The Pediatric Examination of Educational Readiness: validation of an extended observation procedure

The Pediatric Examination of Educational Readiness (PEER) is a standardized observation system for use by health care professionals. It combines a prekindergarten physical examination with a neurodevelopmental and behavioral assessment. The PEER was field tested on 386 children, of whom 22% revealed a "definite concern" in one area of development or behavior, 8% in two, and 14% in three or more areas. (A concern was a finding that required direct intervention, continuing surveillance or further evaluation.) Children with multiple areas of concern were found to have lower teacher rating scores at the end of kindergarten than those with isolated or no concerns. An observation procedure, such as the PEER, can be a productive part of the pediatric assessment of children entering kindergarten.