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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

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
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
Federal Law: Individuals with Disabilities Education Act (IDEA) Amendments of 1997, 2004
  • Mandates early identification of and intervention for developmental disabilities
aap statement 2006
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
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
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
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
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

we can do something
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
Informal assessments don’t work
  • Review milestones
  • Clinical judgment/gestalt
  • Check lists in the chart
what works
What Works

Validated Instruments

  • Professionally-administered screening tests
  • Parental concerns/questionnaires
utility of parent report measures
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
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
ad