Case Study: Interpreting the PEDS

The provider applies the score to the PEDS interpretation form, ticking off the developmental concern on the score sheet that corresponds to the parent comments. This is completed easily during the visit interview.

Recommendations for referral are based on the number of predictive concerns found. Certain developmental concerns at different ages are predictive of a developmental disability; these “predictive concerns” drive the algorithm toward referral for further evaluation. If such concerns are found, the child may be eligible for publicly funded services.

  • If two or more predictive concerns are found, it’s recommended that the patient be referred at least for either speech and language assessment and Audiology testing or for intellectual and educational evaluation. In real life, we generally send children to Early Intervention or Public School evaluations, so specific referrals are not always relevant.
  • If one predictive concern is found, it’s recommended that you bring the patient back for either second-stage developmental screening or for other, more specific screens. In our large practice, we have set up Second Stage Screening visits; Early Intervention sees children under 3 on site and children over 3 are screened by an educational specialist using the Brigance (see the AAP Policy Statement for more description of this screener). Most practices cannot set up Second Stage Screening. In that case, if a child’s experienced pediatrician is not concerned after interviewing the parent and child, then that child is often monitored and not referred immediately.
  • If a non-predictive concern is found, additional screening, behavioral counseling, or referral to a community program such as Head Start or Early Head Start may be appropriate.
  • If the parent does not write down any concerns, be sure to consider whether the parent has literacy or language barriers before assuming the parent has no concerns.

Clinical judgment remains vital and parent endorsements will always have to be reviewed with a conversation. But a survey does provide structure to the interview. Parents express higher satisfaction when pediatric providers address behavior and development than when they don’t perceive that was done. Remember, too, that fewer than 30% of children with developmental needs are identified by clinician judgment before children enter school.