If You Don't Ask, Parents May Not Tell: Noticing Problems vs Expressing Concerns

I am concerned about the measurement methods and conclusions reported by Ehrmann Feldman et al¹ in “When and by Whom Is Concern First Expressed for Children With Neuromotor Problems” in the September issue of the ARCHIVES. The authors state that “parents recognized neuromotor problems in their children at older ages than did physicians,”^1(p884) yet the research question asked of parents was not, “Who first noticed problems and when?” but instead “Who was the first person or professional who first expressed a concern regarding your child's development?” Expressing concerns and noticing potential difficulties are not synonymous. In a study I conducted on 408 families, more than one third of parents with concerns as elicited by Parents' Evaluations of Developmental Status, a brief screening and surveillance tool,² had spontaneously raised concerns to health care professionals.³ Although differing levels of education and parenting experience were not associated with differences in the frequencies and types of elicited concerns, parents were more likely to have discussed concerns if they could identify a regular source of health care, were highly educated, were fathers, were worried about their child's health, and had concerns about expressive language development.