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Published on: July 18, 2020
Effectiveness of developmental screening in an urban setting
James P Guevara1, Marsha Gerdes, Russell Localio
1PolicyLab, Center to Bridge Research, Practice, Policy, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania19104, USA. guevara@email.chop.edu
Insights
Developmental screening significantly improves the identification of developmental delays and referrals for early intervention (EI) services. This approach ensures children receive timely support compared to standard developmental surveillance.
Area of Science:
- Pediatric Health
- Developmental Pediatrics
- Public Health Policy
Background:
- Early identification of developmental delays is crucial for timely intervention.
- Developmental screening tools, such as the Ages and Stages Questionnaire-II (ASQ-II) and the Modified Checklist for Autism in Toddlers (M-CHAT), are increasingly used in pediatric settings.
- Developmental surveillance, relying on age-appropriate milestones, is a common alternative but may be less effective in identifying delays.
Purpose of the Study:
- To evaluate the effectiveness of developmental screening versus surveillance in identifying developmental delays.
- To assess the impact of screening on early intervention (EI) referrals and eligibility.
- To compare the timeliness of identification and referral between screening and surveillance groups.
Main Methods:
- A randomized controlled trial involving 2103 children aged <30 months across 4 urban pediatric practices.
- Participants were randomized into three groups: screening with staff assistance, screening without staff assistance, and developmental surveillance.
- Outcomes, including identification of delays, EI referrals, and EI eligibility, were analyzed using an intention-to-treat approach.
Main Results:
- Children in both developmental screening groups were significantly more likely to be identified with delays (23.0%, 26.8% vs. 13.0%) compared to the surveillance group.
- Screening also led to higher rates of EI referrals (19.9%, 17.5% vs. 10.2%) and EI eligibility (7.0%, 5.3% vs. 3.0%).
- The screening arms demonstrated a shorter time to identification, EI referral, and EI evaluation.
Conclusions:
- Developmental screening is more effective than surveillance alone in identifying children with developmental delays.
- Screening programs facilitate timely referrals and eligibility for early intervention services.
- These findings support the adoption of developmental screening policies in pediatric care.
Objective:
To determine the effectiveness of developmental screening on the identification of developmental delays, early intervention (EI) referrals, and EI eligibility.
Methods:
This randomized controlled, parallel-group trial was conducted from December 2008 to June 2010 in 4 urban pediatric practices. Children were eligible if they were <30 months old, term, without congenital malformations or genetic syndromes, not in foster care, and not enrolled in EI. Children were randomized to receive 1 of the following: (1) developmental screening using Ages and Stages Questionnaire-II (ASQ-II and Modified Checklist for Autism in Toddlers (M-CHAT) with office staff assistance, (2) developmental screening using ASQ-II and M-CHAT without office staff assistance, or (3) developmental surveillance using age-appropriate milestones at well visits. Outcomes were assessed using an intention-to-treat analysis.
Results:
A total of 2103 children were enrolled. Most were African-American with family incomes less than $30,000. Children in either screening arm were more likely to be identified with delays (23.0% and 26.8% vs 13.0%; P < .001), referred to EI (19.9% and 17.5% vs 10.2%; P < .001), and eligible for EI services (7.0% and 5.3% vs 3.0%; P < .001) than children in the surveillance arm. Children in the screening arms incurred a shorter time to identification, EI referral, and EI evaluation than children in the surveillance arm.
Conclusions:
Children who participated in a developmental screening program were more likely to be identified with developmental delays, referred to EI, and eligible for EI services in a timelier fashion than children who received surveillance alone. These results support policies endorsing developmental screening.
