Early intervention improves outcomes for children with developmental
delays, but performing routine, formal developmental screening as recommended
by the American Academy of Pediatrics can be a challenge for busy
pediatricians. The experience of pediatric staff at a large medical practice
in Eugene, Ore., however, has demonstrated that a systematic screening program
in which parents fill out a validated assessment questionnaire can
dramatically increase the number of children identified with potential
problems that required further
The program is described and its effects are analyzed in an article in the
August Pediatrics by Hollie Hix-Small, Ph.D., and colleagues.
In the period between April 1, 2005, and March 1, 2006, a simple process
was incorporated in routine well-child visits at 12 or 24 months. At each
visit, a parent or caregiver was given the Ages and Stages Questionnaire
(ASQ), a 30-item, screening tool for monitoring child development, which has
been shown to be valid and reliable for children between 4 months and 5 years
old. Participants in the program had the option to complete the questionnaire
at home and mail it in or complete the questionnaire at the medical
The research staff reviewed the completed questionnaires and referred
children with suspected developmental problems to the Program for Infants and
Toddlers (part C of the Individuals with Disabilities Education Act [IDEA], a
federal grant program) based on predetermined criteria for ASQ scores.
Meanwhile, pediatricians at the practice independently saw these children as a
part of standard care, documented their ratings of each child's developmental
status and determined whether the child needed a referral to the same part C
agency evaluation. The pediatricians were unaware of the children's ASQ
The result was impressive: out of 1,428 children who were seen at the
practice, 107 children were referred to an IDEA part C agency for further
developmental evaluations. That represented a 224-percent increase over the
period April 2003 to March 2004, when only 33 referrals were made. On the
basis of their clinical impression alone, physicians referred 45 children,
while researchers identified and referred 82 children on the basis of ASQ
scores. Only 20 were cases overlapping from both processes.
Of all the referrals, 25 children were screened out by the state's part C
agency as "no concern," 38 met the eligibility criteria for IDEA
part C special-education services immediately, and 44 were scheduled for
future screening because of suspected developmental delays.
Once a child is referred to a part C agency, the agency contacts the
parents or caregiver and conducts further evaluations to determine whether the
child is eligible for state-provided care.
The authors cited the importance of early intervention, which requires
early detection of signs or symptoms, to achieve optimal outcomes for children
with developmental delays. Although the American Academy of Pediatrics has
published guidelines for identifying infants and young children with
developmental disorders, busy pediatricians may find it challenging to use
these algorithms during routine visits. In contrast, the ASQ can be completed
by parents or caregivers at home and potentially teach them possible signs to
look for in children.
"One anecdotal observation in the clinic was that often the act of
filling out the ASQ increased the parent's observational skills for child
development," Hix-Small told Psychiatric News.
The authors estimated that the cost of incorporating the screening program,
including distributing the ASQ to parents or caregivers upon check-in and
collecting the forms at the clinic or by postage-paid mail, was only $1.61 to
$2.43 per patient. Kevin Marks, M.D., one of the study authors and a physician
at the medical practice group, noted that "the ASQ screening system was
found to be feasible [and] low cost and did not impede office flow."
An abstract of "Impact of Implementing Developmental Screening
at 12 and 24 Months in a Pediatric Practice" is posted at<http://pediatrics.aappublications.org/cgi/content/abstract/120/2/381>.▪