The mean SPOT score (Wilcoxon Mann-Whitney Test, p > 0.05) for student confidence in performing a developmental assessment at the end of the terms in which they took the paediatric course in 2003, before the introduction of the program, was 3.95. In 2004 and 2005, after the introduction of the program, it was 4.08 and 4.13 respectively, but the increase in the means was not statistically significant. The response rates were 67%, 86% and 85% respectively.
The findings from the student Stycar assessment and the parents' ASQ report were similar (70% percentage agreement). Where the findings differed, the students sought possible explanations, e.g., some students wrote that the parent explained their child behaved differently at home, an explanation that was usually supported by the ASQ score. The students also noted the busy environment sometimes distracted the child from the assessment task. Further discussion sometimes revealed parental concern rather than actual developmental delay, e.g., one child's parents were concerned about the child's poor pronunciation of words (she had recently had grommets inserted), but the child scored 60/60 on the communication sub-domain of the ASQ and the student assessed there was no language or communication deficit. At other times, the student's assessment appeared inconsistent with the ASQ findings, e.g. one child had a speech and language delay on ASQ (the child's problem solving was borderline, there were no intelligible words, no recognition of pictures, tended to ignore the mother) but the student found the child's hearing normal.
There were five key themes arising from an analysis of the students' reports. These were:
1. Increased understanding of the process of screening for development
The students' comments demonstrated that through use of the ASQ compared to using the Stycar alone, the exercise increased their understanding of the range of normal development and what was considered an acceptable cut off score, as well as their understanding of parents' perceptions or feelings, e.g., that the parents were happy to know their child's development was similar to their peers and what parents considered were normal milestones. Through interaction with parents structured around the ASQ, there was increased reporting as compared to previous student assessments in earlier cohorts of play, socio-emotional and problem solving. Students often prefaced assessment with good observational descriptors of the child's temperament and interaction.
"A happy and interactive child who initially engaged with me got tired and bored and turned to mother for a hug."
The two methods were both generally considered to be useful, but with limitations such as operator skill and the child's cooperation. Comments about using the ASQ as a tool indicated it was more helpful than the Stycar guidelines, because it was clearly set out and age-specific, it allowed for graded responses and gave specific examples, and it was easier to undertake, simple to interpret, and useful if the parent had limited English.
"Now understand I can do a valid and valuable appraisal using simple tools."
"The structured approach of ASQ enabled me to direct my attention."
"The ASQ gave me a better mental picture."
"The ASQ helps the parents give a more unbiased opinion regarding their child."
2. Awareness of techniques and engagement of the child
Student comments revealed they gained a lot from interaction with the child. They learnt about: observing the child at play; the challenge of creating rapport before attempting the assessment; the need for flexibility of tasks; the importance of preparation; using play as a test tool; the realisation that how you say things can influence the reply.
"They will naturally do a lot of tasks you want them to do."
"I was interested to see trust develop in the child, happy to be weighed without mother despite very shy at first."
"I took a non-structured approach as I soon realised this would be impossible."
"I learnt not to play ball games before less exciting activities."
"No chance to stop and read through milestones while a very active toddler is constantly running away to go and play with other kids."
"Easy to structure the play to test specific components."
3. Increased confidence in recognition of normal development and problems
Only one student commented that the exercise was not useful for learning. All the others stated that the exercise increased their confidence in assessment of development.
"Despite initial hesitations, this has been useful exercise; actually doing has cemented the ideas more firmly in my mind and increased my confidence in assessing and interpretation."
"I can now explain results more succinctly."
4. Parents as reliable and valid reporters
Two sub themes emerged:
Recognition of parents as expert in their children, as they spend the most time with them.
"I found the child hard to engage verbally, he rarely followed instructions and generally ignored the test administrator. I felt comfortable accepting the parent's input, as they were more used to his speech and mannerisms, in this way, I felt I gained a more accurate picture of his communicative development."
Potential parental bias. Some students commented on the parents' ability to complete a reliable and valid assessment of their child. In some cases this was appropriate, e.g., when the parents expressed concern about their child's diminished visual acuity following cataract surgery, although no gross visual deficit was observed and the ASQ was well above cut off for vision. However, some comments revealed student perceptions that parents could over-estimate their child's ability rather than give an objective assessment. This was even the case when the ASQ demonstrated good concordance with the student's assessment.
"(The) mother seemed to have a good grasp on the developmental level; I understand this may not be so in many other mothers, especially those with developmentally delayed children."
"Even though ASQ more specific, I still think observer's examination more useful, mother may have bias or mislead the examiner, whilst physical examination allows clinicians to identify problems without mother's bias affecting the result. ASQ can fill in the gaps, which may be true at home."
"The mother may have overemphasised her child's communication ability and seemed intent on making him do what was requested, even interrupting his play, perhaps I needed to clarify any concerns the mother had."
5. Enjoyment of the process
The students enjoyed the assessment and often completed further assessments independently.
"I enjoyed the opportunity to perform this assessment, because in many ways it relies on actually joining in with the child's play, something that I always enjoy given the chance!"
"I would benefit from doing more of these with children of all different ages because it really cements in my mind the abilities the children have at different ages."
Parents' perception of their role
The response rate for the parents' questionnaire was 61% (N = 31). All parents found the ASQ very easy or easy to use (mean 4.2) and took between 5 and 45 minutes (mean 13 minutes) to complete it. The students were considered respectful (mean 4.64) and fairly confident in approaching the child (mean 4.5). Parents felt confident they knew their child best and perceived they were therefore able to contribute to the students' learning (mean 4.4). However one parent was concerned that students relied too heavily on their assessment. Overall the parents felt they learnt more about their child by participating, but this was the weakest response (mean 3.9). All agreed they were honest in describing their child's abilities (mean 4.6). They also agreed that parents should be involved in teaching students (mean 4.3) and said they gained a sense of satisfaction from participating (mean 4.4). Some examples of their comments:
"I feel parents have a role in providing anecdotal evidence and in raising issues they would like to know more about (what they would like doctors to be able to answer)."
"It was a good idea to do the questionnaire with the student. As a parent I am the one most able to answer the questions about my child."
"I was very impressed with the student's professional manner but also with their caring and friendly attitude."
"I was happy to help out and will continue to do so in the future if asked to."
"I think the student should give themselves more time to assess the children independently. As some parents may be a little biased toward their child's development, they should assess on what they see."