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Indian Pediatr 2016;53: 1110-1112 |
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Parents’ Evaluation of
Developmental Status (PEDS) in Screening for Developmental Delay
in Thai Children Aged 18-30 Months
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*# Pornchanok
Wantanakorn, #Khemsuang
Sawangworachart, #Rawiwan
Roongpraiwan and #Jariya
Chuthapisith
*Chakri Naruebodindra Medical Institute, #Division
of Developmental and Behavioural Pediatrics, Department of Pediatrics;
Faculty of Medicine; Ramathibodi Hospital, Mahidol University, Bangkok,
Thailand.
Email:
[email protected]
Published
online: November 05, 2016. PII:S097475591600028
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The PEDS-Thai is a developmental screening tool. We studied its
diagnostic performance among 137 Thai children (48.9%) aged 18-30 month.
It had a sensitivity of 92.8% and a specificity of 49.2%. The positive
and negative likelihood ratios were 1.82 and 0.14 when compared with
clinical diagnosis and diagnostic tool, the Mullen Scales of Early
Learning.
Keywords: Developmental delay, Early
diagnosis, Mullen scale of early learning
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A national health survey of Thai children in 2010
found 30.3% of children aged 1-5 years with delayed development [1].
An early detection of delayed development is crucial for early
intervention and a better outcome. Parents are the key source for
developmental screening information [2]. The Parents’ Evaluation of
Developmental Status - Thai version has previously been validated by
developmental-behavioral pediatricians, but the only study [3] that
compared PEDS-Thai to Denver-II showed a sensitivity of 57.1% and a
specificity of 97.6%, but no study has compared it to the standard
developmental diagnostic test.
From children attending the Well Child Clinic at our
center, 137 children aged 18-30 months whose parents were willing to
participate were enrolled. Chronically ill children, or who had known
developmental delays were excluded. The PEDS was completed by
parents, PEDS divides children into three groups at risk of
disabilities: high (Path A), moderate (Path B) and low risk group (Path
C, D, and E). The Mullen Scales of Early Learning [4],
a standardized instrument to evaluate overall
developmental level, was administered to all children, as well as a
clinical diagnosis made by the developmental behavioral pediatrician to
confirm the diagnosis of typically developing children and children with
developmental delays. The study received prior approval of the
Institutional Ethics Committee.
Baseline characteristics of participants are shown in
Web Table I. The PEDS result was positive
for 77 children, from which 13 were found to have developmental delays (Table
I). PEDS had 92.9% sensitivity, 49.2% specificity, a positive
predictive value of 17.1%, and a negative predictive value of 98.4%. The
positive and negative likelihood ratio were 1.8 and 0.1, respectively.
The accuracy level of the test was 53.3%.
TABLE I PEDS Results Compared to the Diagnosis by The Mullen Scales of Early Learning and the
Developmental-Behavioral Pediatrician
PEDS results |
No. of case |
Children with
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(%) (N = 137) |
developmental delay*
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(%) (N = 14) |
Test Positive# |
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High risk group
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Path A |
31 (22.6) |
6 (42.8) |
Moderate risk group
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Path B |
46 (33.6) |
7 (50) |
Test Negative$ |
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Low risk group |
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Path C |
45 (32.8) |
– |
Path D |
– |
– |
Path E |
15 (11) |
1 (7.2) |
*The final diagnosis by clinical and MSEL were globally
delayed development (n=8) and developmental language delay (n=6,
expressive type 4 children and mixed expressive and receptive
type in 2 children); #The positive screening test were children
in the high and moderate risk groups, which were defined as Path
A and B. Path A were children with 2 or more significant
concerns while Path B were those with 1 significant concern;
$The negative screening test result were children in the low
risk group (Path C, D, and E), which were defined as children
with 1 or more non-significant concern. |
At least one significant concern was shown by 55%
parents. The most common concern was behavioral problems (n = 88,
64.2%) followed by expressive language development (n= 66,
48.2%), which is a significant concern for this age group, as shown in
Web Fig. 1.
Our study of PEDS compared with standardized direct
assessment showed high sensitivity and moderate accuracy, which was
similar to previous studies [5,6]. The most significant parental concern
in this study was language which is an emerging development in this
particular age group and is easily noticed by parents [7,8]. The
relatively low specificity of PEDS seen here may be because of the
excessive concern of parents regarding their child’s development,
especially who are in relatively high socioeconomic status. Due to a
parental lack of knowledge in terms of child development or
misinterpretation of the questions, we found that the content of the
comment in developmental concerns did not match the question’s interest
[9], which can also explain the low specificity of PEDS in our study.
Major limitation of this study was a selection bias of convenient
participants which tend to have relatively high socioeconomic status,
and was not nationally representative.
To conclude, PEDS is a promising developmental
screening tool with a high sensitivity but moderate accuracy among a
high socio-economic status population. Future studies need to have a
representative sample of population to better evaluate its diagnostic
performance.
Acknowledgement: Mrs Umaporn Udomsubpayakul for
assistance with statistical analyses.
Contributors: PW: Substantial contributions to
the conception or design of the work; or the acquisition, analysis, or
interpretation of data for the work. Drafting the work and revising it
critically for important intellectual content and final approval; KS:
Substantial contributions to the conception or design of the work and
data collection. RR: Correspondence and final approval; JC: Drafting the
work and revising it critically for important intellectual content.
Funding: Faculty of Medicine Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand.
Competing interest: None stated.
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