1. Who are we missing? Early Developmental & Behavioural Screening Shirley V. Leew, PhD Pediatric Rehabilitation Clinical Research Scientist Decision Support Research Team Calgary Health Region

2. Why is this research important? Present methods of early screening miss between 70 - 80% of the 16% of children who have developmental &/or behavioural disabilities. –We need reliable and usable ways to identify all young children who are at risk Mild to moderate Possibly to ameliorate future disability.

3. Who are most at risk? Children of mothers with history of poor mental health (including depression) Children living in poverty Children of mothers with poor social supports Children of young mothers Children of single mothers Children of mothers with less than high school education Who are not being referred early? Children who don’t regularly see a developmental pediatrician or a family doctor Children in good general health Children with no ear infections before 2 years of age Girls First born or only child Children born at term

4. Enhancing screening for developmental &/or behavioural problems Maternal mental health characteristics: –Infant – mother social interactions influence development –short and long term consequences for an infant’s cognitive, social and emotional development

5. ‘ Early identification of developmental risk associated with maternal mental well-being revealed in early screening’

6. Cuddles Research Questions 1) What is the rate of identification of developmental concerns in infants when using a standardized, online, screening measure in a community health clinic at 6 month, 12 month, and 18 month well-child visits? 2) What is the relationship between maternal self- reported depression and developmental screening outcomes at 6 month, 12 month and 18 month well- child visits? 3) What is the relationship between maternal self- reported anxiety and developmental screening outcomes at 6, 12, and 18 month well-child visits?

7. Methods Recruitment screening at 6 month well child visits 2 CHC in Calgary 200 participants per clinic Re-screening at 12 and 18 month well child visits Measures –The Parental Evaluation of Developmental Status (PEDS) Computer/online administered –Edinburgh Postpartum Depression Scale –STAI-Y (State-Trait Anxiety Inventory, form Y) –Brigance Parent-Child Interaction Scale –Demographic questionnaire

8. Planned Analyses Descriptions of prevalence and proportions of risk –means and ratios Relationships between maternal mental health and developmental/behavioural risk: –Stepwise regression analyses dependent variable: –numerical value assigned to PEDS paths independent variables: –EPDS, STAI-Y Relationship between infant-mother social interactions and maternal mental health –Regression analyses DV: maternal mental health IV: Brigance Relationship between mother-child interactions and developmental risk –Regression analyses DV: PEDS Path IV: Brigance

9. Cuddles Progress Acadia CHC –Piloting is completed –Screening has started NW CHC –Recruitment posters are in the community Recruitment screening will begin Feb1,2008

10. Anticipated Impact Rate of identification of developmental &/or behavioural risk/disabilities of children < 2yrs in Calgary will increase: –including children with symptomatic (high) and asymptomatic (low – moderate) risk Primary health care providers will develop trust in early screening processes –Screening as education –Partnerships with community providers Mothers with history of poor mental health will get parenting guidance that will impact development/behaviour for their children.