the survey of well-being of young children (swyc) ellen c. perrin, m.d. r. christopher sheldrick,...

The Survey of Well-being of Young Children

(SWYC)

Ellen C. Perrin, M.D.R. Christopher Sheldrick, Ph.D.

We have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity.

We do not intend to discuss an unapproved/investigative use of a commercial product/device in this presentation.

Historical perspective

• Rosie D. lawsuit• CBHI• Available Instruments

– Lengthy– Proprietary– Scoring complex– Fragmented

Our goals

• Surveillance Instrument (birth to 5)– First level screening– Integrate “behavior” and “development”– Include family context/risks– Quick to fill out, score & interpret– “Developmental growth curve”

• Free and in public domain• Amenable to electronic format

– Computer– Telephone– Internet

DevelopmentBehavior

Family Context

DevelopmentBehavior•Internalizing•Externalizing

Family Risk

Baby Pediatric Symptom

Checklist (BPSC)

Preschool Pediatric Symptom Checklist

(PPSC)

Development•Delays•Autism

Behavior•Internalizing•Externalizing

Family Risk

Baby Pediatric Symptom

Checklist (BPSC)

Preschool Pediatric Symptom Checklist

(PPSC)

Milestones

Parent’s Observations of

Social Interactions (POSI)

DevelopmentBehavior

FAMILY RISK FACTORS

Family Risk

FAMILY RISK FACTORSDepressionPHQ-2Substance AbuseAlcoholTobacco Other drugsParental DiscordHunger

Four Domains

• Social-emotional-behavioral– BPSC (Birth to 18 months) – 12 items– PPSC (18 months to 5 years) – 18 items

• Cognitive, Language and Motor– Milestones (each WCV) – 10 items

• Autism– POSI (18 to 36 months) – 7 items

• Family Risks– Each WCV - 11 items

SWYCPsychometrics!

• Latent variable modeling• Comparative effectiveness

Item 1

Item 2

Item 3

Item 4

Item 5

Item 6

Item 7

Item 8

Item 9

Item 10

Item 11

Item 12

Item 13

Item 14

Item 15

Item 16

Item 17

Item 18

Social/emotional problems

f1

f2

f3

Latent variable modelingPPSC bifactor model

general factor

item clusters

•Reliability

•Differential Item Functioning

SES ?

PPSC

ASQ-SE

PPSC

ASQ-SE

PRIMARY CARE SAMPLESensitivity Specificity

Total Internalizing Externalizing

CBCL 1.5-5

Total Internalizing Externalizing

CBCL 1.5-5

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

PPSC

ASQ-SE

Sensitivity Specificity

PPSC

ASQ-SE

Total Internalizing Externalizing

CBCL 1.5-5

Total Internalizing Externalizing

CBCL 1.5-5

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

CLINIC SAMPLE

Sensitivity Specificity

ADHD Anxiety Behavior or Conduct Any diagnosis

Parent report of existing diagnosisSpecificity

PPSC

ASQ-SE

CBCL 1.5-5

0.0

0.2

0.4

0.6

0.8

1.0

Other SWYC studies

• POSI v MCHAT• Milestones v ASQ-3• BPSC v ???

Example SWYC Forms

12-Month 24-MonthMilestones

Social/ Emotional Behavior

Page 2 (on the back)

12-Month 24-MonthAutism

Family RiskQuestions

Summary• Surveillance/first level screening instrument• Includes

– Cognitive, language, motor, and social-emotional development

– Autism spectrum disorders– Family context/risks

• Compares well with older instruments• Free, public domain• English and Spanish• Convertible to computer platform

– Tailored for child’s age– Link to follow-up questionnaires

• eperrin@tuftsmedicalcenter.org• rsheldrick@tuftsmedicalcenter.org