Pediatrician Practices Regarding Referral to Early Intervention Services: Is an Established Diagnosis Important?

Silverstein, Michael; Sand, Nina; Glascoe, Frances P.; Gupta, Vidya B.; Tonniges, Thomas P.; O’Connor, Karen G.

doi:10.1016/j.ambp.2005.09.003

« Previous Next »Ambulatory Pediatrics
Volume 6, Issue 2 , Pages 105-109, 1 March 2006

Pediatrician Practices Regarding Referral to Early Intervention Services: Is an Established Diagnosis Important?

Michael Silverstein, MD, MPH
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Mass
- Address correspondence to Michael Silverstein, MD, MPH, Boston Medical Center, Maternity Building, 4th Floor, 91 E Concord St, Boston, MA 02118
Nina Sand, MD
- Neurodevelopmental Center, Akron Children’s Hospital, Akron, Ohio
Frances P. Glascoe, PhD
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Mass
- Neurodevelopmental Center, Akron Children’s Hospital, Akron, Ohio
- Department of Pediatrics, New York Medical College, Valhalla, NY
- Department of Community Pediatrics, American Academy of Pediatrics, Elk Grove Village, Ill
- Division of Health Policy Research, American Academy of Pediatrics, Elk Grove Village, Ill
Vidya B. Gupta, MD, MPH
- Department of Pediatrics, New York Medical College, Valhalla, NY
Thomas P. Tonniges, MD
- Department of Community Pediatrics, American Academy of Pediatrics, Elk Grove Village, Ill
Karen G. O’Connor
- Division of Health Policy Research, American Academy of Pediatrics, Elk Grove Village, Ill

Received 21 September 2004; accepted 28 September 2005.

Objective

Early intervention (EI) programs provide services to children with developmental conditions, regardless of whether such children have an underlying medical diagnosis. We aim to (1) Determine the proportion of general pediatricians who believe an established diagnosis is important when considering EI referral; and (2) Determine whether this perception is associated with lower reported likelihood of referral.

Methods

Mailed survey to random sample of pediatricians. We used multivariable logistic regression to study the association between the perception that a medical diagnosis is important when referring to EI, and the reported likelihood of EI referral for children with common developmental conditions.

Results

Response rate was 55% (894 of 1617). A total of 64% of respondents considered an established diagnosis important for EI referral. Likelihood of referral for delayed speech was lower among those who considered a diagnosis important than among those who did not (77% vs 87%; P = .02). Similar patterns held for global delay (91% vs 97%; P = .02), loss of developmental milestones (80% vs 88%; P = .03), and parental concern for inappropriate development (45% vs 60%; P = .002). In multivariable models, perception of the importance of an established diagnosis was associated with lower likelihood of referral for children with delayed speech (adjusted odds ratio [aOR] 0.48; 95% confidence interval [CI] 0.26–0.87) and for parental concern for inappropriate development (aOR 0.46; 95% CI 0.30–0.72).

Conclusions

A majority of general pediatricians believe that an established diagnosis is important when considering EI referral. This perception is associated with decreased reported referral for children with speech delay and those whose parents express concern for inappropriate development.

Key words: children with special health care needs , developmental disability , developmental screening , early intervention