Raymond A. Sturner

Questionnaires in behavioral pediatrics: Guidelines for selection and use

There is a dearth of information for pediatricians to use in choosing questionnaires that would be useful in medical practice. In this article, general guidelines are presented for primary child health clinicians to use in selecting questionnaires. Concepts such as reliability, validity, readability, response format, scoring and completion time, and norms are reviewed, and the implications of these concepts for practitioners are discussed. Guidelines are applied to selected behavioral questionnaires to illustrate their importance.

Preschool Speech and Language ScreeningA Review of Currently Available Tests

Fifty-one preschool speech-language screening tests were reviewed with regard to criteria crucial to screening test selection: professional time required, comprehensiveness, norms, and reliability/...

Preschool prediction of early school performance: Relationship of McCarthy scales of children's abilities prior to school entry to achievement in kindergarten, first, and second grades

Two studies assessing the predictive validity of the McCarthy Scales of Childrens Abilities (MSCA) are reported. In Study 1, the MSCA was administered prior to school entry to a stratified sample of 129 children chosen from a countywide cohort, with oversampling of those at risk for developmental delay. California Achievement Tests (CATs), retention, and special education outcomes were assessed in kindergarten, first, and second grades. Preschool MSCA scale scores showed significant positive correlation with achievement outcomes (r=.35–.70). Children who scored low (<68 or between 68 and 84) on the MSCA General Cognitive Index (GCI) had significantly lower CAT scores in all grades than did children scoring within the normal range (≥84) on the GCI. By second grade 94% of children scoring less than 68 on the preschool GCI and 74% of those scoring between 68 and 84 on the GCI had failed a grade, had been placed in special education classes, or were scoring in the bottom 20% of their cohort on the CATs in that year. In Study 2, these results were replicated through first grade for a second cohort.

Toxocara canis Infestation: Clinical and Epidemiological Associations with Seropositivity in Kindergarten Children

We studied a cohort of 333 children in kindergarten to determine the prevalence of seropositivity to Toxocara canis, and to detect and measure chronic health effects that might be attributable to past infection. We found that 23.1% of the children had serologic evidence of infection (antibody titer greater than or equal to 1:32), assayed by means of an enzyme-linked immunosorbent assay. Black children were more frequently infested than white children, as were children of parents who did not graduate from high school. In a subsample of seropositive and seronegative children, we found associations between seropositivity and both pica and puppy ownership; we did not find differences in the symptoms and signs that occur in toxocaral visceral larva migrans nor differences in measures of growth and nutrition. No child had ocular toxocariasis although 31.8% (106) of the children had antibody titers greater than or equal to 1:16. In a population in which approximately 20 to 30% of the children show serologic evidence of Toxocara infestation, care must be taken in differentiating toxocariasis-like ophthalmic lesions, due to the potential for the coincidental occurrence of retinoblastoma in a child who is seropositive for the Toxocara parasite.

Preschool Denver Developmental Screening Testas a predictor of later school problems

We compared three preschool tests as predictors of school problems at the end of first grade. A stratified sample of 113 4 1/2- to 5 1/2-year-old children, oversampling those at risk for developmental difficulties, was administered the Denver Developmental Screening Test (DDST), the Stanford-Binet IQ test (SB), and a two-stage shortened form of the DDST in the spring before school entry. Data from achievement tests, special class placement, and grade retention were obtained for 106 of the children at the end of first grade. Eighty-four percent of children with abnormal DDST scores had school difficulties by the end of first grade, compared with 47% of children with scores in the questionable range and only 15% of children in the normal range. Prediction from the SB was not as accurate; 72% of the children who scored less than 68 and 42% of those who scored between 68 and 84 on the preschool SB had school problems. Prediction for those children who had abnormal or questionable scores on the two-stage DDST was as good as prediction from the full DDST. However, far fewer of the total number of school problems were identified by the two-stage DDST. It appears that the DDST can be used on an individual basis for prediction of school problems.

Preschool speech and language screening : Further validation of the Sentence Repetition Screening Test

A recent review indicated that only one speech and language screening test (the Sentence Repetition Screening Test; SRST) designed for preschoolers has been successfully validated in a representative population. This study sought to replicate the SRST validation study using a somewhat younger age group and to compare predictive indices to typical measures of parent concern and teacher judgment. A sample of (N=343) prekindergarten children (ages 54 to 66 months) attending school registration in the spring before kindergarten entry was tested with the SRST. A stratified sample of 76 returned for criteria testing within 2 months. Teacher ratings were obtained 5 months later. Outcome measures were standard language (Bankson and Illinois Test of Psycholinguistic Abilities) and speech articulation (Arizona) tests. With a prevalence of 11%, SRST prediction of language outcomes resulted in the following indices: sensitivity, .62; specificity, .91; predictive validity, .44; overreferral, 8.4%; and underreferral, 4%. Prediction of the articulation outcome with a prevalence of 11% resulted in indices as follows: sensitivity, .57; specificity, .95; predictive validity, .75; overreferral, 3.7%; and underreferral, 8.3%. Teacher ratings and a parent questionnaire (Speech and Language Screening Questionnaire) approached the same rate of prediction of articulation but with a higher overreferral rate. The predictive indices from the SRST exceeded the comparison measures for language outcomes.

ELICITED IMITATION: ITS EFFECTIVENESS FOR SPEECH AND LANGUAGE SCREENING

The authors explored the clinical usefulness of a brief sentence‐repetition screening task (SRST), by screening 382 kindergarten children and performing follow‐up tests on a stratified sample of 78. Results indicate that an elicited‐imitation task can predict the combined outcome of receptive and expressive language problems, as well as articulation problems. Replication, cross‐validation and assessment of children with selective receptive impairments are recommended. Nevertheless, the present study demonstrates that the use of sentence‐repetition screening tasks could be a very efficient strategy for screening for both language and articulation problems in kindergarten children.

The Routine "Well Child" Examination A Study of Its Value in the Discovery of Significant Psychological Problems

The practice of well child care by pediatricians has been a subject of increas ing controversy. Previous reports in the literature have indicated a low yield of significant organic or psychological findings. In the present study, three post-residency pediatricians, working in the general pediatric unit of an HMO setting at different times, evaluated the developmental and psychological problems of patients seen in consecutive well child examinations. The nature of their problems was measured by the actual degree of intervention re quired of the pediatrician, rather than by standard mental health terminology or diagnosis. The combined results of these evaluations (with close individual agreement among the three examiners) contradicted previous pediatric reports by indicating that 38 per cent of the children seen had definable develop mental or psychological problems requiring some action or intervention by the pediatrician. Eleven per cent of the cases required major intervention— either 3 or more visits or referral to a mental health facility. These results indicate a wide prevalence of significant developmental and/or psychological problems in children and demonstrate the capability of general pediatricians working in a standard pediatric setting to detect them.

Cognitive development related to performance on preschool hearing screening tests.

Behavioral responses to routine hearing screening were measured on 730 preschool children (ages 52 to 70 months). A stratified sample (which oversampled children “at risk” for developmental delay) also received a standardized test of cognitive abilities (McCarthy Scales or the Stanford-Binet). The results revealed that children without audiologic pathology who failed one or more of three hearing test behavioral scales scored significantly lower on the McCarthy Scales or Stanford-Binet than other children. Children failing two or more scales formed a definite risk group, with a group mean approximately two standard deviations below the national mean on both the McCarthy Scales and the Stanford-Binet. The data thus indicate that it is possible to gather simultaneous information about hearing ability and cognitive status.

Simultaneous Technique for Acuity and Readiness Testing

Almost all pediatricians feel that developmental screening should be a standard part of routine child health examinations (Smith, 1978). However, this belief is only rarely reflected in actual practice. The reason most often given by pediatricians for their failure to carry out the screening is that the tests are too time-consuming. Although pediatricians typically claim that they are able to accomplish developmental screening through informal observations of the child’s responses to the usual health examination procedures, this approach to screening has been shown to be unreliable (Bierman, Connor, Vaage, & Honzik, 1964; Korsch, Cobb, & Ashe, 1961). On the theory that reliable, valid, and efficient developmental screening can be accomplished during the course of routine health examinations, providing simultaneous screening of health and development, the current study attempted to revitalize and systematize the observational process that pediatricians claim to do during health examinations. The research being reported here is an attempt to test the proposition that simultaneous screening can be both effective and efficient. Specifically, it uses the routine preschool vision acuity screening test to not only screen for visual acuity, but also as a means to detect children with educational handicaps.