Glascoe F P
Division of Child Development, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-3573, USA.
Child Care Health Dev. 2000 Mar;26(2):137-49. doi: 10.1046/j.1365-2214.2000.00173.x.
Half of all children with disabilities are not identified before school entrance, which precludes their participation in early intervention programs. Such programs have known value in reducing high school drop-out rates, increasing employment, delaying child-bearing and reducing criminal behaviour. Although there are many screening tests that can greatly improve detection rates, these have not been popular in primary care due to test length, difficulty managing children's behaviour, etc. An alternative is to carefully elicit and interpret parents' concerns. Research shows that parents' concerns are as accurate as quality screening tests and that parents are equally able to raise important concerns regardless of differences in education and child-rearing experience. Parents' concerns can be elicited quickly and 92% of parents can answer questions in writing while in exam or waiting rooms. Unlike screening tests, use of parents' concerns facilitates an evidenced-based approach to comprehensive surveillance and aids in making a range of other important decisions about children's developmental and behavioural needs. These include when to: offer suggestions on developmental promotion; watch children more vigilantly; screen for emotional and behavioural problems; advise families about behaviour management; offer reassurance and routine monitoring of development that is likely normal; administer a second screening test; or refer for additional testing and the kinds of testing needed.
所有残疾儿童中有一半在入学前未被识别出来，这使得他们无法参与早期干预项目。这类项目在降低高中辍学率、增加就业、推迟生育以及减少犯罪行为方面具有公认的价值。尽管有许多筛查测试能够大幅提高检出率，但由于测试时间长、难以应对儿童行为等问题，这些测试在初级保健中并不受欢迎。另一种方法是仔细了解并解读家长的担忧。研究表明，家长的担忧与高质量筛查测试的准确性相当，而且无论教育程度和育儿经验存在何种差异，家长都同样能够提出重要的担忧。可以迅速了解家长的担忧，92%的家长能够在诊室或候诊时以书面形式回答问题。与筛查测试不同，利用家长的担忧有助于采用基于证据的方法进行全面监测，并有助于就儿童的发育和行为需求做出一系列其他重要决策。这些决策包括何时：提供促进发育的建议；更密切地观察孩子；筛查情绪和行为问题；就行为管理向家庭提供建议；提供安慰并对可能正常的发育进行常规监测；进行第二次筛查测试；或转介进行进一步测试以及所需的测试类型。
