Post-Test Questions

When training yourself or others, you’ll want an indicator of how well content has been mastered, to identify what else you or your audience need to learn, how to improve future talks, etc. Our pre- and/or post-test questions cover:

• knowledge of child development and its domains
• the meaning of terms like “delays” and “disabilities”
• the value of early intervention and developmental promotion
• psychosocial risk, resilience, and parenting issues
• knowledge of referral options
• specifics about administration, scoring and interpretation of PEDS Tools
• and…. questions for program evaluation. Note to Trainers

Note to Trainers

1. You can paste these questions into Word and edit out what you don’t plan to cover. If helpful we have a Word version of these questions and scoring guide you can download here: Appendix B .
2. In terms of deciding which trainees are competent to administer tools, we suggest at least an 80% success rate with items. For train-the-trainer sessions, 90% or greater is surely wise. 
3. The pre-/post-test questions are presented first. They are followed by a scoring key version in which the correct answers appear in bold.
4. Some questions are open-ended, in which case, you’ll need to decide whether trainees have provided quality answers (a few suggestions are provided in the scoring key).
5. The open-ended questions at the end are designed to give you feedback on your training, and…to encourage participants to think hard about what they plan to do with the information and skills they acquired from your session. Such questions are known to encourage application of new information. 
6. Please send us suggestions for new questions or edits for the ones below. This is a work in progress. Feel free to add your own but please let us know what you think is needed so we can improve this measure. Please contact us
7. If you are training and would like a blank certificate of completion/participation, please contact us or download here: Appendix B.

POST-TEST on EARLY DETECTION

General questions about screening, surveillance, disability, intervention, and use of other measures, etc.

What does IDEA stand for:

1. Irksome Developmental Efforts and Annoyances
2. International Development and Education Association
3. Individuals with Disabilities Education Act
4. Intervening in Development is Effective Act of 1976

IDEA services (circle all that apply)

1. Are rarely available
2. Are expensive and involve lengthy waiting lists
3. Exist in every county and State
4. Must be provided within approximately 40 days of referral

What does early intervention accomplish?

1. improves high school graduation rates
2. increases employment rates
3. reduces teen pregnancy and criminality
4. all of the above
5. a and c above

When explaining screening results to families, it is wise to: (circle all that apply)

1. describe the more potentially adverse future outcomes
2. explore what families already know
3. affirm the potential value  of their concerns
4. allow time for questions and expression of emotions
5. discuss the negative impact on siblings
6. suggest out of the home placements
7. explain risk/prevalence in several ways
8. give news over the telephone
9. offer a follow-up meeting with other family members
10. offer global reassurance (e.g., likelihood that a problem may not exist)
11. present early intervention in a positive light
12. provide a diagnostic label (if you have not administered diagnostic measures of development and behavior)
13. use everyday language (e.g., “seems behind”)
14. provide a take home summary of results/recommendations
15. sit behind a desk or stand to deliver information to families
16. avoid giving difficult news because it is uncomfortable

List some appropriate activities for parent-child interactions when children are 6 – 12 months of age.

1. ___________________________________________________________
2. ___________________________________________________________
3. ___________________________________________________________
4. ___________________________________________________________

Parents sometimes ask for parenting advice and suggestions for age-appropriate parent-child activities. Please name some sources for information you can share with parents:

Rate each of these statements as true or false: 

Developmental-behavioral problems are usually innate, genetic, or congenital and present at birth.

___True   ___ False

Most children with developmental-behavioral problems have dysmorphic features (e.g., unusual eye shape, hairlines, gait problems, floppy tone, etc.)

___True   ___ False

What is the prevalence of developmental disabilities in the 0 through 18 year age range?

(a) 6% – 8%

(c) 16% - 18%

(d) 22% – 25%

(e) 28%

 

Rate this statement as true or false: If working with low-income families, professionals should expect incidence rates to be higher than national averages.

___True   ___ False

The national prevalence rates (in the far right column) do not match the age groups (shown in the middle column). Please write the correct prevalence for each age group in the left-hand column.

Correct Prevalence  Age Group Prevalence

For Age Group

Which new (or previously undiagnosed) developmental-behavioral problems might we expect to discover in children 8 years and older (circle all that apply):

(a)  speech-language impairment

(b)  learning disabilities

(c)   cerebral palsy

(d)  mild autism spectrum disorder

(e)  slow learning (e.g., IQ < 85)

(f) mental health problems

(g)  none of the above

A failed score on the Modified Checklist of Autism in Toddlers means (check all that apply):

___ a diagnosis of autism spectrum disorders (ASD) can be made

___ a referral to ASD specialists is all that is needed

___ failed items should be readministered by interview

___ referrals to Early Intervention and the ASD specialists are needed

___ a child may have ASD or other conditions such as intellectual disabilities or language impairment

 

Of the 16% - 18% of children with disabilities, primary care providers typically identify what percent of children with disabilities prior to kindergarten enrollment (circle one):

a) 5%

b) 15%

c) 30%

d) 60%

e) 90%

 

Children with disordered development may talk, walk, even read on time. They may not always exhibit delays on milestones type screening tests. This means that providers should:

___ consider the quality of performance on milestones tasks

___ listen carefully to parents’ observations and concerns

___ wait and see

___ refer only children with obvious delays

 

Disabilities and delays are difficult to detect by clinical judgment. Reasons include:

(a) most children seem typically developing in the first two years of life

(b) psychosocial risk factors take a slow toll on developmental outcomes that may not be visible until ages 3 - 4

(c) the limits of the “broad range of normal” are too broad in the absence of criteria/cutoffs

(d) all of the above

(e) a and c above

 

Minimal but acceptable standards for screening test accuracy are:

(a)  sensitivity and specificity of 70% to 80%

(b) sensitivity and specificity  of 60% to 70%

(c) sensitivity and specificity of 50% to 60%

(d) sensitivity and specificity of 80% to 90%

 

Specificity is the:

(a) percentage of children without disabilities correctly detected

(b) percentage of children with disabilities correctly detected

(c) the percentage of children with failing screening test scores who   actually receive a diagnosis

 

Match parenting styles with their definitions by placing the definition number in space next to parenting style:

Parenting Style Definition

Psychosocial risk factors include (check all that apply):

___ a permissive parenting style

___authoritarian or uninvolved parenting style

___two parents with stressful full-time jobs

___single parent

___parents with < H.S. Education

___frequent household moves

___first born/only child

___4 or more children in the home

___limited social support

___parental mental health problems such as depression

___minority status

___limited parental literacy

___“nanny factors”

___teen motherhood

___limited two-way communication between parent and child

 

Psychosocial risk factors (circle all that apply: 

a) cause declines in intelligence, language and academic skills

b) are associated with being held back in school

c) increase the likelihood of dropping out of high school

d) may lead to teen pregnancy, criminality, and unemployment

e) are rarely changeable and thus not an effective target for intervention

f)   have a greater adverse impact on child development than prematurity

 

Children at risk for developmental problems  (circle all that apply):

(a) may have potentially emerging disabilities

(b) may need to be enrolled in Head Start

(c) often have numerous psychosocial risk factors

(d) are likely to be over-referred by screening tests

(e) may not qualify for early intervention

(f) benefit from quality preschool or Head Start

(g) have parents who may need to be taught parenting skills

(h) have parents who may need social work services for assistance with housing, food, job training, etc.

(i) have parents who may have depression, anxiety or other mental health problems needing treatment

 

Rank the common disabilities of early childhood in order of prevalence:

1. ___ intellectual disabilities
2.   ___attention deficit hyperactivity disorder
3.   ___specific learning disabilities
4.   ___speech-language impairment/delays
5. ___autism
6. ___cerebral palsy and other physical impairments

Why is it better to use a quality screening test than a milestones checklist or selected items from longer measures?

How is early intervention beneficial? Circle all that apply:

(a) reduces the impact of psychosocial risk factors

(b) reduces drop-out rates

(c) increases chance of employment and school success

(d) decreases teen pregnancy and violent crime

(e) saves society money

(f) increases likelihood of owning a home

(g) increases chance of graduating from high school

 What is meant by “developmental screening”? Circle all that apply:

(a)  use of informal milestones checklists

(b)  use of selected items from lengthier screens

(c)  use of measures that are standardized and reliable

(d)  use of measures that are validated, sensitive and specific

(e)  informal questions to parents

 

Over-referrals on screening tests (circle all that apply)

a) Should be minimized by waiting to see if problems persist

b) Require monitoring but should not result in recommendations for additional services

(c) Are generally children who perform below average and have risk factors for school failure

(d) Should lead to referrals such as Head Start, quality preschool programs, parenting training etc.

Circle all that apply. The Denver-II:

(a) takes longer to administer than the average well visit/parent-teacher  conference

(b) was never validated by the authors

(c) is inaccurate and misses children with developmental-behavioral problems

(d) leads to use of selected items that lack scoring criteria (e.g., cutoff  scores)

(e) does a good job detecting academic problems in older children

 

Milestones checklists, even if items are drawn from validated tools, are problematic because (circle all that apply):

(a)   Items are often ambiguously worded (e.g., “Knows Colors”: How many colors? Should colors be named or is pointing to colors an acceptable response)?

(b)   Items are usually set at the 50%tile and so about half of all children will fail

(c)   Milestones do not provide referral criteria

(d)   Informal milestones checklists lead providers to refer only about 30% of children with delays, and so they miss 70% of children with problems

(e)   Neither lend credibility to a referral recommendation nor generate reimbursement for billable services

(f)   (a) and (d) above

 

 What is meant by developmental surveillance? (circle all that apply):

(a)  eliciting and addressing parents’ concerns at each visit

(b)  monitoring milestones at each visit

(c)  identifying and intervening with psychosocial risk factors

(d)  promoting development and educating parents

(e)  exclusive reliance on provider judgment to identify children with problems

(f) refining families’ needs for various types of services

(g)  maintaining child and family medical history

(h)  conducting a thorough physical exam

(i) monitoring parental well-being

 

Developmental-behavioral surveillance (circle all that apply):

a) is enhanced by frequent use of accurate screening tools

b) should be evidence-based

c) relies exclusively on clinical judgment

d) can be accomplished in many cases with screening tools

e) is only needed at a few well-child visits

Screening tools using information from parents are (circle all that apply):

a) as accurate than other tools

b) more economical

c) no substitute for clinical opinion

d) enhance provider-parent collaboration

e) save providers time and money

f) not useful with parents with limited education

 

When coding for developmental screens in primary care and public health, you may (circle all that apply):

(a)  attach the -25 modifier and then add 96110

(b)  add to 96110 the number of screens administered

(c)   expect to receive about $10.00 - $20 per screen

(d)  appeal claims denied by private payers

(e)  use the -59 modifier but only with denied claims

(f) only use the preventive service visit code

(g)  appeal repeatedly denied claims to the American Academy of Pediatrics

(h)  have each clinic’s coordinator check with each payer for specific coding details

 

What are the components of the American Academy of Pediatrics 2006 policy  statement on screening and surveillance? Circle all that apply:

(a)  encourages providers to address psychosocial risk factors

(b)  discourages use of screening tests

(c)  emphasizes clinical judgment as a detection method

(d)  encourages watchful waiting

(e)  emphasizes prompt referrals to early intervention

(f) encourages periodic use of screening tests

(g)  encourages monitoring of developmental milestones

 

 Why does the American Academy of Pediatrics 2006 policy statement state, in effect, “We hope the combination of surveillance and screening sets up a pattern of practice that extends to each well-visit beyond the 24 – 30 month visit”?  Circle all that apply:

(a)  developmental-behavioral problems are still developing

(b)  language and other impairments aren’t always visible before 24 – 30 months

(c)   clinical observation, judgment, and informal milestones checklists are not an effective early detection method

(d)   psychosocial risk factors have not yet impacted adversely children’s development

(e)  early intervention continues to be effective after 24 – 30 months of age

(f) because detection at 24 – 30 months will pick up most children with problems and so additional screening/surveillance is only marginally essential

 

Please indicate whether the following statements are true or false. Collaboration with community services on referral processes:

Specific questions on the administration of Parents’ Evaluation of Developmental Status (PEDS)

PEDS is for children:

a) 4 months to 6 years of age

b) birth to age 17

c) birth to age 8

d) birth through age 8

 

If parents complete the PEDS Response Form on their own you must (circle all that apply):

1. Make sure they have written something on the Response Form

2. Administer by interview if only “yes”, “no” or “a little” boxes are checked

3. Follow up their answers with additional questions about developmental milestones

4. Make sure they’ve been asked first, “Would you like to go through this on your own or would you like someone to go through it with you?”

5. Make sure you’ve given them the correct foreign language translation if they do not speak English at home.

6.  Give them the Score Form so they can mark the categories of their concerns

When scoring PEDS (circle all that apply):

1. Correct for prematurity for children 2 years and younger born 3 or more weeks early.
2. Match the PEDS questions in descending order with the categories on the score form
3. Read all responses, view the Brief Guide showing the types of concerns, and then mark the appropriate box on the Score Form
4. Score the global/cognitive category for any response to Question 1 on the PEDS Response Form

Match the category of concern with the following responses from the PEDS Form:

If a parent marks “No” to all PEDS questions, but writes the following, in what category of concerns would you place such comments:

“ She’s doing about as well as any other child. …Occasional meltdowns but that’s typical for his age and we can deal with it. …He’s advanced, precocious really…. Great kid.”

a) behavior problems

b) none

c) other/health concerns

d) all of the above

 

How would you categorize comments such as:

 “My other kids could do lots more at the same age…. His friends are much better at learning, talking, and taking care of themselves”… “She’s struggling with everything”

a) Global/Cognitive

b) Other/Health

c) School skills

d) Self-help

e) Expressive Language

 

When parent’s concerns about self-help or school skills describe their child’s difficulties using eating utensils, fasteners or with writing/coloring, an additional category should be scored. This category is:

___ Other/health

___ gross motor

___ global/cognitive

___ fine motor

 

If a parent says, “she doesn’t listen to me”, this should be scored as (check all that apply):

___receptive language

___behavior

___social-emotional

___other/health

 

When parents mark that they are “a little” concerned, this should be considered:  (check all that apply)

___an area of concern

___ ignored as not a real issue for the family

___ interpreted as not a concern

 

When parents make statements such as “I used to be worried about his speech but now I think he’s doing better….”I don’t know what a 6 month old should be saying”, the Score Form box for expressive language (check all that apply):

___ does not need to be marked as a concern for the parent

___ should be marked as an area of concern

___ should be explored further with an additional screen  before making a decision about what to do next.

Sometimes parents describe concerns that do not appear to professionals to be especially problematic or predictive of problems. In such cases professionals should NOT checkbox next to the concern parent raised. True or false?

___True ___False

Sometimes professionals notice delays or are troubled by a child’s development but the parent does not express concerns. In these cases you should (check all that apply):

___Use an informal milestones checklist to consider developmental status

___Explain your concerns to the family and the need for additional screening

___Check the box on the Score Form to note your own concern and/or place the child on Path A or Path B

___ Administer an additional screen such as PEDS: Developmental Milestones

PEDS screens for the following conditions of childhood (circle all that apply):

1. Learning Disabilities

2. Speech-language Impairments

3. Autism Spectrum Disorders

4. Physical Impairments for which special education eligibility is likely

5. Developmental delay/mental retardation

6. Giftedness/Academic Talent

7. Typical/Normal Development

8. Behavioral/Emotional/Mental Health problems

 

Match the risk levels with the PEDS Paths:

PEDS is known to (check all that apply):

___ help parents learn to think about development like professionals do, as a range of domains

___ encourage parents to observe their children closely

___ increase parents’ worries about their children’s development

___ teach parents that development and behavior are a part of health care

___ increase parents’ willingness to come back for well-child visits and other    appointments.

___ increase positive parenting practices such as time out, instead of spanking

___open the door to parent-teacher discussions about child-rearing

___make parents less willing to follow through with referrals to other services

 

When children fall on Path C (circle all that apply):

1. They should be promptly referred for mental health services

2. Given parents’ advice about child-rearing is the optimal first response

3. If concerns persist, mental health screening is needed and if failed, children should be referred for mental health/behavioral interventions

4. Professional advice should be tailored to the challenges parents’ describe

5. The effectiveness of professional advice should be monitored in a few weeks to determine if other services are needed

Some parents don’t raise concerns on PEDS when they should. Reasons often include (check all that apply):

___ a belief that providers will notice problems and shouldn’t be    influenced by parents’ concerns

___ parental anxiety and lack of confidence in their observations

___ lack of awareness that providers are interested in developmental-behavioral issues

___ lack of education, poverty, stresses at home

___ lack of quality questions that elicit parents’ concerns

___ limited ability to read

___ limited understanding of the language in which PEDS was administered (in writing or by interview)

___ informal translations of PEDS

___ asking only a few of the PEDS questions

 

Why do parents of infants and toddlers need to be asked the PEDS’ question about school skills:

___ parents don’t need to be asked that and frankly, shouldn’t be asked that question

___ because that question encourages parents to use flash cards to teach number and alphabet knowledge to best prepare their children for school

___ because it informs providers about parents’ knowledge of what is developmentally appropriate

___ it helps providers get an idea of what parents are doing with    children at home in terms of teaching children new things

___ it alerts providers that parents may not be aware of what to teach young children

In your own words, what is a desirable response from a parent of a 0 - 36 month old when the PEDS’ school skill question is asked?

In your own words, why should we ask parents of infants and toddlers the PEDS question about self-help skills?

Parents’ concerns (circle one):

(a) always reflect the domains in which children have developmental  delays

(b) can be significant predictors of disabilities

(c) should consistently be met with reassurance and watchful waiting

(d)  may suggest the need for in-office counseling and monitoring

(e)  b and d above

(f)  all of the above

 Parents with limited education are (circle one):

a) as likely to have concerns about their children’s development as more educated parents

b) less likely to raise concerns spontaneously

c) less likely to notice problems in their children

d) less likely to know that health care providers are interested in child development

e) all of the above

f)   a,b,d above

The value of using PEDS to elicit parents’ concerns in their own words is (check all that apply):

___ reduces “oh by the way” concerns at the end of visits

___ saves time during visits

___ enables providers to figure out in advance what families’ needs

___ creates a collaborative relationship between professionals and parents

___ helps parents know that providers are interested in development and behavior

___ helps providers know when to look further at children’s skills

___ helps providers view disordered development (e.g., age-appropriate two- word utterances but that are too repetitive and non-communicative)

___ enhances reimbursement for services

Why is it critical to refer to the PEDS Brief Guide or to use PEDS Online when scoring PEDS?

PEDS Online offers (check all that apply):

___Modified Checklist of Autism in Toddlers

___ Ages and Stages Questionniare

___PEDS

___PEDS:Developmental Milestones

___ automated accurate scoring

___ a diagnosis for various kinds of disabilities

___ referral letters when needed

___a summary report for parents

___academic screens for children 8 years and older

___mental health screens for parents

___procedure codes for billing

Specific Questions onf PEDS:Developmental Milestones (PEDS:DM)

PEDS:DM items are tied to which cutoff:

a) 10^th percentile

b) 16^th percentile

c) 25^th percentile

d)  50^th percentile

e) 75^th percentile

f)  90^th percentile

If a child does not meet a milestone on the PEDS:DM it means that he or she (check all that apply):

___ simply needs watchful waiting and rescreening

___ is probably well behind same-age peers in that domain of development

___ needs further evaluation

___ has a diagnosable problem that can be identified by the PEDS:DM

 

Scores on the PEDS:DM are defined as (check all that apply):

___ milestones met or unmet

___ pass or fail

___ optimal or suboptimal

___ disabled or not disabled

 

True or False: Continuing performance below the 16^th percentile is worrisome because the child is likely to have substantive difficulties in school.

___ True ___ False

 

PEDS:DM measures development in which areas (check all that apply):

____ expressive language

____ self-help

____ social-emotional

____ fine motor

____ receptive language

____ health, vision, hearing

____ gross motor

____ behavior

____ academics in math and reading

 

Please identify these statements as true or false:

The PEDS:DM consistently detects disordered development.

___ True ___ False

The PEDS:DM detects probable delayed development.

___ True ___ False

When making referrals on the basis of PEDS or the PEDS:DM (circle all that  apply):

1. Early intervention/public school services under IDEA are the one-stop shop for additional screening and evaluation

2. A diagnosis is needed before early intervention services can be initiated

3. It is not necessary to refer if a child is on PEDS Path A (high risk), instead, watchful waiting is the optimal response

4. Professionals should consider, based on observations of family functioning, medical history, etc. whether social work, mental health, parent training or other services are needed in addition to IDEA

5. A teaching hospital or private diagnostic evaluation clinic should be consulted prior to referring to IDEA

The PEDS:DM can be administered in various ways. Check all administration methods that apply:

___ interviewing parents

___ professional observation

___ hands-on with children

 

Please rate these statements as true or false:

It is acceptable to probe unmet milestones on the PEDS:DM by administering lower level items

____ True ____ False

If a child is suspected of advanced development it is NOT acceptable to administer higher level items and note these on the PEDS:DM Recording Form.

____ True ____ False

The following statements describe implementation of screening in primary care. Place them in logical order: (note: there is no absolute right or wrong numbering here)

____ Choose a quality instrument

____ Conduct training

____ Organize parent education materials

____ Provide a rationale for office staff

____ Consider the details and order of the existing work flow

____ Plan training, gather training materials

____ Identify physicians or other staff heavily interested in the issue

____ Monitor implementation of screening

____ Allow staff to determine how the workflow steps will be executed

____ Gather a list of referral resources

____ Set a timeline

____ Review implementation and decide on needed adjustments to the process

____ Encourage staff to evenly allocate steps in the new work process

____ Work with the Early Intervention Community to establish referral mechanisms, the kinds of reports you’d like to receive, times to communicate, preferred mechanisms for communication (e.g., email, fax, phone, surface mail). 

 

Training Evaluation Questions

The following questions are not scored but are known to promote implementation of newly learned material or simply provide helpful feedback to improve training.

What did you like most about your training experience:

What did you like least about your training experience:

What additional information did you wish had been covered?

What suggestions do you have for improving this presentation?

How will you use the information you acquired during training?

Which measures do you intend to use in your setting and why?

Scoring Guide to POST-TEST on EARLY DETECTION

General questions about screening, surveillance, disability, intervention, and use of other measures, etc.

a)  What does IDEA stand for:

b)  Irksome Developmental Efforts and Annoyances

c)  International Development and Education Association

d)  Individuals with Disabilities Education Act

e)  Intervening in Development is Effective Act of 1976

 

IDEA services (circle all that apply)

1.  Are rarely available

2.  Are expensive and involve lengthy waiting lists

3.  Exist in every county and State

4.  Must be provided within approximately 40 days of referral

 

What does early intervention accomplish?

(a) improves high school graduation rates

(b) increases employment rates

(c) reduces teen pregnancy and criminality

(d) all of the above

(e) a and c above

 

When explaining screening results to families, it is wise to: (circle all that apply)

1. describe the more potentially adverse future outcomes

2. explore what families already know

3. affirm the potential value  of their concerns

4. allow time for questions and expression of emotions

5. discuss the negative impact on siblings

6. suggest out of the home placements

7. explain risk/prevalence in several ways

8. give news over the telephone

9. offer a follow-up meeting with other family members

10. offer global reassurance (e.g., likelihood that a problem may not exist)

11. present early intervention in a positive light

12. provide a diagnostic label (if you have not administered diagnostic measures of development and behavior)

13. use everyday language (e.g., “seems behind”)

14. provide a take home summary of results/recommendations

15. sit behind a desk or stand to deliver information to families

16. avoid giving difficult news because it is uncomfortable

 

List some appropriate activities for parent-child interactions when children are 6 – 12 months of age.

1. ___________________________________________________________

2. ___________________________________________________________

3. ___________________________________________________________

4. ___________________________________________________________

 

(Desirable answers including book-sharing, talking about things the child is noticing, imitating the child’s sounds/word attempts back to him/her, engaging in the child’s self-initiated play, taking the child places and talking about what he/she sees, encouraging creative play such as block stacking, leggos, scribbling, showing the child new things including sounds, objects, etc.) 

Parents sometimes ask for parenting advice and suggestions for age-appropriate parent-child activities. Please name some sources for information you can share with parents:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(Desirable answers should include parenting books, reputable websites such as www.kidshealth.com, parenting information handouts, orally delivered advice drawn from professional experience, parenting video series, parent training classes, etc.)

Rate each of these statements as true or false: 

Developmental-behavioral problems are usually innate, genetic, or congenital and present at birth.

___True   ___ False

Most children with developmental-behavioral problems have dysmorphic features (e.g., unusual eye shape, hairlines, gait problems, floppy tone, etc.)

___True   ___ False

What is the prevalence of developmental disabilities in the 0 through 18 year age range?

(a) 6% – 8%

(c) 16% - 18%

(d) 22% – 25%

(e) 28%

 

Rate this statement as true or false: If working with low-income families, professionals should expect incidence rates to be higher than national averages.

___True  ___ False

The national prevalence rates (in the far right column) do not match the age groups (shown in the middle column). Please write the correct prevalence for each age group in the left-hand column.

Correct Prevalence  Age Group Prevalence

For Age Group

Which new (or previously undiagnosed) developmental-behavioral problems might we expect to discover in children 8 years and older (circle all that apply):

(a)  speech-language impairment

(b)  learning disabilities

(c)   cerebral palsy

(d)  mild autism spectrum disorder

(e)  slow learning (e.g., IQ < 85)

(f) mental health problems

(g)  none of the above

 

A failed score on the Modified Checklist of Autism in Toddlers means (check all that apply):

___ a diagnosis of autism spectrum disorders (ASD) can be made

___ a referral to ASD specialists is all that is needed

___ failed items should be readministered by interview

___ referrals to Early Intervention and the ASD specialists are needed

___ a child may have ASD or other conditions such as intellectual disabilities or language impairment

 

Of the 16% - 18% of children with disabilities, primary care providers typically identify what percent of children with disabilities prior to kindergarten enrollment (circle one):

a) 5%

b) 15%

c) 30%

d) 60%

e) 90%

 

Children with disordered development may talk, walk, even read on time. They may not always exhibit delays on milestones type screening tests. This means that providers should:

___ consider the quality of performance on milestones tasks

___ listen carefully to parents’ observations and concerns

___ wait and see

___ refer only children with obvious delays

 

Disabilities and delays are difficult to detect by clinical judgment. Reasons include:

(a) most children seem typically developing in the first two years of life

(b) psychosocial risk factors take a slow toll on developmental outcomes that may not be visible until ages 3 - 4

(c) the limits of the “broad range of normal” are too broad in the absence of criteria/cutoffs

(d) all of the above

(e) a and c above

 

Minimal but acceptable standards for screening test accuracy are:

(a)  sensitivity and specificity of 70% to 80%

(b) sensitivity and specificity  of 60% to 70%

(c) sensitivity and specificity of 50% to 60%

(d) sensitivity and specificity of 80% to 90%

 

Specificity is the:

(a) percentage of children without disabilities correctly detected

(b) percentage of children with disabilities correctly detected

(c) the percentage of children with failing screening test scores who   actually receive a diagnosis

 

Match parenting styles with their definitions by placing the definition number in space next to parenting style:

Parenting Style Definition

Psychosocial risk factors include (check all that apply):

___ a permissive parenting style

___authoritarian or uninvolved parenting style

___two parents with stressful full-time jobs

___single parent

___parents with < H.S. Education

___frequent household moves

___first born/only child

___4 or more children in the home

___limited social support

___parental mental health problems such as depression

___minority status

___limited parental literacy

___“nanny factors”

___teen motherhood

___limited two-way communication between parent and child

Psychosocial risk factors (check all that apply):

___cause declines in intelligence, language and academic skills

___are associated with being held back in school

___increase the likelihood of dropping out of high school

___may lead to teen pregnancy, criminality, and unemployment

___are rarely changeable and thus not an effective target for intervention

___have a greater adverse impact on child development than   prematurity

 

Children at risk for developmental problems  (circle all that apply):

(a) may have potentially emerging disabilities

(b) may need to be enrolled in Head Start

(c) often have numerous psychosocial risk factors

(d) are likely to be over-referred by screening tests

(e) may not qualify for early intervention

(f) benefit from quality preschool or Head Start

(g) have parents who may need to be taught parenting skills

(h) have parents who may need social work services for assistance with housing, food, job training, etc.

(i) have parents who may have depression, anxiety or other mental health problems needing treatment

 

Rank the common disabilities of early childhood in order of prevalence:

(3)___ intellectual disabilities

(2) ___attention deficit hyperactivity disorder

(4) ___specific learning disabilities

(1) ___speech-language impairment/delays

(5) ___autism

(6) ___cerebral palsy and other physical impairments

Why is it better to use a quality screening test than a milestones checklist or selected items from longer measures?

(correct answers include: proven accuracy in early detection, clear scoring criteria, higher levels of sensitivity and specificity, ability to detect more children with problems)

How is early intervention beneficial? Circle all that apply:

(a) reduces the impact of psychosocial risk factors

(b) reduces drop-out rates

(c) increases chance of employment and school success

(d) decreases teen pregnancy and violent crime

(e) saves society money

(f) increases likelihood of owning a home

(g) increases chance of graduating from high school

 

 What is meant by “developmental screening”? Circle all that apply:

a. use of informal milestones checklists

b. use of selected items from lengthier screens

c. use of measures that are standardized and reliable

d. use of measures that are validated, sensitive and specific

e. informal questions to parents

 

Over-referrals on screening tests (circle all that apply)

a) Should be minimized by waiting to see if problems persist

b) Require monitoring but should not result in recommendations for additional services

(c) Are generally children who perform below average and have risk factors for school failure

(d) Should lead to referrals such as Head Start, quality preschool programs, parenting training etc.

 

Circle all that apply. The Denver-II:

(a) takes longer to administer than the average well visit/parent-teacher conference

(b) was never validated by the authors

(c) is inaccurate and misses children with developmental-behavioral problems

(d) leads to use of selected items that lack scoring criteria (e.g., cutoff scores)

(e) does a good job detecting academic problems in older children

 

Milestones checklists, even if items are drawn from validated tools, are problematic because (circle all that apply):

a)  Items are often ambiguously worded (e.g., “Knows Colors”: How many colors? Should colors be named or is pointing to colors an acceptable response)?

b)  Items are usually set at the 50%tile and so about half of all children will fail

c)    Milestones do not provide referral criteria

d)  Informal milestones checklists lead providers to refer only about 30% of children with delays, and so they miss 70% of children with problems

e)  Neither lend credibility to a referral recommendation nor generate reimbursement for billable services

f)  (a) and (d) above

 

 What is meant by developmental surveillance? (circle all that apply):

a)  eliciting and addressing parents’ concerns at each visit

b)  monitoring milestones at each visit

c)  identifying and intervening with psychosocial risk factors

d)  promoting development and educating parents

e)  exclusive reliance on provider judgment to identify children with problems

f)   refining families’ needs for various types of services

g)  maintaining child and family medical history

h)  conducting a thorough physical exam

i) monitoring parental well-being 

 

Developmental-behavioral surveillance (circle all that apply):

a)  is enhanced by frequent use of accurate screening tools

b)  should be evidence-based

c)  relies exclusively on clinical judgment

d)  can be accomplished in many cases with screening tools

e)  is only needed at a few well-child visits

 

Screening tools using information from parents are (circle all that apply):

a) as accurate than other tools

b) more economical

c) no substitute for clinical opinion

d) enhance provider-parent collaboration

e) save providers time and money

f) not useful with parents with limited education

 

When coding for developmental screens in primary care and public health, you may (circle all that apply):

(a)  attach the -25 modifier and then add 96110

(b)  add to 96110 the number of screens administered

(c)   expect to receive about $10.00 - $20 per screen

(d)  appeal claims denied by private payers

(e)  use the -59 modifier but only with denied claims

(f) only use the preventive service visit code

(g)  appeal repeatedly denied claims to the American Academy of Pediatrics

(h)  have each clinic’s coordinator check with each payer for specific coding details

 

What are the components of the American Academy of Pediatrics 2006 policy  statement on screening and surveillance? Circle all that apply:

a. encourages providers to address psychosocial risk factors

b. discourages use of screening tests

c.  emphasizes clinical judgment as a detection method

d. encourages watchful waiting

e. emphasizes prompt referrals to early intervention

f.   encourages periodic use of screening tests

g. encourages monitoring of developmental milestones

 

Why does the American Academy of Pediatrics 2006 policy statement state, in effect, “We hope the combination of surveillance and screening sets up a pattern of practice that extends to each well-visit beyond the 24 – 30 month visit”?  Circle all that apply:

a)  developmental-behavioral problems are still developing

b)  language and other impairments aren’t always visible before 24 – 30 months

c)   clinical observation, judgment, and informal milestones checklists are not an effective early detection method

d)   psychosocial risk factors have not yet impacted adversely children’s development

e)  early intervention continues to be effective after 24 – 30 months of age

f) because detection at 24 – 30 months will pick up most children with problems and so additional screening/surveillance is only marginally essential

 

Please indicate whether the following statements are true or false. Collaboration with community services on referral processes:

 

Specific questions on the administration of Parents’ Evaluation of Developmental Status (PEDS)

PEDS is for children:

a)  4 months to 6 years of age

b)  birth to age 17

c)  birth to age 8

d)  birth through age 8

If parents complete the PEDS Response Form on their own you must: (check all that apply)

1.   Make sure they have written something on the Response Form

2.   Administer by interview if only “yes”, “no” or “a little” boxes are checked

3.   Follow up their answers with additional questions about developmental milestones

4.   Make sure they’ve been asked first, “Would you like to go through this on your own or would you like someone to go through it with you?”

5.   Make sure you’ve given them the correct foreign language translation if they do not speak English at home.

6.   Give them the Score Form so they can mark the categories of their concerns

When scoring PEDS (circle all that apply):

1. Correct for prematurity for children 2 years and younger born 3 or more weeks early.

2. Match the PEDS questions in descending order with the categories on the score form

3. Read all responses, view the Brief Guide showing the types of concerns, and then mark the appropriate box on the Score Form

4. Score the global/cognitive category for any response to Question 1 on the PEDS Response Form

Match the category of concern with the following responses from the PEDS Form:

 

If a parent marks “No” to all PEDS questions, but writes the following, in what category of concerns would you place such comments:

“ She’s doing about as well as any other child. …Occasional meltdowns but that’s typical for his age and we can deal with it. …He’s advanced, precocious really…. Great kid.”

a) behavior problems

b) none

c) other/health concerns

d) all of the above

How would you categorize comments such as:

 “My other kids could do lots more at the same age…. His friends are much better at learning, talking, and taking care of themselves”… “She’s struggling with everything”

a) Global/Cognitive

b) Other/Health

c) School skills

d) Self-help

e) Expressive Language

 

When parent’s concerns about self-help or school skills describe their child’s difficulties using eating utensils, fasteners or with writing/coloring, an additional category should be scored. This category is:

___ Other/health

___ gross motor

___ global/cognitive

___ fine motor

 

If a parent says, “she doesn’t listen to me”, this should be scored as (check all that apply):

___receptive language

___behavior (behavior is optional but is incorrect if the only answer)

___social-emotional

___other/health

When parents mark that they are “a little” concerned, this should be considered:  (check all that apply)

___an area of concern

___ ignored as not a real issue for the family

___ interpreted as not a concern

When parents make statements such as “I used to be worried about his speech but now I think he’s doing better….”I don’t know what a 6 month old should be saying”, the Score Form box for expressive language (check all that apply):

___ does not need to be marked as a concern for the parent

___ should be marked as an area of concern

___ should be explored further with an additional screen  before making a decision about what to do next.

Sometimes parents describe concerns that do not appear to professionals to be especially problematic or predictive of problems. In such cases professionals should NOT checkbox next to the concern parent raised. True or false?

___True

___False

Sometimes professionals notice delays or are troubled by a child’s development but the parent does not express concerns. In these cases you should: (check all that apply)

___Use an informal milestones checklist to consider developmental status

___Explain your concerns to the family and the need for additional screening

___Check the box on the Score Form to note your own concern and/or place the child on Path A or Path B

___ Administer an additional screen such as PEDS: Developmental Milestones

PEDS screens for the following conditions of childhood (check all that apply):

1. Learning Disabilities

2. Speech-language Impairments

3. Autism Spectrum Disorders

4. Physical Impairments for which special education eligibility is likely

5. Developmental delay/mental retardation

6. Giftedness/Academic Talent

7. Typical/Normal Development

8. Behavioral/Emotional/Mental Health problems

Match the risk levels with the PEDS Paths:

 

PEDS is known to (check all that apply):

___ help parents learn to think about development like professionals do, as   a range of domains

___ encourage parents to observe their children closely

___ increase parents’ worries about their children’s development

___ teach parents that development and behavior are a part of health care

___ increase parents’ willingness to come back for well-child visits and other    appointments.

___ increase positive parenting practices such as time out, instead of spanking

___open the door to parent-teacher discussions about child-rearing

___make parents less willing to follow through with referrals to other services

 

When children fall on Path C (check all that apply):

1. They should be promptly referred for mental health services

2. Given parents’ advice about child-rearing is the optimal first response

3. If concerns persist, mental health screening is needed and if failed, children should be referred for mental health/behavioral interventions

4. Professional advice should be tailored to the challenges parents’ describe

5. The effectiveness of professional advice should be monitored in a few weeks to determine if other services are needed

 

Some parents don’t raise concerns on PEDS when they should. Reasons often include (check all that apply):

___ a belief that providers will notice problems and shouldn’t be   influenced by parents’ concerns

___ parental anxiety and lack of confidence in their observations

___ lack of awareness that providers are interested in developmental- behavioral issues

___ lack of education, poverty, stresses at home

___ lack of quality questions that elicit parents’ concerns

___ limited ability to read

___ limited understanding of the language in which PEDS was    administered (in writing or by interview)

___ informal translations of PEDS

___ asking only a few of the PEDS questions

Why do parents of infants and toddlers need to be asked the PEDS’ question about school skills:

___ parents don’t need to be asked that and frankly, shouldn’t be asked that   question

___ because that question encourages parents to use flash cards to teach number and alphabet knowledge to best prepare their children for school

___ because it informs providers about parents’ knowledge of what is   developmentally appropriate

___ it helps providers get an idea of what parents are doing with children at home in terms of teaching children new things

___ it alerts providers that parents may not be aware of what to teach young children

In your own words, what is a desirable response from a parent of a 0 - 36 month old when the PEDS’ school skill question is asked?

 

 (Desirable answers are “He’s too young for that; We read books together; She’s learning in her own time frame; He enjoys playing school; We watch Sesame Street together and talk about the show.”)

 

In your own words, why should we ask parents of infants and toddlers the PEDS question about self-help skills?

Desirable answers include content such as (so professionals can tell whether the tasks that parents require of children are age-appropriate, legal (e.g., demands for an older child to supervise without adult oversight far younger children), improves parents’ observational skills about children’s emerging competence), etc.

Parents’ concerns (circle one):

(a) always reflect the domains in which children have developmental delays

(b) can be significant predictors of disabilities

(c) should consistently be met with reassurance and watchful waiting

(d) may suggest the need for in-office counseling and monitoring

(e) b and d above

(f) all of the above

 Parents with limited education are (circle one):

a)  as likely to have concerns about their children’s development as more educated parents

b)  less likely to raise concerns spontaneously

c)  less likely to notice problems in their children

d)  less likely to know that health care providers are interested in child development

e)  all of the above

f)   a,b,d above

The value of using PEDS to elicit parents’ concerns in their own words is (check all that apply):

___ reduces “oh by the way” concerns at the end of visits

___ saves time during visits

___ enables providers to figure out in advance what families’ needs

___ creates a collaborative relationship between professionals and parents

___ helps parents know that providers are interested in development and   behavior

___ helps providers know when to look further at children’s skills

___ helps providers view disordered development (e.g., age-appropriate   two-word utterances but that are too repetitive and non-   communicative)

___ enhances reimbursement for services

Why is it critical to refer to the PEDS Brief Guide or to use PEDS Online when scoring PEDS?

 

 

 

 

(desirable answers include accuracy of results, correct scoring)

 

PEDS Online offers (check all that apply):

___Modified Checklist of Autism in Toddlers

___ Ages and Stages Questionniare

___PEDS

___PEDS:Developmental Milestones

___ automated scoring

___ a diagnosis for various kinds of disabilities

___ referral letters when needed

___a summary report for parents

___academic screens for children 8 years and older

___mental health screens for parents

___procedure codes for billing

 

Specific Questions onf PEDS:Developmental Milestones (PEDS:DM)

PEDS:DM items are tied to which cutoff:

a) 10^th percentile

b) 16^th percentile

c) 25^th percentile

d)  50^th percentile

e)  75^th percentile

f)  90^th percentile

 

If a child does not meet a milestone on the PEDS:DM it means that he or she (check all that apply):

 

___ simply needs watchful waiting and rescreening

___ is probably well behind same-age peers in that domain of development

___ needs further evaluation

___ has a diagnosable problem that can be identified by the PEDS:DM

 

Scores on the PEDS:DM are defined as (check all that apply):

___ milestones met or unmet

___ pass or fail

___ optimal or suboptimal

___ disabled or not disabled

 

True or False: Continuing performance below the 16^th percentile is worrisome because the child is likely to have substantive difficulties in school.

 

___ true

___ false

 

PEDS:DM measures development in which areas (check all that apply):

____ expressive language

____ self-help

____ social-emotional

____ fine motor

____ receptive language

____ health, vision, hearing

____ gross motor

____ behavior

____ academics in math and reading

Please identify these statements as true or false:

The PEDS:DM consistently detects disordered development.

___ True

___ False (children can, for example, use two word utterances age-appropriately but if these are repetitive and not communicative, disorder may be missed. This phenomena is the case for all skill-focused measures)

The PEDS:DM detects probable delayed development.

___ True

___ False

When making referrals on the basis of PEDS or the PEDS:DM (check all that apply):

1. Early intervention/public school services under IDEA are the one-stop shop for additional screening and evaluation

2. A diagnosis is needed before early intervention services can be initiated

3. It is not necessary to refer if a child is on PEDS Path A (high risk), instead, watchful waiting is the optimal response

4. Professionals should consider, based on observations of family functioning, medical history, etc. whether social work, mental health, parent training or other services are needed in addition to IDEA

5. A teaching hospital or private diagnostic evaluation clinic should be consulted prior to referring to IDEA

The PEDS:DM can be administered in various ways. Check all administration methods that apply:

___ interviewing parents

___ professional observation

___ hands-on with children

 

Please rate these statements as true or false:

It is acceptable to probe unmet milestones on the PEDS:DM by administering lower level items

____ True

____ False

If a child is suspected of advanced development it is NOT acceptable to administer higher level items and note these on the PEDS:DM Recording Form.

____ True

____ False

 

 

The following statements describe implementation of screening in primary care. Place them in logical order: (note: there is no absolute right or wrong numbering here)

____ Choose a quality instrument

____ Conduct training

____ Organize parent education materials

____ Provide a rationale for office staff

____ Consider the details and order of the existing work flow

____ Plan training, gather training materials

____ Identify physicians or other staff heavily interested in the issue

____ Monitor implementation of screening

____ Allow staff to determine how the workflow steps will be executed

____ Gather a list of referral resources

____ Set a timeline

____ Review implementation and decide on needed adjustments to the process

____ Encourage staff to evenly allocate steps in the new work process

____ Work with the Early Intervention Community to establish referral mechanisms, the kinds of reports you’d like to receive, times to communicate, preferred mechanisms for communication (e.g., email, fax, phone, surface mail). 

Training Evaluation Questions

The following questions are not scored but are known to promote implementation of newly learned material or simply provide helpful feedback to improve training.)

What did you like most about your training experience:

What did you like least about your training experience:

What additional information did you wish had been covered?

What suggestions do you have for improving this presentation?

How will you use the information you acquired during training?

Which measures do you intend to use in your setting?

Why? (Please explain your choice):