Developmental Screening

Refers to the administration of brief, formal standardized evaluation that aids in early identification of patients at risk for a developmental and/or behavioral disorder

Why?

Developmental and social-emotional delays can be subtle and car occur in children who appear to be developing typically.

Most children who would benefit from early intervention are not identified until after they start school.

Even pediatricians and child health specialists fail to detect delays more than 70% of the time when they rely on clinical judgment alone.

Screening results will enable child health specialists to initiate early intervention.

Early Intervention

Provides special services and programs for children from birth to age 3 who have:

Developmental delays

A physical or mental condition known to cause developmental delays.

Early intervention services are critical to the success of children with disabilities.

To prepare children for the future academic tasks they will need to master as part of the general education curriculum

An early intervention program should significantly increase their functional skills and their successful entry into adulthood.

Importance of Early Intervention

Developmental delays, learning disorders, and behavioral and social-emotional problems are estimated to affect 1 in every 6 children.

Only 20% - 30% of these children are identified as needing help before school begins.

If social-emotional problems are identified and addressed early, children are less likely to be placed in special education problems--and later in life, they're also less likely to experience school failure and unemployment.

What is an Ideal Screening Method?

It should be easy to perform and interpret.

In should be inexpensive.

It should have a good sensitivity and specificity at 70-80% range (American Academy of Pediatrics)

Screening Tools

Do not provide diagnosis.

When a child passes a screening test, he should be given the opportunity to have developmentally appropriate activities.

When a child fails a screening test, a close follow up is needed and he may need to further assessment.

Developmental Screening Tools

Ages and Stages Questionnaire

Modified Checklist for Autism in Toddlers (M-CHAT)

Parents' Evaluation of Development Status (PEDS)

Denver II

Ages and Stages Questionnaire

ASQ is a series of 20 questionnaires that correspond to age intervals from birth to 6 years.

Each questionnaire contains simple questions for parents to answer about activities their child is (or is not) able to do.

The answers are scored and help to determine whether the child's development is on schedule or whether the child should be referred for a developmental checkup with a professional.

Activities discussed in each questionnaire reflect developmental milestones for each age group. Parents can learn more about what to expect their child to be able to do at each stage of development.

A Mom's Reaction to ASQ

Working with pediatrician "The website is really helpful. It’s great to know there are pediatricians excited to use the ASQ. My children's doctor photocopied their most recent ASQ assessment to share with the rest of the doctors."

Modified Checklist for Autism in Toddlers (M-CHAT)

Designed to screen for Autism Spectrum Disorders in toddlers (16-30 months of age); tests for ASD against normally developing children.

A parent can complete the items independently.

Useful and has excellent sensitivity and specificity.

Positive results suggest a high risk for an Autism Spectrum Disorder, and may necessitate referral.

There are 23 items in M-CHAT. Critical Items 2 - Does your child take an interest in other children? 7 - Does your child ever use his index finger to point, to indicate interest in something? 9 - Does your child ever bring objects to you (parent) to show you something? 13 - Does your child imitate you? (e.g. make a face - will your child imitate it?)

14 - Does your child response to his/her name when you call? 15 - If you point a toy across the room, does your child look at it?

A child fails the checklist when 2 or more critical items are failed OR when any three items are failed.

Not all children who fail the checklist will meet criteria for a diagnosis on the autism spectrum.

However, children who fail the checklist should be evaluated in more depth by the physician or referred for a developmental evaluation with a specialist.

Parents' Evaluation of Developmental Status (PEDS)

Developmental screening test for age birth up to 8 years old developed by Frances Glascoe.

It is a 10-question parental questionnaire.

Parents can complete it in 5 minutes (literacy of 4th-5th grade)

Efficacy Test Sensitivity: 74-80% Test Specificity: 70-80%

Recommendations for referral are based on the number of predictive concerns found.

PED'S Questions: 1 - Please list any concerns about your child's learning, development, and behavior? (Global/Cognitive)

Do you have any concerns about how your child: 2 - ... talks or makes speech sounds? (expressive language) 3 - ... understands what you say? (receptive language) 4 - ... uses his hands and fingers to do things? (fine motor) 5 - ... uses his arms and legs? (gross motor) 6 - ... behaves? (behavior) 7 - ... gets along well with others? (social-emotional) 8 - ... is learning to do things for himself? (self-help) 9 - ... is learning pre school or school skills? (school) 10 - Please list any other concerns

Certain developmental concerns at different ages are predictive of a developmental disability.

There "predictive concerns" drive the algorithm toward referral for further evaluation.

If two or more predictive concerns are found the patient should be referred for either speech and language assessment Audiology testing or for intellectual and educational evaluation.

If one predictive concern is found patient should come back for either second-stage developmental screening or for other more specific screens.

If a non-predictive concern is found, additional screening, behavioral counseling, or referral to a community program may be appropriate.

If the parent does not write down any concerns, be sure to consider whether the parent has literacy or language barriers before assuming the parent has no concerns.

Denver II

A test for screening cognitive and behavioral problems in preschool children.

Enables the clinician to identify children whose development deviates significantly from that of other children warranting further investigation to determine if there exists a problem requiring treatment.

In 2006, the American Academy of Pediatrics Council on Children with Disabilities; Section of Developmental Behavioral Pediatrics published a list of screening test for clinicians to consider when selecting a test to use in their practice. This list includes DENVER II among its choices. Most recently, the Denver II has fallen out of favor with early childhood organizations.