Developmental and Behavioral Screening: Overview

Kids

A group of boys "hangs out" while waiting to see their pediatricians for a well child visit at Centennial Pediatrics, Southern Hills.


The American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care
(AAP Periodicity Schedule) http://aappolicy.aappublications.org/cgi/reprint/pediatrics;108/1/192.pdf
calls for a developmental/behavioral assessment by history and appropriate physical examination at each visit interval. If findings identify concerns, specific objective developmental or behavioral testing is needed.1

In an updated 2006 policy statement (http://www.pediatrics.org/cgi/content/full/118/1/405) the AAP recommends routine surveillance and using standardized developmental and behavioral screening at least 3 specific times:the 9, 18 and 24/30 month visits.2 The statement notes that "early identification of developmental disorder is critical to the well-being of children and families" and that this is "an integral function of the primary care medical home and an appropriate responsibility of all pediatric health care professionals." It also notes that developmental screening instruments have improved over the years and that they are accurate and easy to use in an office setting. And, good, accurate instruments are readily available to pediatricians.

Despite this recommendation, few pediatricians use standardized techniques to screen for developmental problems.3 Physicians often rely on lists of developmental milestones or prompting for parental concern or depend on clinical judgment.4 Some may administer a screening tool only after a problem is noticed.

The result of these prevailing practices is under detection. Research shows that clinical judgment detects fewer than 30% of children who have mental retardation, learning disabilities, and other developmental disabilities, and clinical judgment identifies fewer than 50% of children who have serious emotional and behavioral disturbance.5 Currently, the pediatrician sees more children with suspected Autistic Spectrum Disorder (ASD) diagnosis, and is faced with the challenge of early detection and diagnosis in order to implement a timely treatment plan.6

In 2004, TennCare's EPSDT Screening Guidelines Committee recommended that all infants and young children should be assessed for developmental delays and that all school-age children and adolescents should receive additional evaluation for emotional/behavioral problems. It stated that the use of standardized screening instruments improve the accuracy of these assessments. It recommended a list of screening tools that are both efficient and effective in primary health offices and public health centers. View List of Recommended Screening Tools (PDF)

The Tennessee Chapter of the American Academy of Pediatrics (TNAAP) offers an educational program to help pediatric care providers - including pediatricians, family physicians, nurse practitioners, nurses, and others - learn skills and strategies to implement routine developmental and behavioral screening using standardized screening tools as part of their health care procedures. This educational program called Screening Tools And Referral Training (START) was adapted with permission from the Illinois Chapter of the American Academy of Pediatrics (ICAAP).

The program is a collaboration with Tennessee's Early Intervention System (TEIS) funded by the Tennessee Department of Education via the American Recovery and Reinvestment Act (ARRA). For more information, go to TNAAP's D/B Training (START)

References

1. American Academy of Pediatrics Recommendations for Preventive Health Care (Periodicity Schedule) 2007 

2. Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee and Medical Home Initiatives for Children With Special Needs, Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics 2006; 118: 405-420.
http://www.pediatrics.org/cgi/content/full/118/1/405

3. AAP Periodic Survey of Fellows # 53, April
http://www.aap.org/research/periodicsurvey/ps53exs.htm 

4. Sices, L., Feudtner, C., McLaughlin, J., Drotar, D., Williams, M.  How do primary care physicians manage young children with developmental delays? A national survey with an experimental design. Developmental and Behavioral Pediatrics. 2003; 24:409-417.

5. Glascoe, F. Early detection of developmental and behavioral problems. Pediatrics in Review.  2000; 21(8): 272-280.

6.  American Academy of Pediatrics, Committee on Children With Disabilities. Technical Report:  The pediatrician's role in the diagnosis and management of autistic spectrum disorder in children. Pediatrics. 2001; 107(5): p.e85.
http://pediatrics.aappublications.org/cgi/reprint/107/5/1221