title: How do primary care physicians manage children with possible developmental delays? A national survey with an experimental design.
abstract: OBJECTIVE
  Although early detection and treatment of developmental delays can improve outcome, little is known about factors that influence how primary care physicians manage young children with probable developmental delays. The objective of this study was to describe physician referral practices for children with developmental delays and to test whether the probability of referral is increased by 1) the expression of parental concern; 2) female gender in a child with language delay; 3) disruptive, as opposed to avoidant behaviors; and 4) physician characteristics, including female gender or being a pediatrician.
  
  
  METHODS
  A cross-sectional survey was mailed to a national random sample of 800 pediatricians and 800 family practice physicians in primary care practice, using an experimental randomized block design. Recipients randomly received alternative variants of clinical vignettes, which differed only in regard to the variable specific to each of the first 3 hypotheses. Physicians answered questions about the likelihood of referral on a 5-point scale for listed referral options. Hypotheses were tested using multivariable logistic regression modeling. A total of 55% of pediatricians and 43% of family practice physicians returned the survey, for an overall response rate of 49%.
  
  
  RESULTS
  A girl with language delay was 60% more likely to be referred to audiology than a boy (odds ratio: 1.6; 95% confidence interval: 1.1-2.3), and respondents who were female or pediatricians were more likely to refer patients. The expression of parental concern did not increase the probability of referral to diagnostic and treatment services, and avoidant rather than disruptive patient behaviors were associated with an increased probability of referral.
  
  
  CONCLUSIONS
  Patient gender and type of behavioral presentation seem to influence referrals to diagnostic and treatment services for young children with probable developmental delays described in clinical vignettes. These findings can guide targeted educational interventions to increase rates of detection and referral for young children with developmental delays.
authors.affiliation: Division of Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, Ohio 44106-6038, USA. Laura.Sices@uhhs.com
authors.forename: Laura
authors.initials: L
authors.lastname: Sices
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.forename: John
authors.initials: J
authors.lastname: McLaughlin
authors.forename: Dennis
authors.initials: D
authors.lastname: Drotar
authors.forename: Michelle
authors.initials: M
authors.lastname: Williams
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D002658:Developmental Disabilities / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007805:Language Development Disorders / Q000628:therapy; D008297:Male; D010372:Pediatrics; D010821:Physicians, Family; D011368:Professional-Family Relations; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012737:Sex Factors; D014481:United States