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Developmental Screening Tools: What they are and do they work PowerPoint PPT Presentation


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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. Developmental/behavioral disorders are common! .

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Developmental Screening Tools: What they are and do they work

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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


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


Federal Law: Individuals with Disabilities Education Act (IDEA) Amendments of 1997, 2004

  • Mandates early identification of and intervention for developmental disabilities


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.


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


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)


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


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


Perceived barriers


We can do something!

  • Early Intervention limits long-term morbidity

    • Higher HS graduation rates

    • Less grade retention

    • Less criminality

      (Reynolds, JAMA, 2001)


Informal assessments don’t work

  • Review milestones

  • Clinical judgment/gestalt

  • Check lists in the chart


What Works

Validated Instruments

  • Professionally-administered screening tests

  • Parental concerns/questionnaires


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


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


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