Correspondence

The Infant or Young Child with Developmental Delay

N Engl J Med 1994; 331:56July 7, 1994

Article

To the Editor:

Drs. First and Palfrey (Feb. 17 issue)1 emphasize the importance of assessing language and cognitive skills -- the two developmental areas most predictive of overall outcome and success in school -- but they are in error in stating that parents' worries can usually be responded to with simple reassurance. Much research indicates that parental concern about certain issues is highly predictive of true developmental problems2-6. Specifically, concern about language, behavioral or emotional status, and cognitive and fine-motor skills has a sensitivity value ranging from 43 percent to 80 percent in identifying children in need of further evaluation. In other areas parents' expression of concern is not predictive of developmental problems but nevertheless suggests an important opportunity to promote development by means of counseling, handouts, parent training, and other methods.

Clearly, parents' concern should not simply be met with reassurance, but should be taken as a valuable indicator of either probable developmental problems or the parents' needs.

Frances Page Glascoe, Ph.D.
Vanderbilt University School of Medicine, Nashville, TN 37232

6 References

1. 1

   First LR, Palfrey JS. The infant or young child with developmental delay. N Engl J Med 1994;330:478-483
   Full Text | Web of Science | Medline

2. 2

   Oberklaid F, Dworkin PH, Levine MD. Developmental-behavioral dysfunction in preschool children: descriptive analysis of a pediatric consultative model. Am J Dis Child 1979;133:1126-1131
   Web of Science | Medline

3. 3

   Glascoe FP, Altemeier WA, MacLean WE. The importance of parents' concerns about their child's development. Am J Dis Child 1989;143:955-958
   Web of Science | Medline

4. 4

   Dulcan MK, Costello EJ, Costello AJ, Edelbrock C, Brent D, Janiszewski S. The pediatrician as gatekeeper to mental health care for children: do parents' concerns open the gate? J Am Acad Child Adolesc Psychiatry 1990;29:453-458
   CrossRef | Web of Science | Medline

5. 5

   Glascoe FP, MacLean WE, Stone WL. The importance of parents' concerns about their child's behavior. Clin Pediatr (Phila) 1991;30:8-11
   CrossRef | Web of Science | Medline

6. 6

   Glascoe FP. Can clinical judgment detect children with speech-language problems? Pediatrics 1991;87:317-322
   Web of Science | Medline

To the Editor:

The Early Language Milestone Scale,1 which I developed, was recommended by First and Palfrey as a means of assessing children from birth to three years of age with speech and language delay. Unfortunately, the address listed for obtaining this scale was out of date. The correct address is as follows: PRO-ED, 8700 Shoal Creek Blvd., Austin, TX 78758.

James Coplan, M.D.
State University of New York Health Science Center, Syracuse, NY 13210

1 References

1. 1

   Coplan J. The Early Language Milestone Scale. 2nd ed. Austin, Tex.: PRO-ED, 1993.
   

Author/Editor Response

The authors reply:

To the Editor: Dr. Glascoe makes a valuable point in discussing the opportunities that arise when a parent voices concern about developmental issues. Even in the case of normal variation (which was the context of our statement about reassurance), we agree that the encounter should still be used to enhance the parents' understanding of a child's development, as well as the provider's role in supporting and enhancing further developmental advancement.

Lewis R. First, M.D.
Judith S. Palfrey, M.D.
Children's Hospital, Boston, MA 02115