Screening & Monitoring
Routine developmental screening of young children is recommended by the American Academy of Pediatrics (AAP) and is fully described in the 2006 Policy Statement titled Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening. The use of evidence based developmental screening tools is also encouraged by the American Academy of Family Physicians and is included in the curriculum recommendations for Family Practice residents in the care of Infants and Children.
"When should I screen my patients?"
The AAP recommends that routine developmental screening be conducted at least three times before a child’s third birthday and provides an algorithm that includes developmental screening at 9, 18 and 24 to 30 months. In addition, all children should be screened specifically for Autism Spectrum Disorder at 18 or 24 months. Furthermore, the policy recommends the use of an evidence based screening tool anytime the parent or physician has any developmental concerns.
“I already do developmental surveillance. Why add a tool?”
Currently, the AAP (2006) policy recommends developmental screening as best practice and it has been shown statistically that without developmental screening, about 70% of children who may be eligible for early intervention ( EI) or early childhood special education ( ECSE) services are missed because their delays are mild or moderate. Developmental surveillance alone is not enough to accurately identify those children who have moderate delays and might be eligible for EI or ECSE services. In California, for example, children under the age of 3 are eligible to receive services if they have a 33.3% delay in any area. It is unrealistic to expect any physician to visually discriminate between a 30% or 40% delay for a child based on their age, which is why valid and reliable screening tools are recommended.
“What screening tools are recommended?”
There are two parent-completed screening tools widely used in clinics and medical practices to assess for multiple areas of development: The Ages and Stages Questionnaires-3 © (ASQ-3) and the Parental Evaluation of Developmental Status © (PEDS). In addition, the Ages and Stages Questionnaires: Social Emotional-2 © (ASQ:SE-2) can screen children in the domain of social emotional development and behavior. The Modified Checklist for Autism in Toddlers, Revised with Follow Up (M-CHAT R/F) is designed to identify children who should receive a more thorough assessment for possible early signs of ASD specifically. These parent completed questionnaires are valid and reliable and are used to identify children who are typically developing from those who are at risk for developmental delay.
“What can I do with screening results once I've discussed them with the cargivers(s)?“
Children who score at risk should be referred to additional developmental support and/or further evaluation. In addition, developmental and behavioral screening data can be entered and viewed on an online database called the OC Children’s Screening Registry. This free database enables primary health care providers and community-based providers to share screening results and information on referrals and outcomes. Access to the OC Children’s Screening Registry will be given to practices who have signed the OC Children’s Screening Registry “Application Packet“ document with their organization.
“What if I prefer not to do developmental screening in my office?”
Any practice not doing routine in-office developmental screening with an evidence based tool can: (1) refer their patients to Help Me Grow, Orange County to help connect to a program or agency that will offer the service at no cost to you or your patient, or (2) direct their patients to visit http://helpmegrowoc.org/on-track-oc.html to complete a free developmental screening. If you would like to learn more about how Help Me Grow, OC can help you refer your patients for developmental screening or to an array of community based programs please schedule a Health Care Provider Outreach visit. In addition, Help Me Grow OC, as part of the CHOC Children’s Hospital Population Health Division, has partnered with the Quality Improvement Advisor Team (QIAs) at CHOC. QIAs can support your developmental screening efforts by helping you implement processes to enhance your work flow and reduce the challenges associated with the screening process. To be linked with your QIA, please email Jessica Lopez at firstname.lastname@example.org.