Pediatrician and parental evaluation of child neurodevelopment at 2 years of age
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Updated: Oct 9, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Giulia Segre1, Antonio Clavenna1, Elisa Roberti1
1Laboratory of Epidemiology of Developing Age, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan, 20156, Italy.
Insights
Early identification of developmental disorders in infants is crucial. Combining pediatrician and parent insights using tools like the M-CHAT-R can improve early detection and intervention for at-risk children.
Area of Science:
- Pediatric Health
- Developmental Psychology
- Early Childhood Intervention
Background:
- Early identification of infants at risk for neurodevelopmental disorders is vital for optimal developmental outcomes.
- Integrating family pediatrician and parent perspectives is essential for comprehensive child health assessments.
- Parental input and pediatrician clinical judgment are key sources of information for identifying developmental warning signs.
Purpose of the Study:
- To assess the feasibility of parent-report instruments in detecting developmental warning signs in infants.
- To determine the agreement between family pediatricians' clinical judgments and parental perceptions of warning signs.
- To investigate the relationship between parental distress and child development in the early years.
Main Methods:
- Utilized the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) for parent-reported assessments of child's language, social skills, behavior, and sensory areas.
- Administered the Parenting Stress Index, Short Form (PSI-SF) to measure parental stress within the parent-child system.
- Conducted univariate and multivariate analyses to explore associations between child/parent characteristics and developmental warning signs within the NASCITA birth cohort.
Main Results:
- Out of 435 infants, 69 (15.8%) showed warning signs, with 10 identified by both pediatrician assessment and M-CHAT-R.
- Male infants and those with sleep disorders had a higher likelihood of presenting warning signs (OR 2.46 and 2.43, respectively).
- Reading aloud emerged as a protective factor (OR 3.14), and increased parental distress was linked to children with warning signs (OR 2.36).
Conclusions:
- Integrating physician and parental perspectives during well-child visits is feasible.
- Combined approaches enhance the identification of children at risk for developmental disorders.
- This integrated strategy supports timely intervention and improved developmental trajectories for at-risk infants.
Background:
The early identification of infants with a risk for neurodevelopmental disorders in the first few years of life is essential for better developmental outcomes. Screenings should be carried out by combining the family pediatricians' and parents' perspectives, the two fundamental sources of information on children's health. The present study has three aims: (a) to test the feasibility of parent-report instruments to detect warning signs in their children's development; (b) to ascertain whether there is an agreement between the family pediatricians' (FP) clinical judgments of warning signs and the parental perceptions; (c) to determine whether there is a link between parents' distress and child development.
Methods:
Within the NASCITA birth cohort, in addition to the family pediatrician's clinical evaluation with routine tools, the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) was completed by parents to assess the child's language, social skills, behavior, and sensory areas. Parents were also asked to complete the Parenting Stress Index, Short Form (PSI-SF) to verify the magnitude of stress in the parent-child system. Univariate and multivariate analyses were performed to evaluate the association between child and parental characteristics and the presence of warning signs.
Results:
The follow-up assessment was completed for 435 infants: 69 (15.8%) presented warning signs: 43 in the pediatrician's assessment and 36 in the M-CHAT-R (10 in both). A total of 16 children (14 with warning signs) received a diagnosis after a specialist evaluation. Being male (OR 2.46, 95%CI: 1.23-4.91) and having sleep disorders (OR 2.43, 95% CI 1.17-5.04) was associated with a greater likelihood of warning signs in the multivariate analysis, while reading aloud was a protective factor (not exposed versus exposed (OR = 3.14; 95% CI 1.60-6.17). For 73 children (18.4%), at least one parent tested positive for PSI-SF. An increased prevalence of parental distress was observed in children with warning signs (OR 2.36, 95% CI 1.27-4.37).
Conclusions:
Integrating physician and parental perspectives during well-child visits and in clinical practice appears feasible and can improve the identification of children at risk of developmental disorders.
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