Translation Disclaimer

Home > For Physicians & Professionals > Screening and Prevention > Developmental Screening

Developmental Screening

What is Developmental Screening?

It is the administration of a brief standardized tool to aid in the identification of children at risk of a developmental disability. [Soreca: 2008] Concerning results from the screen should trigger further evaluation for specific developmental disabilities. Developmental screening of ALL children is recommended at the 9, 18, and 30 month well-child visits (or at 24 months if a 30 month visit is not conducted). [Hagan: 2008]

What is Developmental Surveillance?

It is a flexible, longitudinal, continuous, and cumulative process whereby health care professionals identify children who may have developmental problems. Developmental surveillance is recommended to occur at every pediatric visit. If concerns arise as a result of developmental surveillance, a developmental screening tool should be administered or, if there is sufficient concern, further evaluation undertaken for specific developmental disabilities.
How is Developmental Surveillance Different than Developmental Screening?

Developmental surveillance entails:
  1. Listening to parents' concerns
  2. Obtaining and maintaining a developmental history
  3. Observing the child during visits
  4. Identifying risk and protective factors
  5. Documenting relevant information and findings
Developmental screening entails the use of a validated, parent-completed questionnaire. Screening provides greater sensitivity and specificity than surveillance in identifying children who may have developmental delay.


Why is it Recommended to Repeat Developmental Screening at Multiple Ages?

Repeated developmental screening provides a more accurate assessment of development than a one time evaluation, and developmental screening at multiple ages allows for monitoring of developmental progress (or regression) over time.

What is the Rationale for Developmental Screening?

Developmental disabilities are common, yet many children with developmental disabilities are not identified in primary care settings and opportunities for early intervention thus lost or significantly delayed. [Palfrey: 1987] Developmental screening programs result in increased detection of developmental delays. [Earls: 2009] Participation in an Early Intervention Program improves child and family outcomes. [Berlin: 1998] [Guralnick: 1998] [Reynolds: 2001]

The use of checklists of developmental skills are ineffective because they lack the consistent scoring to trigger referrals found in validated developmental screening tools. Though developmental surveillance could occur at every visit, a variety of issues may lead to its omission or incomplete performance at times. A recent study found that only 57% of parents reported their child’s development was assessed during a pediatric visit. [Zuckerman: 2004] Developmental screening tools can save time in thoroughly evaluating all domains of development (social/emotional, language, cognitive, gross/fine motor). And parents who report receiving developmental screening tools are more satisfied with their pediatric care. [Zuckerman: 2004]

Finally, federal law mandates that health care professionals provide services that identify children with developmental disabilities (Title V of the Social Security Act and the Individuals With Disabilities Education Improvement Act).

Other Names

Some approaches to developmental screening can also encompass social-emotional screening.

Early Signs

See Learn the Signs. Act Early. (CDC), a page on the CDC web site providing an overview of developmental milestones and screening.
ICD-9

315, Specific delays in development

317, Mild mental retardation

318, Other specified mental retardation

783.4, Lack of expected normal physiologic development in childhood

The above are general codes, each of which includes a number of more specific codes (with 4th and 5th digits) that should be specified. The last, 783.4, is generally used more for anatomic/physiologic delays or failure to thrive.

CPT

96110, Developmental testing, limited

This code reflects the associated physician work and screening program expenses. Compensation varies by geography and insurer. Many insurers “bundle” compensation into their standard compensation for health supervision visits. However, in some states and, particularly, in some Medicaid programs, compensation is provided when the codes described below are submitted. Working with insurers, perhaps through your Chapter of the American Academy of Pediatrics or American Academy of Family Physicians, may be effective in their providing appropriate compensation. For insurers that compensate for screening , the health supervision code is used with the modifier 25 appended and 96110 listed for each screening tool administered.

Guidelines

Bright Futures, 3rd Edition , published in 2008, provides general and specific guidance for health supervision of children, including developmental surveillance and screening. [Hagan: 2008]

Tools

For a detailed overview of developmental screening instruments and how to choose one for your practice, see Pediatric Developmental Screening: Understanding and Selecting Screening Instruments. Below is a summary of screening tools that meet the following criteria:
  1. validated for a primary care population
  2. broadband instruments that screen in multiple domains of development
  3. favorable psychometric properties, defined as sensitivity and specificity between 70% and 80%
  4. parent completed questionnaire
  5. administration time of 15 minutes or less
  6. designed for use at the 9, 18 and 30 (or 24) month visits
  7. compatible with electronic medical records
  8. available in multiple languages

Ages and Stages Questionnaires (ASQ), now it its 3rd edition

Description:

  • 21 age specific questionnaires, 30 items per questionnaire
  • Age range: 2 – 60 months o Published validation studies [Gollenberg: 2010]
  • Scoring: cut off points for each domain that indicate recommendation for referral
  • Parent reading level: 4th to 6th grade

Source: Can be purchased from Paul H. Brookes Publishing Co. Ages and Stages Questionnaire: Developmental (ASQ-3) Forms for administration and scoring ($199 for photocopiable paper forms and CD-ROM with pdf versions; $250 for “starter kit” with User’s Guide; as of Jan 2011)

Parents Evaluation of Developmental Status (PEDS)

Description:

  • Single parental response form used for all ages, 10 items per questionnaire
  • May also be useful as a surveillance tool
  • Age range: same questionnaire used from 0 – 8 years
  • Published validation studies
  • Scoring: algorithm that indicates need for referral, further screening or continued surveillance
  • Parent reading level: 5th grade

Source: By Frances P. Glascoe, PhD; can be purchased at Parent's Evaluation of Developmental Status (PEDS) site Forms for administration ($18 for 50, 1 per visit) and scoring ($18 for 50, 1 per child), and a manual ($80); also available in Spanish (prices as of Jan 2011)

Response to a Positive Screen

Primary Care

A positive screening test may cause considerable anxiety for the parents. We can help them understand that a concerning developmental screen does not always indicate an abnormality nor does it provide a diagnosis or treatment plan. Rather it identifies areas in which a child’s development differs from same-age norms. If results are concerning, the child should be referred to an early intervention program and scheduled for a comprehensive developmental evaluation.

Specialty Care

Intervention for developmental delay need not wait for a comprehensive evaluation or a definitive diagnosis. Referral to a program that can both assist in the evaluation and provide services to help the child and parents is recommended when there is concern about developmental delay.
  • Early Intervention (see see all Early Intervention Programs services providers (36) in our database)
    • Families may self refer to Early Intervention, but the clinician may send a referral form to provide specific information and to better coordinate care
    • The Early Intervention Program (EIP) may provide services such as developmental therapies, service coordination, family training, counseling, and home visits
    • The EIP will NOT perform a medical evaluation or other evaluations to establish a diagnosis of a specific developmental disability
    • A diagnosis of a specific developmental disability is NOT necessary for an EIP referral to be made or for services to begin
The evaluation of a child for developmental delay may involve some or all of the several specialists and disciplines noted below, depending on the specific findings at each stage of evaluation. Some communities will have a multi-disciplinary developmental clinic where all of the needed services will be available. If there are no such clinics nearby, the Medical Home may identify individual providers of the various components.
  • Comprehensive Evaluation
    • The goal of a comprehensive evaluation is to identify a specific developmental disability to aid in developing an appropriate treatment plan and to offer a prognosis for the child.
    • The developmental and medical components of the comprehensive evaluation should ideally be interdisciplinary. The table below describes the roles of the various disciplines in such an evaluation.
Team member Role
Audiologist Evaluates for hearing loss as a potential cause or contributor to developmental delay
(see all Audiology services providers (64) in our database)
Primary care clinician or
Developmental pediatrician
Performs medical evaluation; identifies and treats associated conditions
(Child Development Clinic, CSHCN, (801-584-8510); See also Services below)
Geneticist and genetic counselor Performs evaluation when an underlying medical condition or genetic syndrome is suggested by family history, examination, or clinical course
(Medical Genetics, (801-231-3599); See also Services below)
Psychiatrist Evaluates and treats associated psychiatric conditions and maladaptive behaviors
(Neurobehavior H.O.M.E. Program, (801-581-5515); See also Services below)
Psychologist Administers cognitive or developmental testing or other diagnostic tools; Identifies associated psychiatric conditions and develops behavioral treatment plan
(see all Child Psychology services providers (58) in our database)
Occupational therapist Evaluates for fine and gross motor deficits; Evaluates for sensory processing deficits; develops plan for treatment
(see all Occupational Therapy services providers (33) in our database)
Social worker Identifies family needs; refers family to formal and informal support agencies and organizations
(see all Social Work services providers (21) in our database)
Speech-language pathologist Evaluates for expressive, receptive, and pragmatic language deficits; develops plan for treatment
(see all Speech/Language Therapy services providers (48) in our database)

Resources

Information & Support

For Professionals

Screening and Surveillance (PowerPoint)
An overview of developmental screening and surveillance by Katherine TeKolste, MD; presented in a learning collaborative in Utah in 2004.

Baby Watch Referral Form(PDF Document 156 KB)
Information referral and release form to exchange information between the Medical Home and early intervention programs in Utah.

Developmental Red Flags(PDF Document 186 KB)
From Kids Get Care, King County, Washington, this checklist gives tips for finding possible developmental delays.

Baby Watch Early Intervention Locations
A list of Utah Baby Watch locations throughout Utah providing early intervention programs.

Developmental Screening and Assessment Instruments(PDF Document 997 KB)
This 20-pg document, published in 2008, compares developmental and social-emotional screening instruments with descriptions; age ranges; time to administer, scoring procedures, psychometric properties; requirements for administrators; who can administer the instrument; and more. From the National Early Childhood Technical Assistance Center, with funding from the U.S. Office of Special Education Programs.

Genetics in Primary Care Institute (GPCI)
Increases collaboration in the care of children with known or suspected genetic disorders. Includes health supervision and management guidelines, and other useful resources; a collaboration among the Health Resources & Services Administration, the Maternal & Child Health Bureau, and the American Academy of Pediatrics.

For Parents and Patients

Help Me Grow Utah
Information service that connects families of young children to community resources; developmental screening tool provided to parents; and monitoring of referrals to resources. Services are available in English and Spanish. Help Me Grow’s target population is children ages 0-8 years-old who live in Utah.

Developmental Screening from the CDC
This site gives an overview of screening, the pros and cons of screening tools and a link to the CDC recommendations for screening, plus links to federal resources and tips for parents.

Early Developmental Guide for Parents
From the Utah Department of Health, a list of milestones for ages 1-2 months, 3-4 months, 6 months, 9 months, 12 months, 18 months, 2-3 years. Includes development, nutrition, communication/hearing/vision, and guidance for parents

Parenting Children Aged Zero to Three
A webpage from the Zero to Three national, nonprofit organization dedicated to supporting families and communities in the care of young children. This site has links to FAQs; parenting tips; and reproducible handouts for parents. Topics include behavior, play, language, and more.

Bureau of Children with Special Health Care Needs (UDOH)
An agency under the Utah Department of Health, Division of Community and Family Health Services, the Bureau provides services for children with special health care needs, including clinical services, care coordination, newborn screening, birth defect surveillance, and more.

Parent's Guide to Understanding Subspecialists
An American Academy of Pediatrics webpage that links to information about pediatric subspecialists and transport teams. Includes guidelines for referral to pediatric surgical specialists.

UtahClicks
Provides online applications to Utah programs for children, including Baby Watch Early Intervention, Baby Your Baby, Head Start, Early Head Start, and Children with Special Health Care Needs (CSHCN).

Utah Parent Center
This statewide nonprofit organization, founded in 1984, provides training, information, referral and assistance to parents of children and youth with all disabilities, including physical, mental, hearing, vision, learning, behavioral, and emotional. Staff consists primarily of parents of children and youth with disabilities.

Learn the Signs. Act Early. Tools
Checklists, booklets, and other tools to learn about and track developmental milestones for infants and young children.

Practice Guidelines

American Academy of Pediatrics.
Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening.
Pediatrics. 2006;118(1):405-20. PubMed abstract / Full Text
Children diagnosed with developmental disorders should be identified as children with special health care needs, and chronic-condition management should be initiated. Identification of a developmental disorder and its underlying etiology may also drive a range of treatment planning, from medical treatment of the child to family planning for his or her parents.

Patient Education

Learn the Signs. Act Early. (CDC)
Page in the CDC web site providing an overview of developmental screening and early developmental milestones for children. Links to tools for parents to monitor developmental milestones.

Tools

Ages and Stages Questionnaire: Developmental (ASQ-3)
Parent-completed questionnaire of about 30 age-related questions that screens for developmental delays between one month and 5½ years. A Brookes Publishing Company website where users can purchase the ASQ screening tools or arrange for a training seminar.

Developmental Screening Toolkit for Primary Care Providers
This site, from the Children's Hospital Boston, provides an educational overview for clinicians interested in implementing developmental screening in their practice.

Parent's Evaluation of Developmental Status (PEDS) site
Published by Ellsworth & Vandermeer Press; the site offers copious information about the tests and their background, and links to purchase online.

Services

Audiology

See all Audiology services providers (64) in our database.

Child Psychiatry

See all Child Psychiatry services providers (15) in our database.

Child Psychology

See all Child Psychology services providers (58) in our database.

Developmental Evaluation

See all Developmental Evaluation services providers (45) in our database.

Early Intervention Programs

See all Early Intervention Programs services providers (36) in our database.

Occupational Therapy

See all Occupational Therapy services providers (33) in our database.

Pediatric Genetics

See all Pediatric Genetics services providers (3) in our database.

Social Work

See all Social Work services providers (21) in our database.

Speech/Language Therapy

See all Speech/Language Therapy services providers (48) in our database.

For other services related to this condition, browse our Services categories or search our database.

Helpful Articles

Drotar D, Stancin T, Dworkin PH, Sices L, Wood S.
Selecting developmental surveillance and screening tools.
Pediatr Rev. 2008;29(10):e52-8. PubMed abstract

Sices L .
Developmental Screening in Primary Care: The Effectiveness of Current Practice and Recommendations for Improvement.
(2007) http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007.... A comprehensive report from The Commonwealth Fund. Accessed on 2-10-11.
Developmental conditions are common in early childhood, and are predictive of later behavioral difficulties. Early treatment improves outcomes. This report makes recommendations to strengthen developmental surveillance and screening, and improve outcomes for young children and families.

Authors

Author: Paul Carbone, MD - 2/2011
Reviewing Author: Sarah Winter, M.D. - 2/2011
Content Last Updated: 2/2011

Page Bibliography

Berlin LJ, Brooks-Gunn J, McCarton C, McCormick MC.
The effectiveness of early intervention: examining risk factors and pathways to enhanced development.
Prev Med. 1998;27(2):238-45. PubMed abstract
The effectiveness of early intervention, especially vis-à-vis (a) child and family risk factors and (b) the pathways to enhanced child and family development, is examined. Findings were drawn from the Infant Health and Development Program (IHDP) for low-birth-weight premature infants. The data presented reveal the considerable effectiveness of the IHDP intervention in enhancing several aspects of early and later child and family development.

Earls MF, Andrews JE, Hay SS.
A longitudinal study of developmental and behavioral screening and referral in North Carolina's Assuring Better Child Health and Development participating practices.
Clin Pediatr (Phila). 2009;48(8):824-33. PubMed abstract
The main objectives of this descriptive study were to determine the number of children who were screened and whether this rate improved with time, observe patterns and trajectories for children identified at risk in 1 or more of the 5 developmental domains, and examine referral rates and physician referral patterns.

Gollenberg AL, Lynch CD, Jackson LW, McGuinness BM, Msall ME.
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(4):485-90. PubMed abstract
Study results suggest the ASQs provide a simple, valid, and cost-effective method for clinicians and researchers to reduce the number of standardized assessments required to identify developmentally delayed infants at age 24 months.

Guralnick MJ.
Effectiveness of early intervention for vulnerable children: a developmental perspective.
Am J Ment Retard. 1998;102(4):319-45. PubMed abstract
An analysis of the current state of our knowledge of the effectiveness of early intervention for children at risk and for those with established disabilities was provided.

Hagan JF, Shaw JS, Duncan PM, eds. .
Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents.
3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2008. 978-1-58110-223-9 http://brightfutures.aap.org/
Authoritative compilation of guidelines and evidence for health supervision, including developmental surveillance and screening, physical exam, laboratory and other testing, and anticipatory guidance. The Affordable Care Act of 2010 cites Bright Futures as the standard for well child and adolescent care.

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(5):651-9. PubMed abstract
In the absence of clear assumption of responsibility for early identification, much terrain remains uncharted by medical practitioners and the schools. A better systematic sharing of responsibility for the early identification of developmentally disabling conditions is needed.

Reynolds AJ, Temple JA, Robertson DL, Mann EA.
Long-term effects of an early childhood intervention on educational achievement and juvenile arrest: A 15-year follow-up of low-income children in public schools.
JAMA. 2001;285(18):2339-46. PubMed abstract / Full Text

Soreca I, Fagiolini A, Frank E, Houck PR, Thompson WK, Kupfer DJ.
Relationship of general medical burden, duration of illness and age in patients with bipolar I disorder.
J Psychiatr Res. 2008;42(11):956-61. PubMed abstract

Zuckerman B, Stevens GD, Inkelas M, Halfon N.
Prevalence and correlates of high-quality basic pediatric preventive care.
Pediatrics. 2004;114(6):1522-9. PubMed abstract
Because of its association with other services, processes, and outcomes of care, the BPS scale may serve as a useful construct for monitoring quality and stimulating efforts to improve national pediatric preventive care.