The American Academy of Pediatrics' Committee on Children with Disabilities states that all infants and young children should be screened for developmental delays. The process of developmental surveillance includes eliciting and attending to parental concerns, obtaining a relevant developmental history, making accurate and informative observations of children, and sharing opinions and concerns with other relevant professionals. Developmental screenings are brief, structured tests to identify children who require further in-depth examination. Risk factors for developmental, behavioral, and social-emotional problems include poverty, maternal depression, domestic violence, and substance abuse. Routinely and periodically asking parents about these issues invites non-stigmatizing discussion and support, and gives the message that any visit to the primary care provider is an appropriate time in which to bring up these issues. However, implementing screening does not mean that every primary care physician needs to become expert in developmental and behavioral evaluation. Infants and children who are identified as "at risk" should be referred for assessment by professionals who can determine whether a delay or disability exists, and assist the family with intervention decisions.
The use of screening has often been limited due to the perception that it takes too long, that tools are difficult to administer, and that reimbursement is limited or nonexistent. Additionally, it has been thought that an infant or toddler is not likely to perform on demand when not in her/his natural environment. However, there are several newer tools that are completed by parents that are brief and accurate and meet the desired sensitivity and specificity (70 to 80 percent). These tools include the Ages & Stages Questionnaire (ASQ), the Infant Developmental Inventory (IDI), and the Parents Evaluation of Developmental Status (PEDS). An informal checklist should not be used in lieu of screening tool as such checklists have no validated criteria for referral. This module provides clinicians with advice on how to choose and administer a tool and offers efficient strategies for implementing developmental surveillance into their own practices. It includes the following materials:
In the Practioner's Own Words
Dr. Clark was skeptical of the push to increase screening efforts for developmental and psychosocial problems. Her response was: "I don't feel that I really miss much in terms of developmental delay." However, when screenings were instituted in Dr. Clark's practice, the whole tenor of the visit changed. Rather than questions about lumps behind the ears or immunization reactions, parents began asking different types of questions—regarding behavior, literacy, childcare centers, and early childhood education programs. "It brought the developmental needs of the children back into the center of the conversation between the parents and the provider," she said. "Now I feel that the well-child visit is focusing time and attention on the issues that most seriously impact the future of our children."
—Francis Rushton, M.D., FAAP