Developmental Screening Tools: What they are and do they work

1. Developmental Screening Tools: What they are and do they work Alison Schonwald MD Children’s Hospital, Boston Harvard Medical School Massachusetts Developmental Disabilities Council Maternal Child Health Bureau

2. Developmental/behavioral disorders are common! • 12-18% U.S. children have a developmental or behavioral disorder • Speech and language impairments • Mental retardation, learning disorders • Emotional/behavioral disturbance Glascoe, 2000 AAP Policy Statement, Pediatrics, 2001

3. Federal Law: Individuals with Disabilities Education Act (IDEA) Amendments of 1997, 2004 • Mandates early identification of and intervention for developmental disabilities

4. AAP Statement, 2006 • Developmental surveillance at every well-child visit • Recognizing children who may be at risk of developmental delays • Standardized developmental screening tests at 9-, 18-, and 30-month visits • To identify and refine that risk Pediatrics, Vol 118, July 2006, 405-420.

5. AAP Policy Statement, 2006 • Regular and repeated screening with a validated instrument • To detect a problem not identified with a single screen or surveillance • Waiting until a child misses a developmental milestone may result in later recognition

6. Pediatrician Surveys • 1998: 50% report routine developmental screening in WCC (Minkovitz, J of Urban Health,1998) • 2002: 23% (almost) always use a standardized screening instrument, usually DDST (Sand, Pediatrics, 2005)

7. The Data • Only 30-40% of parents volunteer concerns without prompting Glascoe, Pediatrics, 1995 • 57% of parents report child’s development was ever assessed in a pediatric visit Halfon, Pediatrics, 2004 • Low identification rate <30% identified by clinician judgment Palfrey, 1987

8. Parent Perceptions • Parents who report receiving developmental assessments are • More likely to report other anticipatory guidance (Reading, toilet training, discipline) • More satisfied with pediatric care Halfon, Pediatrics, 2004

9. Perceived barriers

10. We can do something! • Early Intervention limits long-term morbidity • Higher HS graduation rates • Less grade retention • Less criminality (Reynolds, JAMA, 2001)

11. Informal assessments don’t work • Review milestones • Clinical judgment/gestalt • Check lists in the chart

12. What Works Validated Instruments • Professionally-administered screening tests • Parental concerns/questionnaires

13. Utility of parent report measures • Eliminate the need for child cooperation • Data gathering while waiting • Sensitivity of parent observations • Several studies show parent report of current skills is predictive of developmental delay Bricker, Topics in Early Childhood Spec Ed, 1989 Diamond, Topics in Early Childhood Spec Ed, 1993 Doig, J Pediatrics, 1999

14. Summary • Developmental screening with validated tools is necessary and mandated • Reasonable and studied tools finally exist • Despite the obstacles, it can be integrated into practice to improve care