PEDIATRICS Vol. 86 No. 3 September 1990, pp. 398-404
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Examining High-Risk Children for Learning Problems in the Health Care Setting

James A. Blackman MD, MPH1 and Julie Bretthauer 1

1 Department of Pediatrics, University of Iowa, Iowa City

The validity of the Pediatric Evaluation of Educational Readiness (PEER) in evaluating high-risk 5-year-old children who passed developmental screenings through age 30 months was assessed by comparing it with a battery of standardized psychoeducational tests. High-risk children who "failed" the PEER scored significantly below those who "passed" the PEER on tests of verbal, perceptual-motor, and preacademic skills. Furthermore, scores on the PEER of the high-risk group were significantly below those of a normal comparison group. When the standardized test battery was used as the true indicator of developmental concerns, the sensitivity of the PEER averaged 0.60; specificity averaged 0.88. The overall hit rate was 78%. False-positive rate was 27%, the false-negative rate, 20%. Observations of behavior, including attention and activity, correlated at the .63 level (P < .001) with those made independently by a psychometrist. The correlation of these observations to ratings of behavior by parents on the Child Behavior Checklist was .32 (P < .001). It is concluded that the PEER distinguishes between groups of children at risk and not at risk for learning problems; however, in individual cases, the PEER and the standardized test agreed that a child had problems only 60% of the time. Thus two out of five children who may have problems would be missed by the PEER. The observations of behavior feature of the PEER seemed to be a reliable measure and to have some relationship to concerns indicated by parents. With the health history and physical examination, the PEER can assist in the developmental surveillance of children known to be at risk for learning problems. However, based on this study, it cannot be recommended for screening of general populations.

Submitted on June 14, 1989
Accepted on September 25, 1989




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