Developmental Screening in Primary Care: The Effectiveness of Current Practice and Recommendations for Improvement

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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.

Key Findings

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.

Recommendations

The following steps could promote early identification of developmental delays inyoung children:

  • Research is needed to: 1) elucidate the reasons for the gap between the prevalence of developmental conditions and their identification in early childhood; 2) document the effectiveness of physicians' developmental monitoring and screening efforts over time, as policies to encourage developmental screening are implemented; and 3) understand and address any negative consequences of developmental screening, such as increasing parental anxiety.
  • Financial, educational, and other barriers to the use of developmental screening tools need to be addressed to increase physicians' use of these tools. Residents in pediatrics and family medicine need to be trained to use developmental screening tools as part of the routine care of pediatric patients, to ensure that the next generation of providers is ready to use developmental screening tools.
  • Resources are needed to develop high-quality screening tools that are available in the public domain and are compatible with electronic medical records.
  • Communication models need to be developed to assist physicians in discussing with families the implications of developmental screening test results.
  • Adding a 30–month preventive care visit to the well-child visit schedule, as recommended by organizations such as Bright Futures, would increase the number of opportunities to provide developmental screening and identify developmental delays at a critical time in young children's development.
  • Successful models to promote developmental screening, such as the Assuring Better Child Health and Development (ABCD) program in North Carolina, need to be spread to other states. This is already occurring through the ABCD Screening Academy, jointly sponsored by National Academy for State Health Policy and The Commonwealth Fund.

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.

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Publication Details

Publication Date:
December 1, 2007
Authors:
Laura Sices
Citation:

L. Sices, Developmental Screening in Primary Care: The Effectiveness of Current Practice and Recommendations for Improvement, The Commonwealth Fund, December 2007


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