title: Household language, parent developmental concerns, and child risk for developmental disorder.
abstract: BACKGROUND
  Provider elicitation of parent developmental and behavioral (DB) concerns is the foundation of DB surveillance. Language differences may affect whether providers assess parental DB concerns.
  
  
  OBJECTIVE
  The aim of this study was to compare children in English versus Spanish primary language households by risk for DB disorder and provider elicitation of parental developmental and behavioral concerns.
  
  
  METHODS
  The 2003 National Survey of Children's Health was used to compare 29,692 children, aged 0 to 71 months, who received preventive care in the previous 12 months and were in English versus Spanish primary language households. Using logistic regression, we tested the association of household primary language with child risk of developmental and behavioral disorder and parent-reported elicitation of developmental and behavioral concerns at health care visits.
  
  
  RESULTS
  After adjusting for sociodemographic differences, children in Spanish primary language households were less likely than children in English primary language households to be at risk for DB disorder (40.5% vs 40.8%; AOR [adjusted odds ratio] 0.68, 95% confidence interval [CI], 0.55-0.85). Parents in Spanish primary language households reported less provider elicitation of developmental and behavioral concerns compared to all English primary language households (31.0% vs 43.7%; AOR 0.70, 95% CI, 0.57-0.85), but similar rates of elicitation compared to Hispanic English primary language households. Among households with children at moderate/high risk for DB disorder, parents in Spanish primary language households reported less elicitation of concerns than parents in English primary language households (AOR 0.63, 95% CI, 0.41-0.96).
  
  
  CONCLUSIONS
  Parents in Spanish primary language households reported lower child risk for developmental and behavioral disorder and less provider elicitation of developmental and behavioral concerns. These findings suggest that primary language may affect risk for developmental and behavioral disorder and likelihood of DB surveillance in children.
authors.affiliation: Department of Pediatrics, Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass., USA. kzuckerman@partners.org
authors.forename: Katharine E
authors.initials: KE
authors.lastname: Zuckerman
authors.forename: Alexy Arauz
authors.initials: AA
authors.lastname: Boudreau
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Lipstein
authors.forename: Karen A
authors.initials: KA
authors.lastname: Kuhlthau
authors.forename: James M
authors.initials: JM
authors.lastname: Perrin