Developmental Screening (page 3)
What is developmental screening?
Developmental screening is a procedure designed to identify children who should receive more intensive assessment or diagnosis, for potential developmental delays. It can allow for earlier detection of delays and improve child health and well-being for identified children.
Why is developmental screening important?
Many children with behavioral or developmental disabilities are missing vital opportunities for early detection and intervention.
Many children with developmental delays are not being identified early.
In the United States, 17% of children have a developmental or behavioral disability such as autism, mental retardation, and Attention-Deficit/Hyperactivity Disorder. In addition, many children have delays in language or other areas, which also impact school readiness. However, less than 50% of these children are identified as having a problem before starting school, by which time significant delays may have already occurred and opportunities for treatment have been missed.
Early identification and intervention for children with developmental
delays is mandated
The Individuals with Disabilities Education Act (IDEA) Amendments of 1990 to 1997 require states to provide early identification and provision of services to infants and toddlers with 1) developmental delays, 2) established conditions that are associated with developmental delays, and, 3) at the state’s option, children at risk for developmental delays. States that do not serve the at-risk population are encouraged to track and monitor these children’s development, so that they may be referred in the future if needed. IDEA also mandates that states refer children, free of charge, for a comprehensive, multidisciplinary evaluation by a team who, with the family, decides on which services are needed for the child (via the Individualized Family Service Plan). Furthermore, it mandates states to implement coordinated, family-centered, and culturally competent community-based systems of care, to provide early intervention services for children identified with developmental problems. The National Early Childhood Technical Assistance Center, lists early intervention programs by state and provides their contact information for interested parents and professionals.
Parents are interested in knowing more about their child’s development
and pediatric practitioners need to be better prepared for this.
Recent surveys indicate that parents want information and guidance from their health care provider about their child’s development. However, studies sponsored by the American Academy of Pediatrics show that about 65% of pediatricians feel inadequately trained in assessing children’s developmental status.
Who provides developmental screening services?
Developmental screening can be done by various professionals in healthcare, community, or school settings. The role of health professionals has become particularly important, because of the greater emphasis placed on early identification of children with delays. Through well-child visits, health professionals have regular contact with children 0 to 3 years-of-age, allowing them an opportunity to monitor development through periodic developmental screening. This has led healthcare professional organizations, such as the American Academy of Pediatrics (AAP) and the American Academy of Neurology, to recommend that all infants and young children be screened for developmental delays periodically in the context of office-based primary care.
Today, a number of good screening tools are available designed for a variety of settings, ages, and purposes.
Milestones which may be used as part of developmental screening
0 to 1 years— infants (link already on our website)
1 to 2 years—toddlers (link already on our website)
2 to 3 years—toddlers (link already on our website)
3 to 5 years—preschoolers (link already on our website)
Barriers to integrating developmental screening into pediatric practice
Barriers to developmental assessment [PDF document]
AAP findings from recent Periodic Survey of the Fellows, which include information on barriers to developmental screening
(When reviewing the results of these surveys it is important to note that the response rate of most of them is about 60%)
State and national efforts
Significant efforts (for example, by the American Academy of Pediatrics Committee on Children with Disabilities, the Commonwealth Fund, or the Department of Education) have been made, over an extended period of time, to address the issue of developmental screening. This has allowed for the implementation of several national and multistate programs. However, there are currently no national datasets that track this practice and how it is integrated into primary care. There are a few datasets that are particularly relevant to developmental screening and there are several that cover related topics.
Notes from Working Group on Developmental Screening
The National Center on Birth Defects and Developmental Disabilities, CDC, invited experts in the field of developmental screening and some key stakeholders, to determine how CDC can best contribute to the goal of promoting optimal child development within public and private health systems. The focus of the meeting was on creating a change in the way general pediatricians address and manage the developmental needs of children. Meeting Notes
References to some relevant articles
Committee on Children and Disabilities, American Academy of Pediatrics. Developmental surveillance and screening for infants and young children. 2001;108(1):192-6.
Boyle CA, Decoufle P, Yeargin-Allsopp M. Prevalence and health impact of developmental disabilities in US children. Pediatrics 1994;93(3):399-403.
Dawson G, Osterling J. Early intervention in autism. In: Guralnick MJ, editor. The effectiveness of early intervention. Baltimore (MD): Paul H. Brookes; 1997.
Glascoe, FP. Early detection of developmental and behavioral problems. Pediatrics in Review 2000; 21(8):272-280.
Halfon N, Hochstein M, Sareen H, O'Connor KG, Inkelas M, Olson LM. Pediatric Academic Societies periodic survey of fellow: barriers to the provision of developmental assessments during pediatric health supervision [abstract]. 2001 May. Available from URL: http://www.aap.org/research/ps46pas4.htm.
Lavigne JV, Binns HJ, Christoffel KK, Rosenbaum D, Arend R, Smith K, Hayford JR, Mc Guire PA, Pediatric Practice Research Group. Behavioral and emotional problems among preschool children in pediatric primary care: prevalence and pediatricians' recognition. Pediatric Practice Research Group. Pediatrics 1993;91(3):649-55.
National Research Council, Committee on Educational Interventions for Children with Autism, Division of Behavioral and Social Sciences and Education. Educating children with autism. Washington, DC: National Academy Press; 2001.
Regalado M, Halfon N. Primary care services promoting optimal child development from birth to age 3 years. Archives of Pediatrics and Adolescent Medicine 2001;155:1311-1322.
Centers for Disease Control and Prevention content is free and public domain.
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