Case Examples

Because screening tests do not provide a diagnosis (and assessment tests don’t either), what to say to parents when the results are problematic must be delicately worded. Anything too strongly stated may scare parents away from following up. Similarly, statements that are too ‘wussy’ may not be effective either.

So here's what NOT to do:

"My abundant experience as a diagnostician made me quite incautious with screening tools. One of the first children I screened was a four-year-old boy referred by his day-care teachers due to concerns that he was behind other children. Because he failed every subtest: language, motor, cognitive, self-help, and preacademic, on a forty-minute screening test, I recognized the probable hallmarks of mental retardation. But, without benefit of his social history, knowledge of his home environment, information about his medical status or history, or insight into his parents’ awareness or feelings about his difficulties, I advised them that he might have mental retardation, might need special education, and should have additional evaluations to determine his eligibility for services".

His parents, without another word, put on their coats, wrapped up their son, and walked out the door. I asked them to stop and talk with me but my requests were met only by their retreating figures. They did not return subsequent phone calls and never scheduled a follow-up evaluation.

"I feel strongly that I lost this child to apparently much needed early intervention and doomed him to school failure and its inevitable secondary emotional problems, by inappropriately using a diagnostic label, particularly an inflammatory one which is fraught with unpleasant connotation. Clearly, the ‘diagnosis’ lacked credibility and simply frightened this family away--at a time when they most needed encouragement to seek help".

"I’ve seen the other side of the coin too. I watched a young pediatric resident clap and cheer a little girl all the way through the Denver, a measure not known for its sensitivity to developmental problems in the first place. He bent a lot of rules about standardized administration of tests: Reworded items, gave multiple chances, tons of prompts and cues. Even so, the child performed very poorly and I think the resident just found it too painful and dissonant to believe. He said things to the family like, ‘She seemed to have a little trouble with the tasks I gave her, but this test may be wrong. It’s just a screen and it may not mean anything. It may be that nothing’s wrong....’ This resident had understandably, much wishful thinking; no one wants there to be a significant problem with a child".

But he so ‘back-pedaled’ the results that the parents didn’t hear clearly that there was a very large chance their daughter had a developmental problem and needed additional work-ups. Those parents didn’t come back for diagnostic testing either.

These adverse response are avoidable. The next page provides useful suggestions for explaining the results of screening (and assessment level measures) to families—in a way that encourages follow through.

--From Glascoe FP, Robertshaw NS. PEDS:Developmental Milestones: Professional’s Manual. Nolensville, TN: PEDSTest.com, LLC