Is developmental assessment worthwhile?

BACKGROUND: There is increasing research evidence that early intervention in a range of children's problems can have a positive effect on both children and families. There are a number of widely used screening tests available for the early detection of children's developmental problems, including the Denver II test; however, the routine uptake of these tests has been disappointing. They are time consuming; in some instances they require special training, and the general practitioner needs to purchase kits containing the required testing items. OBJECTIVE: This article looks at how developmental and behavioural disorders can be detected early on in the child's development by applying a new screening method which is useful in a general practice setting. DISCUSSION: As the focus of clinical practice moves more to prevention and early intervention, GPs are likely to become more involved with the early detection of developmental problems. Recently a new test--the Parents' Evaluation of Developmental Status (PEDS) has been developed. It requires parents to complete a 10 item questionnaire which the GP can then score and interpret according to a predetermined algorithm. The PEDS is simple and quick, and is thus ideal for the busy GP and has similar psychometric properties to other developmental screening tests. It also has the distinct advantage of actively involving parents in the process.

The development of a practical and reliable assessment measure for atopic dermatitis (ADAM).

Previous measures of Atopic Dermatitis (AD) have not been adequate for research purposes. This paper describes a study conducted in dermatology clinics of the Royal Children's Hospital, Melbourne, Australia, to develop a reliable, valid and practical measure. A pool of items to describe both site and morphology of AD was generated from a literature survey and expert opinion. Selected items were incorporated into a measure with each item rated on a four point scale. The measure was piloted and revised to a simpler format and called the Atopic Dermatitis Assessment Measure (ADAM). Unidimensionality was established. Reliability was determined by comparing two doctors blind ratings on 51 patients (mean age = 70 months). Agreement varied depending upon site and morphology with more agreement on "mild" AD than on "severe" AD. These results imply that operational definitions of the scales need to be defined more clearly. The measure satisfies the assumptions for a partial credit analysis.

Risk indicators: assessment of infancy predictors of pre-school behavioural maladjustment.

The prediction of later outcome from factors present in infancy has been an ongoing concern, with difficult temperament frequently being posited as one important risk factor. Using data from a longitudinal study of a large representative sample of children, and a categorical approach to analysis, a set of infancy risk factors covering within-child, environmental and relationship variables was related to behavioural and emotional adjustment at 4-5 years. Single risk factors, including difficult temperament, resulted in only modest increases in the prevalence of later maladjustment. However, certain combinations of risk factors were associated with markedly increased prevalence rates. The results indicate the cumulative effects of risk factors, and the need to consider temperament within a contextual framework.

Assessment of temperament in the toddler age group.

We used the Toddler Temperament Scale with large representative samples of younger (mean age = 20.5 months; N = 1188) and older (mean age = 35.4 months; N = 1360) Australian toddlers. There were significant sex differences on 6 of the temperament dimensions for the young group, and on 5 of the 9 dimensions for the older group. Older boys were also more likely to be categorized clinically as having a "difficult" temperament and less likely to have an "easy" temperament. Each group was divided into quartiles according to socioeconomic status. For the younger toddlers there were significant differences in 3 of 9 temperament dimensions, and for the older group there were significant differences in 7 of 9 dimensions. Groups with higher socioeconomic status had temperament ratings which were more likely to make them easier to manage, and to be categorized clinically as having an easy temperament, but toddlers with low socioeconomic status were more likely to have a difficult temperament. There were significant differences in temperament dimension scores between Australian toddlers and those studied in an American setting. These results indicate that toddler temperament ratings differ according to age, sex, social class, and cultural context. Great caution needs to be taken in interpreting individual temperament profiles utilizing comparison data obtained from different sociocultural settings. Future temperament "norms" may need to specify characteristics of the group of children from which they were derived to allow more valid comparisons.

Factors affecting the selection of doctor of first contact in the western region of Melbourne: an interview study of parents of sick children.

An interview study investigating attitudinal and other factors influencing the selection of primary medical care (PMC) is described. It focuses on parents of sick children, excluding those with trauma or medical/surgical emergencies, and was conducted in part of the Western Region (WR) of Melbourne in late 1983, the period immediately prior to the introduction of Medicare. It is based on a cross-sectional survey of in-hours attenders of eight general practices (GP), the Western Region Community Health Centre (WRCHC), the general clinic of the casualty departments at the Western General Hospital (WGH), and the Royal Children's Hospital (RCH), a teaching hospital outside the region. The most commonly stated reasons for attendance at services generally were 'closeness to home/work', 'recommendation' and 'good service'. 'Cheap/economic reasons' were given less frequently overall than the above reasons. There were however some differences in reasons given by attenders at different places of care. 'Cheap/economic reasons' was offered significantly more often and 'recommendation' significantly less often by WGH attenders compared with other attenders. 'Specialists available' and 'dissatisfaction with other doctors' was offered significantly more frequently and 'close to home' and 'no other doctor' significantly less frequently by RCH attenders than other attenders. Health insurance status did not differ significantly at the different places of care. Attenders of the RCH were significantly more knowledgeable about community health centres than GP or WGH attenders. Non-GP attenders had more often used other than their current place of care for treatment in the recent past than GP attenders had.(ABSTRACT TRUNCATED AT 250 WORDS)

The development of Australian normative data for infant temperament.

Utilizing the revised Infant Temperament Questionnaire previously validated for use with Australian populations, a cohort of 2443 infants aged 4-8 months was studied. This sample was recruited in such a manner as to be representative of all infants of this age group in the State of Victoria. Temperament values obtained differed significantly from American norms on four of the nine temperament dimensions, providing further evidence for the importance of using culturally appropriate norms. There were associations between temperament and problem behaviours and some parent characteristics. The normative values for temperament presented are recommended for use in Australian settings.

The assessment of children with school problems: evaluation of a hospital-based multidisciplinary clinic.

A hospital based multidisciplinary clinic for the assessment of children with school problems was evaluated. Questionnaires were sent to parents and teachers of 44 children seen during the first year of operation of the clinic. The majority of parents found the assessment and report valuable in answering their questions about the child; felt the report was clear and helpful, and the recommendations appropriate and practical. Ninety per cent of recommendations made were implemented. These results indicate that such clinics would seem to be an appropriate way to address the needs of children with school problems, an important segment of the new paediatric morbidity.

Evaluation of a multidimensional assessment procedure for preschool children.

The Pediatric Examination of Educational Readiness was administered to 386 preschool children to determine whether the predictive value of this instrument could be enhanced by the inclusion of systematic measures of processing efficiency, selective attention, behavioral adaptation, and neuromaturation. Findings on these dimensions, as well as the traditional developmental attainment measure, were consistent with McCarthy cognitive scores. Concerns regarding developmental attainment, processing efficiency, and selective attention were more common in children later found to have weak kindergarten mastery skills. Data analysis revealed minimal redundancy and specific additive effects in this multidimensional assessment. It is concluded that such instruments can contribute to a broader, more integrated diagnostic procedure for behavioral and developmental problems.