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Developmental-behavioral surveillance and screening in primary care

Angela LaRosa, MD
Section Editor
Carolyn Bridgemohan, MD
Deputy Editor
Mary M Torchia, MD


This topic review discusses the rationale for, challenges of, and components of developmental-behavioral screening and surveillance in the primary care setting. Detailed descriptions of developmental-behavioral screening tests and screening for autism spectrum disorders are discussed separately. (See "Developmental and behavioral screening tests in primary care" and "Autism spectrum disorder: Surveillance and screening in primary care" and "Autism spectrum disorder: Screening tools".)


Development is a broad term that encompasses language, cognitive, and motor, as well as behavioral, social-emotional, and mental health domains (table 1).

It is estimated that 17 percent of children (0 to 18 years) have a developmental and/or behavioral disorder [1]. However, only 30 percent are identified before school entrance [2]. Children who are detected after school entrance miss the opportunity to participate in early developmental intervention/early childhood services, which are associated with long-term benefits [3-10].

Milestones checklists within age-specific encounter forms or informal questions to parents about their concerns detect only approximately 30 percent of children with developmental delays and disabilities [2]. To increase detection, it is necessary to use validated developmental-behavioral surveillance and screening measures [11]. The use of such measures is feasible in busy clinics [12,13], aids in decision making, improves parent-provider satisfaction with clinic services, and is reimbursable.

To improve the early identification of children with developmental and behavioral problems, the American Academy of Pediatrics (AAP) recommends that all infants and young children be screened for developmental delays [11]. The AAP recommends a combination of developmental surveillance and/or screening and surveillance at all well-visits. At a minimum, standardized screening tools should be administered at the 9-month, 18-month, and 24- or 30-month visits, and if developmental concerns are raised by the parent or provider during surveillance. The AAP algorithm is available in the full text of reference [11]. The AAP policy statement on identifying developmental disorders does not address developmental screening and surveillance in children older than 30 months, but a separate clinical report recommends that behavioral screening continue through childhood and adolescence [14]. The author of this topic review recommends developmental-behavioral screening at the three-year well-child visit and annually thereafter. Developmental screening tools for children between three and eight years of age are discussed separately (see "Developmental and behavioral screening tests in primary care", section on 'Developmental screening tests'). After age eight, annual psychosocial screens (eg, Pediatric Symptom Checklist) can be administered to facilitate the identification of cognitive, emotional, and behavioral problems. (See "Developmental and behavioral screening tests in primary care".)

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Literature review current through: Nov 2017. | This topic last updated: Feb 17, 2017.
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