1. Developmental Screening Tools: What they are and do they work Alison Schonwald MD Children’s Hospital, Boston Harvard Medical School Massachusetts Developmental Disabilities Council Maternal Child Health Bureau

2. Developmental/behavioral disorders are common! 12-18% U.S. children have a developmental or behavioral disorder  Speech and language impairments  Mental retardation, learning disorders  Emotional/behavioral disturbance Glascoe, 2000 AAP Policy Statement, Pediatrics, 2001

3. Federal Law: Individuals with Disabilities Education Act (IDEA) Amendments of 1997, 2004 Mandates early identification of and intervention for developmental disabilities

4. AAP Statement, 2006 Developmental surveillance at every well-child visit –Recognizing children who may be at risk of developmental delays Standardized developmental screening tests at 9-, 18-, and 30-month visits –To identify and refine that risk Pediatrics, Vol 118, July 2006, 405-420.

5. AAP Policy Statement, 2006 Regular and repeated screening with a validated instrument –To detect a problem not identified with a single screen or surveillance –Waiting until a child misses a developmental milestone may result in later recognition

6. Pediatrician Surveys 1998: 50% report routine developmental screening in WCC (Minkovitz, J of Urban Health,1998) 2002: 23% (almost) always use a standardized screening instrument, usually DDST (Sand, Pediatrics, 2005)

7. The Data Only 30-40% of parents volunteer concerns without prompting Glascoe, Pediatrics, 1995 57% of parents report child’s development was ever assessed in a pediatric visit Halfon, Pediatrics, 2004 Low identification rate <30% identified by clinician judgment Palfrey, 1987

8. Parent Perceptions Parents who report receiving developmental assessments are –More likely to report other anticipatory guidance (Reading, toilet training, discipline) –More satisfied with pediatric care Halfon, Pediatrics, 2004

9. Perceived barriers

10. We can do something! Early Intervention limits long-term morbidity –Higher HS graduation rates –Less grade retention –Less criminality (Reynolds, JAMA, 2001)

11. Informal assessments don’t work Review milestones Clinical judgment/gestalt Check lists in the chart

12. What Works Validated Instruments 1.Professionally-administered screening tests 2.Parental concerns/questionnaires

13. Utility of parent report measures Eliminate the need for child cooperation Data gathering while waiting Sensitivity of parent observations –Several studies show parent report of current skills is predictive of developmental delay Bricker, Topics in Early Childhood Spec Ed, 1989 Diamond, Topics in Early Childhood Spec Ed, 1993 Doig, J Pediatrics, 1999

14. Summary Developmental screening with validated tools is necessary and mandated Reasonable and studied tools finally exist Despite the obstacles, it can be integrated into practice to improve care