Published online September 14, 2009
PEDIATRICS Vol. 124 No. 4 October 2009, pp. e705-e713 (doi:10.1542/peds.2009-0286)
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ARTICLE

Sugar-coaters and Straight Talkers: Communicating About Developmental Delays in Primary Care

Laura Sices, MD, MSa, Lucia Egbert, BAb and Mary Beth Mercer, MPHc

a Department of Pediatrics, Division of Child Development, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts
b Department of Maternal and Child Health, School of Public Health, Boston University, Boston, Massachusetts
c Department of Bioethics, Cleveland Clinic, Cleveland, Ohio

OBJECTIVES: The goals were to investigate parents' and early intervention (EI) specialists' beliefs and experiences regarding discussing child development in primary care and to identify communication barriers and opportunities.

METHODS: Focus groups were held with (1) mothers of young children with typical development, (2) mothers of young children who received EI services, and (3) EI specialists. Seven groups (N = 46 participants) were conducted in the greater Cleveland, Ohio, area. Meetings were audio-recorded, transcribed, coded, and analyzed, to identify themes.

RESULTS: Most mothers reported a preference for a nonalarmist style of communication when developmental delays are suspected. In contrast, some mothers preferred a more direct style, including the use of labels to help them understand their child's development. The importance of preparation to accept information about developmental delays emerged as a theme in all groups. Elements contributing to preparedness included information about expected developmental skills, suggestions for promoting skills, and a specific time frame for follow-up evaluation. Mothers of children with disabilities perceived that early reassurance of normalcy by providers in response to their concerns led to self-doubt and increased difficulty accepting the diagnosis.

CONCLUSIONS: Mothers and EI specialists have clear ideas about factors that promote or impede communication regarding child development. This information can inform primary care providers' approaches to monitoring and screening the development of young children and to communicating with parents regarding suspected developmental delays.

Key Words: child development • developmental concerns • communication • primary care

Abbreviations: EI—early intervention

Accepted May 29, 2009.


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