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Developmental Screening and Follow-up by Nurses.

Brian A Lynch1, Amy L Weaver, Stephanie R Starr

  • 1Brian A. Lynch is an Assistant Professor of Pediatrics, Division of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. The author can be reached via e-mail at lynch.brian@mayo.edu Amy L. Weaver is a Statistician, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN. Stephanie R. Starr is an Assistant Professor of Pediatrics, Mayo Clinic, Rochester, MN. Karen L. Ytterberg is an Assistant Professor of Pediatrics, Division of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Paulette V. Rostad is a Developmental Screening Coordinator, Division of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. David J. Hall is a Mayo Clinic Pediatric Resident, Mayo Clinic, Rochester, MN. Sharon J. Tucker is the Director, Nursing Research, Evidence-Based Practice and Quality, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA.

MCN. the American Journal of Maternal Child Nursing
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Summary

Mailed developmental and autism screening at 18 months is insufficient for general pediatric populations. A standardized, nurse-led follow-up process can improve referral rates for early intervention services.

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Area of Science:

  • Pediatric Health
  • Developmental Pediatrics
  • Autism Spectrum Disorder Screening

Background:

  • The Ages and Stages Questionnaire (ASQ) and Modified Checklist for Autism in Toddlers (M-CHAT) are standard tools for identifying developmental delays and autism in young children.
  • Early identification and intervention are crucial for optimizing developmental outcomes in children.
  • Screening by mail offers a potential method for reaching a wider population, but its effectiveness requires evaluation.

Purpose of the Study:

  • To assess the efficacy of a mail-based developmental and autism screening program for 18-month-old children.
  • To evaluate a standardized follow-up protocol for children with abnormal screening results.
  • To identify demographic factors associated with parental response rates to mailed screening questionnaires.

Main Methods:

  • A prospective cohort study involved mailing the ASQ and M-CHAT to 892 children at 18 months.
  • A registered nurse scored questionnaires, conducted follow-up screening, and arranged referrals.
  • Medical records were reviewed to determine clinical outcomes; demographic data were analyzed for response associations.

Main Results:

  • A 59.3% return rate was observed for the mailed questionnaires (529/892).
  • Parents of White children and those with private insurance were significantly more likely to return questionnaires.
  • 20.6% of children failed initial screens, and 2.3% were referred after follow-up screening.

Conclusions:

  • Mail-based screening alone is inadequate for comprehensive screening of a general pediatric population.
  • A standardized, nurse-managed follow-up process following failed developmental screens can enhance the identification of children needing early intervention or subspecialty referrals.