Ellen C. Perrin, M.D.
R. Christopher Sheldrick, Ph.D.

We have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity.
We do not intend to discuss an unapproved/investigative use of a commercial product/device in this presentation.

• Rosie D. lawsuit
• CBHI
• Available Instruments
– Lengthy
– Proprietary
– Scoring complex
– Fragmented

• Surveillance Instrument (birth to 5)
– First level screening
– Integrate “behavior” and “development”
– Include family context/risks
– Quick to fill out, score & interpret
– “Developmental growth curve”
• Free and in public domain
• Amenable to electronic format
– Computer
– Telephone
– Internet

Behavior Development
Family Context

Preschool Pediatric
Symptom Checklist
(PPSC)
Behavior
•Internalizing
•Externalizing
Development
Baby Pediatric
Symptom
Checklist (BPSC)
Family Risk

Preschool Pediatric
Symptom Checklist
(PPSC)
Behavior
•Internalizing
•Externalizing
Baby Pediatric
Symptom
Checklist (BPSC)
Development
Family Risk
•Delays
•Autism
Milestones
Parent’s
Observations of
Social Interactions
(POSI)

Behavior Development
Family Risk
FAMILY RISK FACTORS
Depression
 PHQ-2
Substance Abuse
 Alcohol
 Tobacco
 Other drugs
Parental Discord
Hunger

• Social-emotional-behavioral
– BPSC (Birth to 18 months) – 12 items
– PPSC (18 months to 5 years) – 18 items
• Cognitive, Language and Motor
– Milestones (each WCV) – 10 items
• Autism
– POSI (18 to 36 months) – 7 items
• Family Risks
– Each WCV - 11 items

• Latent variable modeling
• Comparative effectiveness

Latent variable modeling
•Reliability
•Differential Item Functioning
SES
?
PPSC bifactor model general factor
Social/ emotional problems
Item 1
Item 2
Item 3
Item 4
Item 5
Item 6
Item 7
Item 8
Item 9
Item 10
Item 11
Item 12
Item 13
Item 14
Item 15
Item 16
Item 17
Item 18 item clusters f1 f2 f3

1.0
0.8
0.6
0.4
0.2
0.0
Total
Sensitivity Specificity
1.0
0.8
0.6
0.4
0.2
PPSC
ASQ-SE
Internalizing Externalizing
CBCL 1.5-5
0.0
Total
PPSC
ASQ-SE
Internalizing Externalizing
CBCL 1.5-5

1.0
0.8
0.6
0.4
0.2
0.0
Total
Sensitivity Specificity
1.0
0.8
0.6
0.4
0.2
PPSC
ASQ-SE
Internalizing Externalizing
CBCL 1.5-5
0.0
Total
PPSC
ASQ-SE
Internalizing Externalizing
CBCL 1.5-5

Sensitivity Specificity
1.0
0.8
0.6
0.4
0.2
0.0
ADHD Anxiety Behavior or Conduct Any diagnosis
Parent report of existing diagnosis
PPSC
ASQ-SE
CBCL 1.5-5
Specificity

• POSI v MCHAT
• Milestones v ASQ-3
• BPSC v ???

Example SWYC Forms
12-Month
Milestones
24-Month
Social/
Emotional
Behavior

12-Month
Page 2 (on the back)
Autism
24-Month
Family Risk
Questions

• Surveillance/first level screening instrument
• Includes
– Cognitive, language, motor, and socialemotional development
– Autism spectrum disorders
– Family context/risks
• Compares well with older instruments
• Free, public domain
• English and Spanish
• Convertible to computer platform
– Tailored for child’s age
– Link to follow-up questionnaires

• eperrin@tuftsmedicalcenter.org
• rsheldrick@tuftsmedicalcenter.org