Comparison of the ASQ and PEDS in Screening for
Developmental Delay in Primary Care Settings
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Marjolaine M. Limbos1,2, PhD & David P. Joyce2, MD, CCFP
1Department of Psychology, Sunny Hill Health Centre for Children & 2Department of Family Medicine,
University of British Columbia, Vancouver, BC
Table 2. Demographic Characteristics of Study
Participants (N=334)
METHODS
ABSTRACT
334 Children Aged 12-60 months (Mean = 32.4 months)
Presenting for Routine Primary Care
Objectives: The purpose of this study was to investigate the
sensitivity and specificity of two brief, parent-completed
developmental screening measures, the Ages and Stages
Questionnaire (ASQ) and the Parents Evaluation of
Developmental Status (PEDS) in children presenting to their
primary care provider.
All
Children
N(%)
Developmental
Delay*
N(%)
No
Developmen
tal Delay
N(%)
Comparis
on†
χ 2, p value
Total Sample
334
34
300
NA
Child Age, mo
12-18
19-24
25-36
≥37
90(27)
57(17)
75(22)
122(37)
8(24)
13(38)
10(29)
13(38)
82(27)
44(26)
65(22)
109(36)
χ2=1.64
p=0.65
Gender
Female
147(44)
9(27)
138(46)
χ2=4.73
p=0.03
Race/Ethnicity (Mother)
White
Black
Aboriginal
Other
284(85)
1(<1)
42(12)
7(2)
29(85)
0
5(15)
0
255(85)
1(<1)
37(12)
7(2)
χ2=1.04 /
5.25
p=0.79 /
0.15
Languages of Testing
English
French
254(76)
80(24)
23(68)
11(32)
231(77)
69(33)
χ2=1.47
p=0.23
80 Primary Care Providers :
70 Family Physicians
7 Nurse Practitioner
3 Pediatricians
Maternal Education
Less than high school
High school
More than high school
60(18)
59(18)
196(59)
9(27)
7(21)
14(41)
51(17)
52(17)
182(61)
χ2=3.75
p=0.15
Annual Income
< 15 000
15 000-30 000
30 000-60 000
>60 000
Refused
42(13)
54(16)
73(22)
131(39)
32(10)
10(29)
10(29)
5(15)
4(12)
4(12)
32(11)
44(15)
68(23)
127(42)
28(9)
χ2=21.4
p=0.0001
Results: The mean age of children was 32.4 months.
Developmental delay was identified in 34 children (10%). The
PEDS had moderate sensitivity (74%) and reasonable specificity
(64%). In comparison, the ASQ had significantly higher
sensitivity (82%) and specificity (78%). Using ≥2 predictive
concerns on the PEDS or ≥2 abnormal domains on the ASQ
significantly improved specificity of both tests (89% and 94%,
respectively) but resulted in very low sensitivity (41% and 47%,
respectively).
Community Type
Urban Clinic
Rural Clinic
198(59)
136(41)
26(74)
9(26)
173(58)
127(42)
χ2=3.18
p=0.07
Bayley III (12-30 months)
WPPSI III (30-60 months)
 Disagreement in classification
between the ASQ and PEDS was
seen in over 1/3 of children (slight to
fair agreement).
CONCLUSIONS
Screening Tests:
• Ages and Stages Questionnaire (ASQ)
• ≥ 1 Abnormal Domain
• ≥ 2 Abnormal Domain
Speech and Language:
• Parents Evaluation of Developmental Status
(PEDS)
•
≥ 1 Predictive Concern
•
≥ 2 Predictive Concerns
Adaptive Functioning:
Vineland II
 This study adds to the growing
literature supporting the use of the
ASQ and PEDS for developmental
screening in primary care.
Clinical Assessment by
Registered Psychologist
INTRODUCTION
Figure 1. Sensitivity and Specificity of the ASQ and PEDS
in Detecting Developmental Delay (N=334)*
 Primary care physicians provide health care services to
young children on a regular basis and may be ideally
suited to screen for developmental delay.
Accuracy of PEDS and ASQ:
10
Sensitivity (%)
Sensitivity = TP/TP+ FN
Specificity = TN/TN+FP
90
Specificity (%)
 There is mounting evidence that early intervention
improves outcomes for children and their families in
terms of behavioral, social and cognitive competence.
RESULTS
70
 While there is growing research demonstrating the
accuracy of both tests in research settings,
generalization of the findings to primary care settings
is limited by several factors including:
Children
Without
Development
al Delay
Children
with
Developm
ental
Delay
50
 Future research should replicate this
study engaging actual primary care
physicians in the administration,
scoring, interpretation, and follow up
to better understand the performance
of these tests in real world settings.
40
30
 A scarcity of study in primary care settings
 Conflicting results for those studies that have used
primary care samples
 Failure to administer an adequate criterion measure
PEDS
≥1
Predictive
Concerns
No
Concerns
20
≥1
Predictive
Concerns
No
Concerns
20
8
10
 The purpose of this study was to :
≥
21
45
1 Failed
Domains
0
ASQ 1†
PEDS 1
ASQ 2
PEDS 2
ASQ
68
160
1
5
No Concerns
*DD refers to developmental delay based on a score of
≤ 10th
percentile on adaptive function and one other criterion
measures.
†ASQ1 and PEDS1 refer to a cutoff of one or more abnormal
domains or predictive concerns. ASQ2 and PEDS2 refer
to a cutoff of 2 or more abnormal domains or predictive concerns.
*Developmental delay refers to children with a score of ≤10 % on adaptive
function and one other criterion measure.
†The presence of ≥1 predictive concern on the PEDS or ≥1 failed domain on
the ASQ was the cutoff for an abnormal screen.
 Although the ASQ appears to have
higher sensitivity and specificity, the
choice of which measure to use should
be determined by the:
 The findings support the guidelines of
the AAP and others to institute
regular developmental screening using
standardized screening tests.
60
Table 1. Two by Two Matched Sample Tables for PEDS
and ASQ for Children With and Without
Developmental Delay*†
 Both the ASQ and PEDS have
reasonable test characteristics to be
used for screening for developmental
delay in preschool children.
 Practice setting
 Population served
 Preference of the provider
80
%
 Examine the agreement between the ASQ and
PEDS in classifying children with and without
developmental delay.
 Use of ≥ 2 predictive concerns/
abnormal domains had higher
specificity (>90%) but very low
sensitivity (<50%) for both ASQ and
PEDS.
Cognition/Development:
Preschool Language Scale IV
 Compare the sensitivity and specificity of the ASQ
and PEDS in identifying developmental delay in
preschool children presenting for primary care.
 Use of ≥ 1 predictive concerns
(PEDS) & ≥ 1 abnormal domain
(ASQ) is the preferred cut-off.
Criterion Measures:
Conclusions: These findings support the guidelines of the
American Academy of Pediatrics and others, demonstrating that
both the PEDS and ASQ have reasonable test characteristics for
developmental screening in primary care settings. Although the
ASQ appears to have higher sensitivity and specificity, the choice
of which measure to use should be determined by the practice
setting, population served and preference of the physician.
 The Parents’ Evaluation of Developmental Status
(PEDS) and Age and Stages Questionnaire (ASQ) are
parent-completed developmental screening tools that
are increasingly being recommended for use in clinical
practice.
 The PEDS had moderate sensitivity
and reasonable specificity.
 The ASQ had significantly higher
sensitivity and specificity.
Characteristics
Method: A sample of 334 children aged 12-60 months was
recruited. Parents completed the ASQ and the PEDS in their
home. The presence of ≥1 predictive concern or abnormal
domain was considered a positive screen. All children underwent
evaluation with the criterion measures, administered by a
psychologist: the Bayley Scales of Infant Development or the
Wechsler Preschool and Primary Scale of Intelligence, the
Preschool Language Scale and the Vineland II.
DISCUSSION
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