L. Sices, Developmental Screening in Primary Care: The Effectiveness of Current Practice and Recommendations for Improvement, The Commonwealth Fund, December 2007
Developmental delays and conditions are common in early childhood, affecting at least 10 percent of children. Early developmental delays are markers for later developmental conditions such as autism, intellectual disability, hearing or vision impairment, cerebral palsy, speech and language disorders, and learning disabilities. Risk factors such as family poverty, parents' mental illness, and child neglect and abuse increase the likelihood of developmental delays.
Recent studies emphasize the importance of the interaction of brain development and environment on children's developmental and behavioral outcomes. The tremendous adaptability of the brain in the first three years of life means that early treatment of delays leads to improved outcomes, whereas later intervention is less effective. In order to provide treatment to improve children's outcomes, early identification of delays and sensory impairments (i.e., vision and hearing problems) is critical.
Pediatricians and other primary care medical providers who see children for regularly scheduled preventive care visits during their first three years of life, and who are trained in child development, could play a key role in the early identification of developmental delays. For this report, a literature review was conducted to determine the effectiveness of current efforts by primary care providers to detect developmental delays in early childhood and to consider ways to improve.
According to the literature review, early developmental delays are often not identified in a timely way. Many children are not identified until kindergarten entry or later—well beyond the period in which early intervention is most effective. Therefore, in many cases, opportunities to intervene early to improve children's developmental outcomes are missed.
To monitor children's development, pediatricians and other primary care medical providers rely mainly on informal developmental milestones and their clinical impressions. Validated developmental screening tools that could increase identification of developmental delays exist, but most physicians do not use them systematically to screen all patients. Recently revised guidelines from the American Academy of Pediatrics recommend routine screening at three specific ages in early childhood, and may lead to the increased use of screening tools.
Given the prevalence and impact of developmental conditions in childhood, the number of scientific studies in this area is surprisingly limited.
The following steps could promote early identification of developmental delays inyoung children:
Systematic developmental screening will mean that greater numbers of children with developmental delays are identified. Planning and resource allocation at the state and federal levels are needed to ensure sufficient resources for their evaluation and treatment.