Overreferrals for Developmental Screening Are Not a Problem

Abstract

Source: Glascoe FP. Are overreferrals on developmental screening tests really a problem? Arch Pediatr Adolesc Med. 2001;155:54–59.A national sample of 512 parents and their children (age range 7 months to 8 years) participated in the validation of several developmental screening tests. Test subjects were 61% white, 23% African-American, and 16% Hispanic or other. Parents averaged 13 completed grades of school, and 14% had not graduated from high school. Two age-appropriate screening measures were administered by trained psychological examiners. The results of these tests were then validated by a concurrent battery of standardized diagnostic measures of adaptive behavior, intelligence, language, and academic achievement. Children who failed the screening tests but did not have a disability diagnosis (false positives) were more likely to be non-white and to have parents who did not complete high school. These children were found to have significantly lower scores on the standardization battery than those children who passed the screening tests and did not have a disability diagnosis (true negatives). The authors concluded that children overreferred for diagnostic testing by developmental screens perform substantially lower than children with true-negative scores on measures of intelligence, language, and academic achievement (the 3 best predictors of school success). These same children also have greater psychosocial difficulties (limited parental education and minority status). Because of these two conclusions, such children are an at-risk group.These findings reinforce the concept that developmental problems occur across a continuum: more significantly delayed children will qualify for specific developmental diagnoses and mandated services, while more mildly delayed children without diagnoses may still benefit from comprehensive assessments to plan supportive developmental services that may be community based and at low or no cost. Therefore, a high rate of false positive screenings does not necessarily lead to unnecessary and expensive overreferrals.1 Careful developmental assessments of children who “just miss” qualifying for classification-related special services can be viewed as valuable. The screening tests employed in this study (Briggance Screens, Battelle Developmental Inventory Screening Test, Denver II, Parents’ Evaluations of Developmental Status) are not necessarily those in common use among pediatricians, and in this study they were administered by psychological examiners in public schools and day care centers, both of which are different from the pediatric office setting. The extent to which this would affect the outcome is unknown.Although this study was cross-sectional and not longitudinal (so we cannot know if disabilities eventually emerge in the “false-positive” study population), we still cannot ignore these false-positive results in our patients and just let things develop. Tools such as the relatively recent Parents’ Evaluations of Developmental Status (PEDS)2 allow a pediatrician to screen a patient in less than 5 minutes. Referral to appropriate follow-up services is warranted on the chance it may improve the outcome for those children who have abnormalities noted on developmental screening and surveillance.