Evidence for Using Screening
Federal legislation, through the Individuals with Disabilities Act (IDEA), Part C, mandates early identification of, and intervention for, young children with developmental disabilities through community-based systems. This legislation was implemented to:
- Enhance the development of infants and toddlers with disabilities and to minimize their potential for developmental delay;
- Reduce the educational costs to our society, including our nation's schools, by minimizing the need for special education and related services after infants and toddlers with disabilities reach school age;
- Minimize the likelihood of institutionalization of individuals with disabilities and maximize the potential for their independently living in society;
- Enhance the capacity of families to meet the special needs of their infants and toddlers with disabilities; and
- Enhance the capacity of State and local agencies and service providers to identify, evaluate, and meet the needs of historically underrepresented populations, particularly minority, low-income, inner-city, and rural populations.1
It is estimated that between 12-16% of American children have developmental or behavioral disorders.2 The earlier a disability or disorder is identified the sooner appropriate intervention can begin.
In an updated 2006 policy statement http://www.pediatrics.org/cgi/content/full/118/1/405, the AAP recommends routine surveillance and standardized developmental and behavioral screening. The statement reiterates what was said in the 2001 policy statement but also provides an algorithm as a strategy to support health care professionals in developing a pattern and practice for addressing developmental concerns in children from birth through 3 years of age. It recommends that developmental surveillance be incorporated at every well-child preventive care visit and any concerns raised during surveillance should be promptly addressed with standardized developmental screening tools. In addition, screening tools should be administered regularly at the 9, 18, and 24 or 30-month visits.3
While standardized and routine screenings are recommended, a 2003 Periodic Survey of Fellows (PS53)4 concludes that, despite the AAP’s policy and national efforts to improve developmental screening in the clinical setting, only 50% bf the participating pediatricians said they used standardized techniques to screen for developmental problems. Physicians often rely on lists of developmental milestones or prompting for parental concern5 or depend on clinical judgment. 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.6 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.7
The State of Tennessee’s EPSDT Screening Guidelines Committee in its April 2004 report recommended that all infants and young children should be assessed for developmental delays. The Committee also recommended that school-age children and adolescents receive additional evaluation for emotional/behavioral problems. They recommended the use of standardized screening tools, because these tools improve the accuracy of developmental assessments.8
Currently, there are tools available that are both efficient and effective in the pediatric office and other health care settings.
To view a list of these tools and how to obtain them click on the link: Developmental/Behavioral Screening Tools
References
1. IDEA, Part C – Infants and Toddlers with Disabilities, Section 631: Findings & Policy amended January 7, 1997. http://www.cec.sped.org/law_res/doc/law/law/index.php
2. Boyle, C., Decoufle, P., Yeargin-Allsoop, M. Prevalence and health impact of developmental disabilities. Pediatrics. 1994; 93: 863-865.
3. 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
4. Lavigne, J, Binns, H, Christoffel, K, Rosenbaum, D, Arend, R, Smith, K, Hayford, J., McGuire, P, and the Pediatric Practice Research Group. Behavioral and emotional problems among preschool children in Pediatric primary care: prevalence and pediatricians’ recognition. Pediatrics 1993; 91: 649-655. (Abstract only) http://pediatrics.aappublications.org/cgi/content/abstract/91/3/649
5. Palfry, J, Singer, J, Walker, D, Butler, J. Early identification of children’s special needs: a study in five metropolitan communities. Journal of Developmental and Behavioral Pediatrics 1994; 111: 651-655.
6. Sturner, R. Parent questionnaires: basic office equipment? Journal of Developmental and Behavioral Pediatrics 1991; 12:51-64.
7. Squires, J, Nickel, R, Eisert, D. Early detection of developmental problems: strategies for monitoring young children in the practice setting. Journal of Developmental and Behavioral Pediatrics 1996; 17: 420-427.
8. State of Tennessee: Recommendations of the EPSDT screening guidelines
committee. April, 2004.
