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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.
Developmental surveillance entails:
- Listening to parents' concerns
- Obtaining and maintaining a developmental history
- Observing the child during visits
- Identifying risk and protective factors
- Documenting relevant information and findings
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
Tools
- validated for a primary care population
- broadband instruments that screen in multiple domains of development
- favorable psychometric properties, defined as sensitivity and specificity between 70% and 80%
- parent completed questionnaire
- administration time of 15 minutes or less
- designed for use at the 9, 18 and 30 (or 24) month visits
- compatible with electronic medical records
- 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 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 (38) 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
- 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 (59) in our database) |
| Primary care clinician or Developmental pediatrician |
Performs medical evaluation;
identifies and treats associated conditions
(Child Development Clinic, (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 (see all Child Psychiatry services providers (19) in our database) |
| Psychologist | Administers cognitive or developmental testing or other diagnostic tools;
Identifies associated psychiatric conditions and develops behavioral treatment plan
(Alternative Behavior Strategies, (801-935-4171); See also Services below) |
| Occupational therapist | Evaluates for fine and gross motor deficits;
Evaluates for sensory processing deficits;
develops plan for treatment
(Pediatric Therapy Services, (801-946-1860); See also Services below) |
| Social worker | Identifies family needs;
refers family to formal and informal support agencies and organizations
(see all Social Work services providers (11) 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 (39) 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
(
156 KB)
Information referral and release form to exchange information between the Medical Home and early intervention programs in
Utah.
Developmental Red Flags
( 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
( 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.
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, Utah Department of Health
Utah Children with Special Health Care Needs (CSHCN) is a bureau within the Utah Department of Health, Division of Community
and Family Health Services that provides services for children who "have or are at increased risk for a chronic physical,
developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond
that required by children generally".
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 non-profit 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. The Center provides information on support and
advocacy for families of children with special health care needs.
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.
Tools
Ages and Stages Questionnaire
A Brookes Publishing Company website where users can purchase the ASQ screening tools or arrange for a training seminar.
The ASQ is used for general developmental screening and can be filled out by parents or providers.
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
Early Intervention Programs
See all Early Intervention Programs services providers (38) 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.
