Parents' concerns about children's development: Prescreening technique or screening test?
Parents' concerns about children's development: Prescreening technique or screening test?
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DOI：
10.1542/peds.99.4.522
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发表时间：
1997-04-01
期刊：
影响因子：
8
通讯作者：
Glascoe, FP
中科院分区：
文献类型：
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作者：
Glascoe, FP
Objective.由于以往研究的局限性，父母的关注被推荐为一种预筛选技术，一种用于识别需要更深入的发育筛查的儿童子集的简要方法。本研究的目的是评估父母的担忧是否可以：（1）作为一种筛查措施;（2）帮助做出有针对性的转诊决定;（3）帮助儿科医生针对家庭进行发展促进和办公室咨询。另一个目标是确定为什么大多数家长的关注是准确的，虽然有些不是。设计调查/设置，公立学校和日托中心在四个不同的地理位置代表北方，中部，南部和西部的美国。共408名年龄在21至84个月的儿童及其父母，其社会经济和人口统计学特征反映了1990年美国人口普查的比例。有执照的心理检查员和教育诊断师引起了家长对儿童发展的关注，并用广泛的电池测量儿童的发展，包括智力，语言，运动和学校技能的测量。某些问题，即运动，语言，全球/认知，和学校（4岁及以上的儿童）有很高的敏感性，并确定了79%的56名残疾儿童。在56名儿童中，70%可以进行准确的转诊。在352名发育正常的儿童中，72%（N = 255）的儿童在其他方面（即社会化、自助或行为）没有担忧或担忧，具有合理的特异性。其余28%（N = 97）的父母有重大的关注，但他们的孩子没有残疾，大多数孩子在几乎所有发展领域的表现大大低于255父母没有重大的关注。此外，超过一半的97名儿童可以区分一个单一的关注（通常是关于表达性语言），而大多数准确关注的父母有多种关注。12名残疾儿童的父母中，有相当一部分没有提出问题，他们用英语或西班牙语沟通有困难。如果系统地引出，父母的关注接近筛查测试的标准，并可用于做出合理准确的转诊决定。过度转诊可以显着减少管理筛选测试的一小群儿童（16%）的父母有一个单一的重大关注。那些通过筛查或父母没有重大问题的人可以成为发展促进和办公室咨询的目标。通过对父母有沟通困难的儿童进行筛选测试（必要时在口译员的帮助下），可以尽量减少转诊不足的情况。
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 fan be minimized by administering screening-tests (with the help of an interpreter as needed) to children whose parents have communication difficulties.