Parents' concerns about children's development: prescreening technique or screening test?

OBJECTIVE: Due to the limitations of previous studies, parents' concerns have been recommended as a prescreening technique, a brief method for identifying a subset of children in need of more in-depth developmental screening. The purpose of this study was to assess whether parents' concerns could: (1) serve instead as a screening measure; (2) aid in making focused referral decisions; and (3) help pediatricians target families for developmental promotion and in-office counseling. An additional goal was to determine why most parents' concerns are accurate although some are not. DESIGN SURVEY/
SETTING: Public schools and day care centers in four diverse geographic sites representing the northern, central, southern and western United States. PATIENTS AND OTHER PARTICIPANTS: A total of 408 children between 21 and 84 months of age and their parents, whose socioeconomic and demographic characteristics reflect proportions in the 1990 United States Census. MAIN OUTCOME MEASURES: Licensed psychological examiners and educational diagnosticians elicited parents' concerns about children's development and measured children's development with a broad battery including measures of intelligence, language, motor, and school skills.
RESULTS: Certain concerns, ie, motor, language, global/ cognitive, and school (in children 4 years and older) had high levels of sensitivity and identified 79% of the 56 children with disabilities. Accurate referrals could be made for 70% of the 56 children. The absence of concerns or concerns in other areas, ie, socialization, self-help, or behavior, had reasonable specificity and identified 72% (N = 255) of the 352 typically developing children. Of the remaining 28% (N = 97) of parents with significant concerns but whose children did not have disabilities, most had children with substantially lower performance in almost all developmental areas than the children of the 255 parents without significant concerns. Further, more than half of the 97 children could be distinguished by a single concern (usually about expressive language) whereas the majority of accurately concerned parents had multiple concerns. A significant proportion of the 12 parents of disabled children who did not raise concerns could be identified by difficulties communicating in either English or Spanish.
CONCLUSION: If systematically elicited, parents' concerns approach standards for screening tests and can be used to make reasonably accurate referral decisions. Over-referrals can be significantly reduced by administered screening tests to the small group of children (16%) whose parents have a single significant concern. Those who pass screening or whose parents have nonsignificant concerns can be targeted for developmental promotion and in-office counseling. Under-referrals can be minimized by administering screening tests (with the help of an interpreter as needed) to children whose parents have communication difficulties.