Developmental Surveillance and Screening

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Developmental Surveillance and Screening

• Paul H. Lipkin, MD
• D-PIP Training Workshop
• June 16, 2006

I have no relevant financial relationships with
the manufacturer(s) of any commercial product(s)
and/or provider of commercial services discussed
in this CME activity.
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Domains of Development

• Motor
• Gross motor
• Fine motor
• Adaptive
• Communication
• Speech
• Language
• Expressive
• Receptive
• Social pragmatics

• Social-emotional
• Blend of fine motor, adaptive, communication,
  cognition
• Cognition
• Language
• Visual-motor/ problem solving

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Definitions Developmental surveillance

• A flexible, longitudinal, continuous, and
  cumulative process whereby knowledgeable health
  care professionals identify children who may have
  developmental problems (AAP 2006)
• Longitudinal
• Continuous
• Cumulative

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Definitions Developmental screening

• The administration of a brief standardized tool
  aiding the identification of children at risk of
  a developmental disorder (AAP 2006)
• Brief
• Standardized
• Identification of risk
• NOT DIAGNOSTIC

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Developmental Surveillance
Developmental Screening
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Definitions Developmental evaluation

• Aimed at identifying the specific developmental
  disorder or disorders affecting the child (AAP
  2006)
• Synonym Developmental Assessment
• Completed in children who do not pass
  developmental screening
• Coupled with medical evaluation
• Diagnostic

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Developmental Surveillance and Screening AAP
Policy Statement 2006

• Identifying Infants and Young Children with
  Developmental Disorders in the Medical Home An
  Algorithm for Developmental Surveillance and
  Screening

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Developmental SurveillanceAAP 2006

• Surveillance can be useful for determining
  appropriate referrals, providing patient
  education and family-centered care in support of
  healthy development, and monitoring the effects
  of developmental health promotion through early
  intervention and therapy

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Components of Surveillance- IAAP 2006

• Eliciting and attending to the parents concerns
  about their childs development
• Do you have any concerns about your childs
  development? Behavior? Learning?
• Documenting and maintaining a developmental
  history
• What changes have you seen in your childs
  development since our last visit?
• Age-specific queries, such as whether the child
  is walking or pointing

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Components of Surveillance- IIAAP 2006

• Making accurate observations of the child
• A careful physical and developmental examination
  within the context of the preventive care visit
• Observation of the parent-child interaction
• Identifying risk and protective factors
• Environmental, genetic, biologic, social, and
  demographic factors
• Children with established risk factors may be
  referred directly for evaluation or more frequent
  developmental surveillance
• Identify protective factors

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Components of Surveillance- IIIAAP 2006

• Maintaining an accurate record of documenting the
  process and findings
• Document all surveillance and screening
  activities during preventive care visits
• Document specific actions taken or planned
• Scheduling an earlier follow-up visit
• Scheduling a visit to discuss developmental
  concerns more fully
• Referrals to medical specialists or early
  childhood programs and specialists
• Developmental growth chart

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Developmental Screening

• Cross sectional analysis
• Tests administered to whole population to
  identify those not meeting standard expectations
  of development
• Results of periodic screens must be interpreted
  within the context of the practitioners
  knowledge of environment, social, biological and
  historical risks to the individual child

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Developmental ScreeningAAP 2006

• All children, most of whom will not have
  identifiable risks or whose development appears
  to be proceeding typically, should receive
  periodic developmental screening using a
  standardized test

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Developmental ScreeningAAP 2006

• In the absence of established risk factors or
  parental or provider concerns
• 9 months
• 18 months
• 30-months

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Developmental Screening The Asterisk AAP 2006

• Because the 30-month visit is not yet a part of
  the preventive care system and is often not
  reimbursable by third-party payers at this time,
  developmental screening can be performed at 24
  months of age
• In addition, because the frequency of regular
  pediatric visits decreases after 24 months of
  age, a pediatrician who expects that his or her
  patients will have difficulty attending a
  30-month visit should conduct screening during
  the 24-month visit.

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Choosing an testKey screening instrument
qualities

• Reliability The ability of a measure to produce
  consistent results
• Validity The ability to discriminate between a
  child at a determined level of risk for delay
  from the rest of the population
• Sensitivity The accuracy of the test in
  identifying delayed development
• Specificity The accuracy of the test in
  identifying individuals who are not delayed
• If a test incorrectly identifies a child as
  delayed, this practice will result in
  over-referrals
• If a test incorrectly identifies a child as
  normal, this practice results in under-referrals

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Developmental Screening Instruments General

• Ages and Stages Questionnaire
• Battelle Developmental Inventory (BDI) Screening
  Test
• Bayley Infant Neurodevelopmental Screener (BINS)
• Brigance Screens-II
• Infant Development Inventory
• Child Development Review
• Child Development Inventory (CDI)
• Denver-II Developmental Screening Test
• Parents' Evaluation of Developmental Status (PEDS)

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Developmental Screening Instruments
Domain-specific

• Gross motor
• Early Motor Pattern Profile (EMPP)
• Motor Quotient (MQ)
• Communication/Cognition
• Capute Scales (aka Cognitive Adaptive
  Test/Clinical Linguistic Auditory Milestone
  Scale-CAT/CLAMS)
• Communication and Symbolic Behavior Scales-
  Developmental Profile (CSBS-DP) Infant Toddler
  Checklist
• Early Language Milestone Scale (ELMS -2)

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Developmental Screening Instruments
Disorder-specific

• Autism and pervasive developmental disorders
  Perform at 18 month visit
• Autism Behavior Checklist (ABC)
• Checklist for Autism in Toddlers (CHAT)
• Modified Checklist for Autism in Toddlers
  (M-CHAT)
• Modified Checklist for Autism in Toddlers-23
  (CHAT-23)
• Pervasive Developmental Disorders Screening
  Test-II (PDDST-II) - Stage 1-Primary Care
  Screener
• Pervasive Developmental Disorders Screening
  Test-II (PDDST-II) - Stage 2-Developmental Clinic
  Screener
• Screening Tool for Autism in Two-Year-Olds (STAT)
• Social Communication Questionnaire (SCQ)
  (formerly Autism Screening Questionnaire-ASQ)

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Developmental Screening Principles (AAP 2006)

• When the results are normal
• Inform the parents and continue with other
  aspects of the preventive visit
• Provide an opportunity to focus on developmental
  promotion
• When administered due to concerns
• Schedule early return visit for additional
  surveillance, even if the screening tool results
  do not indicate a risk of delay
• When results are concerning
• Schedule developmental evaluations
• Schedule medical evaluations

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Surveillance and Screening Guidelines AAP 2006

• the bottom line

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Surveillance and Screening Guidelines AAP 2006

• Perform developmental surveillance at every
  well-child visit
• Perform developmental screening using a
  standardized screening tool at 9, 18, and 30
  months or when concern is expressed
• If screening results are concerning, refer to
  developmental and medical evaluations and early
  intervention services
• Follow up on referrals made and continually track
  childs developmental status

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