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Effectiveness of Enhanced Developmental Screening at 18 Months to Identify Developmental Delays
Emily Hamovitch1,2,3, Tharani Raveendran3, Eyal Cohen1,2,3,4,5,6
1Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Insights
Enhanced 18-month well-baby visits using developmental screening tools significantly improve the early identification of developmental delays in children. Routine visits were less effective in timely detection of these crucial developmental concerns.
Area of Science:
- Pediatrics
- Developmental Psychology
- Public Health
Background:
- Early identification of developmental delays is crucial for timely intervention.
- Standard 18-month well-baby visits often rely on surveillance rather than standardized screening tools.
- The effectiveness of enhanced well-baby visits in improving developmental delay detection requires further investigation.
Purpose of the Study:
- To compare the time to identification of developmental delays between enhanced 18-month well-baby visits with developmental screening and routine visits.
- To assess the impact of enhanced developmental monitoring on early detection rates.
Main Methods:
- A cohort study in Ontario included children aged 17-22 months receiving an 18-month well-baby visit between March 2020 and March 2022.
- Linked health administrative datasets were used to track developmental delay diagnoses up to September 2022.
- Piecewise Cox proportional hazards models analyzed the association between enhanced (n=83,554) versus routine (n=15,723) visits and early (within 6 months) or late (after 6 months) developmental delay identification.
Main Results:
- Children with enhanced visits were slightly older, less likely to be from deprived backgrounds, and more often seen by pediatricians.
- After adjustment, enhanced visits were associated with a higher likelihood of early developmental delay detection (aHR 1.19, 95% CI 1.11–1.28).
- No significant association was found for late detection of developmental delays following the 18-month visit.
Conclusions:
- Enhanced 18-month well-baby visits incorporating developmental screening tools are linked to earlier identification of developmental delays.
- These findings suggest that enhanced developmental monitoring can facilitate earlier recognition of developmental concerns in young children.
- Implementing screening tools during well-baby visits may improve developmental surveillance outcomes.
Objective:
We sought to measure whether receipt of an enhanced 18-month well-baby visit with use of a developmental screening tool versus a routine 18-month well-baby visit (which typically involves developmental surveillance without screening) is associated with time to identification of developmental delays.
Method:
We conducted a cohort study of children (17-22 months) in Ontario who received an 18-month well-baby visit (March 2020‒March 2022), followed to September 2022 using linked health administrative datasets. Visits were categorized as enhanced (n = 83,554) or routine (n = 15,723). The outcome was the identification of a developmental delay within 6 months (early) and more than 6 months after (late) the 18-month visit. Piecewise Cox proportional hazards models estimated hazard ratios (aHR) adjusted for child, maternal, and physician factors, comparing developmental delay diagnosis by visit type.
Results:
Children who received an enhanced visit were slightly older, had a lower representation in the most deprived group, and a higher percentage of patients with pediatricians as their usual provider of care. After adjustment, children with enhanced compared with routine visits were more likely to have developmental delays detected in the early period (aHR 1.19 95% CI 1.11‒1.28) but not in the late period following the well-baby visit.
Conclusion:
Enhanced visits are associated with earlier identification of developmental delays compared with routine visits in the 6 months following the 18-month well-baby visit. Enhanced developmental monitoring using screening tools may facilitate earlier recognition of developmental concerns.
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