Screening for developmental delay among children aged 1-4 years: a systematic review
Rachel Warren1, Meghan Kenny1, Teresa Bennett1
1Evidence Review and Synthesis Centre, and Offord Centre for Child Studies, McMaster University, Hamilton, Ont.
Insights
Screening young children for developmental delay has mixed results. While one tool increased early intervention referrals, long-term academic outcomes showed no difference, indicating inconclusive evidence for current screening practices.
Area of Science:
- Pediatric developmental screening
- Early childhood development research
- Systematic review methodology
Background:
- Current guidelines for screening young children (under 5) for developmental delay lack consistency.
- This systematic review synthesizes existing literature on the effectiveness and potential harms of developmental delay screening in asymptomatic children aged 1-4 years.
Purpose of the Study:
- To evaluate the effectiveness of developmental delay screening in asymptomatic children aged 1-4 years.
- To assess the harms associated with developmental delay screening in this population.
- To provide evidence to inform guidelines on developmental delay screening for young children.
Main Methods:
- Systematic literature search of MEDLINE, Embase, and PsychINFO up to June 16, 2015.
- Inclusion of studies on children aged 1-4 years, without high risk for developmental delay, screened in primary care.
- Consideration of randomized trials and controlled cohort studies for benefits; no design restrictions for harms review.
Main Results:
- One study using the Ages and Stages Questionnaire II showed significantly more referrals to early intervention in screened groups.
- The same study indicated a 64-70% shorter time to referral for early intervention with screening.
- Another study using the VroegTijdige Onderkenning Ontwikkelingsstoornissen Language Screening instrument found no difference in academic outcomes at age 8.
Conclusions:
- Evidence regarding the effectiveness and harms of developmental delay screening in asymptomatic 1-4 year olds is currently inconclusive.
- Further research focusing on longer-term outcomes is necessary to guide decisions on screening practices and intervals.
- The findings highlight the need for more robust evidence to support developmental screening recommendations.
Background:
Existing guidelines on screening children less than 5 years of age for developmental delay vary. In this systematic review, we synthesized the literature on the effectiveness and harms of screening for developmental delay in asymptomatic children aged 1-4 years.
Methods:
We searched MEDLINE, Embase and PsychINFO for relevant articles published to June 16, 2015. We identified studies that included children aged 1-4 years who were not at high risk of developmental delay, screened in a primary care setting. Randomized trials and controlled cohort studies were considered for benefits (cognitive, academic and functional outcomes); no restrictions on study design were imposed for the review of harms.
Results:
Two studies were included. One used the Ages and Stages Questionnaire II for screening and reported significantly more referrals to early intervention in the intervention groups than in the control group (relative risk [RR] 1.95, 95% confidence interval [CI] 1.49-2.54, in the intervention group with office support and RR 1.71, 95% CI 1.30-2.25, in the intervention group without office support). The time to referral was 70% shorter in the intervention group with office support (rate ratio 0.30, 95% CI 0.19-0.48) and 64% shorter in the intervention group without office support (rate ratio 0.36, 95% CI 0.23-0.59), compared with the control group. The other study used the VroegTijdige Onderkenning Ontwikkelingsstoornissen Language Screening instrument to screen children aged 15 months at enrolment for language delay. It reported no differences between groups in academic performance outcomes at age 8 years.
Interpretation:
The evidence on screening for developmental delay in asymptomatic children aged 1-4 years is inconclusive. Further research with longer-term outcomes is needed to inform decisions about screening and screening intervals.
