Home            Past Issues            About IP            About IAP           Author Information            Subscription            Advertisement              Search  

   
research letter

Indian Pediatr 2016;53:1110-1112

Parents’ Evaluation of Developmental Status (PEDS) in Screening for Developmental Delay in Thai Children Aged 18-30 Months

*#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



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

 


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
 (%) (N = 137) developmental delay*
(%) (N = 14)
Test Positive#
High risk group
  Path A 31 (22.6) 6 (42.8)
Moderate risk group
  Path B 46 (33.6) 7 (50)
Test Negative$
Low risk group
  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.

References

1. Sirithongthaworn S, Narkpongpan A, Pongtaweeboon N, Kasemsook W, Itsarapong P, Pila S. Developmental of Child Development Skills Inventory for Thai children from birth to 5 years, Mental Health Department Version, the Ministry of Public Health. Chiang Mai: Rajanagarindra Institute of Child Development; 2011. Available from: www.saiyairakhospital.com/back-office/upload/document/aaaa.doc. Accessed July 15, 2016.

2. Glascoe FP, Dworkin PH. The role of parents in the detection of developmental and behavioural problems. Pediatrics. 1995;95:829-36.

3. Theeranate K, Chuengchitraks S. Parent’s Evaluation of Developmental Status (PEDS) detects developmental problems compared to Denver II. J Med Assoc Thai. 2005;88:188-92.

4. Mullen EM. Mullen Scales of Early Learning Manual, AGS Ed. Minneapolis, MN: NCS Pearson, Inc.; 1995.

5. Glascoe FP. Parents’ concerns about children’s development: prescreening technique or screening test? Pediatrics. 1997;99:522-8.

6. Kiing J, Low PS, Chan YH, Neihart M. Interpreting parents’ concerns about their children’s development with the parents Evaluation of Developmental Status: culture matter. J Dev Behav Pediatr. 2012;33:179-83.

7. Pornsamrit S., Chunsuwan I., Hansakunachai T. Developmental screening by PEDS (Parents’ Evaluation Developmental Status) survey during 9 months of age at well child clinic, Thammasat University Hospital. Thai J Pediatr. 2014; 53:136-43.

8. Sheldrick RC, Neger EN, Perrin EC. Concerns about development, behaviour & learning among parents seeking pediatric care. J Dev Behav Pediatr. 2012; 33: 156-60

9. Cox JE, Huntington N, Saada A, Epee-Bounya A, Schonwald AD. Developmental screening and parents’written comments: An added dimension to the parents’ evaluation of developmental status questionnaire. Pediatrics. 2010;126:S170-6.


 

Copyright © 1999-2016 Indian Pediatrics