Laura Sices

How do primary care physicians identify young children with developmental delays? A national survey.

Little is known about the current practices of primary care physicians regarding developmental surveillance and screening during pediatric preventive care visits. We conducted a mailed survey of a random national sample of pediatricians and family physicians to describe their practices and identify factors that predict use of developmental screening tools, an efficacious way of identifying children with developmental delays. Most physicians reviewed developmental milestones and prompted parents for developmental concerns at preventive care visits. Approximately half of the physicians used a formal developmental screening instrument. Female physician gender predicted higher rates of use of screening tools for family physicians, but not for pediatricians. Most physicians seemed committed to the early diagnosis of developmental delays. Substantial variability in surveillance and screening practices, barriers of time and reimbursement, and under-reliance on parent-completed questionnaires underscore areas for improvement.

Use of Developmental Milestones in Pediatric Residency Training and Practice: Time to Rethink the Meaning of the Mean

Despite the development of highly effective treatments for the disease, pediatric human immunodeficiency virus (HIV) infection continues to affect a substantial number of families both in the United States and worldwide. This article reviews the psychosocial functioning of children with HIV, taking a socioecological perspective to organize the literature. When compared to children from similar socioeconomic situations, children with HIV demonstrate a range of possible outcomes. However, beyond the direct effects on childrens neurocognitive and psychological functioning, HIV infection may disrupt many of the social support systems that children depend on for optimal development. Further, unlike many other illnesses, children with HIV infection are more likely to experience parental illness and possible death, social stigmatization, and the prospect of lifelong adherence to complicated medical regimens. Families face difficult decisions regarding disclosure of the illness both to the child and to others within and outside of the family. Children who are disclosed to about their illness generally evidence better adjustment. Similarly, appropriate disclosure outside of the immediate family may confer some benefits to the child in terms of psychological and physical health. However, research into the larger social ecologies of youth with HIV remains lacking, limiting the conclusions that can be drawn regarding longer term outcomes.

Relationship Between Speech-Sound Disorders and Early Literacy Skills in Preschool-Age Children: Impact of Comorbid Language Impairment

Objective: Disorders of articulation or speech-sound disorders (SSD) are common in early childhood. Children with these disorders may be at risk for reading difficulties because they may have poor auditory, phonologic, and verbal memory skills. Methods: We sought to characterize the reading and writing readiness of preschool children with SSD and identify factors associated with preliteracy skills. Subjects were 125 children aged 3 to 6 years with moderate to severe SSD; 53% had comorbid language impairment (LI). Reading readiness was measured with the Test of Early Reading Ability-2 (TERA) and writing skills with the Test of Early Written Language-2 (TEWL), which assessed print concept knowledge. Linear regression was used to examine the association between SSD severity and TERA and TEWL scores and analysis of variance to examine the effect of comorbid LI. Performance on a battery of speech and language tests was reduced by way of factor analysis to composites for articulation, narrative, grammar, and word knowledge skills. Results: Early reading and writing scores were significantly lower for children with comorbid LI but were not related to SSD severity once language status was taken into account. Composites for grammar and word knowledge were related to performance on the TERA and TEWL, even after adjusting for Performance IQ. Below average language skills in preschool place a child at risk for deficits in preliteracy skills, which may have implications for the later development of reading disability. Conclusion: Preschool children with SSD and LI may benefit from instruction in preliteracy skills in addition to language therapy.

PEDS and ASQ Developmental Screening Tests May Not Identify the Same Children

OBJECTIVE: In analyzing data from a larger study, we noticed significant disagreement between results of 2 commonly used developmental screening tools (Parents’ Evaluation of Developmental Status [PEDS; parent concern questionnaire] and Ages & Stages Questionnaires [ASQ; parent report of developmental skills]) delivered to children at the same visit in primary care. The screens have favorable reported psychometric properties and can be efficient to use in practice; however, there is little comparative information about the relative performance of these tools in primary care. We sought to describe the agreement between the 2 screens in this setting. METHODS: Parents of 60 children aged 9 to 31 months completed PEDS and ASQ screens at the same visit. Concordance (PEDS and ASQ results agree) and discordance (results differ) for the 2 screens were determined. RESULTS: The mean age of children was 17.6 months, 77% received Medicaid, and 50% of parents had a high school education or less. 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. CONCLUSIONS: There was substantial discordance between PEDS and ASQ developmental screens. Although these are preliminary data, clinicians need to be aware that in implementing revised American Academy of Pediatrics screening guidelines, the choice of screening instrument may affect which children are likely to be identified for additional evaluation.

Selecting developmental surveillance and screening tools.

1. Dennis Drotar, PhD* 2. Terry Stancin, PhD† 3. Paul H. Dworkin, MD‡ 4. Laura Sices, MD§ 5. Susan Wood** 1. *Professor of Pediatrics, Cincinnati Childrens Hospital Medical Center, Cincinnati, Ohio 2. †Professor of Pediatrics, Psychiatry and Psychology, Case Western Reserve University and Metro Health Medical Center, Cleveland, Ohio 3. ‡Professor of Pediatrics, University of Connecticut School of Medicine, Farmington, Conn 4. §Assistant Professor of Pediatrics, Boston University School of Medicine, Boston, Mass 5. **Coordinator, Division of Behavioral and Developmental Pediatrics, Rainbow Babies & Childrens Hospital, Cleveland, Ohio The importance of surveillance and screening for developmental problems in primary care has been well recognized in scholarly reviews and practice guidelines. (1) The need for early detection of developmental problems in infants and young children in primary pediatric care settings stems from the high prevalence of such problems and the potential for early intervention for the child and family. Frequent longitudinal contact with young children and their families at critical times in their early development provides pediatricians and other practitioners with important opportunities to conduct developmental surveillance and screening to detect clinically significant developmental problems and institute early intervention. (1)(2)(3)(4) Early identification and referral to early intervention programs can ameliorate the negative consequences of developmental problems on children, families, and society. (3) However, studies have indicated consistently that many infants and young children who have clinically significant developmental delays are not detected in pediatric primary care. (1)(3)(4) As a consequence, critical opportunities for early intervention for young children who are at risk for developmental problems may be lost. (2)(5)(6)(7) To address this need, the American Academy of Pediatrics (AAP) developed a policy statement for identifying infants and young children who have developmental delays and disorders. (8) This statement is a significant advance in the clinical application of developmental screening in several respects. One is the recommendation to address parental concerns about development as one of several health topics in routine pediatric preventive care visits throughout the first 5 years after birth. Developmental surveillance, defined as a flexible, longitudinal, continuous, and cumulative process, is recommended for inclusion at every pediatric visit. The five components of developmental surveillance described in the AAP statement include: 1) eliciting and attending to the parents concerns about his …

Feasibility of Conducting Autism Biomarker Research in the Clinical Setting

Objective: Recruitment and completion of research activities during regular clinical care has the potential to increase research participation in complex neurodevelopmental disorders. We evaluated the feasibility, and effect on clinical care, of conducting biomarker research within a subspecialty clinical visit for autism spectrum disorder (ASD). Methods: Children, aged 5 to 10 years, were recruited by providers in ASD clinics at 5 institutions. Biomarkers collected were growth measurements, head circumference, neurologic and dysmorphology examinations, digit ratio (2D:4D) measurement, and platelet serotonin and urinary melatonin sulfate excretion levels. Parents completed the Aberrant Behavior Checklist—Community and a medical/demographic questionnaire. Cognitive level was abstracted from the medical record. Parents and clinicians completed surveys on the effect of the study on the clinical visit. Results: Eighty-three children and their caregivers participated. Factors limiting participation included difficulty reaching families by phone and parent concern about the study blood draw requirement. All children completed at least 4 of 7 planned research activities. Demographic factors, educational placement, and child behavior were not associated with completion of study activities. Lower nonverbal cognitive function was weakly associated with fewer activities completed. Forty-four percent of clinicians reported an effect of the research study on the clinical visit. However, neither parent-reported nor clinician-reported effect was associated with the degree of study activity completion. Conclusion: Recruiting study participants in the context of scheduled ASD clinical visits required significant effort. However, once recruited, participants completed most study activities, regardless of behavioral symptom severity. Research activities did not adversely affect the clinical visit.