Developmental and behavioral screening tests in primary care
- Angela LaRosa, MD
Angela LaRosa, MD
- Associate Professor
- Medical University of South Carolina
It is estimated that 16 percent of children have a developmental and/or behavioral disorder . However, only 30 percent are identified before school entrance . Children who are detected after school entrance miss the opportunity to participate in early interventions services.
To improve the early identification of children with developmental disability, the American Academy of Pediatrics (AAP) recommends that all infants and young children be screened for developmental delays [3,4]. They recommend performing developmental surveillance at every well-child visit and using formal, standardized screening tools both at select age intervals (9, 18, and 24 or 30 months) and whenever developmental concerns are raised by the parent or provider during surveillance. In addition to the use of a general developmental screening tool, an autism-specific tool should be administered to all children at 18 or 24 months. Developmental screening and surveillance in the preschool- and school-age child were not addressed in the AAP policy statement . The author of this topic review recommends developmental-behavioral screening at the three-year well-child visit and annually thereafter. Screening tools that may be used for children older than three years are listed in the tables (table 1A-C).
Selected screening measures that are brief, accurate, and easy to administer and score are available to assist primary care providers in the early detection of developmental and behavioral disorders . These measures will be discussed below, after a brief overview of desirable qualities of screening tests. The process and outcome of developmental surveillance and screening are discussed separately. (See "Developmental-behavioral surveillance and screening in primary care".)
Screening is defined as a brief, formal, standardized evaluation, the purpose of which is the early identification of patients with unsuspected deviations from normal. A screening instrument enables detection of conditions/concerns that may not be readily apparent without screening. As an example, the rates of detection of developmental delay and mental health problems increase from approximately 20 to 30 percent to 70 to 90 percent with the use of formal screening tools [2,6-8]. Screening does not provide a diagnosis; it helps to determine whether additional investigation (eg, a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary .
It is a common misconception that screening tests are too difficult or too long to administer. Several validated developmental and behavioral screening instruments that are easily and briefly administered are discussed below. The ideal screening test should have established psychometric qualities (ie, validity, reliability, accuracy), be easy to perform and interpret, inexpensive, and acceptable to the child and parents .
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