS were submitted to our online scoring engine and then returned to researchers. Maternal mental health predicts risk of developmental problems at 3 years of age: follow up of a community based trial. BMC Pregnancy Childbirth. 2008 May 6;8:16. Tough SC, Siever JE, Leew S, Johnston DW, Benzies K, Clark D. Department of Paediatrics, University of Calgary, Calgary, Alberta, BACKGROUND: Undetected and untreated developmental problems can have a significant economic and social impact on society. Intervention to ameliorate potential developmental problems requires early identification of children at risk of future learning and behaviour difficulties. The objective of this study was to estimate the prevalence of risk for developmental problems among preschool children born to medically low risk women and identify factors that influence outcomes. METHODS: Mothers who had participated in a prenatal trial were followed up three years post partum to answer a telephone questionnaire. Questions were related to child health and development, child care, medical care, mother's lifestyle, well-being, and parenting style. The main outcome measure was risk for developmental problems using the Parents' Evaluation of Developmental Status (PEDS). RESULTS: Of 791 children, 11% were screened by the PEDS to be at high risk for developmental problems at age three. Of these, 43% had previously been referred for assessment. Children most likely to have been referred were those born preterm. Risk factors for delay included: male gender, history of ear infections, a low income environment, and a mother with poor emotional health and a history of abuse. A child with these risk factors was predicted to have a 53% chance of screening at high risk for developmental problems. This predicted probability was reduced to 19% if the child had a mother with good emotional health and no history of abuse. CONCLUSION: Over 10% of children were identified as high risk for developmental problems by the screening, and more than half of those had not received a specialist referral. Risk factors for problems included prenatal and perinatal maternal and child factors. Assessment of maternal health and effective screening of child development may increase detection of children at high risk who would benefit from early intervention. TRIAL REGISTRATION: Current Controlled Trials ISRCTN64070727. Measuring the Prevalence of Children at Risk for Developmental Problems using the Parents’ Evaluation of Developmental Status (PEDS) in a Telephone Survey HEALTH STATISTICS DATA USERS CONFERENCE 2007 Wil Ng, MHSc1, Donna L. Reynolds, MD, MSc2,3, Erin Kennedy, MHSc4, Kate Feightner, MSc5, Philippa Holowaty, PhD3,5, Karen Wade, BScN, MSc1, Paul Fleiszer, MSc1, Frances P. Glascoe, PhD6, David Northrup, MA7 1 Toronto Public Health, Toronto, Ontario, Canada 2 Formerly with Durham Region Health Department, Whitby, Ontario, Canada 3 University of Toronto, Toronto, Ontario, Canada 4 Formerly with Toronto Public Health, Toronto, Ontario, Canada 5 Formerly with City of Hamilton Public Health and Community Services Department, Hamilton, Ontario, Canada 6 Vanderbilt University, Nashville, Tennessee 7 York University, Toronto, Ontario, Canada Introduction: The Parents' Evaluation of Developmental Status (PEDS) identifies children at risk for developmental problems and has been validated in a written format for use in clinical settings. This project assessed the feasibility and reliability of using PEDS in a telephone-based lay-interviewer survey. Methods: Adults in three public health regions in Ontario, Canada with children aged 0-6 years in their households were surveyed over the telephone by trained lay interviewers. Responses to the PEDS portion of the survey were taped and reviewed by the author of PEDS, an expert in child development. Reliability was assessed by comparing the PEDS scores of the telephone interviewers and the expert (Phase A). In addition, participants were mailed a hard copy PEDS for written completion. Scores from the written PEDS were compared with those from the telephone interviews (Phase B). Reliability was assessed by agreement, kappa, weighted Kappa, and prevalence adjusted bias adjusted Kappa (PABAK). Results: For Phase A, 221 participants resulted in overall agreement of 83.3% with a weighted Kappa of 0.74 (95% CI: 0.66-0.82) and PABAK of 0.78, indicating good to excellent agreement. For Phase B, there were 198 participants resulting in overall agreement of 69.2% and weighted Kappa of 0.62 (95%CI: 0.53-0.70) and PABAK of 0.59, representing fair to good agreement. Conclusion: Lay telephone interviewers can be trained to administer PEDS over the telephone. This method of administration provides a new and reliable method for measuring children at risk of developmental problems at the community level. In this study, parents completed clinical PEDS online by independently accessing our website’s scoring service. Can a broadband developmental-behavioral screening test identify children likely to have autism spectrum disorder? Clin Pediatr (Phila). 2007 Nov;46(9):801-5. Epub 2007 Jul 19. Glascoe FP, Macias MM, Wegner LM, Robertshaw NS. Department of Pediatrics, Vanderbilt University, Nashville, Tennessee Because services for children with autism spectrum disorder (ASD) are scarce, when children fail a broadband screening measure, providers need to carefully discern which children need ASD evaluations and which do not. This research considers how well a broadband screening test sorts those with and without probable ASD. The subjects were 427 children between 18 and 59 months of age with elevated risk scores on broadband screening, ie, Parents' Evaluation of Developmental Status (PEDS), a 10-item measure eliciting parents' concerns. Parents also completed the Modified Checklist of Autism in Toddlers (M-CHAT), an autism specific screen. The results showed that of the 427 children at risk on PEDS, 34% (N = 144) passed the M-CHAT. To determine whether these potential over referrals could be reduced, parents' concerns on PEDS were used to predict M-CHAT results. Three or more discrete types of concerns, varying by age, characterized children who failed the M-CHAT while fewer than 3 were associated with passing. This reduced over referrals by 70% while maintaining high levels of sensitivity (81%). Although compliance with the American Academy of Pediatrics recommendations for both broadband and autism-specific screening at 18 and 24 months is still recommended, viewing performance patterns on a broadband screening test can substantially reduce over referrals to autism specialty services. Credits: a collection of research by various authors