Comparison of the ASQ and PEDS in Screening for Developmental Delay in Children Presenting for Primary Care

OBJECTIVES: This study investigated the sensitivity and specificity of two brief, parent-completed developmental screening measures-the Ages and Stages Questionnaire (ASQ) and the Parents' Evaluation of Developmental Status (PEDS)-in children presenting to their primary care providers. METHOD: A sample of 334 children aged 12 to 60 months was recruited. Parents completed the PEDS and the ASQ in their home or the primary care clinic of one of the investigators. The presence of ≥ 1 predictive concerns or abnormal domains was considered a positive screen. All children underwent evaluation (administered by a psychologist) with the following criterion measures: the Bayley Scales of Infant Development-Third Edition or the Wechsler Preschool and Primary Scale of Intelligence-Third Edition, the Preschool Language Scale-Fourth Edition, and the Vineland Adaptive Behavior Scales-Second Edition. RESULTS: The mean age of children was 32.3 months. Developmental delay was identified in 34 children (10%). The PEDS had moderate sensitivity (74%) but low specificity (64%); comparatively, the ASQ had significantly higher sensitivity (82%) and specificity (78%). The ASQ had moderate sensitivity and specificity across age subgroups, whereas the PEDS had either low sensitivity or specificity in each of the age subgroups, except for the ≤ 30 month group, where there was moderate sensitivity (78%) and specificity (75%). Using ≥ 2 predictive concerns on the PEDS or ≥ 2 abnormal domains on the ASQ significantly improved specificity of both tests (89% and 94%, respectively) but resulted in very low sensitivity (41% and 47%, respectively). CONCLUSIONS: These findings support the guidelines of the American Academy of Pediatrics, demonstrating that both the ASQ and, to a lesser extent, the PEDS have reasonable test characteristics for developmental screening in primary care settings. Although the ASQ seems to have higher sensitivity and specificity across a variety of age groups, the choice of which measure to use should be determined by the practice setting, population served, and preference of the physician.

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