Developmental screening requires a multifaceted approach

Because all screening tests have their limitations, it is likely there will never be a “perfect” developmental screening test. Therefore, research efforts should focus on integrating across sectors, from the pediatrician’s office to family services to state and federal developmental health initiatives, according to several speakers at the Pediatric Academic Societies Annual Meeting held in Baltimore this week.

Paul Dworkin, MD, of the University of Connecticut School of Medicine, said he thinks that creating a range of options to identify those children at risk is key not only for diagnosis but also for getting those children referred to the services they need.

Frances Page Glascoe, PhD,of Vanderbilt University, who also spoke during the session agreed. “People need choices, some providers are comfortable asking parents questions, others are focusing more on milestones, some want hands-on stuff,” she said. “We need to give people choices of measurement but give them quality tools as well.”

Dworkin and Glascoe’s comments came amidst a morning of discussion on developmental screening tests.

Glascoe presented data that noted that those states with the highest aggressive early intervention enrollment were those that used high-quality screens, which had better referral rates to services and were more effective at picking up children with problems at earlier ages.

The national average for early intervention enrollment, according to the CDC, is about 3%, whereas the actual figure of those requiring enrollment is closer to 8%. Those states with aggressive surveillance and testing programs, like Hawaii, have consistently higher rates of diagnosis and early intervention than those with less-aggressive programs, like Florida and Alaska.

Glascoe cited data that showed when the Ages and Stages Questionnaire was used, there was a 224% increase in the detection of those children who may have had developmental problems when compared with physician judgment alone.

Using these screening tools is key to getting children to school programs and health interventions where they can get the services they need, Dworkin said. – Colleen Zacharyczuk

Lipkin P. #3060. Pediatric Academic Societies Annual Meeting. Baltimore, MD; May 2-5, 2009.

We have many tests to choose from so we need to think about what the tests are, their strengths, weaknesses and we have to develop a concept of what surveillance should be. We took our best guess about proper ages of screening, but we need data on, are these really the best times?

At the 9-month visit, we focus on motor skills, hearing and vision. At the 18-month visit, we’re looking at language and autism. At the 30-month visit we are looking at learning milestones, language and communication, and at the 4-year visit we are starting to get into school readiness, behavioral issues, and intellectual milestones.

- Paul Lipkin, MD

Infectious Diseases in Children Editorial Board