Reference Work Entry

Encyclopedia of Autism Spectrum Disorders

pp 2147-2150

Pediatric Evaluation of Disability Inventory (PEDI)

  • Daniel MruzekAffiliated withDepartment of Pediatrics (SMD), University of Rochester, School of Medicine and Dentistry Email author 
  • , Christen SzymanskiAffiliated withDepartment of Pediatrics (SMD), University of Rochester, School of Medicine and Dentistry

Synonyms

PEDI

Description

The Pediatric Evaluation of Disability Inventory (PEDI; Haley, Coster, Ludlow, Haltiwanger, & Andrellos, 1992) is a clinical assessment instrument designed for use with children aged 6 months to 7.5 years who have disabilities resulting in delays or impairments in functional independence. Specific applications of the PEDI include ascertaining the extent of functional delay in children, monitoring progress in rehabilitation and intervention programs, and measuring outcomes in therapeutic and educational programs. Though the instrument also may be given as part of an initial developmental or diagnostic assessment, caution is warranted because extensive validation studies of using the PEDI for this purpose have not been completed.

Administration of the PEDI is typically completed through a 45–60-min structured interview with the parent or primary caregiver, direct assessment by therapists or educators who are familiar with the child, or a combination of these two approaches. If there are severe time constraints, the PEDI may be completed directly by the parents as a “paper-and-pencil” checklist; however, the authors strongly recommend that a clinician review responses carefully with the parent and interpret the resultant data with caution.

PEDI content is based on a conceptual model that centers upon identifying the child’s functional limitations in the context of developmental expectations, task conditions, and caregiver assistance. Consistent with this model, the PEDI has three sets of scales (i.e., functional skills, caregiver assistance, and modifications), each of which is organized by three “content areas” (i.e., self-care, mobility, and social function; see Table 1). The functional skills scales include items on daily living activities, such as use of utensils, toilet transfers, and interactive play. The caregiver assistance scales assess the amount of help a child requires to complete functional skills, with responses rated on a 6-point rating system that is “weighted” so that the greatest degree of specification is provided at the “higher” end of the scale (i.e., toward the independent end). The modifications scale presents the same items as the caregiver assistance scale but asks caregivers to assess the degree to which environmental modifications and equipment are necessary for use by the child to complete functional or routine daily living activities. The ratings from the modifications scale cannot be converted into normative data; therefore, they can only be analyzed as frequency counts.
Pediatric Evaluation of Disability Inventory (PEDI), Table 1

Organization of the PEDI

Scales

Number of content items

Rating scale

Scoring system

Self-care

Mobility

Social function

Functional skills

63

59

65

Dichotomous

Standard scoresa and scaled scoresb

Unable/capable

Caregiver assistance

8

7

5

6-point scale

Standard scoresa and scaled scores b

“Total Assistance” to “Independent”

Modifications

8

7

5

4-point scale

Frequency counts

“None” to “Extensive”

aMean of 50, standard deviation of 10

bRange from 0 to 100 and used to compare child’s relative strengths and weaknesses

Historical Background

The Pediatric Evaluation of Disability Inventory (PEDI; Haley et al., 1992) was developed at the New England Medical Center and first published in 1992. The development and testing of the test in the prior decade noted favorable comparison to the Battelle. The PEDI was designed to assess the functional independence of children with developmental disabilities. Scaled scores in multiple domains estimate the child’s capabilities. It has been used internationally, and in 2008, a computer-assisted version was developed. The literature indicates greater accuracy for children with motor disabilities than language impairment.

Psychometric Data

For each of the functional skills scales and the caregiver assistance scale, two different domain scores can be determined: “normative standard scores” and “scaled scores.” The normative standard scores have a mean of 50 and a standard deviation of 10 and compare the individual child’s functioning to a group of children within the same age range in the normative sample. The normative group is composed of a small sample of 412 typically developing children residing in the northeastern United States. This sample was composed of a nearly equal number of males and females (49.3% and 50.7%, respectively). Distribution by race is commensurate with 1980 US census data, with the exception of an overrepresentation of African-American children (18.7% in the normative sample versus 11.7% in the US population).

The “scaled scores” are used to provide an estimate of functional independence across the items that compose each of the scales by comparing the child’s performance relative to the maximum number of points possible (Haley et al., 1992). The scaled score range is 0−100, with “0” reflecting low functioning and “100” reflecting high functioning. These scores can be graphed on the score form for analysis of an individual child’s relative strengths and weaknesses. As the authors point out, these scaled scores do not take into account the age of the child but, rather, provide an estimate of the child’s capability in each content domain. To this end, scores can be plotted on a “score profile” located on the score summary page of the score form for visual analysis of a child’s relative strengths and weaknesses. Confidence intervals are provided for both normative standard scores and scaled scores, and a 95% confidence interval is recommended by the authors.

The PEDI manual contains evidence of high internal consistency (i.e., the degree to which the items in each of the domains measure a similar concept). Internal consistency has since been replicated and found to be adequate in a population of children with cerebral palsy (McCarthy et al., 2002). Additional evidence of instrument reliability is provided when comparing the results of separate PEDI administrations by two different examiners with two respondents who know the child well (e.g., a child’s parent and member of his or her rehabilitation team). Interrater/intrarater reliability was shown to be fairly consistent when two caregivers of a child were interviewed by the same clinician (Berg, Jahnsen, & Hussain, 2004). However, when multiple clinicians interviewed providers, reliability of results was lower (Berg et al., 2004). Test-retest reliability data are not available.

The PEDI authors provide evidence of satisfactory validity on several dimensions. The results of reviews of the instrument by developmental experts suggest that the PEDI does measure the presence of a pediatric functional disability (i.e., content validity). A strong positive correlation between the age of the children in the normative sample and their PEDI scores suggests that the skills measured by the instrument are closely tied to overall child development (i.e., construct validity). Scores on the PEDI were found to be strongly correlated with scores on the Battelle Developmental Inventory Screening Test (BDIST; Newborg, Stock, Wnek, & Svinicki, 1984) for both a group of typically developing children and a group of children with disabilities (Feldman, Haley, & Coryell, 1990). Evidence of strong discriminant validity is provided in the PEDI manual as well, suggesting that the instrument effectively distinguishes between children with and without disabilities. A comparison of PEDI scores of a group of children at hospital intake for traumatic injuries with their follow-up scores at 1 and 6 months postrehabilitation showed that the PEDI detected change in the functional status of children over time, suggesting evaluative validity (i.e., the ability of the instrument to detect change in functional status of the individual).

Since its publication in 1992, the PEDI has been translated and used in several other countries with solid psychometric results (e.g., Ganotti & Cruz, 2001; Wassenberg-Severijnen, Custers, Hoz, Vermeer, & Helders, 2003), suggesting that the instrument is a good measure of overall functional skill development. A recent attempt to abbreviate the measure and make a computer version shows promise (Coster, Haley, Pengsheng, Dumas, & Fragala-Pinkham, 2008). The PEDI has been utilized with a variety of populations (e.g., premature infants, brain injuries, autism, cerebral palsy) but may be best suited for populations with severe motor deficits. For example, while the PEDI has been consistently shown to be effective in identifying motor progress of children with cerebral palsy (e.g., Vos-Vromans, Ketelaars, & Gorter, 2005), it is less sensitive in detecting subtle deficits of children with primary language impairments (Mayrand, Mazier, Menard, & Chiningaryan, 2009).

Clinical Uses

For children with autism, the PEDI is most likely to be administered as part of an intake evaluation (e.g., such as during referral for early intervention services) or when there is a concern about additional physical disabilities or delays that impact the independent functioning of the child. Given the “prompt dependency” that many children with autism demonstrate (i.e., the necessity of caregivers to direct a child to initiate and/or complete a task that is otherwise within his or her skill repertoire), the PEDI may be a useful tool for monitoring independence and timely use of functional skills. Repeated administrations of the PEDI as part of ongoing treatment for a child with autism may allow caregivers and clinicians the ability to monitor progress with functional skills over time. Given that the data used to establish the norms was collected over 30 years ago, it is recommended that normative standard scores be interpreted with great caution.

The PEDI is most useful in the assessment of children with motor disabilities such as children who were premature infants or who have cerebral palsy.

See Also

Functional Life Skills

Vineland Adaptive Behavior Scales

Copyright information

© Springer Science+Business Media New York 2013
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