Two developmental screening tests may identify different groups of children

Article Outline

• Question
• Design
• Setting
• Participants
• Intervention
• Outcomes
• Main Results
• Conclusions
• Commentary
• Copyright

Sices L, Stancin T, Kirchner HL, Bauchner H. PEDS and ASQ developmental screening tests may not identify the same children. Pediatrics 2009;124:e640-7.

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Question 

Among children at increased risk for developmental delays, do the Parents' Evaluation of Developmental Status (PEDS; parent concern questionnaire) and the Ages & Stages Questionnaires (ASQ; parent report of developmental skills) perform similarly as a screening test?

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Design 

Analysis of a cohort of children who were recruited as part of a larger study evaluating the impact of a developmental screening test on parent-physician communication.

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Setting 

Community-based, hospital-affiliated practice in Northeast Ohio.

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Participants 

Parents of 60 children ages 9 to 31 months (mean, 17.6 months). 77% received Medicaid, and 50% of parents had a high school education or less.

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Intervention 

Completed PEDS and ASQ screens at the same visit.

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Outcomes 

Concordance and discordance rates for the 2 screens.

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Main Results 

Overall, 37% failed the PEDS and 27% failed the ASQ. Thirty-one children passed (52%) both screens; 9 (15%) failed both; and 20 (33%) failed 1 but not the other (13 PEDS and 7 ASQ). Agreement between the 2 screening tests was only fair, statistically no different from agreement by chance.

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Conclusions 

There was substantial discordance between PEDS and ASQ developmental screens. Although these are preliminary data, clinicians must be aware that in implementing revised American Academy of Pediatrics (AAP) screening guidelines, the choice of screening instrument may affect which children are likely to be identified for additional evaluation.

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Commentary 

The AAP has issued a policy statement that recommends the implementation systematically of a validated screening tool in children at various points in time, yet no specific guidance is provided as to which validated screening tool(s) should be used. Although parent-completed screening questionnaires have been validated independently in research studies using standardization samples, they have rarely been directly compared in real-life ambulatory practice samples. This study, comparing the PEDS and ASQ questionnaires, documents a concordance rate (roughly two thirds) between the 2 tools that is disappointingly no better than chance alone. Methodologically, the study has several limitations. There is a relatively small size, a systematic bias in term of the order of administering the screens in relation to the visit (PEDS before and ASQ after), and no standardized developmental assessment to determine the accuracy of either screening tool in terms of correctly identifying either a normal developmental trajectory or possible developmental delays that merits further evaluation. The lack of concordance may reflect the inherent different conceptualization of these questionnaires: The PEDS asks about parental concerns, whereas the ASQ documents actual child skills attainment. Unfortunately, this study does not directly aid the clinician in selecting the best screening questionnaire or practice strategy that will correctly identify children with developmental concerns. Such a strategy would need to be expeditious (ie, timely), efficient (ie, parsimonious utilization of available resources), representative (ie, a broad range of children), and accurate (ie, minimal numbers of false-positives and false-negatives). What remains to be done from a best evidence perspective is a prospective study directly comparing the accuracy of developmental screening algorithms that are used in the ambulatory community setting.