Developmental Screening
by Dr. Mark Rosenberg
When parents visit their pediatrician, the two questions that they want answered above all others are ‘How is my baby/child doing?’ and ‘How am I doing as a parent?’  In order to give parents an answer, your pediatrician will ask a series of questions at the ‘well child visit’ to assess your child’s developmental progress as well as nutrition and recent illnesses. However, often the few developmental questions asked do not allow for a complete picture of your child’s development, or for the emotional well being of you and your child. For that reason, many pediatricians are following recent recommendations of the American Academy of Pediatrics and physicians who specialize in early child development to use specific developmental screening tools at the periodic well child visits. The use of these screening tools provides parents with a complete assessment of different aspects of a child’s developmental progress. “These brief assessments designed to identify children who should receive more intensive diagnosis or assessment—can improve child health and well-being, especially for children with autism and other developmental disabilities or delays. Research has demonstrated that early detection of developmental disabilities and appropriate intervention can significantly improve functioning and reduce the need for lifelong interventions. For example, children with autism identified early and enrolled in early intervention programs show significant improvements in their language, cognitive, social, and motor skills, as well as in their future educational placement.” (www.cdc.gov , 2005) The developmental screening tools discussed below are a small sample of the many questionnaires available for physicians to use in guiding discussions with parents. We often refer to these discussions as ‘teachable moments’- those instances when a parent’s concerns become the focus of the well child visit. Time may not permit a lengthy evaluation but the use of a questionnaire often provides an opportunity to discuss a concern such as sleep or an eating problem. Most of the questionnaires are readily available at a reasonable price and may be completed by the parent at the time of the visit. Some physicians prefer to have parents complete the questionnaires at home and bring them to the visit. That allows both parents to participate in the completion and use direct observations of their child. A good developmental tool must be: • accurate, both in terms of sensitivity and specificity; • quick and easy to use; • flexible for use at each well-baby visit; • affordable, both at the initial and re-ordering stages. (www.firstsigns.org, 2009) If a concern or developmental challenge is identified, the child may be referred to a developmental specialist. All states have an early intervention program that provides an evaluation of a child’s development. Some developmental delays may be followed up with observations, and frequently the early intervention programs will provide guidance to parents on how they can help their child in the specific areas of their developmental challenge. A Summary of Some Developmental Screening Tools:PEDS (Parent’s Evaluation of Developmental Status):This is a questionnaire that is not age specific with primarily open ended questions that relate to a child’s development and specific parent observations. Due to its open-ended questions the approach may be used at any infant or toddler well visit.To see a case example of how PEDS can be used click here ASQ (Ages and Stages Questionnaire):An age specific questionnaire from 1 month through to 5 1/2 years that looks at the different aspects of child development including motor skills, language and communication as well as social skills. This is preferred by some pediatricians because of its focus on a specific age attained skill.To see some example ASQ questions click here ASQ SE (Ages and Stages Social Emotional):This questionnaire is also age specific and focuses on the relationship between parent and child by examining social skills and connections.To see a sample of the 30 month old questionnaire and scoring sheet click here M CHAT (The Modified Checklist for Autism in Toddlers):This questionnaire is used to evaluate children between 16 and 30 months as a screening for the Autism Spectrum Disorder using a scoring system that highlights characteristics of children with challenges in language and/or social skills.To see the M CHAT checklist click here Vanderbilt ADHD Diagnostic Rating Scale:The Vanderbilt scale (for 6 to 12 year olds) includes both parent and teacher questionnaires filled out at home and returned to the physician for scoring. It is used to evaluate behaviors consistent with Attention Deficit Hyperactivity Disorders[ADHD]as well as learning disorders. It is useful to follow the progress and response to medications used to treat ADHD.To see the parent rating scale click here To see the teacher rating scale click here GAPS (Guidelines for Adolescent Preventive Services):A questionnaire developed by the American Medical Association to be completed by adolescents (aged 11-21) to provide a subjective evaluation of risk behaviors. There is a questionnaire for younger adolescent, older adolescents and parents/guardians. It is frequently used in the well child visits of teens and pre-teens to guide discussions with adolescents by physicians.To see the younger adolescent questionnaire click here To see the older adolescent questionnaire click here To see the parents/guardian questionnaire click here Please remember that these developmental tools are best used with the help of your health professional. Also remember that these are only some of the developmental screening tools available to help parents, pediatricians and teachers - but that they all share one goal, and that is to ensure the child is on the right developmental path, and can get help early if developmental challenges are identified. By Mark Rosenberg M.D. FAAP
Children's Healthcare Associates Associate Professor of Clinical Pediatrics Feinberg School of Medicine Northwestern University |
