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LETTER TO THE EDITOR |
We appreciate the commendation offered by Lipkin, in his role as Chair of both the American Academy of Pediatrics Council on Children With Disabilities and the Policy Revision Committee for Developmental Surveillance and Screening, and Gwynn. The commendation serves to validate our intent and efforts with respect to our initial attempt to evaluate prospectively 2 parent-completed questionnaires relevant to developmental screening.1 Our efforts were motivated by observations that despite widely endorsed policy statements,2 practice constraints were limiting the widespread use of standardized screening tools,3 with the result being a lamentable late identification of developmentally impaired children.4
To respond to Lipkin and Gwynn's specific questions, the pediatrician's opinion was evaluated as a modifier of concerns raised by the Ages and Stages Questionnaire and Child Development Inventory. Specifically, if the pediatrician was concerned by some aspect of the child's development, did this make it more likely that a failing score on the Ages and Stages Questionnaire or Child Development Inventory would be associated with a failure on the Battelle Development Inventory? The answer was no, thus our statement that the pediatrician's opinion did not improve the predictive value of the questionnaires tested, which suggested good specificity and poor sensitivity with respect to this opinion. Discordant cases were not excluded from the study, as per Lipkin and Gwynn's suggestion, but were merely excluded from the analysis of the physician's opinion as a modifier, because we could not a priori provide a hierarchy of relative value to the questionnaire's result versus the physician's opinion. As cited in our article and mentioned by Lipkin and Gwynn, previous studies have shown that parents do consistently provide accurate information regarding their child's development,5 hence the rationale for standardized parent-completed questionnaires as a viable option to health care provider–completed questionnaires. Thus, parental opinion was formalized by standardized questioning, and it was this opinion that we analyzed.
We would most certainly concur with Lipkin and Gwynn's suggestion of the limits of relying on either a single point in time or a single piece of information. What is missing at the moment are data to justify rationally proposing a strategy of when to evaluate and with what mechanisms that meets the challenges of timeliness, cost-effectiveness, and efficiency. What is most likely is that a single strategy may not encompass diverse socioeconomic challenges; thus, future testing that builds on our work and that of others in a variety of practice milieus is clearly necessary.
REFERENCES
This article has been cited by other articles:
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  M. I. Shevell Should General Pediatricians Not Select the Ages & Stages Questionnaire in Light of the Rydz et al Study?: In Reply Pediatrics, August 1, 2007; 120(2): 458 - 458. [Full Text] [PDF]
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