Below is a summary of psychometric findings for standardization, reliability, validity, and accuracy:
STANDARDIZATION SUMMARY:

  • PEDS was re-standardized in 2012 on a nationally representative sample of 47,531 families in 27 US states and Canada, representing the major geographic regions of the US.
  • Parents’ levels of education were similar to US Census Bureau 2010 indicators (e.g., 16% had not completed high school while 28% had completed college).
  • Sites included rural and urban/suburban areas in proportion to prevalence.
  • Ethnicities were represented at percentages between US Census Bureau indicators for 2010 and projections for 2020, and included white (not Hispanic), Black, American Indian, Asian, Hawaiian/Pacific Islander, Hispanic, etc.
  • Six percent of families were administered PEDS in Spanish (in keeping with Census Bureau indicators for those not speaking English well).
  • Children’s gender and poverty rates also matched Census parameters.
  • Children ranged in age from 0 – 11 months (20%, N = 13,523) through 7 years, 11 months years (2%, N = 913), i.e., a much younger sample than in PEDS original norming studies.
  • 91% of children and families participated in general pediatric clinics and the remainder participated from public schools (kindergarten intake), day care/preschool programs, developmental-behavioral pediatric clinics, and non-emergent crisis call centers.
  • The frequency of parents’ concerns and risk on PEDS rises, as expected, with children’s age, and with psychosocial risk factors. Hispanics and Blacks were more likely to have concerns as well as higher risk PEDS’ paths.
  • Educated families are more likely to receive Path C scores (i.e., to be the “worried well” in need of professional advice).
  • Native Americans were more likely to have social-emotional and behavioral concerns as compared to other ethnicities, probably in keeping with the tribal custom of respect for elders.
  • PEDS has been translated into 21 languages and standardized separately in many other nations and languages. In many international studies, different constellations of concerns and thus assignation of PEDS Paths have been established. For example, self-help concerns are of greater concerns to parents and also more predictive of overall problems than in the US.
  • Survey PEDS (used in the National Survey of Child Health, First Five California, the Promoting Healthy Development Survey, The Child and Adolescent Health Measurement Initiative (CAHMI)) depends on 12 closed-ended questions and is scored only from \"yes\", \"no\", or \"a little\" responses. Although risk rates on Survey PEDS are similar to clinical PEDS, assignation to PEDS Paths is strikingly different because 24% to 32% of families across studies are not answering the questions according to their intended content. For this reason, Survey PEDS may not be used in clinical care with individual families--only for broad population-based needs assessment.
SUMMARY OF 2012 RELIABILITY STUDIES

  • Test-retest reliability studies were conducted on 193 children over a 0 – 32 day time frame and revealed 94% agreement in PEDS Paths and parents’ concerns.
  • Inter-rater reliability (between expert coders and the PEDS Online text-based scoring analyzer) was established on 355 children for both categorization of concerns (95% agreement) and for correct assignment to PEDS Paths (97% agreement). Teachers and parents had lower levels of agreement (74%), but PEDS was not normed for teachers’ appraisals (and, children often behave quite differently at home than at school).
  • Stability of concerns for parents of older children (N = 402) was high over a two year time frame (for children approximately 5 – 7 years of age). Parents with predictive concerns when their children were five years of age were 5 times to have ongoing predictive concerns when their children were 7 years old (as compared to parents who did not have predictive concerns when their children were five years old.
  • Stability of concerns in younger children (N = 325) from 6 months to 18 months was also high, with 48% percent of parents with concerns at 6 months, having ongoing concerns 12 months later.
  • Internal consistency studies (on 45,310 children) showed a predictable factor structure: verbal versus non-verbal items clustered significantly and accounted for the majority of test variance. There were significant but only modest inter-correlations among concerns, suggesting that answers to each PEDS question contributes uniquely to overall results. The coefficient of reliability/index of generalizability was moderately high, again suggesting PEDS items are not redundant.
SUMMARY of 2012 VALIDITY STUDIES

  • PEDS’ content validity is evident in the finding that PEDS facilitates a discussion of concerns across developmental (also meaning behavioral, social-emotional/mental health) domains in a way that other questions do not.
  • PEDS’ construct validity is shown in the finding that each type of parent concern clusters in predictable ways via associations among related domains (e.g., fine motor and gross motor; expressive and receptive language).
  • The concurrent validity of PEDS was studied on 1158 children in relationship to measures of development, including academics, intelligence, language, and motor skills. Although each type of parental concern enjoys significant associations with measures or subtests focused on the same domain, parents often have concerns in seemingly unrelated domains. For example, academic deficits are associated with social-emotional concerns—meaning parents may be commenting on self-esteem problems related to under-achievement or difficulties performing well in a group, i.e., parents’ concerns often reflect not just the apparent problem but also its impact on other aspects of development.
  • Parents’ concerns on PEDS and PEDS Paths are also associated not just with eligibility for early intervention or special education but also with emerging delays and psychosocial risk factors.
  • There are unique patterns of concerns for most diagnoses (e.g., cerebral palsy, ASD, language impairment). The sensitivity of these patterns is discussed in the Accuracy Chapter on PEDS.
  • PEDS’ predictive validity is established in studies showing that concerns raised early in a child’s life have a strong association with later deficits and diagnoses. For example, certain patterns of concerns along with specific content of concerns (e.g., repetitive behavior) when raised at 12 months of age is significantly predictive, 18 months later at 30 months of age, of a diagnosis of autism spectrum disorder, 83% sensitivity.
SUMMARY OF 2012 ACCURACY STUDIES

  • Overall accuracy indices were computed on 4473 children across two separate studies who were administered a variety of diagnostic measures to determine eligibility for special education services. Summary figures are: Sensitivity = 86% and specificity = 74%.
  • Over-referrals on PEDS continue to include children with psychosocial risk factors and delays, but not delays sufficient for special education eligibility. For this reason, positive predictive value (37% for special education eligibility) lacks meaning.
  • Discriminant sensitivity (meaning research on how well PEDS identifies specific conditions) were conducted on an additional 4,000 children across more than 20 different studies. These show unique patterns of concerns and often PEDS Path differences when children have autism spectrum disorder, mental health problems, cerebral palsy/motor disorders, intellectual disabilities, language impairment, etc. In all cases sensitivity was greater than 80%.
  • Two studies viewed the ability of parents without and with depression, anxiety, and other mental health difficulties to raise concerns on PEDS. Both groups performed similarly suggesting that PEDS can be used effectively with parents who have mental health difficulties (at least mild ones). PEDS performed less well in identifying abusend and neglected children with developmental-behavioral problems when the informant was the suspected perpetrator.
  • PEDS in nations outside the US (including in translation) shows high sensitivity and specificity to problematic development.

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The PEDS research team welcomes studies on PEDS Tools and naturally, we want to make sure they are done well. If you need advice, guidance, or ideas, please check the enormous range of information on www.pedstest.com and if more is needed, then go to www.pedstest.com/ContactUs. This portion of the site helps you identify the focus of your questions and diverts messages appropriately (e.g, if about translation issues then the message goes to the PEDS Translation and Research team).