PII: S0022-3476(96)70227-5

Abstract

Dr. Brayden poses an interesting question about how and when to elicit parents' estimations of children's developmental ages. In our study, families participated after the completed encounter so that the sponsoring pediatricians and their staffs were not inconvenienced.1Glascoe FP Sandler H. Value of parents' estimates of children's developmental ages.J Pediatr. 1995; 127: 831-835Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar Although the prior well-child visit might have altered parents' perceptions, this seems unlikely. Evidence comes from research on other types of parental appraisals in which parents' concerns were elicited before they were questioned about specific aspects of their children's development. The results were similar to the those of current study; the majority of children with and without problems were correctly identified.2Glascoe FP. It's not what it seems: the relationship between parents' concerns and children's global delays.Clin Pediatr. 1994; 33: 292-296Crossref PubMed Scopus (76) Google Scholar It makes sense that parents' judgments are not obviously affected by questions about specific developmental skills. Most parents derive their appraisals, not on the basis of formal training or study of child development, but rather by comparing their child with others.3Glascoe FP MacLean WE. How parents' appraise their child's development.Family Relations. 1990; 39: 280-283Crossref Google Scholar In our observations, parents waiting for pediatric appointments often spend their time talking with other parents, watching other children, and drawing appropriate conclusions. This phenomenon seems to explain why first-time parents and those with limited education are as able as more educated and experienced parents to offer accurate indicators of their children's developmental status.1Glascoe FP Sandler H. Value of parents' estimates of children's developmental ages.J Pediatr. 1995; 127: 831-835Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar, 2Glascoe FP. It's not what it seems: the relationship between parents' concerns and children's global delays.Clin Pediatr. 1994; 33: 292-296Crossref PubMed Scopus (76) Google Scholar, 3Glascoe FP MacLean WE. How parents' appraise their child's development.Family Relations. 1990; 39: 280-283Crossref Google Scholar, 4Glascoe FP Altemeier WK MacLean WE. The importance of parents' concerns about their child's development.Arch Pediatr Adolesc Med [Am J Dis Child]. 1989; 143: 855-858Crossref Scopus (110) Google Scholar, 5Glascoe FP Can clinical judgment detect children with speech-language problems?.Pediatrics. 1991; 87: 317-322PubMed Google Scholar There is much wisdom in the recommendation of the American Academy of Pediatrics Committee on Practice and Ambulatory Medicine6American Academy of Pediatrics Committee on Practice and Ambulatory Medicine Recommendations for preventive pediatric health care.Pediatrics. 1988; 81: 466Google Scholar that children's functioning in all developmental domains be reviewed routinely. However, because only a fraction of children with disabilities are identified by the informal questions asked at most well-child visits,7Lavigne JV Binns JH Christoffel KK Rosenbaum D Arend R Smith K et al.Behavioral and emotional problems among preschool children in pediatric primary care: prevalence and pediatricians' recognition.Pediatrics. 1993; 91: 649-655PubMed Google Scholar, 8Palfrey JS Singer JD Walker DK Butler JA. Early identification of children's special needs: a study in five metropolitan communities.J Pediatr. 1987; 111: 651-659Abstract Full Text PDF PubMed Scopus (132) Google Scholar, 9Korsch B Cobb K Ashe B. Pediatricians' appraisals of patients' intelligence.Pediatrics. 1961; 29: 990-995Google Scholar, 10Bierman JM Connor A Vaage M Honzik MP Pediatricians' assessment of the intelligence of two-year-olds and their mental test scores.Pediatrics. 1964; 43: 680-690Google Scholar it appears that physicians need assistance in devising appropriate questions, interpreting parents' responses, or both. Our objective, in this and prior research on other types of parental appraisals, was to identify and validate questions that identify, with acceptable rates of accuracy, children who may have developmental problems (i.e., questions with sensitivity to developmental problems and specificity to normal development approaching 80%).11Barnes KE Preschool screening: the measurement and prediction of children at risk. : Charles C Thomas, Springfield (IL)1982Google Scholar, 12Frankenburg WK Selection of diseases and tests in pediatric screening.Pediatrics. 1974; 54: 1-5PubMed Google Scholar Because of the small sample sizes in most studies of parents' appraisals, we recommended their use as prescreening tools, to be followed by standardized screening as needed. Thus the use of parents' appraisals fits nicely within the committee's recommendation that developmental monitoring include sensitive questioning and occasional, but not routine, use of standardized screening measures. We concluded that questions eliciting age estimates or parental concerns can replace informal and less proven techniques for monitoring developmental and behavioral progress. That the accuracy of parents' appraisals have held up to a range of study conditions (before or after developmental assessment) and research sites (teaching hospitals, private practices, and day care centers) suggests that these appraisals can be employed with confidence. 9/35/73316