Developmental, Mental Health/Behavioral and Academic Screens
Compiled by Frances Page Glascoe, Ph.D., Professor of Pediatrics, Vanderbilt University, with assistance from other screening test authors including Drs. Jane Squires, Margaret Briggs-Gowan, Glen Aylward, and screening test researchers including Drs. Kevin Marks, Ray Sturner, and Barbara Howard, whose works are described below.
Updated: December, 2009
The following chart is a list of measures that meet standards for screening test accuracy, meaning that they correctly identify at least 70% of children with disabilities, referred to as sensitivity or co-positivity, while also correctly identifying at least 70% children without disabilities, referred to as specificity or co-negativity. All included measures were standardized on national samples (including ethnic minorities, varying levels of parent education and income, and child gender--all in proportion to their prevalence as identified by the US Census Bureau. All measures are proven to be accurate for English and Spanish-speaking families (and often with other language groups within the US), proven to be reliable in various ways (test-retest, inter-rater, and internal consistency), and all have been validated against a range of diagnostic measures. As a consequence, information on standardization, reliability, and validity is not belabored in this table, although accuracy by age and disability types detected is described.
Throughout, the first column provides publication information, the cost of purchasing a specimen set, and the training options available. The
The “Description” column provides information on alternative ways, if available, to administer measures (e.g., by parent report, interview, or direct administration). For parent-report tools, the "Description" column includes information about readability for parent report tools and shows grade level reading requirements. A helpful indicator of likely reading ability is to subtract 4 grade levels from the highest grade parents completed (e.g., 9th grade – 4 grade levels = 5th grade)].
The “Scoring” column indicates the results provided. Although all scores are essentially cutoffs for deciding which children need referring and which do not, screening test results are rendered in various ways with some tests providing a range of results helpful for deciding when to refer, monitor, screen further, advise parents, or reassure.
The “Accuracy” column shows the percentage of patients with and without problems identified correctly, i.e., sensitivity and specificity. These figures are shown first as a range embracing accuracy across age levels (thus describing how well a measure predicts performance on diagnostic measures with younger versus older children). Following this is information on discriminant validity, meaning how well performance on screening tests predicts performance on diagnostic measures (viewed by developmental-behavioral domain and/or by specific conditions studied (e.g., learning disabilities or autism spectrum disorder). Authors/researchers do not always study measures for discriminant validity but when they do, results may take the form of correlations, sensitivity/specificity within a relatively high-risk sample, or sensitivity alone (determined by selecting those children who performed poorly on a screening test and then viewing the types of disabilities they were found to have). Thus a range of data, when available, is included in the Accuracy column.
Predictive validity studies (how well a screen predicts performance on diagnostic measures given 1 or more years later) are extremely rare and not essential because repeated screening is a better indicator of performance over time. Such studies are not included here, but when they exist, reports are usually included in test manuals or publishers websites.
The “Time Frame/Costs” column shows the time required for scoring, associated costs of professional (using an average salary of $50.00 per hour), and costs of materials per administration [meaning the cost of purchasing test forms or cost of photocopying (if permissible) at $0.06 cents per page]. When parents can complete screens independently, the “Total (Self-Report)” figure reflects the total costs to providers. Below that figure is the time required for an interview, its associated costs, plus the costs for scoring and materials. These costs are summarized as “Total (Interview).” For measures that elicit skills directly from children, “Total” reflects the costs associated with administration, scoring, and materials. Time/cost estimates do not include expenses associated with referring.
Tools are sorted into those that are most feasible in health care versus early childhood or similar settings, where the latter may have more time and, for educational programming purposes, a greater need to observe and directly test children during the process of screening.
Measures are then listed according to the time required to administer each by interview or directly to children, from least to most. Information about electronic options is included at the end of the table. Electronic applications can reduce human error, automate scoring, generate referral letters, provide procedure and billing codes, and aggregate results across patients/clients/students, which is helpful for program evaluation and quality improvement initiatives. While somewhat more costly than print, electronic options offer time-savers that offset the costs of hand-scoring, writing referral letters, etc.
General or broad-band screens are presented first. These uniformly cover most or all domains of development, i.e., cognitive/academic, language, motor, self-help). Some broad-band screens also cover social-emotional/behavioral/mental health.
A list of condition-specific or narrow-band tools follows. These typically focus on a single area of development, behavior/social-emotional or mental health and are used to refine referral decisions. Because narrow-band tools focus on specific conditions (e.g., autism spectrum disorder, developmental-behavioral/mental health status, etc.) they should not be used as the sole indicator of developmental-behavioral status—most narrow-band screens will miss the majority of children with difficulties because of their limited focus. The many screens focused only on language or motor development are not covered here because broad-band screens uniformly capture these domains and so such narrow-band tools are largely used, and best used, by specialists.
While narrow-band screens can hone decisions about needed subspecialty evaluations (e.g., autism clinics), it is critical to refer simultaneously for the free evaluations and intervention services guaranteed through the Individuals with Disabilities Education Act (IDEA), i.e., to local early intervention or public school services. This allows intervention to commence even while children typically need to wait for medical subspecialty exams, autism focused clinics, etc.
Medical professionals may find it odd to refer for treatment before a diagnosis is finalized, but with young children (who most benefit from early intervention), eligibility criteria are generally defined as a percentage of delay on diagnostic/assessment level measures (not screens), and so young children do not require specific nosology for enrollment. See footnotes for essential referral options.a In settings with health care providers, such professionals can and should, document carefully, both medical history, physical exam, and sensory status to determine whether organic conditions are contributory, a list of exam foci are described in a footnote.b
Only measures reaching standards, i.e., 70% or greater sensitivity and specificity are described in the tables below.
1) Not included are measures such as the Denver-II, DIAL-III, ESP, E-LAP, etc. because they fail meet standards (limited standardization, absent validation, and no proof of accuracy); measures such as the CAT-CLAMS (because they were not standardized on general populations); and/or measures of a single developmental domain (e.g., language or motor), because these are best deployed by specialists.
2) Also not included are diagnostic measures such as the Vanderbilt Diagnostic ADHD Scale, because such tools should only be used after a broad-band screening test indicates the need (e.g., PSC, Connors, etc.). The rationale is that, for example, conditions that present as ADHD can actually be symptoms of other problems such as academic deficits, depression, anxiety, etc.
Screens for Primary Care* (all rely on information from parents due to enhanced efficiency under time constraints. All cover development in all domains. Some also cover social-emotional, behavioral and mental health issues. Some can be administered by interview while others depend on parents, and optionally clinicians, to elicit skills). All also over at least some degree of compliance with the American Academy of Pediatrics, 2006 Statement on developmental-behavioral screening and surveillance.BEHAVIORAL and/or DEVELOPMENTAL SCREENS RELYING ON INFORMATION FROM PARENTS / Age range / Description / Scoring / Accuracy / Time Frame/Costs*
Parents’ Evaluations of Developmental Status (PEDS). (2009) PEDSTest.com 1013 Austin Court, Nolensville, TN 37135 (615-776-4121) http://www.pedstest.com ($36.00)
Electronic Options: See below. Training Options: offers through its website self-training/train-the-trainer support via downloadable slide shows with notes, case examples, pre-post-test questions, FAQs, participant handouts, website discussion list (covering all screens), short videos, with some live training available. / Birth to 8 years / 10 questions eliciting parents’ (and providers’) concerns in English, Spanish, Vietnamese and many other languages. Items written at the 5th grade level. Longitudinal Score and Interpretation Forms, assign risk levels, track decision-making and offer specific guidance on how to address concerns. Provides screening, longitudinal surveillance and triage for developmental as well as behavioral/social-emotional/mental health problems. PEDS can be used in conjunction with the PEDS:DM (below) for compliance with AAP Policy on screening as well as surveillance, i.e., eliciting and addressing parents’ concerns and monitoring milestones. / Identifies when to: Refer and what types of referrals are needed; Advise parents; Monitor vigilantly; Screen further (or refer for screening); or Reassure. / By age,
Sensitivity:
74% to 79%
Specificity:
70% to 80%
By disabilities, i.e., learning, intellectual, language, mental health, and autism spectrum disorders,
Sensitivity:
71% - 87% / Scoring time: 1 min.
Scoring cost: $1.20
Materials: $0.39
Total (Self-Report): $1.59
Interview Time: 2 min.
Interview Cost: $2.40
Scoring/ Materials: $1.59
Total (Interview): $3.99
PEDS: Developmental Milestones (Screening Version) PEDSTest.com 1013 Austin Court, Nolensville, TN 37135 (615-776-4121) http://www.pedstest.com ($275.00). Electronic Options: See below.
Training Options: offers through its website self-training/train-the-trainer support via downloadable slide shows with notes, case examples, pre-post-test questions, participant handouts, FAQs, website discussion list (covering all screens), short videos, with some live training available. The PEDS:DM manual includes extensive suggestions for training medical students, residents, and nurses. / Birth to 8 years / PEDS-DM is designed to replace informal milestones checklists (such as key items from other measures) with evidence. It consists of 6 – 8 items at each age level. Each item taps a different domain: fine/gross motor, self-help, academics, expressive/receptive language, social-emotional. The PEDS:DM provides screening, triage, and surveillance via a longitudinal score form for tracking milestones progress. Written at the 2nd to 3rd grade level and can be completed by self-report, interview, or administered directly to children. Forms are laminated and completed with a dry erase marker. Supplemental measures focused on AAP policy include the M-CHAT, Family Psychosocial Screen, Pictorial PSC-17, the SWILS, the Vanderbilt ADHD scale, and the Brigance Parent-Child Interactions Scale. In English, Spanish and Taiwanese. / Pass/Fail cutoffs tied to performance above and below the 16th percentile for each item and its domain. / By age,
Sensitivity:
70% - 94%;
Specificity:
77% - 93%
By developmental domain,
Sensitivity:
75% - .87%;
Specificity:
71% - 88% / Scoring time: 1 min
Scoring cost: $1.20
Materials: $0.02
Total (Self-Report): $1.22
Interview Time: 3
Direct Administration: 4
Scoring/ Materials: $1.22
Total (Interview): $3.82
Total (Direct Admin): $6.10
Ages & Stages Questionnaires®, Third Edition (ASQ-3™) (2009). Paul H. Brookes Publishing Co., Inc., P.O. Box 10624, Baltimore, MD 21285.
Phone: 1-800-638-3775; fax: 410-337-8539; http://www.agesandstages.com. ($199.95)
Electronic Options: See below. Training Options: DVDs for purchase, case examples, and live training / 1 mo. to 66 mos. / Parents indicate children’s developmental skills on 30 items plus overall concerns. The ASQ has a different form (5-8 pages) for each age interval. Written at the 4th – 6th grade level. Can be used in mass mail-outs for child find programs. Manual contains detailed instructions for organizing child-find programs and includes activity handouts for parents. The ASQ-3 is available in English, Spanish, with the ASQ-2 also available in French and Korean with additional translations underway. / Cutoff scores set at 2 SDs below the mean, in 5 developmental domains: Indicate need for referral or monitoring, / By age,
Sensitivity:
82% - 89%
Specificity:
77% - 92%
By domain,
Sensitivity: 83% Specificity: 91%
By disabilities, i.e., CP, visual and Hearing Impairment,
Sensitivity: 87%
Specificity: 82% / Scoring time: 2 min
Scoring cost: $2.40
Materials: $~0.36 - $0.48
Total (Self-Report): $2.76 - $2.88
Interview Time: 12 min.
Interview Cost: $14.40
Scoring/ Materials: $2.76 - $2.88
Total (Interview): $17.28
Modified Checklist for Autism in Toddlers (M-CHAT) (1999). Freely downloadable and available for inclusion in electronic records by clinicians. Commercial software vendors must pay a licensing fee. www.mchatscreen.com
Also included in print in the PEDS:DM. Electronic Options: See below.
Training Options: the site contains a guide to the needed follow-up interview for missed items, and houses research papers and reviews on ASD screening. / 18 –60 months / Parent report of 23 yes-no questions and written at 4-6th grade reading level. Screens for Autism Spectrum Disorder (ASD). Downloadable scoring template and .xls files for automated scoring. Requires a follow-up interview for failed items. Available in multiple languages. / Pass/fail scores based on failing at least 2 critical items, or 3 or more non-critical items / By age and By disability, i.e, autism spectrum disorders:
Sensitivity: 90%;
Specificity: 99%. / Scoring Time: 2 min
Scoring costs: $2.40
Materials: $0.06
Total (Self-Report): $2.46
Interview Time: 5 minutes (excluding follow-up on any failed items)
Interview Cost: $6.00
Scoring/Materials: $2.46
Total (Interview): $8.46
Brief-Infant-Toddler Social-Emotional Assessment (BITSEA);
Pearson/Psych Corp, Inc.
19500 Bulverde Road, San Antonio, Texas 78259 (1-800-627-7271)
http://pearsonassess.com/ ($105.00)
Electronic Options: None
Training Options: none / 12 – 36 months / 42 item parent-report measure (with separate forms if clinical observation is needed). Identifies social-emotional/behavioral. problems and delays in competence. Written at the 4th – 6th grade level. Can be followed by the more detailed ITSEA. Available in Spanish, French,Dutch, Hebrew. Has a CD-ROM for ease of scoring and generating reports and referral letters. / Cut-points based on child age and sex show present/