Developmental Screening Instruments Research Articles

Quality Developmental Screenings Are Essential to Quality Surveillance

There is much to praise in the American Academy of Pediatrics’ Clinical Report, “Motor Delays: Early Identification and Evaluation” ( Pediatrics . 2013;131:e2016–e2027). The expert panel provided helpful guidance, useful resources, and placed invaluable emphasis on a 48-month visit to evaluate fine motor and other skills essential to school success. Nevertheless the panel erred considerably in stating, “The most commonly used developmental screening instruments have not been validated on children with motor delays.” In fact the measures cited have multiple discriminant validity studies, …

Evidence-Based Milestones for Surveillance of Cognitive, Language, and Motor Development

ObjectiveFewer than half of the nation’s pediatricians conduct systematic surveillance of young children’s development. Because time and cost are among the barriers, our objective was to create a brief set of parent-report questions about cognitive, motor, and language milestones that is freely available and can be administered and scored quickly. MethodsA team of experts developed candidate items after reviewing existing instruments and prior research. We selected final items based on statistical fit to a graded item response model developed and replicated in separate samples enrolled from primary care settings (n = 469 and 308, respectively). We then developed a 10-item form for each visit on the pediatric periodicity schedule. Combining our initial samples with 395 families enrolled from referral clinics, we tested these forms’ concurrent validity with respect to the ASQ-3 and parent reports of developmental diagnoses. ResultsA final set of 54 items displayed adequate fit to our statistical model regardless of race/ethnicity, education level, and child gender. Beginning at 4 months, scores on 10-item forms displayed consistent associations with the ASQ-3, and all but the 60-month form detected parents’ reports of developmental delay with adequate sensitivity and specificity. ConclusionsThe Milestones is one element of the Survey of Well-being of Young Children (SWYC), a brief but comprehensive screening instrument for children under 5 years. The Milestones is a set of evidence-based items with individual normative data that are appropriate for pediatric surveillance. In addition, the scoring of 10-item Milestones forms may provide many advantages of a first level developmental screening instrument.

Psychometric properties of the Brazilian-adapted version of the Ages and Stages Questionnaire in public child daycare centers

Well-designed screening assessment instruments that can evaluate child development in public daycare centers represent an important resource to help improve the quality of these programs, as an early detection method for early developmental delay. The Ages and Stages Questionnaire, 3rd edition (ASQ-3), comprises a series of 21 questionnaires designed to screen developmental performance in the domains of communication, gross motor skills, fine motor skills, problem solving, and personal–social ability in children aged 2 to 66months. The purpose of the present work was to translate and adapt all of the ASQ-3 questionnaires for use in Brazilian public child daycare centers and to explore their psychometric characteristics with both Classical Test Theory and Rating Scale analyses from the Rasch model family. A total of 18 Ages & Stages Questionnaires — Brazilian translation (ASQ-BR) questionnaires administered at intervals from 6 to 60months of age were analyzed based on primary caregiver evaluations of 45,640 children distributed in 468 public daycare centers in the city of Rio de Janeiro. The results indicated that most of the ASQ-BR questionnaires had adequate internal consistency. Exploratory factor analyses yielded a one-factor solution for each domain of all of the ASQ-BR questionnaires. The only exception was the personal–social domain in some of the questionnaires. Item Response Theory based on Rating Scale analysis (infit and outfit mean squares statistics) indicated that only 44 of 540 items showed misfit problems. In summary, the ASQ-BR questionnaires are psychometrically sound developmental screening instruments that can be easily administered by primary caregivers.

Improving the odds for effective developmental surveillance

Improving the odds for effective developmental surveillance

Analyse aktueller Untersuchungsinstrumente zur Früherkennung von Auffälligkeiten in Sprechen und Sprache in der pädiatrischen Vorsorgeuntersuchung U8

The current analysis is a contribution to application information and quality assurance. It is intended to evaluate and optimise the use of German developmental screening instruments to identify deficits in speech, speech fluency and language during the early paediatric toddler check-up Kindervorsorgeuntersuchung U8 in the age of 43-50 months. A systematic literature search was conducted seeking current specific, standardised, norm-referenced assessment tools, particularly those relevant to the early detection of developmental speech and language retardation. They were subsequently evaluated quantitatively and qualitatively with specific regard to 15 psychometric criteria and construction features. 4 assessment tools (ETS 4-8; KiSS; SSV; TSVK-Screen) resulted from literature search. They were subjected to a detailed and rigorous comparative analysis. Quantitatively they met 7-12 of the 15 psychometric criteria whose quality was partly low or demonstrated survey standard to a lesser degree. These developmental screening instruments utilised in the paediatric toddler check-up U8 cannot be recommended without reservation with regard to a dichotomous decision (suspected disorder versus no suspected disorder). More qualificatory research focusing specifically on the existing screenings and the construction of new screening tools is required in order to gain vital developmental psychological information of the speech/language status of a child during the preventive paediatric examination U8. Alternatively, it should be evaded to the approach of taking diagnostic language developmental tests.

Early identification of autism: A comparison of the Checklist for Autism in Toddlers and the Modified Checklist for Autism in Toddlers

There is still debate as to what is the most effective strategy for identifying the early signs of autism in very young children. Two levels of screening having been advocated: broad-based developmental surveillance and targeted screening. Two popular tools for use in developmental surveillance are the Checklist for Autism in Toddlers (CHAT) and the Modified Checklist for Autism in Toddlers (M-CHAT). The purpose of this article is to summarise the current evidence for screening for autistic symptoms in very young children using CHAT and M-CHAT. A systematic search was carried out of electronic database and other sources for original studies which evaluated the use of CHAT and M-CHAT in screening for autism in children younger than 5 years of age. Studies were included for review if they evaluated the sensitivity and/or specificity of CHAT or M-CHAT, or described the best age to administer these instruments. The available evidence suggests that characteristic behaviours in autism should be evident in simple forms before the age of 18 months, while screening at 24 months should be conducted to identify those who regress. Administering a screening tool during 18- to 24-month well-child visits improves early identification of autism, while the stability of diagnosis at the ages of 18 months and 24 months is confirmed. M-CHAT has slightly better sensitivity and specificity compared to CHAT, and is preferable to use as a developmental surveillance screening instrument.

Concerns About Development, Behavior, and Learning Among Parents Seeking Pediatric Care

To describe responses to the questions "Do you have concerns about your child's behavior? Development? Learning?" among parents seeking pediatric care, and to analyze their correspondence to formal screening questionnaires. Of 465 parents of children aged 3 to 65 months recruited at pediatric primary care practices in Greater Boston, 451 provided complete data for analysis. After completing a questionnaire that asked whether they had any or all of these concerns, parents filled out a developmental screener (Ages and Stages Questionnaire-3) and a behavioral screener (Ages and Stages Questionnaire: Social-Emotional). One hundred eight parents (24%) reported having at least 1 concern about their child. Greater child age, male gender, and lower family income were associated with more concerns about development, behavior, and learning. Moderate agreement was found between parents' concerns and their responses on screening instruments, but among parents who identified no concerns, 18% were identified as at risk on one or both screening tests. Compared with children who were not identified on either screener, parents of children identified only on the behavioral screener were more likely to have concerns about behavior and parents of children identified on both screeners were more likely to have noted concerns about both behavior and development. No type of concern was associated with identification on the developmental screener alone. Parents' self-report of concerns showed moderate agreement with the results of developmental and behavioral screening instruments. Agreement was higher for behavioral concerns than for developmental concerns.

Gender differences of children's developmental trajectory from 6 to 60 months in the Taiwan Birth Cohort Pilot Study

The parental report instrument is the most efficient developmental detection method and has shown high validity with professional assessment instruments. The reliability and validity of the Taiwan Birth Cohort Study (TBCS) 6-, 18- and 36-month scales have already been established. In this study, the reliability and validity of the 60-month scale was tested. The gender differences in children's longitudinal gross motor, fine motor, language and social development were also investigated. Using the dataset from the Taiwan Birth Cohort Pilot Study (TBCS-p), 2048 infants were followed up when they were 6-, 18-, 36- and 60-month-old. At the final stage, 1620 children were followed up. Development of the children was measured using the TBCS 6-, 18-, 36-, and 60-month developmental scales. The reconstructed TBCS 60-month scale yielded 16 items measuring children's development in the four dimensions of gross motor, fine motor, language and social. The scale yielded an internal consistency of 0.39–0.71. Structural equation modeling also showed good construct and predictive validity, in that the 6-, 18-, and 36-month scales were predictive of the 60-month scale. No gender differences between the gross motor dimension was found. Gender had an effect on the fine motor dimension at 36 and 60 months, language dimension at 36 months, and social dimension at 18, 36 and 60 months. Gender had a transient effect in language development and social development a continuous effect from 18 to 60 months. Thus different gender norms may need to be established to prevent misdiagnosis. The TBCS scale is a valid and reliable developmental screening instrument that can be used in continuous surveillance of children's development in community and clinical settings from 6 months to 5 years of age.

Coding for Developmental Screening

Providers often use age-appropriate developmental checklists and parent questionnaires during preventive care visits as part of developmental surveillance. The use of developmental screening instruments of a limited nature (eg, Developmental Screening Test II, Early Language Milestone Screen, Parents’ Evaluation of Developmental Status–PEDS, Ages and Stages, and Vanderbilt ADHD rating scales) may be reported using CPT code 96110 (developmental testing; limited). Code 96110 is often reported when screening is performed in the context of preventive medicine services but may also be reported when screening is performed with other evaluation and management (E/M) services such as office visits for acute illness or follow-up.

Improved Detection of Developmental Delays Among Young Children in Foster Care

Our goal was to determine if systematic use of a validated developmental screening instrument is feasible and improves the detection of developmental delay (DD) in a pediatric medical home for children in foster care. This study had a pre-post study design, following a practice intervention to screen all children in foster care for DD by using the Ages and Stages Questionnaire (ASQ). The baseline detection rate was determined by medical chart review for all children aged 4 to 61 months who were new to foster care (NFC) during a 2-year period. After implementation of systematic screening, caregivers of young children who were NFC or already in foster care (IFC) completed the ASQ at preventive health care visits. We assessed the feasibility of systematic screening (the percentage of ASQs completed among the NFC and IFC groups). We compared the detection of DD among the baseline NFC group and the screening-NFC group by using bivariate and multivariable logistic regression. Of 261 visits that occurred after initiation of screening, 251 (96%) visits had a completed ASQ form in the medical chart, demonstrating high feasibility. Among children who were NFC, the detection of DD was higher in the screening than baseline period for the entire population (58% vs 29%; P < .001), for each age group (infants: 37% vs 14%; toddlers: 89% vs 42%; preschool: 82% vs 44%; all P < or = .01), and for all developmental domains. On adjusted analyses, the detection of potential DD in toddler and preschool children was higher among the NFC screening group than the NFC baseline group. Systematic screening for DD using the ASQ was feasible and seemed to double the detection of DDs.

Child developmental screening instrument from six to thirty-six months in Taiwan Birth Cohort Study

Background A reliable and valid assessing tool to detect the problem before the child becomes deviant is very important. Aim This study aimed to further test the reliability and validity of developmental screening instrument for follow-up of thirty-six months children in Taiwan. Also, the stability and changes in the development of children from six to thirty-six months were investigated. Methods A total of 1751 infants were administered the six-month scale, which included levels of Gross and Fine Motor, Language/Communication, and Social ability. At eighteen months, 1267 infants were followed up, and at thirty-six months, 1630 infants were followed up. Results Item analysis showed the thirty-six months scale had a Cronbach's alpha of 0.793. By confirmatory factor analysis, the correlations of the four dimensions in this scale were within the range of 0.38 to 0.61. Structural equation modeling showed that the six month scale could directly predict the eighteen months scale, and the gross motor, language, and social dimensions in the thirty-six months scale. The eighteen-month scale was also predictive of the thirty-six months scale. The six, eighteen and thirty-six-month scales all had acceptable reliability and validity, including content, construct and predictive validity. Additionally, the language development at six months was predictive of the language and social development at thirty-six months. The predictive model showed there were correlations between each dimensions at different ages. Conclusions This study is the pilot of a large and scientifically robust longitudinal first national birth cohort study in Taiwan, and the findings should provide useful reference for future studies.

Implementing Electronic Health Record-Based Quality Measures for Developmental Screening

The goal was to examine the current abilities and future potential of electronic health record (EHR) systems to measure childhood developmental screening and follow-up rates in primary care settings. A group of pediatric clinicians and health informatics experts was convened to develop quality indicators reflecting different aspects of the developmental screening process. These indicators included the administration of a standardized, validated instrument to screen children for developmental delays, the documentation of abnormal screening results, and the provision of follow-up care. Six integrated provider systems across the United States, with fully implemented EHR systems, were evaluated to determine the feasibility of implementing these measures within each system. Barriers related to measure implementation were identified. The EHR systems of all 6 health care organizations could implement measures examining developmental screening rates and could identify and track children with abnormal screening results. However, most of the systems did not have the ability to capture data for more-complex EHR-based measures. In particular, data elements based on workflow actions could not be captured with current EHR system designs. This study identified 2 main barriers to the implementation of developmental quality measures: concerns about data reliability and the tracking of care coordination within patient records. Potential solutions to these problems, including terminology standardization, patient portal use, and use of a single developmental screening instrument, are discussed.

Lowering Developmental Screening Thresholds and Raising Quality Improvement for Preterm Children

To determine: 1) if preterm children were referred, identified and received early intervention (EI)/ early childhood special education (ECSE) services at rates equivalent to term children after implementation of a universal, periodic Ages and Stages Questionnaire (ASQ) surveillance and screening system; 2) if pediatricians sufficiently lowered their screening thresholds with preterm children;and 3) if quality improvement opportunities exist. Secondary analysis was performed on 64 lower-risk, mostly late-preterm and 1363 term children who originally presented to their 12- or 24-month well- visits. Higher-risk preemies already involved with an EI agency/ identified with a delay were excluded. Board-certified pediatricians (N=18), and nurse practitioners (N = 2), blind to the ASQ results, were secondary participants. Differences between preterm and term developmental agency referrals were examined comparing Pediatric Developmental Impression to the ASQ under natural clinic conditions using a combined in-office or mail-back data collection protocol. Medical record and county EI/ECSE follow-up outcomes were conducted at 36 to 60 months. At 12 and 24 months, preterm (versus term) referral rates were 9.5%(versus 5.6%) with Pediatric Developmental Impression and 26.2% (versus 8.1%) with the ASQ. By 36 to 60 months, 37.5% of preterm (20.8% term) children were referred to EI/ECSE; of which, 50.0% of preterm (42.4% term) children were eligible for services, 54.2%of preterm children were identified with a developmental-behavioral disorder and 29.2% of preterm (20.8% term) children did not follow-up. For ASQ-only preterm referrals,55.6% were subsequently diagnosed with a developmental delay and/or disorder.Preterm children were 2 times more likely to be eligible than term children [corrected]. Combined referral, quality improvement and outcome data suggests that clinicians should lower their threshold for administering a psychometrically sound developmental screen when providing surveillance for ex-preemies. Quality improvement opportunities exist with diligent developmental surveillance and a more collaborative, standardized, reliable and interpersonal referral process.

Communication About Child Development During Well-Child Visits: Impact of Parents’ Evaluation of Developmental Status Screener With or Without an Informational Video

The American Academy of Pediatrics recommends periodic administration of standardized developmental screening instruments during well-child visits to facilitate timely identification of developmental delay. However, little is known about how parents and physicians communicate about child development or how screening impacts communication. Our goal was to examine whether parent-physician communication about child development is affected by (1) administration of a developmental screen or (2) video presentation on child development before well-child visits. Six primary care pediatricians in a practice serving predominantly Medicaid-insured children participated. Fifteen parents of children 9 to 31 months of age per pediatrician were assigned to 1 of 3 previsit conditions (n = 89): (1) usual care; (2) parent completed the Parents' Evaluation of Developmental Status screen; or (3) parent viewed 5-minute "activation" video before completing the Parents' Evaluation of Developmental Status. Visits were audiorecorded and coded by blinded raters using a classification system that assesses communication content. Outcomes included visit length, physicians' questions, information giving, reassurance or counseling about development, and parents' concerns and requests for developmentally related services. Mean visit duration was similar for the 3 groups (22.5 minutes). Physicians made more information-giving and counseling statements about development and raised more developmental concerns in group 3 (video plus the Parents' Evaluation of Developmental Status) than in group 1 (usual care) visits. A trend toward increased use of such communication was also seen in group 2 (Parents' Evaluation of Developmental Status only). Parents were more likely to raise a developmental concern in group 3 than in group 1. No parent requested early intervention, therapy, or other related services. Use of a validated screening test did not increase average visit duration, an important consideration in primary care. Although use of the Parents' Evaluation of Developmental Status alone led to some increase in parent-physician communication about development and developmental concerns, additional increase in communication was seen with the addition of a brief parent activation video shown before the Parents' Evaluation of Developmental Status was completed.

Efficient developmental screening instrument for 6‐ and 18‐month‐old children in the Taiwan Birth Cohort Pilot Study

To develop an efficient developmental screening instrument for interview purposes. Using random sampling, two groups of babies were selected: The pilot group of 1747 babies was selected for testing of reliability and validity. Another group of 100 babies was selected for testing of the concurrent validity with the second edition of the Bayley Scale of Infant Development. The Taiwan Birth Cohort Study scales include four developmental dimensions: gross motor, fine motor, language/communication (language) and social/self-care ability (social). In testing the concurrent validity, the structural equation model showed that Taiwan Birth Cohort Study dimensions correlated with the Bayley Scale of Infant Development dimensions. In testing the predictive validity of the Taiwan Birth Cohort Study, the correlation between the 6- and 18-month results of the motor index was 0.29, and the language social index was 0.31. The Taiwan Birth Cohort Study 6- and 18-month scales fulfill the criteria of developmental norm, predictive validity, validity and identification of relative risk for screening instruments. As a self-report checklist, it is economical and efficient, thus, it can be utilized in clinical and community settings.

Developmental Assessment

Developmental Assessment

Developmental Assessment

Developmental Assessment

Neurodevelopmental Screening in Toddlers and Early Preschoolers With Sickle Cell Disease

Sickle cell disease is associated with an elevated risk for neurologic complications beginning in early childhood. Detecting higher-risk cases with developmental screening instruments may be a cost-effective method for identifying young children in need of more frequent or intensive assessment. We evaluated the validity of the Denver II test as a tool to detect lower levels of developmental attainment and their association with neurologic risk in 50 young children with sickle cell disease. Children with suspect Denver II outcomes showed lower scores for functional communication skills, had lower hematocrit percentage, higher mean velocities on transcranial Doppler ultrasound imaging, and were more likely to have had preterm birth. Validity of age equivalencies from specific Denver II areas was demonstrated for Language and Fine Motor scores, suggesting the instrument could be used to index children's developmental levels in these domains. The Denver II may be a useful behavioral screening tool for neurodevelopmental risk in sickle cell disease.

Coding for Developmental and Behavioral Disorders

Coding for Developmental and Behavioral Disorders

Adaptation of the 36-Month Ages and Stages Questionnaire in Taiwan: Results From a Preliminary Study

Identification of children with developmental disabilities is the first critical step in providing early intervention services. Currently, only 20% of Taiwanese children who could potentially benefit from early intervention have been identified. One possible reason for this low identification rate is the lack of a culturally appropriate, developmental screening instrument for Taiwanese children. A multi-pronged pilot study was conducted to explore the reliability and validity of scores using a Chinese translation of the 36-month version of the Ages and Stages Questionnaire (ASQ) with a sample of Taiwanese children. Results indicated that the translated Chinese version of the 36-month ASQ demonstrates initial cultural appropriateness, and reliability and validity of scores when used with a sample of 3-year-old Taiwanese children. The potential viability of the 36-month ASQ as a developmental screening instrument to identify Taiwanese children in need of early intervention services and the need for further validation research are discussed.