Screening for developmental delay at 18 months using the Infant Toddler Checklist: A validation study

Area of Science:

• Pediatric Health
• Developmental Pediatrics
• Health Services Research

Background:

• Early detection of developmental concerns is crucial for timely intervention.
• The Infant Toddler Checklist (ITC) is a potential tool for screening at the 18-month well-child visit.
• Understanding the predictive validity and healthcare utilization associated with positive ITC screening is important.

Purpose of the Study:

• To examine the predictive validity of the Infant Toddler Checklist (ITC).
• To assess the association between positive ITC screening and subsequent healthcare utilization (HCU).

Main Methods:

• Prospective cohort study of 1460 children at their 18-month primary care visit.
• Parents completed the ITC; health administrative databases tracked healthcare utilization.
• Neurodevelopmental consultation was the primary outcome measure.

Main Results:

• 11% of children screened ITC positive; 2.6% received a neurodevelopmental consultation by age 8.
• The ITC demonstrated 40% sensitivity and 90% specificity for detecting neurodevelopmental consultation.
• A positive ITC was significantly associated with increased rates of 6 of 7 HCU types, including neurodevelopmental consultation (aRR 2.78).

Conclusions:

• The ITC exhibits high specificity and a low false positive rate, minimizing unnecessary anxiety and resource use for most children.
• The low sensitivity of the ITC underscores the necessity of continued developmental surveillance.
• Findings suggest the ITC can be a valuable screening tool when complemented by ongoing developmental monitoring.