HOW TO ADMINISTER PEDS: PARENTS

EVALUATION OF DEVELOPMENTAL STATUS

BASED ON DR. GLASCOES
RECOMMENDATIONS
VANDERBILT UNIVERSITY

PARENTS EVALUATION OF
DEVELOPMENTAL STATUS
A Method for Detecting and Addressing
Developmental and Behavioral Problems
For children 0 to 8 years
Takes about 5 minutes for parents to complete, 1-2
2 minutes to score
Elicits parents concerns (in multiple languages
Sorts children into high, moderate or low risk for
developmental and behavioral problems
4th 5th grade reading level so > 90% can complete
independently
Score/Interpretation form used longitudinally
Online application with automated scoring/results

Peter Jones

7/7/04

PEDS Evidenced Based Decisions

Path A: high risk of developmental disabilities, shows
what kinds of referrals are needed.
Path B: moderate risk of disabilities, need for additional
screening, developmental promotion, monitoring
Path C: low risk of developmental disabilities but
elevated risk for mental health problems, need for
parent education, monitoring, and/ or additional
behavioral screening
Path D: moderate risk of developmental disabilities,
problems with parental communication and need for
hands-on screening
Path E: low risk for either type of disability for which
reassurance is the best response

Oh, by the way..

Reduces doorknob concerns
Focuses visit and facilitates patient flow
Improves parent satisfaction and positive
parenting practices
Increases provider confidence in decisionmaking
Survey version used in evaluation of health
care plans by FACCT and NSECH

HOW TO ADMINISTER PEDS

1.

ASK PARENTS WHETHER THEY WOULD

LIKE TO COMPLETE THE RESPONSE FORM
ON THEIR OWN OR HAVE SOMEONE GO
THROUGH IT WITH THEM.

!
IF, IN WRITING, PARENTS ONLY CIRCLE
ANSWERS AND DONT WRITE ANYTHING ON
THE FORM, YOU CANNOT BE SURE OF
LITERACY AND SHOULD READMINISTER PEDS
AS AN INTERVIEW

Once parents have

completed the Response
Form, begin the scoring
process by

COMPUTING THE CHILDS AGE

Correct for prematurity if less than 24 months
old

SCORING: FIND AGE COLUMN

Find the correct column for the childs age on the
PEDS Score Form

SCORING: CATEGORIZE CONCERNS

Read through all comments
Look at the PEDS Brief Guide for examples of how to categorize
concerns in the various domains of development

EXAMPLES OF PARENTS CONCERNS

Expressive Language: He cant talk plain
Receptive Language: She doesnt seem to understand us
Gross Motor: Hes clumsy, falls a lot, awkward, late to walk
Fine Motor: She cant write well, messy eater
Global/Cognitive: Slow and behind, cant do what other kids can
Other: trouble hearing, seeing, health problems, family issues
Social/Emotional: Hes mean, shes bossy, doesnt have friends

Behavior: He wont mind me, temper tantrums

Academic/preacademic: trouble in school, doesnt know ABCs
Self-Help: Cant get dressed by himself
I used to be worried but now I think hes doing OK

SCORING: MARK THE SCORE FORM

Mark the box to show the kind of concern
Even if there are several different kinds of issues under the same
category, only check the box
once (e.g, tantrums, hyperactivity, biting- all
just get a single check under behavior)
When parents circle a little to indicate the degree of concern, view this as
a yes

SCORING: ALERT
Parents dont always answer the question
asked so be sure to focus on the
catagories of concern, not the type of
question asked

SCORING: ADD YOUR CONCERNS TOO

If you have a concern about a child, you
can add checks to the boxes
However, dont remove or ignore the
parents concerns

SCORING: SUMMARY
Total the number of concerns in the shaded boxes
into the large shaded box at the bottom
Total the number of concerns in the unshaded boxes
into the large unshaded box at the bottom

SCORING: FINDING THE CORRECT PATH-I

First, follow the directions below the large
shaded box.
If the number is 2 or more, follow Path A
If the number is 1, follow Path B

SCORING: FINDING THE CORRECT PATH-II

If no shaded boxes are checked but the number in the
large nonshaded boxes is 1 or more, follow Path C
If there is a 0 in both large boxes but you have concerns
about the child, follow Path D
If there is a 0 in both boxes and you dont have
concerns, follow Path E

INTERPRETATION FORM: PATH A

Path A is the High Risk path and suggests possible developmental disabilities. Refer
promptly for evaluations through EI or the public schools.
Path A suggests the type of evaluations needed based
on the types of concerns
Add your clinical judgment about what other kinds of
services may be needed (e.g.,
social work,
mental health, etc.)
Additional screening with the M-CHAT is wise

PATH B
Path B suggests Moderate Risk for
developmental disabilities
In response screen further or refer for screening
Offer developmental promotion to those who
dont qualify for special
services and provide watchful waiting/extra monitoring
Consider referrals to Head Start, after school
tutoring, etc.

PATH C
Path C: Low risk of developmental disability but elevated risk of mental health problems,
especially
in children 4 years and older
For children under 4, give parents advice and written
information, and monitor
effectiveness
If such counseling is not effective, provide mental health screening or refer for screening (both
child and family-focused)
For children 4 and older, give mental health screens or refer for screening (child and family)

PATH D
Path D is rare but is used for parent-provider communication
difficulties (e.g., no
language in common, teen parent who
doesnt know much his child, parents
with serious
mental health or language
problems
Refer these children for hands-on screening
(e.g, with the
PEDS:DM, Brigance or ASQ)

PATH E
Path E: Low risk for problems either in
development or social-emotional areas
Offer reassurance unless your clinical
judgment suggests a problem

PEDS
INTERPRETATION FORM
DETAILS

The Interpretation Form has space on the right to

record your decisions, referrals, advise, etc.
This provides a longitudinal record of
services providedhelpful for audits, etc.

CASE EXAMPLES
Next up are three case examples. The first case is a 2 year
old who is not yet toilet trained (Path C). The second case is
a child with a possible language delay (Path B). The third
case (Roger files) is a child with features of autism spectrum
disorder (Path A and a failed M-CHATthis provides a
good case to use to demonstrate the capabilities of online
PEDS).

PRACTICE EXAMPLES: AMY

AMY RESPONSE

Peter Jones

7/7/04

Practice Examples: Billy

.

Practice Examples: Roger

This is Roger who was

first seen at age 2 1/2.

Im worried about how my child talks and relates to us. He says things that
dont have anything to do with whats going on. He is oblivious to anything but
what he is doing. Hes not doing as well as other kids in many ways.

Yes, he just repeats things like Wheel of Fortune

I cant tell what he understands or if he is just ignoring us.

Hes good with manipulatives but sometimes does lots of the same
things over and over: flick lights, spin wheels on his cars

Hes very coordinated and very fast!

Lots of tantrums
He just doesnt seem interested in even watching other kids.

He is very independent

Hes too young for that sort of stuff

We spend a lot of time playing and talking with him and this seems to
be helping some. I do wonder about his hearing sometimes though.

Roger

4
2

WHAT NEXT?

Lets think a bit more about all the things that are needed for
children who land on Path A or B, the high and moderate
risk categories. What is needed for Roger and his family?

PEDSONLINE
Web accessible PEDS for
Licensed PEDS users
Self-selected parents
PEDS scoring Web service for
EMR/EHR and other electronic systems

SUBJECT INFORMATION

PARENT INFORMATION

The second page captures additional demographic information including

potential risk factors, like parents age, ethnicity, etc. The demographics
pages only require limited information but can be set to interface and
capture information from the electronic records so that data does not have
be reentered.

THE NEXT PAGES PRESENT THE PEDS QUESTIONS ONE AT A

TIME. PARENTS ARE GIVEN SPACE FOR THEIR ANSWERS.
THEY MUST THEN CLICK THE BOXES FOR YES NO

OR A LITTLE TO INDICATE THE DEGREE

OF CONCERN.

M-CHAT (OPTIONAL)

The site also houses the M-CHAT,

a second-stage screen for autism
and other developmental problems

RESULTS (RECORD)

RESULTS (PARENT INFORMATION)

LETTER OF REFERRAL

RESOURCES FOR PARENTS

DATA RESOURCES

All demographics
captured

De-identified datasets
available for research
(subject to IRB and
HIPPA)
Multiple formats
available (SQL, text,
Excel, etc)
Raw or aggregated
data

FLEXIBLE
Works with several workflow approaches

Adaptable to licensees level of automation

Faster screening and analysis for paper-based
organizations
Can be fully integrated with licensees electronic
systems
or anything in between
Referral letters and parent information sheets are
fully customizable for each licensee or locale
Many options for collection of research data

PRACTICE EXAMPLES: SARAH

SARAH RESPONSE FORM

Sarahs mother, Mrs. Williams, has a few issues with

literacy. She notes to the first question Sarah plays
house by herself and developing a friend that not
there and also cleaning after herself.

2
3

PRACTICE EXAMPLES: JEREMY

The mother of this five year,

Jeremy Rogers, wanted to
complete the PEDS on her own
despite offers of assistance.

JEREMY RESPONSE

3
5

GLASCOE ON DELIVERING DIFFICULT NEWS TO

PARENTS
Prepare parents for screening in a positive way
Inform parents about the purpose for each test
Validate concerns expressed by parents
Use descriptive terms rather than diagnostic labels
Present news in a thoughtful, caring way, preferably in
person
Provide hope
Help parents to establish action plan
Provide contact information for resources in community
Offer ongoing support
Provide information handouts