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Comparison of the ASQ and PEDS in screening for developmental delay in children presenting for primary care
Marjolaine M Limbos1, David P Joyce
1Department of Psychology, British Columbia Children's Hospital, Vancouver, BC, Canada. mlimbos@cw.bc.ca
Insights
The Ages and Stages Questionnaire (ASQ) demonstrated superior sensitivity and specificity for developmental screening in primary care compared to the Parents' Evaluation of Developmental Status (PEDS). Both tools are valuable for identifying developmental delays in young children.
Area of Science:
- Pediatric primary care
- Developmental pediatrics
- Screening tools
Background:
- Early identification of developmental delays is crucial for timely intervention.
- Parent-completed screening tools offer a practical approach in primary care settings.
- The Ages and Stages Questionnaire (ASQ) and Parents' Evaluation of Developmental Status (PEDS) are commonly used for developmental screening.
Purpose of the Study:
- To compare the sensitivity and specificity of the ASQ and PEDS for developmental screening in children.
- To evaluate the performance of these tools in a primary care population.
- To inform the selection of appropriate developmental screening measures.
Main Methods:
- A cohort of 334 children aged 12-60 months presenting to primary care was studied.
- Parents completed the ASQ and PEDS questionnaires.
- Children underwent comprehensive developmental evaluations using standardized criterion measures (Bayley Scales, WPPSI-III, PLS-4, Vineland-II).
Main Results:
- Developmental delay was identified in 10% of the children.
- The ASQ showed higher sensitivity (82%) and specificity (78%) than the PEDS (74% sensitivity, 64% specificity).
- The ASQ maintained moderate performance across age subgroups, while PEDS performance varied, except in younger children (≤30 months).
Conclusions:
- Both ASQ and PEDS demonstrate reasonable test characteristics for developmental screening in primary care.
- The ASQ appears to offer better overall sensitivity and specificity across different age groups.
- The choice between ASQ and PEDS may depend on practice setting, patient population, and clinician preference.
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.
