1. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Developmental Screening, Referral and Services in Health Care Setting

2. SERIES: A Paradigm for Thinking about Screening creening arly Identification eferral ntake ligibility ervices

3. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Topics for today 1.How young children develop and learn and developmental problems in early childhood 2.What is developmental screening and developmental screening tools 3.Next steps after you get the screening results

4. The Children's Hospital of Philadelphia Marsha Gerdes, PhD How children learn Naturally By watching By doing Step-by-step

5. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Language development Cooing First words Two word phrase Sentences Tells stories 6 months 1 year 2 year 3 years 4-5years

6. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Cognitive development Holds and bangs rattle Puts things in container Make believe play Knows colors Counts 6 months 1 year 2 year 3 years 4-5 years

7. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Fine motor development Passes toy from hand to hand Scribbles Draws lines Draws circles Writes name 6 months 1 year 2 year 3 years 4-5 years

8. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Gross motor development Sits Walks (9-15mos) Walks up stairs Jumps Climbs well 6 months 1 year 2 years 3 years 4-5years

9. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Social development Smiles at people Plays games (peek-a- boo) Plays beside peers Has good friend Follows simple rules of a game 6 months 1 year 2 year 3 years 4-5 years

10. The Children's Hospital of Philadelphia Marsha Gerdes, PhD What is a developmental delay? Child learns new skills at a slower rate in one or more domain Some children with delays have medical or genetic disorders.

11. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Risk factors for developmental delay Prematurity Genetic disorders - Down Syndrome, 22q11.2 Medical conditions – Cerebral infarct and other condition Exposure to life stresses Undetermined

12. The Children's Hospital of Philadelphia Developmental Disabilities are common! How common? 1 in 6 children in the US had a DD from 2006-2008 = 15% of children age 3-17 yo = 10 million children Pediatrics 2011; 127:1034- 1042

13. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Help for young children with delays Early Intervention Preschools Therapies Activities at home

14. The Children's Hospital of Philadelphia Marsha Gerdes, PhD What is Early Intervention? Education and therapy for children birth to 5 years Speech therapy, physical therapy, teachers, occupational therapy Available in every state Free in Pennsylvania for everyone

15. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Early Intervention is a legal right Federal Law: Individuals with Disabilities Education Act (IDEA) 2004

16. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Pennsylvania Early Intervention program Children birth through 36 months - Services provided by ChildLink in Philadelphia - Usually at home Children 3 years to 5 years - Services provided by Elwyn in Philadelphia and IUs in counties - Usually at preschools

17. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Does Early Intervention help ? Yes! Children with EI are more likely to… Do better in school Keep up with schoolwork Graduate high school Become successful adults

18. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Developmental Screening The way we find children who have delays and get them the help that they deserve

19. The Children's Hospital of Philadelphia Marsha Gerdes, PhD AAP Policy Statement, 2006 Developmental surveillance at every well-child visit Recognize children who may be at risk of developmental delays Standardized developmental screening tests at 9, 18 and 30 month visits Specific screen for ASD at 18 & 24 month visits Pediatrics, Vol 118, July 2006, 405-420.

20. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Developmental Screening Policy Pennsylvania Medicaid/EPSDT requires that standardized tools be used at the 9, 18, 24, and 30 month well visits for complete reimbursement. Both Private insurance and Medicaid reimburses for use of a standardized tool.

21. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Developmental Screening Informal - Parents notice - Doctors notice Formal - Asking parents questions about their child - Screening can occur in pediatric offices, childcare centers, and case workers

22. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Why formal screening is important? Pediatricians miss 25% of children with developmental delays Parents often unaware that child is delayed

23. The Children's Hospital of Philadelphia Marsha Gerdes, PhD What Works: Validated Instruments 1.Professionally-administered screening tests 2.Parental concerns/questionnaires

24. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Standards for Screening Tests Standardized on national sample Proof of reliability Evidence of validity Accuracy, i.e.: Sensitivity 70-80%, Specificity 70-80%

25. The Children's Hospital of Philadelphia Marsha Gerdes, PhD For development: Ages and Stages Questionnaire-3 (ASQ-III) Parents’ evaluation of developmental status (PEDS) Survey of Well-Being of Young Children (SWYC) For Autism: Modified Checklist for Autism in Toddlers, Revised (MCHAT-R/F) Validated Instruments

26. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Ages and Stages Questionnaire 30 questions parents can answer Easy to use and score Available in Spanish Provides scores in 5 domains ( communication, fine motor, personal-social, problem solving and gross motor)

27. The Children's Hospital of Philadelphia Marsha Gerdes, PhD PEDS 10 questions parents can answer Parent state concerns and then write in what the concern is Algorithium provided for scoring Available in Spanish and many other languages

28. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Survey of Well-being of Young Children (SWYC) 10 questions parents can answer Easy to use Available in Spanish Nepali Burmese

29. The Children's Hospital of Philadelphia Marsha Gerdes, PhD A few SWYC questions How much does your child… - Pull up to standing? - Pick up food and eat it? - Run? - Name a color? - Draw shapes?

30. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Modified Checklist for Autism in Toddlers (M-CHAT R/F) 23 questions with follow up questions for failed items Just about autism Easy to use False positives can be reduced by using the follow up questions

31. The Children's Hospital of Philadelphia Marsha Gerdes, PhD M-CHAT Please fill out the following about how your child usually is. Please try to answer every question. If the behavior is rare (e.g., you've seen it once or twice), please answer as if the child does not do it. 1. Does your child enjoy being swung, bounced on your knee, etc.?Yes No 2. Does your child take an interest in other children? Yes No 3. Does your child like climbing on things, such as up stairs? Yes No 4. Does your child enjoy playing peek-a-boo/hide-and-seek? Yes No 5. Does your child ever pretend, for example, to talk on the phone or take care of dolls, or pretend other things?Yes No 6. Does your child ever use his/her index finger to point, to ask for something? Yes No 7. Does your child ever use his/her index finger to point, to indicate interest in something? Yes No 8. Can your child play properly with small toys (e.g. cars or bricks) without just mouthing, fiddling, or dropping them?Yes No 9. Does your child ever bring objects over to you (parent) to show you something? Yes No 10. Does your child look you in the eye for more than a second or two? Yes No 11-23 not listed here. ©1999 Diana Robins, Deborah Fein, &

32. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Developmental Screening at Well Child Visit Provide questionnaire to family - Prior to visit - In waiting room Score and Review results Have a conversation with the family - Understand their concerns

33. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Developmental Screening at Well Child Visit Refer to EI with strong explanation of services Refer to other supports Offer family a few activities to do at home

34. The Children's Hospital of Philadelphia Marsha Gerdes, PhD Thank You!