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Developmental and behavioral screening tests in primary care

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


It is estimated that 16 percent of children 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 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 [3]. 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 [5]. 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 [9].

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 [6].

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Literature review current through: Nov 2017. | This topic last updated: Feb 06, 2017.
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  1. Newacheck PW, Strickland B, Shonkoff JP, et al. An epidemiologic profile of children with special health care needs. Pediatrics 1998; 102:117.
  2. Palfrey JS, Singer JD, Walker DK, Butler JA. Early identification of children's special needs: a study in five metropolitan communities. J Pediatr 1987; 111:651.
  3. Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, 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.
  4. Noritz GH, Murphy NA, Neuromotor Screening Expert Panel. Motor delays: early identification and evaluation. Pediatrics 2013; 131:e2016.
  5. Marks KP, LaRosa AC. Understanding developmental-behavioral screening measures. Pediatr Rev 2012; 33:448.
  6. Squires J, Nickel RE, Eisert D. Early detection of developmental problems: strategies for monitoring young children in the practice setting. J Dev Behav Pediatr 1996; 17:420.
  7. Lavigne JV, Binns HJ, Christoffel KK, et al. Behavioral and emotional problems among preschool children in pediatric primary care: prevalence and pediatricians' recognition. Pediatric Practice Research Group. Pediatrics 1993; 91:649.
  8. Sturner RA. Parent questionnaires: basic office equipment? J Dev Behav Pediatr 1991; 12:51.
  9. Meisels SJ, Provence S. Screening and Assessment: Guidelines for Identifying Vulnerable Children and Their Families. National Center for Clinical Infant Programs, Washington, DC 1989.
  10. Glascoe, FP. Collaborating with Parents: Using Parents' Evaluation of Developmental Status to Detect and Address Developmental and Behavioral Problems in Children, Ellsworth & Vandermeer Press, Ltd, Nashville, TN 1998.
  11. Glascoe FP. Are overreferrals on developmental screening tests really a problem? Arch Pediatr Adolesc Med 2001; 155:54.
  12. Glascoe FP, Foster EM, Wolraich ML. An economic analysis of developmental detection methods. Pediatrics 1997; 99:830.
  13. Glascoe FP. Screening for developmental and behavioral problems. Ment Retard Dev Disabil Res Rev 2005; 11:173.
  14. Dworkin PH. Detection of behavioral, developmental, and psychosocial problems in pediatric primary care practice. Curr Opin Pediatr 1993; 5:531.
  15. Technical Report on ASQ. Available at: www.brookespublishing.com/store/books/squires-asq/asq-technical.pdf (Accessed on October 17, 2011).
  16. Squires J, Bricker D, Potter L. Revision of a parent-completed development screening tool: Ages and Stages Questionnaires. J Pediatr Psychol 1997; 22:313.
  17. Yu LM, Hey E, Doyle LW, et al. Evaluation of the Ages and Stages Questionnaires in identifying children with neurosensory disability in the Magpie Trial follow-up study. Acta Paediatr 2007; 96:1803.
  18. Gollenberg AL, Lynch CD, Jackson LW, et al. Concurrent validity of the parent-completed Ages and Stages Questionnaires, 2nd Ed. with the Bayley Scales of Infant Development II in a low-risk sample. Child Care Health Dev 2010; 36:485.
  19. Limbos MM, Joyce DP. Comparison of the ASQ and PEDS in screening for developmental delay in children presenting for primary care. J Dev Behav Pediatr 2011; 32:499.
  20. Brigance Early Childhood Screens http://www.curriculumassociates.com/products/detail.aspx?Title=BrigEC-Screens3 (Accessed on December 01, 2016).
  21. Wetherby AM, Prizant BM. Communication and symbolic behavior scales: Developmental profile, Paul H. Brookes Publishing Company, Baltimore, MD 2002.
  22. Eadie PA, Ukoumunne O, Skeat J, et al. Assessing early communication behaviours: structure and validity of the Communication and Symbolic Behaviour Scales-Developmental Profile (CSBS-DP) in 12-month-old infants. Int J Lang Commun Disord 2010; 45:572.
  23. Pierce K, Carter C, Weinfeld M, et al. Detecting, studying, and treating autism early: the one-year well-baby check-up approach. J Pediatr 2011; 159:458.
  24. Wetherby AM, Brosnan-Maddox S, Peace V, Newton L. Validation of the Infant-Toddler Checklist as a broadband screener for autism spectrum disorders from 9 to 24 months of age. Autism 2008; 12:487.
  25. PEDStest.com. Tools for Developmental-Behavioral Screening and Surveillance www.pedstest.com (Accessed on December 05, 2013).
  26. Glascoe FP. Early detection of developmental and behavioral problems. Pediatr Rev 2000; 21:272.
  27. Kiing JS, Low PS, Chan YH, Neihart M. Interpreting parents' concerns about their children's development with the Parents Evaluation of Developmental Status: culture matters. J Dev Behav Pediatr 2012; 33:179.
  28. Glascoe FP. Toward a model for an evidenced-based approach to developmental/behavioral surveillance, promotion and patient education. Ambulatory Child Health 1999; 5:197.
  29. Blackman JA. Developmental screening: Infants, toddlers, and preschoolers. In: Developmental-Behavioral Pediatrics, 3rd ed, Levine MD, Carey WB, Crocker AC (Eds), WB Saunders, Philadelphia 1999. p.689.
  30. Macias MM, Saylor CF, Greer MK, et al. Infant screening: the usefulness of the Bayley Infant Neurodevelopmental Screener and the Clinical Adaptive Test/Clinical Linguistic Auditory Milestone Scale. J Dev Behav Pediatr 1998; 19:155.
  31. Brigance III Early Childhood Screens. Standardization & Validation. Research Highlights. www.casamples.com/downloads/Brig-EC-research.pdf (Accessed on May 01, 2014).
  32. Blackman JA, Cobb LS. A comparison of parents' perceptions of common behavior problems in developmentally at-risk and normal children. Child Health Care 1989; 18:108.
  33. Oberklaid F, Dworkin PH, Levine MD. Developmental-behavioral dysfunction in preschool children. Descriptive analysis of a pediatric consultative model. Am J Dis Child 1979; 133:1126.
  34. Glascoe FP. It's not what it seems. The relationship between parents' concerns and children with global delays. Clin Pediatr (Phila) 1994; 33:292.
  35. Weitzman C, Wegner L, Section on Developmental and Behavioral Pediatrics, et al. Promoting optimal development: screening for behavioral and emotional problems. Pediatrics 2015; 135:384.
  36. Stancin, T, Perrin, EC. Behavioral screening. In: The Zuckerman Parker Handbook of Developmental and Behavioral Pediatrics for Primary Care, 3rd ed, Augustyn, M, Zuckerman, B, Caronna, EB (Eds), Lippincott Williams & Wilkins, Philadelphia 2011. p.44.
  37. Brookes Publishing Co. ASE:SE-2 http://agesandstages.com/products-services/asqse-2/ (Accessed on April 15, 2016).
  38. Pearson. Brief Infant Toddler Social Emotional Assessment (BITSEA). www.pearsonclinical.com/childhood/products/100000150/brief-infant-toddler-social-emotional-assessment-bitsea.html (Accessed on December 05, 2013).
  39. Briggs-Gowan MJ, Carter AS, Irwin JR, et al. The Brief Infant-Toddler Social and Emotional Assessment: screening for social-emotional problems and delays in competence. J Pediatr Psychol 2004; 29:143.
  40. Multi-Health Systems, Inc (MHS). Conners Early Childhood. https://www.mhs.com/product.aspx?gr=edu&prod=cec&id=overview (Accessed on January 23, 2017).
  41. Conners 3rd Edition. www.mhs.com/product.aspx?gr=cli&id=overview&prod=conners3 (Accessed on May 01, 2014).
  42. Conners 3rd Edition www.pearsonclinical.com/psychology/products/100000523/conners-3rd-edition-conners-3.html (Accessed on May 01, 2014).
  43. PAR. Eyberg Child Behavior Inventory (ECBI) & Sutter-Eyberg Student Behavior Inventory-Revised (SESBI-R). www4.parinc.com/Products/Product.aspx?ProductID=ECBI (Accessed on December 05, 2013).
  44. Glascoe FP. Parents' evaluation of developmental status: how well do parents' concerns identify children with behavioral and emotional problems? Clin Pediatr (Phila) 2003; 42:133.
  45. Pediatric Symptom Checklist (PSC) www.massgeneral.org/psychiatry/services/psc_home.aspx (Accessed on December 05, 2013).
  46. Jellinek MS, Murphy JM. The recognition of psychosocial disorders in pediatric office practice: the current status of the pediatric symptom checklist. J Dev Behav Pediatr 1990; 11:273.
  47. Murphy JM, Reede J, Jellinek MS, Bishop SJ. Screening for psychosocial dysfunction in inner-city children: further validation of the Pediatric Symptom checklist. J Am Acad Child Adolesc Psychiatry 1992; 31:1105.
  48. Jellinek MS, Murphy JM, Robinson J, et al. Pediatric Symptom Checklist: screening school-age children for psychosocial dysfunction. J Pediatr 1988; 112:201.
  49. Jellinek MS, Murphy JM, Burns BJ. Brief psychosocial screening in outpatient pediatric practice. J Pediatr 1986; 109:371.
  50. Walker WO Jr, LaGrone RG, Atkinson AW. Psychosocial screening in pediatric practice: identifying high-risk children. J Dev Behav Pediatr 1989; 10:134.
  51. Johnson CP, Myers SM, American Academy of Pediatrics Council on Children With Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics 2007; 120:1183.
  52. Modified Checklist for Autism in Toddlers, Revised with Follow-Up. Modified Checklist for Autism in Toddlers, Revised with Follow-Up. (Accessed on February 06, 2017).
  53. Robins DL, Casagrande K, Barton M, et al. Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics 2014; 133:37.
  54. Wolraich ML, Lambert W, Doffing MA, et al. Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. J Pediatr Psychol 2003; 28:559.