Implementing standardized developmental screening in pediatrics

Implementing standardized developmental screening in pediatrics
Implementing standardized developmental screening in pediatrics

Does your pediatric practice use standardized developmental screening tools? If not, why not?  Research shows that developmental surveillance based on clinician experience alone is not good enough.

The American Academy of Pediatrics (AAP) recommends using standardized developmental screening tools at ages 9, 18, and 24 or 30 months. Yet many pediatric practices are unable or unwilling to administer standardized screening tests, and therefore do not believe or act on their results, data from a pilot test by the AAP to examining implementation of these tools indicate. Reasons reported by participants for not following these guidelines are as follows:

  • Screening takes additional time and resources
  • Lack of knowledge about referral services and specialists
  • Belief that personal experience and competence in identifying children with delays negates the need for standardized screening

My response to pediatric healthcare providers who choose not to follow AAP developmental screening recommendations based on this reasoning is three fold:

  • There are free, validated screening tools available that can be administered briefly
  • If you do not know what resources are available in your community to evaluate children with suspected developmental delay, it is your job to find out
  • Study data show that primary care clinicians are not as good at identifying developmental issues as standardized screening tool

So just accept it! Intervention programs for developmental delay are most effective when children are identified as early as possible. Let's use children who are diagnosed with autism spectrum disorder (ASD) as an example.  ASDs affect approximately 6.5 children per 1,000. In 2007, the AAP recommended specific ASD screening with a standardized validated screening tool at 18 months of age, with repeat screening at 24 months if indicated. 

One such tool is the modified Child Checklist for Autism in Toddlers (M-CHAT) available online for free with scoring guidelines, here. This simple checklist requires a yes or no answer for 23 questions and can be self-administered by the parent and easily scored by clinicians or office staff. The AAP also provides a detailed algorithm that makes determining what steps to take after results are determined a simple matter.    

We also now know that there are effective educational programs available for children with ASDs. Applied behavior analysis (ABA) is an example. ABA applies educational interventions that support desirable behaviors and help children transfer appropriate adaptive behaviors to new contexts. Structured teaching programs, such as the TEACCH method, can also be effective, especially if the principles are applied in the home setting.

Speech and language therapies and social skills instruction are other important adjuncts to behavioral and educational therapies that can help improve communication with children who have ASD. Therapies such as occupational or sensory integration may also be indicated based on the needs of individual children.

Although  therapies for developmental disorders can be intensive, expensive and sometimes not readily available,  this is no excuse for not properly screening and refering children who might benefit from evaluation, diagnosis and subsequent participation in potentially beneficial therapies. 

I challenge you to be an example and initiate standardized screening tools in your practice, if you are not already using them.

Julee B. Waldrop, DNP, FNP, PNP, is the Director of the MSN-DNP Program and an associate professor at the University of Central Florida. She provides health care to children at a local community health center.


For more information:

  1. American Academy of Pediatrics. “Identifying infants and young children with developmental disorders in the medical home:  An algorithm for developmental surveillance and screening.”  Pediatrics. 2006; 118(1): 405.
  2. American Academy of Pediatrics.  “Identification and evaluation of children with autism spectrum disorders.” Pediatrics. 2007; 120(5): 1183.
  3. American Academy of Pediatrics. “Management of children with autism spectrum disorders.” Pediatrics. 2007; 120(5): 1162.
  4. King TM et al. “Implementing developmental screening and referrals: lessons learned from a national project.” Pediatrics. 2010; 125(2): 250.
  5. Thomas S A et al. “Comparison of systematic developmental surveillance with standardized developmental screening in primary care.”  Clinics in Pediatrics. 2011; Sept. 27.
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