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Biomedical subjects

F P Glascoe

Publications and source records attributed to F P Glascoe.

At least 19 recordsLinked to original sources
PubMed1998

Brief approaches to educating patients and parents in primary care.

PURPOSE: Pediatricians are encouraged by the American Academy of Pediatrics and Bright Futures guidelines to use well-child care as an opportunity to promote learning and development, encourage positive parenting practices, help children acquire behavioral self-control, and enhance the well-being of children and their families. Such counseling can consume considerable provider time. In an era of dwindling resources for health care, there is pressure to deliver services as efficiently and effectively as possible. Thus, the purpose of this article is to view methods for patient and parent education that are not only effective but also brief. DESIGN: Review of 114 articles on issues relevant to patient education. RESULTS AND CONCLUSIONS: Parents appear to respond best to information that focuses on their specific area of concern. Media, such as advertising campaigns or office posters, can be helpful for broadening parents' range of interests. In response, verbal suggestions are effective for conveying brief, concrete information when parents are not stressed. Written information should be added for addressing more complex issues. Modeling and role-playing appear especially useful when confronted with problematic parenting or child behavior. These approaches, if selected wisely and applied well, offer families needed assistance that has proven effectiveness in improving children's and families' health and well-being.

Communication Barriers↗
PubMed1997

Parents' concerns about children's development: prescreening technique or screening test?

OBJECTIVE: Due to the limitations of previous studies, parents' concerns have been recommended as a prescreening technique, a brief method for identifying a subset of children in need of more in-depth developmental screening. The purpose of this study was to assess whether parents' concerns could: (1) serve instead as a screening measure; (2) aid in making focused referral decisions; and (3) help pediatricians target families for developmental promotion and in-office counseling. An additional goal was to determine why most parents' concerns are accurate although some are not. DESIGN SURVEY/SETTING: Public schools and day care centers in four diverse geographic sites representing the northern, central, southern and western United States. PATIENTS AND OTHER PARTICIPANTS: A total of 408 children between 21 and 84 months of age and their parents, whose socioeconomic and demographic characteristics reflect proportions in the 1990 United States Census. MAIN OUTCOME MEASURES: Licensed psychological examiners and educational diagnosticians elicited parents' concerns about children's development and measured children's development with a broad battery including measures of intelligence, language, motor, and school skills. RESULTS: Certain concerns, ie, motor, language, global/ cognitive, and school (in children 4 years and older) had high levels of sensitivity and identified 79% of the 56 children with disabilities. Accurate referrals could be made for 70% of the 56 children. The absence of concerns or concerns in other areas, ie, socialization, self-help, or behavior, had reasonable specificity and identified 72% (N = 255) of the 352 typically developing children. Of the remaining 28% (N = 97) of parents with significant concerns but whose children did not have disabilities, most had children with substantially lower performance in almost all developmental areas than the children of the 255 parents without significant concerns. Further, more than half of the 97 children could be distinguished by a single concern (usually about expressive language) whereas the majority of accurately concerned parents had multiple concerns. A significant proportion of the 12 parents of disabled children who did not raise concerns could be identified by difficulties communicating in either English or Spanish. CONCLUSION: If systematically elicited, parents' concerns approach standards for screening tests and can be used to make reasonably accurate referral decisions. Over-referrals can be significantly reduced by administered screening tests to the small group of children (16%) whose parents have a single significant concern. Those who pass screening or whose parents have nonsignificant concerns can be targeted for developmental promotion and in-office counseling. Under-referrals can be minimized by administering screening tests (with the help of an interpreter as needed) to children whose parents have communication difficulties.

Aptitude Tests↗
PubMed1997

An economic analysis of developmental detection methods.

OBJECTIVE: To assess the costs and benefits of various approaches to early detection of developmental disabilities. DESIGN: Cost-benefit analyses based on data from previously published studies of developmental screening tests. SETTING: General pediatric practices and day care centers. PATIENTS AND OTHER PARTICIPANTS: A total of 247 parents and their 0- to 6-year-old children-103 from day care centers and 144 from pediatric practices. MAIN OUTCOME MEASURES: Licensed psychological examiners administered a screening test of parents' concerns about children's development and one or two direct screening tests: the Denver-II and/or the Battelle Developmental Inventory Screening Test. For the day care sample, examiners also administered to each child measures of intelligence, adaptive behavior, and language. In the pediatric sample, children were administered additional assessments. At the same time, diagnostic measures were administered to a randomly selected subsample to make determinations about developmental status. Each screening method was evaluated for its short-term costs (administration, interpretation, diagnosis, and treatment) and long-term benefits (impact of early intervention on adult functioning as inferred from longitudinal studies by other researchers). RESULTS: When the long-term costs and benefits were considered, none of the approaches emerged as markedly superior to another. When viewing the short-term costs, the various screening approaches differed markedly. The use of parents' concerns was by far the least costly for physicians to administer and interpret. CONCLUSION: Physicians can incur tremendous expenses when attempting to detect children with developmental problems. Although the benefits of early detection and intervention are substantial, physicians are not well-compensated for providing a critical service to society. Health policymakers and third-party payers must reconsider their minimal investment in early detection by health care providers. Nevertheless, our findings have encouraging implications for practice, because the use of parents' concerns as a screening technique offers substantial savings over and above other methods.

Child↗
PubMed1995

Value of parents' estimates of children's developmental ages.

OBJECTIVE: To determine whether parents' estimates of children's developmental ages can function as a prescreening technique. DESIGN AND PARTICIPANTS: Parents of 234 children from birth to 77 months of age seeking well-child care in pediatric offices were queried in two separate studies. In the first study, parents were asked to give an estimate of their child's overall developmental age and, in the second study, to estimate ages in each of six developmental domains. Children were administered a range of screening measures of intelligence, speech-language, and adoptive behavior. RESULTS: The overall age-estimate, if less than chronologic age, was 75% sensitive to likely developmental problems and, if equal to or greater than chronologic age, was 90% specific in identifying children likely to have typical development. Age estimates for each developmental domain were 81% sensitive to likely developmental problems if less than chronologic age in the domains of fine motor, language, grass motor, or behavior, and 62% specific if equal to or greater than chronologic age. Estimates at or below chronologic age in receptive language or personal-social domains were 90% sensitive and 43% specific in identifying likely behavior problems. There were no differences in the accuracy of parents estimates on the basis of children's age, gender, race, parents' level of education, or parenting experience. CONCLUSION: Parents' overall age-estimates provided a sensitive and specific indicator of global developmental status, but insufficient information about strengths and weaknesses to enable focused referrals for services. In contrast, discrete patterns of age estimates in each developmental domain sensitively discriminated children with developmental versus behavioral problems, although specificity was limited. Age estimates appear to be a potentially helpful method for identifying a subset of children in need of thorough screening, although further research is needed on a larger sample given diagnostic rather than screening tests.

Adult↗
PubMed1995

Assessing children's development using parents' reports. The Child Development Inventory.

The Child Development Inventory (CDI), completed by parents at home, assesses the development of social, self-help, motor, language, letter and number skills, and presence of symptoms and behavior problems of children between the ages of 15 months and 5 years. The results provide the pediatrician with a profile of the child's development, problems, and strengths, and are an aid to comprehensive assessment. CDI norms and validity were determined for a community sample of 568 children. The CDI developmental scales correlate closely with age (r = 0.84). CDI results identified all the normative group children who were enrolled in early childhood/special education (N = 26) and correlated with academic achievement for children in kindergarten (N = 132). CDI scales correlated with reading achievement in kindergarten as follows: general development 0.69, letters 0.56, language comprehensive 0.42, expressive language 0.36, and self-help 0.35. Thus, the CDI provides a useful measure of children's development and, because of its reliance on parental reports, offers an effective approach to developmental assessment in the busy pediatric practice.

Case-Control Studies↗
PubMed1995

The role of parents in the detection of developmental and behavioral problems.

OBJECTIVE: The success of early identification of children with developmental and behavioral problems is influenced by the manner in which pediatricians elicit, recognize, and select clinical information and derive appropriate impressions. Parents are ready sources of clinical information, and they can be asked to provide two broad types of data: appraisals, including concerns, estimations, and predictions; and descriptions, including recall and report. The purpose of this article is to help pediatricians make optimal use of clinical information from parents to increase the accuracy of clinical judgment in detecting children with developmental and behavioral problems. DESIGN: Review of 78 research articles and tests relying on parent information from pediatric, psychological, and education literature. RESULTS AND CONCLUSION: There are several formats for eliciting parental information that are superior in terms of accuracy and ease of evocation. Specifically, parents' concerns and good-quality standardized parent report measures such as the Child Development Inventories capitalize best on parents' observations and insights into their children. In combination, these two types of parental information offer an effective method for the early detection of behavioral and developmental problems in primary-care settings.

Child↗
PubMed1994

It's not what it seems. The relationship between parents' concerns and children with global delays.

Parents of children with significant behavioral or emotional problems have tended to be concerned about their behavior or emotional well-being, whereas parents of children with speech-language impairments were more concerned about speech-language development. The present study was designed to assess whether a parallel relationship between type of parental concern and type of developmental problem continues when children have global delays. Subjects were 95 parents and their children from birth to 6 years of age who attended day-care centers. Parents' concerns were categorized into developmental domains. Children were given a criterion battery of intelligence and adaptive behavior tests. Global delay was identified in 18 children (19%). Concerns about global development were raised by only 5% of all parents. Concerns about speech-language and/or behavior were sensitive in detecting global deficits (83%), while the absence of such concerns had modest specificity in detecting normal development (47%). Parents' concerns continue to be useful in prescreening and can identify patients in need of further screening. However, pediatricians should anticipate that parents of children with global delays may raise concerns, not about global development, but rather about behavior/emotional status and/or speech-language skills. The best response to such concerns is to administer screening measures which assess multiple developmental domains.

Adult↗
PubMed1993

The usefulness of the Developmental Profile-II in developmental screening.

Timely provision of early developmental intervention depends on accurate developmental screening tests. The Developmental Profile-II (DP-II) relies on parent report to assess children from birth to 7 years old. One of its subtests, the Academic scale, is designed for developmental screening. To test its accuracy in detecting children with problems, the scale was administered to parents of 94 children between 6 and 75 months old. Each child was also given a battery of tests, such as the Bayley Scales of Infant Development and the Stanford-Binet Intelligence Scale. The Academic scale detected only 21% of the 19 children thus determined as having developmental problems, while 85% of the nondiagnosed children received normal or advanced scores on DP-II. Analysis revealed that DP-II scoring criteria are far too lenient and that many items are poorly placed in relation to age expectations. Alternative cutoff scores greatly improved sensitivity. DP-II is a potentially accurate measure that needs updating and restandardizing. Alternative tests include the Minnesota Child Development Inventory and the Battelle Developmental Inventory Screening Test.

Achievement↗
PubMed1993

The usefulness of the Battelle Developmental Inventory Screening Test.

Recent research supporting the effectiveness of early intervention and laws expanding services have increased the demand for accurate developmental screening tests. The Battelle Developmental Inventory Screening Test (BDIST), for children 6 months to 8 years old, has a number of desirable features, including subtests for fine and gross motor, adaptive, personal-social, receptive and expressive language, and cognitive skills; a range cutoff and age-equivalent scores; and national standardization. To assess its accuracy, the BDIST was administered to 104 children 7 to 83 months old, along with several other screening tests and a battery of criterion measures. Tied to 1.5 standard deviations below the mean, BDIST failing scores were moderately sensitive, detecting 75% of the children with developmental problems, such as mental retardation, borderline intelligence, language delays, and learning disabilities. Since 73% of the nonhandicapped children passed the BDIST, the test showed moderate specificity. Children within one month of their birthdays were likely to be over- or underreferred. Although the BDIST needs further research, it is a promising developmental screening instrument. The Receptive Language (RL) subtest, slightly more sensitive than the total BDIST but less specific, takes only a few minutes and thus is useful for prescreening in time-limited settings, such as pediatric practice.

Age Factors↗
PubMed1993

Obstacles to effective developmental surveillance: errors in clinical reasoning.

Recent research and legislation support the importance of early identification and intervention for children with developmental and behavioral or emotional problems. Detecting these children often depends on medical professionals, especially pediatricians. However, few pediatricians use developmental screening tests to help them identify children. Rather, physicians usually rely on their clinical impressions to discriminate children with and without difficulties. Research on the accuracy of clinical impressions, although sparse, suggests that only half the children in need are identified. The most obvious reasons, such as severity of the problem or the type of clinical information physicians select (e.g., parents' concerns, observations of the child, history, etc.), do not fully explain why some children are identified and others are not. More complete explanations are found in research on clinical impression formation that suggests physician's selection from the array of clinical data is mediated by their unique experiences, beliefs, and attitudes. These qualities provide a set of judgment heuristics for sorting seemingly relevant from irrelevant information. Judgment heuristics, depending on their content, may lead to accurate or inaccurate impressions. This article suggests a model of ideal impression formation that may help physicians learn to more accurately identify children with developmental and behavioral or emotional problems.

Child↗
PubMed1992

Improving resources for foster care.

The number of foster children and their psychological and medical morbidity are growing. To gain insight into how to recruit and retain foster homes, characteristics of 64 foster families were determined by interview. Foster parents had low-to-moderate incomes, were approaching middle age, had underutilized home space, and wanted more children. Most enjoyed foster care and planned to continue. Twenty-three percent of the 64 had half of all foster children in the study in their homes at interview and had cared for seven times as many children in the past, including 66% of all the teens and 83% of all the handicapped children who had been in the 64 homes. These "high providers" functioned like group homes for mentally handicapped individuals. Adapting the group-home concept to foster homes could improve care, especially for children with special needs.

Adult↗
PubMed1992

Accuracy of the Denver-II in developmental screening.

One of the oldest and best known developmental screening tests was recently restandardized and revised as the Denver-II. Because it was published without evidence of its accuracy, the present study was undertaken with 104 children between 3 and 72 months of age attending one of five day-care centers. To determine the presence of developmental problems, children were administered individual measures of intelligence, speech-language, achievement, and adaptive behavior. A second psychological examiner, blind to the outcome of the diagnostic battery, administered the Denver-II. Developmental problems including language impairments, learning disabilities, mild mental retardation, and/or functional developmental delay were found in 17% of the children. The Denver-II identified correctly 83% and thus had high rates of sensitivity. However, more than half the children with normal development also received abnormal, questionable, or untestable Denver-II scores. Thus the test had limited specificity (43%) and a high overreferral rate. The alternative scoring method, categorizing questionable/untestable scores as normal, caused sensitivity to drop to 56% although specificity rose to 80%. Since neither scoring method produced acceptable levels of accuracy, an effort was made to locate the sources of accuracy and inaccuracy within the test. Only items in the language domain were modestly helpful in discriminating children with and without difficulties. The findings suggest that the authors of the Denver-II need to engage in further development of the instrument including revising scoring criteria and item placement in relation to children's ages. In the interim, test users should employ screening tests which are more accurate such as the Minnesota Inventories or the Battelle Developmental Inventory Screening Test.

Child, Preschool↗
PubMed1991

The importance of parents' concerns about their child's behavior.

Parents often complain about children's behavior. Pediatricians may be unsure whether to ignore these complaints, counsel parents in-office or refer them to mental health services. This study shows a close relationship between parents' concerns and measurably significant behavior problems. Methods are provided for responding to parents' concerns. These should be useful to pediatricians who are often criticized for failing to detect and refer children with mental health problems including behavior disturbances.

Child↗