Developmental Screening

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The base rates or prevalence of target developmental problems (e.g., developmental delay, autism, language disorders) in your practice are critical in determining the accuracy or predictive values of developmental screening instruments in your setting. In general, the lower the prevalence of delay in a practice, the more accurate (e.g., higher sensitivity and specificity) a screening method needs to be in order to limit the number of false-positive and false-negative results.

How can you identify the base rates of target developmental problems in your practice setting? Clinic records of rates of diagnoses of developmental problems in your practice are one way to identify base rates. However, unless you are routinely screening every child, this may underestimate the true prevalence of developmental problems in your practice. Another way is to estimate the level of biologic/environmental risk for developmental problems experienced by children seen in your practice. The following table can help you determine the level of risk for the prevalence of developmental problems in your practice.

Biologic and Environmental Risk

Lower riskIntermediate RiskHigher risk
  • Regular well-child care
  • Full-term birth
  • Maternal prenatal care
  • Normal birthweight
  • Normal growth
  • Adequate financial resources
  • Healthy parent
  • Two-parent family
  • Family history of developmental problems
  • Intermittent well-child care
  • Intermittent maternal prenatal care
  • Prenatal tobacco exposure
  • Feeding/growth problem
  • Multiple caregivers
  • Stressed parent
  • Single-parent family
  • Infrequent well-child care. No maternal, paternal care
  • Premature birth
  • Prenatal exposure to drugs/alcohol
  • Low birthweight
  • Genetic disorder
  • Chronic illness
  • Feeding/growth disorder
  • Poverty
  • Foster care
  • International adoption
  • Parental depression, mental illness, or substance abuse
  • Exposure to lead, toxins
  • Teen parent
  • Family history of developmental problems

Back to Part I: Defining Your Practice's Screening Needs

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