Developmental Screening Tool Research Articles

Alternative Developmental Evaluation Model for a Changing Health Care Environment ♦ 86

The interdisciplinary evaluation (IE) model has been well established in Centers for Neurodevelopmental Disabilities. This model may be less competitive in a health care environment dominated by patient volume, economics, and outcomes. IE generates long waiting lists resulting in delayed diagnosis and access to care. An alternative evaluation model addressed staff cut-backs, cost accountability, timing and delivery of appropriate services without compromising quality of care. Patients (N=88) in the alternative model(AM) were compared to those (N=94) in the routine clinic (RC). IE averaged 6 hrs per patient with medical, psychological, speech, social, vision and hearing evaluations at a minimum for RC. In AM a decision protocol was used to select appropriate patients for a 90 minute medical and social assessment including standardized developmental screening tools. Of new patients, 49(56%) received AM. Trained social workers used the decision protocol after medical records were procured and considered age, reason for visit, previous testing, and driving distance. AM patients were 3 and 10 years old, 76.9% were males, 88.5% received Medicaid, and 84.6% were referred in by physicians or health clinics. Compared to RC, the time on the waiting list was shortened by 2 months (10.2 vs 18.5 wks) for AM families. The charge per AM patient decreased by 30% ($548 vs $779), with similar level of reimbursement over the 5 mo. AM patients had fewer clinical contacts (6.9 vs 8.1). Surveyed by mail, AM caregiver satisfaction was high (80%), with 72% reporting their questions or concerns were addressed. All surveyed student clinicians (N=8) agreed AM provided a good IE learning opportunity. Outcomes from AM were medical referrals (15.4% for genetics, 15.4% for further laboratory studies, 11.5% for MRI studies, 26.9% for ADHD testing, 15.4% for hearing reassessment, 15.4% for optometry, and 11.5% for physical therapy), IQ testing (42.3%), speech/language therapy (26.9%) and other interventions (family counseling 11.5% preschool 23%). Over half (52%) of families reported recommended services were easily obtained. AM used an IE team effectively to screen for neurodevelopmental disabilities, shorten staff time, costs and waiting lists. Medical concerns were identified sooner by AM and its decision protocol used more community resources than RC.

Revision of a parent-completed development screening tool: Ages and Stages Questionnaires.

Examined the Ages and Stages Questionnaires (ASQ), a series of 11 developmental questionnaires designed to be completed by parents and caregivers of young children from 4 to 48 months of age. The ASQ were recently revised and additional psychometric data were gathered. Analyses on over 7,000 questionnaires indicated high test-retest reliability, interobserver reliability, and internal consistency. Concurrent validity using standardized measures yielded on overall agreement of 85%, with a range of 76-91%. Specificity was high across questionnaire intervals while sensitivity was lower and varied across intervals. Use of parent-completed screening tools such as the ASQ is attractive in terms of cost-effectiveness, parental involvement, and flexibility in administration procedures.

Early Recognition of Autism

To determine which behavioral characteristics of autism are apparent in early childhood and to examine the relative contributions of clinical observation and parental reports to early identification of autism. Blinded comparison of behavioral data obtained through parental reports and clinical observation. Child development referral center. Twenty-six children (23 boys and three girls) younger than age 48 months with a clinical diagnosis of autism. Consecutive sample. None. Social interaction, communication, and activities and interests were evaluated using standard diagnostic criteria for autism. Results suggested that deficits in the areas of social interaction, imitation, play, and nonverbal communication are more prominent than insistence on sameness and routines in young children with autism. Also, parental reports and clinical observation appear to detect different aspects of abnormal behavior patterns in this sample. Improved awareness of the early signs of autism should help physicians recognize this disorder in a timely manner. Further research may identify how observation of play and parental reports might be incorporated efficiently into a physician's repertoire of developmental and behavioral screening tools.

Detection of behavioral, developmental, and psychosocial problems in pediatric primary care practice

By virtue of their ongoing relationship with families and young children, pediatric primary care providers are well positioned to participate in the early detection of children's behavioral, developmental, and psychosocial problems. Yet research suggests that many such problems elude early detection. Awareness of the prevalence of such problems should encourage pediatric providers to carefully elicit parents' opinions and concerns, obtain a relevant behavioral and developmental history, skillfully observe parent and child behaviors, and obtain, when indicated, the opinions of such other relevant professionals as preschool teachers. Possible strategies to improve early detection include the use of parent questionnaires, parent record-keeping of children's behavior, and a developmental screening tool as an aid to surveillance. The development of a classification system for such problems designed for primary care, rather than psychiatry, should also facilitate early detection.

Methodological issues in conducting research on parent-infant attachment.

The study of the parent's attachment to his or her infant has recently become a research topic of great interest to parent-child nursing practitioners. The parent-infant relationship has been examined using a variety of methodological approaches. Brazelton Neonatal Behavioral Assessment Scale demonstrations, home and laboratory observations, process recordings, videotape analyses, self-reported questionnaires, and developmental screening tools have all been used by researchers to measure the quality of this earliest form of human attachment. However, there are rising concerns as to the validity of attachment research in general, as well as methodological limitations in collecting data on parent-infant interactions. This article discusses issues of methodological concern in attachment research and makes suggestions to strengthen validity.

Data collection tools in nursing baccalaureate programs.

Pursuant to AACN recommendations that baccalaureate students in nursing have beginning proficiency in administering developmental, functional, and psychosocial screening tools, the authors designed a survey instrument to quantify the screening measures in current use, their derivation, and the purposes for which they are applied. Of the 468 institutions surveyed, 160 (34 per cent) National League for Nursing-accredited baccalaureate programs in nursing provided the data reported. Measures in use were classified as Standardized, Theorist-specific, Text-specific, and Agency or Institutionally developed and were documented for Developmental, Psychological, Physical. Functional, and Combined screening measures. Findings from the survey suggest that the average instructional program in nursing teaches the use of more than four screening measures and that standardization of the measures taught is not desirable.

The nurse and the early identification of young children at risk

Early identification of young children at developmental risk has long been thought to be important (Zadig and Cracker, 1975). Research into the value of early intervention aimed at the alleviation of some handicapping conditions has caused increased emphasis to be placed on the need for preschool screening (Brazelton, 1977). Recent legislation in the U.S.A. (94-142) has further re-emphasized the importance of already existing federal and state laws mandating preschool screening programs. A review of the literature on existing preschool screening tools reflects that a tool that is both comprehensive and effective is unavailable (Erickson, 1976; Meier, 1973). There exists a clear need for developing an operational theoretical framework for large scale preschool screening which will be both effective and efficient (Hass and Scovell, 1977; Dept. of H.E.W., 1976). The study reported in this paper was conducted in response to such needs.* Experience with the already existing preschool screening programs, coupled with a thorough literature survey, led to the conclusion that certain aspects of the child’s development were neglected. For instance, the literature did not reveal a simple head-to-toe physical screening tool, and none of the available developmental screening tools adequately covered physical development. Also, almost all of the screening tools were binary in nature; that is, they are pass or fail, referral or no referral (Gomes and Nuttal, 1975). Thus, these tools lacked the finer mesh screening capability to deal with a variety of referral types (Sahin, 1978). Furthermore, the medical and educational approaches to screening were found to be disparate and called for conflicting screening strategies (Bailey, 1975; Barnard, 1976). In order to assess the ‘whole’ child, and also because of the multiple nature of ‘special-needs’ presented, an e@ort was made to combine the medical and educational approaches to screening. Further, it was felt that the nurse was in an optimum position to facilitate this interface.