An Introduction to PEDS Tools:
The Valuable Role of Parents
in Detection of Developmental
and Behavioral Problems
Frances Page Glascoe, Professor of Pediatrics,
Vanderbilt University
Nicholas Robertshaw, www.pedstest.com/online
Topics to be covered
in this talk
• Can professionals make accurate
decisions about families’ needs based on
information from parents?
• Can using information from parents help
professionals save time during busy
encounters?
• How PEDS Tools help!
What kinds of information
can parents’ provide?*
• Concerns—meaning parents verbatim
comments about things that worry
them
• Report—meaning parents response to
questions about children’s milestones
and skills
• Note: the AAP recommends gathering both
types of information
How Parents’ Concerns
Help-I
• Focuses visits on what parents need to know
• Creates a teachable moment
How Parents’ Concerns
Help-II
• Helps parents view providers as a source of
information about child-rearing
• Encourages families to return for well-visits
Challenges with Parents’
Concerns-I
• Many parents (especially those with limited
education) don’t volunteer their concerns
Challenges with Parents’
Concerns-II
• Typical questions (e.g., “are you worried about
her development?” don’t work
Challenges with Parents’
Concerns-III
• Some concerns predict problems, some don’t
• Providers need evidence-based decision
support to determine the optimal response
We don’t want to say things like
this when a child may have an
undetected problem
“He’ll grow out of it.”
“He’s just a boy. Boy’s don’t do things as
early.”
“She’s just going through a phase.”
“Even Albert Einstein didn’t talk until he was
5.”
“Let’s just wait and see.”
How ‘Parents’
Evaluation of
Developmental
Status’ (PEDS)
Helps
The PEDS
Response Form in
English.
Translations
include
Portuguese,
Somali, Spanish,
Vietnamese,
Hatian-Creole, etc.
PEDS longitudinal
Score/Interpretation Form
(printed front/back on the
same sheet.
There is space for brief
comments to note your
decisions.
The Score/Interpretation
Form provides decision
support about what to do
next.
PEDS Brief Guide
to Scoring and
Interpretation
“Don’t Leave
Home Without
It!!”
PEDS identifies with
evidence:
•
•
•
•
•
•
•
Children’s risk levels
Who needs a prompt referral
Who needs further screening
Which parents need advice on child-rearing
Which children need more vigilant monitoring
Which children are OK
Which parents just need reassurance
What other kinds of
information can parents’
provide to help us save time
and make accurate decisions?
Reporting
milestones
Strengths of Tools Using
Parent Report
Gives parents and providers information
on children’s actual skills
Helps parents learn important
developmental milestones
Illustrates strengths and weakness in
development
Facilitates providers confidence in
decision-making
What does Parent Report
involve?
 Presenting parents with a list of skills
typically demonstrated at certain ages levels
Parents then endorse whether or not a child
has mastered various skills:
For example:
“Does your child put two words together?”
Yes  Sometimes  No 
“Can your child take off her own shoes?”
Yes  Just Beginning to  No 
So… parents can just answer my usual
milestones questions while in waiting or
exam rooms?
No!
Yo! My milestones are fine!
“ They are drawn
from the
Denver—surely
they are good
ones!”
“Why should I
switch to
something else?”
Sample Checklist—at 4
years of age
Uses hungry, tired, thirsty
Climbs stairs without holding on
Stacks 12 blocks
Knows colors
Dresses self completely
Plays games with rules
“Knows colors?”
What does that mean exactly?
•
•
•
•
•
Pointing?
Matching?
Naming?
Which colors?
How many?
And… how many of us measure
this skill--the most predictive of
kindergarten success?
Naming
letters
out of
order?
How parent report helps
• Parents can answer
questions while they
wait
• Parent report is
accurate but…only if
quality screens are
used
• Quality screens save
time and… ensure
decision-making
So…. PEDS:
Developmental
Milestones
(PEDS:DM) to
the rescue!
PEDS:Developmental Milestones
Case Example: Vernon, age 7
months
Vernon’s
mother, Ms.
Chavez,
completed the
PEDS:DM
while in the
waiting room,
just before
seeing a public
health nurse
for his 6 month
check-up.
PEDS:DM
Family
Book
(English
and
Spanish)
laminated,
one page
with 6 - 8
questions
per visit
Items at the 5 - 7 month level. Each question taps a
different developmental domain
The
orange
marks
show Ms.
Chavez’
answers
about
Vernon’s
skills
When the scoring template is placed over the
parents’ answers, it reveals any skills not passed at
age level.
Fine Motor
Receptive Language
Expressive Language
Gross Motor
Self-Help
Social-Emotional
PEDS:Developmental Milestones: completed
Recording Form with Vernon’s performance at 7
months and prior provider decisions—looking good?
Healthy development, happy
mother
Developing normally, gave mo
suggestions about sleeping skills
 At 5 - 7 months
Why PEDS + PEDS:DM are
needed
Here’s what Ms.
Chavez said in response
to the concerns questions on PEDS:
None.
I’m not sure what he should be
saying at his age
I know he can’t understand what I
say so I don’t talk to him much.
Developmental Status by parent's verbal
behavior and positive perceptions*
Quotients
(Glascoe & Leew, Pediatrics, 2010)
110
105
100
95
90
85
80
75
Age in Months
0-5
06 - 11
12 - 17
18 - 24
* Talks at meals, helps child learn new things, reads aloud,
able to soothe, enjoys child, perceives child as interested in
conversing
PEDS:Developmental Milestones
(Developmental Promotion component)
PEDS:Developmental Milestones and
Developmental promotion. Vernon’s mother
needed parenting information and was given one
of the parenting handouts in the PEDS:DM
Professional Manual
www.pedstest.com
PEDS:Developmental Milestones: completed
Recording Form with Vernon’s performance at 9
months and specific provider decisions
Healthy development, happy
mother
Developing normally, gave mo
suggestions about sleeping skills
Mo raised Q’s about talking to
Vernon. Gave handout on promoting
speech-language
Speech-language and other skills
WNL. Praised mom for reading/talking.
Gave more info
 at 9 months
 at 6 months
So…THE BEST APPROACH is
to use parents’ concerns and
parental report.
This approach:
 gives a better picture of family and child
issues
 complies with the AAP recommendations
for developmental surveillance, screening
and promotion
Wait a minute…..!
Time Savers…How
Information about Parents’
Concerns Helps
• Reduces “oh by the
way concerns”
• Makes visit length
predictable
• Shortens visit
length
How parent report helps
We can also save time if we don’t
hand score measures
• PEDS Tools are most easily administered
online (parent portal, office staff, office computers)
• PEDS Online offers automated scoring,
generates summary reports for parents and
referral letters if indicated
• An autism screen is included
• PEDS Online generates ICD-9 and procedure
codes that optimize reimbursement
• A free trial on 30 patients can be taken at
www.pedstest.com/online
PEDS Online
Here’s an image of
PEDS Online
showing parents
comments to the
PEDS questions
Matty
Walds
Here you see
results for PEDS
and brief
recommendations.
You can opt to
complete other
screens like
PEDS:DM or MCHAT OR click on
links to show a
summary report for
parents, or a
referral letter to
send to others.
Matty Walds
Matty
Walds
PEDS:DM
questions at
age 6
PEDS Online also generates….
A referral
letter you
can print,
save, email
or fax
Notice that
billing/procedure codes…
Are also
generated by
PEDS Online
PEDS Online also creates….
A summary
report for
parents to take
home
Other Time-Savers
• Eliminate milestones lists from age-specific
encounter forms.
• And just add, check boxes to reflect PEDS and
PEDS:DM results, such as …
Modify your encounter forms
Replace your
informal
milestones
checklist
with…
Or if space is limited, with…
Milestones: ____All Met ___ Not All Met
In summary
• PEDS Tools save time
• Facilitate clinic revenues
• Ensure accurate early
detection
• Enhance developmentalbehavioral promotion
• Help us do the best possible
job for families and
children
How do we get reimbursed?
• First, you must use validated, accurate screens
• Add the – 25 modifier to your code for preventive
services
• Add 96110 (times the number of screens administered)
• For private payers, different modifiers may be needed
• Have your clinic coordinator find out about private
payers
• Appeal all denied claims
• If a second denial, contact the AAP’s coding hotline
How can I get PEDS Tools?
www.pedstest.com
•
•
•
•
Online ordering
Downloadable brochure/order form
Trials of PEDS Online
Downloadable parent handouts, videos, slide
shows, and other training material