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Letters to the Editor Indian Pediatrics 2003; 40:439-440 |
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Parents' Evaluation of Developmental Status (PEDS) |
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First, PEDS underwent significant scoring modifications before it was published commercially in 1997(2). It is not clear that the current scoring system was used in their study because PEDS identifies five, not four groups. The group not mentioned is children whose parents were identified via the professional judgement of researchers and clinicians as having difficulty expressing concerns over a complete range of concerns. Communication barriers are usually due to language differences or florid mental health problems. Others who sometimes fall into this category are parents who are not a primary caretaker (e.g., a teen mother whose own mother provides most of the care). When PEDS is used clinically, health care providers can also nominate children for whom they have suspicions not corroborated by parents. In any case, this fifth group, along with another group identified as moderate risk (children whose parents hold only a single predictive concern) are typically nominated for further screening rather than diagnostic assessments. Thus a more complete application of PEDS, might have enhanced the accuracy of the measure. Second, the concurrent test used to assess the accuracy of PEDS is problematic. The Developmental Profile-II both under and over-detects developmental problems(3,4). It uses ratio quotients and non-normalized age equivalent scores that can lead to inflated and deflated scores. To my knowledge, the DP-II has not been normed outside of the US making generalization to other populations questionable. Nevertheless with modified scoring, the Academic Scale of the DP-II can be used for developmental screening. Applying these results to the groups at moderate risk, should enhance the specificity of PEDS within Drs. Singhi and Malhi’s study. Finally and most importantly, it may that PEDS would benefit from an alternative scoring system for use in India. For example, Indian parents often mentioned social, self-help, and behavioral concerns. Indeed, Drs. Singhi and Malhi noted that self-help skills were a significant predictor of problems - a result not found in the four US validation studies of PEDS – but one that appeared in a predictive validity study conducted in Australia(5). Reassessing their data via logistic regression analyses broken out by age might reveal a different and more accurate set of predictive concerns. I am happy to assist with any additional analyses and reinterpretation of data to help ensure that PEDS works effectively in India. Eliciting parents’ concerns systematically is a valuable process associated with improved satisfaction with care and, more importantly, improvement in parenting skills(6). Most health care providers attempt routinely to discuss parents’ concerns but often use questions that are not well understood or effective. Indeed the official Australian adaptation of PEDS, focuses on the tool as a platform for communication more than an early detection device. Even so, I’d prefer to see PEDS serve as many functions as possible, including accurate developmental and behavioral screening. Frances Page Glascoe, |
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