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7/31/2019 Developmental Screening Fall 2012
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Developmental Screening
Slides adapted from the American Academy of Pediatrics and Ages and Stages
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Objectives
Discuss the importance of developmentalscreening
Differentiate between surveillance and screening
Identify components of a good screeninginstrument
Define and discuss benefits of developmentalscreening
Describe features of the Ages and StagesQuestionnaire (ASQ)
Implement and score the ASQ
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How common are developmental
disabilities?
17% of children have developmental
disabilities
Less than 50% are detected prior to school
entrance
EARLY DETECTION = EARLY INTERVENTION
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Why is early detection of developmental
problems so critical?
Children involved in Early Intervention programs
are more likely:
To live independently
Graduate from high school
Save society $30,000-$100,000 per child
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5
Preterm Births
United States, 1983-2003
Preterm is less than 37 completed weeks gestation.
Source: National Center for Health Statistics, 2003 final natality data. Prepared by March of Dimes Perinatal Data Center, 2006.
Percent
HealthyPeople
Objective28 Percent Increase
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Preterm is less than 37 completed weeks gestation. Very preterm is less than 32 completed weeks
gestation. Moderately preterm is 32-36 completed weeks of gestation.
Source: National Center for Health Statistics, final natality data. Retrieved March 29, 2012, from
www.marchofdimes.com/peristats.
Preterm births
US, 1999-2009
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All race categories exclude Hispanics. Preterm is less than 37 completed weeks gestation. Very
preterm is less than 32 completed weeks gestation. Moderately preterm is 32-36 completed weeks of
gestation.
Source: National Center for Health Statistics, final natality data. Retrieved March 29, 2012, fromwww.marchofdimes.com/peristats.
Preterm births by maternal race/ethnicity
US, 2009
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An infant death occurs within the first year of life.
Source: National Center for Health Statistics, period linked birth/infant death data. Retrieved March 29,
2012, from www.marchofdimes.com/peristats.
Infant mortality rates by maternal age
US, 2007
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The key to early detection
of disabilities is quality
surveillance and screening
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WHAT IS SURVEILLANCE VS. SCREENING?
Surveillance: Ongoing and systematic collection,
analysis, and interpretation of health data for
the purpose of planning, implementing, and
evaluating public health interventions.
Surveillance is a continuous process
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What is surveillance involving
children?A flexible, continuous process, in which
knowledgeable professionals perform skilled
observations of children (in consultation w/families,specialists, child care providers, etc).
SM Dworkin, A Shannon, and P Dworkin. ChildServ Curriculum. Center for Childrens Health and Development, St Francis Hospital and Medical
Center; 1999; Hartford, CT.
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Surveillance techniques:
LISTEN
Think
Talk
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Components of Effective Surveillance
Elicit and/or attend to parents' concerns
Obtain a relevant history Skillful observation of the child
Share opinions with other professionals
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What are some good open-ended
questions to ask parents about theirchilds development?
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What is screening?
Screening identifies individuals withunrecognized health risk factors orasymptomatic disease conditions in
populations. Screening tools are used to enhance the
surveillance process.
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CLEARLY
TYPICAL
CLEARLY
ATYPICAL?
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Importance of Being Objective
TOUCH OR TAKE TEMP?
Clinical judgment detects fewer than 30% of children
with developmental disabilities
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Benefits of Screening
Sorts children into 3 categories:
Needs additional evaluation - Did not pass
screening Needs closemonitoring- Passed screening
but has risk factors (e.g. premature infant)
Needs ongoing monitoring in the contextof well-child assessment - Passed screening
and has no known risk factors
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Standards for Screening Tools
Standardized on a national sample
Proof ofreliability
ability of a measure to produce consistent results Evidence ofvalidity
ability of a measure to discriminate between a child
at a determined level of risk for delay (i.e. high,moderate) from the rest of the population (low risk)
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Standards for Screening Tools
Accuracy in ability to categorize is measured
by:
Sensitivity: accuracy in identifying delayed
development. True positive proportion.
Specificity: accuracy in identifying individuals who
are not delayed or typically developing children.
For developmental screenings,Sensitivity and Specificity of 70-80% are
acceptable
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Developmental Screening Instruments:
General Ages and Stages Questionnaire
Battelle Developmental Inventory (BDI) Screening Test
Bayley Infant Neurodevelopmental Screener (BINS)
Brigance Screens-II
Infant Development Inventory
Child Development Review
Child Development Inventory (CDI)
Parents' Evaluation of Developmental Status (PEDS)
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Prescreening Activities
Obtain consent from parent or caregiver and encourageparent to be involved. Check your agency for specific consent form, if required.
Explain purpose of screening to parents and review
questionnaire content. Make sure parents know that ascreening is not the same as a diagnosis.
Provide appropriate questionnaire (if child is premature,correct for prematurity).
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ASQ Screens 5 Domains
Communication
Gross Motor
Fine MotorProblem solving
Personal-social
Overall sensitivity = 72%, specificity = 86%
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Ages and Stages Questionnaire
(ASQ) 4 months to 6 years
19 color-coded questionnaire for use at 2, 4,6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 27, 30, 33,36, 42, 48, 54, and 60 months
30 35 items per form describing skillsCompleted by nurse and parent during home visit,
preferred method. Can also be completed by parent alone.
Takes about 10-15 minutes, and 3 to score
Reading level of tool is 4-6th grade
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Which ASQ to give?
Use a questionnaire that is within a 2 monthwindow of the childs age (or corrected age ifpremature)
If child is exactly in between, then give thelower interval and then follow up with thenext interval.
Questions are hierarchical, easy to difficult Questions are answered: Yes, Sometimes, Not
yet
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ASQ Sample Items
1.When your child wantssomething, does she tell
you bypointing to it?
Yes Sometimes Not Yet
4. Does your child say
eight or more words in
addition to Mama and
Dada?
Yes Sometimes Not Yet
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Scoring the ASQ
Step 1: Total the points in each area. yes= 10,
sometimes= 5, not yet= 0.
Step 2: Transfer the area totals to the informationsummary page. Fill in the matching circle in thespace provided.
Step 3: Read the answers to overall sectionquestions
carefully and respond appropriately.
Step 4: Any score falling near or into the shadedarea
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Bell curve used to determine cutoff
point
Percentage of Population68%
13.5% 13.5%
2.5% 2.5%
ASQ cutoff
-2 SD +2 SD-1 SD +1 SD
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Follow-up Criteria:
Well above cut-off points.
Provide follow up activities for developmentalpromotion
Continue to monitor (surveillance). Rescreen in 4-6 months. Close to cutoffs:
Provide follow up activities to practice specificskills.
Make community referrals as appropriate.
Re screen later, interval based on age
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Referral Criteria for ASQ
Below cutoff in one or more areas:
Refer for developmental evaluation
Parent concern:
Respond to all concerns
Refer if necessary
Your own concern
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Communication tips when there are
concerns:
Avoid terms such as test, passor fail.
Review the screening tool and explain area scores.
Emphasize child and family strengths.
Provide specific examples of concerns.
Use language that encourages follow-up
Avoid negative and meaningless words Be sensitive to cultural meanings of words
People-first language!
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Early Intervention
Zero to three years - Early Start Program.
Services are provided through Regional Centers
(21 in state).
Emphasis is in the natural home setting
3 21 years Special Education
Individual Education Plan
Free and Appropriate Education (FAPE) in theLeast Restrictive Environment (LRE)
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Special Education
3 to 21 years old
Anyone can request eval, but parent must
consent
Eval must be conducted in childs primary
language and in English
DC requires eval started within 90 days of request
(does not include summer or vacation) Repeat eval every 3 years
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IMPORTANT RESOURCE
Learn the Signs. Act Early
http://www.cdc.gov/ncbddd/actearl
y/index.html