PEDS: Developmental Milestones:
A New Measure for Developmental-Behavioral Surveillance and Screening

Brothers KB. PEDS: Developmental Milestones: A New Measure for Developmental-Behavioral Surveillance and Screening. Ambulatory Pediatric Association Newsletter. 2007;43 (3): 21-22.

Most health care providers attempt to identify children with developmental and behavioral problems in order to facilitate enrollment in early intervention and ensure its numerous benefits. Unfortunately, most clinicians rely on informal milestone checklists. These lack reliability, validity, and scoring criteria. The result is that only one-fourth of children eligible for early intervention services actually receive them.

To address this problem and enhance compliance with the American Academy of Pediatrics (AAP)'s new policy statement (July, 2006), which embraces surveillance and screening, there is a helpful new measure called Parents' Evaluation of Developmental Status: Developmental Milestones (PEDS:DM). The PEDS:DM is for children birth to age 8 and consists of 6 - 8 items per visit, one per developmental domain: fine motor, gross motor, social-emotional, self-help, expressive language, receptive language, and for older children, reading and math. Each item serves as a screen for the domain from which it is derived and problematic performance is tied to a cutoff at the 16th percentile or below (the point below which children have great difficulty with regular curricula). Standardized and validated on more than 1600 children around the US, who participated from health care settings as well as day care centers and preschools, the PEDS:DM has sensitivity and specificity across domains as well as age ranges of 70% to 93%, well within standards for screening tools.

There are many interesting features to this measure. It consists of a book of four-color laminated forms, one for each age range, that parents complete with a dry erase marker. The 6 - 8 questions per form are written at the high first grade level and answered, via multiple choice, in less than 5 minutes. Parents are then encouraged to read to their child a short story that is presented in the book on the opposite page. These stories focus on child development and positive parenting practices (such as talking and reading to your baby, giving toddlers choices, making clean-up time into a game, etc.). Since parents are known to learn about child developmental through assessment, the fact that the PEDS:DM actively promotes healthy development and parenting is exciting as are the accompanying photographs and drawings that reflect the diverse ethnicities within American society .

A single scoring template reveals correct and incorrect answers that are then transferred to a longitudinal growth chart. Over time, this builds a bar graph of children's developmental strengths and weaknesses. The accompanying professional manual contains a list of items in developmental order by domain so that clinicians can probe the extent of weaknesses or strengths and check the reliability of parents' answers (or administer the measure directly to children).

The second section of the PEDS:DM Family Book contains supplementary measures (also laminated) helpful in screening and surveillance. These include the Modified Checklist of Autism in Toddlers (M-CHAT), the Pictorial Pediatric Symptom Checklist-17, the Brigance Parent-Child Interactions Scale, The Family Psychosocial Screen, and the Vanderbilt ADHD Scale. A third section contains all essential stimuli for completing the items in an Assessment Level version of the PEDS:DM which is designed for NICU follow-up and early intervention intake. The Assessment Level presents more items in order to produce age-equivalent scores helpful for research, follow-along, and in-depth developmental monitoring. It can be used in mail out programs and the Assessment Level booklet is designed for multiple re-use with the same family.

The authors, Frances Page Glascoe and Nicholas Robertshaw, have certainly capitalized on their vast experience with screening and surveillance by designing a tool that is inexpensive, fits clinician's apparent preferences for measuring development, and above all, has proven accuracy. Vanderbilt University is currently trialling a waiting room computer kiosk version of PEDS:DM and PEDS. The authors expect to have the measure online for use with electronic records at www.forepath.org, a site that currently houses PEDS and the M-CHAT, in the near future and to publish a Spanish-language version of the PEDS:DM by Summer 2007. The use of all three measures, from time to time, offers good compliance with the AAP's new recommendations for routinely eliciting and addressing parents' concerns, monitoring children's development, and administering an autism-specific screen at 18 and 24 months.

Also of note, the PEDS:DM was created with items from several of the Brigance Diagnostic Inventories. Albert Brigance and his publisher, Curriculum Associates, along with Ellsworth & Vandermeer Press has jointly agreed to donate a portion of PEDS:DM sales to the American Academy of Pediatrics Section on Developmental and Behavioral Pediatrics in support of the website devoted in large part to helping health care providers learn about screening, www.dbpeds.org. More information about the PEDS:DM can be found at the PEDS:DM Home Page.

American Academy of Pediatrics Policy Statement
Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening
Pediatrics, July, 2006
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/1/405