Parental Concerns: Consistency Across Question Format and Relationship to Child Performance

Background:

Parental concerns are important to consider when screening children for developmental delays. Studies show that regardless of differences in socioeconomic status and education, parents of children who are diagnosed with a developmental delay expressed early concerns about their child’s development. Understanding differences in parents’ responses, as well as the accuracy of their concerns compared to the child’s performance can enhance the effectiveness of early screening and evaluation procedures.

Objectives:

Parental concerns may vary across questionnaires, depending on the way in which concerns are elicited, e.g., domain-specific questions or broad questions about overall concerns. It is predicted that parents will endorse concerns in more domains of development when asked directly than when asked broadly. It is also predicted that the nature of parental concerns will not accurately predict their child’s performance or diagnosis.

Methods :

Participants completed a diagnostic evaluation after screening positive on the Modified Checklist for Autism in Toddlers (M-CHAT; n=63). Parents also completed the Parents’ Evaluation of Developmental Status (PEDS) questionnaire at a routine 18- or 24-month check up and a history questionnaire (Hx) before their evaluation. After the evaluation, 32 children were diagnosed with ASD, 28 children were diagnosed with another developmental delay or clinical concern, and 3 children were typically developing. Typically developing children were excluded from analyses.

The PEDS consists of 10 items that ask about concerns in specific domains including: global/cognitive, expressive (EL) and receptive language (RL), fine (FM) and gross motor (GM), behavioral, social-emotional (SE), self-help, school, and other. Parents also reported concerns about their child’s development on two broad questions on the Hx. Answers from PEDS and Hx were coded according to whether a parent expressed concerns in each domain. Children’s skills were assessed using direct testing (Mullen Scales of Early Learning; Autism Diagnostic Observation Schedule).

Results:

Parents were significantly more likely to express concerns about their child’s development when given the domain specific format (PEDS: M=4.32, SD=2.21) versus broad format (Hx: M=2.58, SD=1.29; t(59)=6.279, p <.001). Parents of children with ASD did not report more concerns than parents of children with non-ASD developmental delay (PEDS: F(58)=.232, p=.632; Hx: F(58)=.004, p=.949), but they were significantly less likely to report gross motor concerns (χ²(1)=7.037, p=.008). Parents were most likely to remain consistent in their concerns about expressive language (80%) and global development (86.7%) when compared to other domains (53.3-75%). Children whose parents endorsed concerns about their development in specific domains were not likely to perform lower on testing than children of parents without concerns (EL: t(27)=-.623, p=.538; RL: t(52)=.213, p=.828; FM: t(58)=1.059, p=.294; GM: t(51)=-1.808, p=.076; SE: t(46)=-1.18, p=.244).

Conclusions :

To obtain accurate report of parental concerns, domain-specific questions will elicit more responses. Parent report is an essential component to clinical evaluation; however, their concerns may not predict the child’s actual performance on standardized testing. This may be related to parents’ understanding of normative development.