Biomedical subjects

Frances P Glascoe

Publications and source records attributed to Frances P Glascoe.

5 recordsLinked to original sources

PubMed2006

Evaluation of children with reading difficulties.

Reading difficulties are common and are associated with poor long-term academic achievement. Evaluation of a child's developmental, educational, and family histories in conjunction with standardized screening tests (e.g., Ages and Stages Questionnaires, Parents' Evaluation of Developmental Status, Safety Word Inventory and Literacy Screener) can increase recognition of risk factors for reading difficulties. Validated, office-based, standardized screening tests and school-administered standardized achievement tests (e.g., California Achievement Tests, Iowa Tests of Basic Skills, Metropolitan Achievement Tests, Stanford Achievement Test) can be used to assess school-age children with reading difficulties. Reading difficulties in children often are caused by environmental and organic risk factors. However, many children have reading or learning disabilities and will have lifelong difficulties with reading despite adequate intervention. Children with substantial reading difficulties should receive a full educational assessment. There is good evidence that individualized instruction emphasizing increased phonologic awareness can have a favorable long-term effect on academic achievement.

Child↗

PubMed2005

Pediatricians' reported practices regarding developmental screening: do guidelines work? Do they help?

BACKGROUND: In 2001, the American Academy of Pediatrics (AAP) adopted a policy that all infants and young children should be screened for developmental delays at regular intervals. The policy statement promoted the use of valid reliable instruments. It is unknown, however, what proportion of pediatricians follow this recommendation and whether such a practice is associated with improved identification of children with developmental difficulties. OBJECTIVES: To describe the use of developmental screening tests among board-certified pediatricians practicing general pediatrics and to determine the association between standardized screening and the self-reported identification of children with developmental difficulties. METHODS: We mailed a survey to a random sample of AAP members. We used multivariate logistic/linearregression analyses to determine the association between standardized screening and the self-reported identification of children with developmental disabilities. RESULTS: Of the 1617 surveys mailed, 894 were returned, for a response rate of 55%. Of the respondents, 646 practiced general pediatrics and were included in the analysis. Seventy-one percent of those pediatricians indicated that they almost always used clinical assessment without an accompanying screening instrument to identify children with developmental delays. Only 23% indicated that they used a standardized screening instrument. The most commonly used instrument was the Denver II. Logistic regression modeling demonstrated odds ratios between 1.71 and 1.90 for a >10% rate of identification of developmental problems among patients of pediatricians reporting standardized screening. Each adjusted odds ratio bordered on statistical significance. Linear-regression models estimating the difference in mean proportions of children identified with developmental problems across screening groups failed to show a statistically or clinically significant difference in physician-reported identification rates. CONCLUSIONS: Our findings indicate that, despite the AAP policy and national efforts to improve developmental screening in the primary care setting, few pediatricians use effective means to screen their patients for developmental problems. It is uncertain whether standardized screening, as it is practiced currently, is associated with an increase in the self-reported identification of children with developmental disabilities.

Child, Preschool↗

PubMed2004

Assessing development in the pediatric office.

OBJECTIVE: To determine the proportion of children aged 10 to 35 months who were reported ever to have received a developmental assessment (DA) and to examine characteristics of the child, family, and health care setting associated with the receipt of a DA. METHODS: The National Survey of Early Childhood Health, conducted in 2000, is a survey of 2068 parents of children 4 to 35 months of age. Children were classified as having received a DA in response to 2 questions: whether the child's pediatric provider ever told parents that he or she was doing a "developmental assessment" and/or parents recalled explicit components of a DA, such as stacking blocks or throwing a ball. Parent-reported receipt of a DA was assessed in relationship to child and family, health care access, other measures of health care content and process, and measures of quality and satisfaction. RESULTS: Approximately 57% of children 10 to 35 months of age ever received a DA. Forty-two percent of parents recalled ever being told by their child's pediatric provider that a DA was being done. Thirty-nine percent recalled their child's being asked to perform specific tasks routinely included in a DA. Bivariate analysis indicates that receipt of a DA is not associated with child or family sociodemographic characteristics such as maternal education and household income, with the exception of race/ethnicity. Less acculturated Hispanic parents reported a DA more frequently than parents in other racial/ethnic groups (66% vs 56%). A smaller proportion of parents whose children who used community health centers reported their child's ever having received a DA compared with children who use other settings (51% vs 60%). Compared with other children, parents whose child ever received a DA reported more frequently than other parents that the time spent with the child's provider during the last well-child visit was adequate (94% vs 80%). They also reported longer visits (19 minutes vs 16 minutes), higher family-centered care ratings (mean: 71 vs 59), and higher satisfaction with well-child care (8.9 vs 8.4). Receipt of a DA is also associated with the content of developmentally focused anticipatory guidance received. For each health supervision topic analyzed, frequency of discussion is higher for children who ever received a DA. In multivariate analysis, odds of receiving a DA are higher for children with longer visits with the provider (odds ratio: 1.03; 95% confidence interval: 1.01-1.05) and lower for children in community health clinics compared with a private office (odds ratio: 0.61; 95% confidence interval: 0.39-0.96), even accounting for total well-child visits to the pediatric provider. CONCLUSION: Although guidelines endorse the routine provision of DAs, parents of many children do not report receiving DAs. Children who receive assessments are more likely to receive other developmental services, and their parents are more likely to report greater satisfaction with care and rate the interpersonal quality of well-child care more favorably. The substantial number of children who do not receive these routinely recommended services raises important questions about the quality of care received.

Analysis of Variance↗

PubMed2003

Developmental surveillance of infants and young children in pediatric primary care.

PURPOSE OF REVIEW: This article reviews the importance of appropriate developmental surveillance in early childhood, what is known about its effectiveness in current pediatric practice, and ways in which its delivery can be improved to optimize child outcomes. RECENT FINDINGS: Many infants and young children with developmental delays or risk factors for poor developmental outcomes are not identified by pediatric practitioners in a timely manner. When they are identified, they are often not referred to appropriate early intervention services or early childhood development programs. They are therefore denied the opportunity to benefit from programs documented to have long-lasting benefits for children. Structuring developmental screening around the use of validated parent questionnaires improves the rates at which children with developmental needs are appropriately identified. At the same time, lowering thresholds for referral improves the rates at which children with identified needs receive appropriate services. SUMMARY: Pediatric practitioners are uniquely positioned to improve children's developmental outcomes through early identification and referral of children with developmental delays or risk factors for poor developmental outcomes. Unfortunately, inappropriate screening practices, high thresholds for referral, misplaced concerns about causing parental anxiety, and unfamiliarity with local resources all diminish the effectiveness with which many practitioners conduct developmental surveillance. Recent studies show that small changes in screening and referral practices have the potential to greatly improve the effectiveness of developmental surveillance. This, in turn, has the potential to improve lifelong outcomes for children.

Child Health Services↗

PubMedDate not supplied

Pediatrician practices regarding referral to early intervention services: is an established diagnosis important?

OBJECTIVE: Early intervention (EI) programs provide services to children with developmental conditions, regardless of whether such children have an underlying medical diagnosis. We aim to (1) Determine the proportion of general pediatricians who believe an established diagnosis is important when considering EI referral; and (2) Determine whether this perception is associated with lower reported likelihood of referral. METHODS: Mailed survey to random sample of pediatricians. We used multivariable logistic regression to study the association between the perception that a medical diagnosis is important when referring to EI, and the reported likelihood of EI referral for children with common developmental conditions. RESULTS: Response rate was 55% (894 of 1617). A total of 64% of respondents considered an established diagnosis important for EI referral. Likelihood of referral for delayed speech was lower among those who considered a diagnosis important than among those who did not (77% vs 87%; P = .02). Similar patterns held for global delay (91% vs 97%; P = .02), loss of developmental milestones (80% vs 88%; P = .03), and parental concern for inappropriate development (45% vs 60%; P = .002). In multivariable models, perception of the importance of an established diagnosis was associated with lower likelihood of referral for children with delayed speech (adjusted odds ratio [aOR] 0.48; 95% confidence interval [CI] 0.26-0.87) and for parental concern for inappropriate development (aOR 0.46; 95% CI 0.30-0.72). CONCLUSIONS: A majority of general pediatricians believe that an established diagnosis is important when considering EI referral. This perception is associated with decreased reported referral for children with speech delay and those whose parents express concern for inappropriate development.

Attitude of Health Personnel↗