Umbrella Review and Meta-Analysis: Screening Tools for the Identification of Developmental Delay in Early Childhood

This systematic review and meta-analysis aimed to identify the range of developmental screening tools used globally, and to assess their pooled accuracy in identifying developmental delay among children aged 0 to 6 years.

PubMed, MEDLINE, PsycINFO, and Google Scholar were searched up to March 2025, with no language restrictions. Systematic or scoping reviews published within the last 10 years were included if they reported any information on the accuracy of a screening tool designed to identify delay in ≥2 domains. Meta-analyses were conducted to pool estimates of sensitivity, specificity, and area under the curve (AUC). Certainty of evidence for each tool was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Quality was assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) tool.

Thirteen reviews reporting on 38 distinct tools were identified. Nine tools had sufficient data for meta-analysis, of which only the Ages and Stages Questionnaire (ASQ), Parents' Evaluations of Developmental Status (PEDS), and Denver Developmental Screening Test (DDST) were informed by more than 2 independent samples. Although most tools demonstrated good discriminative ability (AUC 0.66-0.89), the majority failed to meet minimal accepted thresholds for both sensitivity (0.8) and specificity (0.8). Wide confidence intervals and high heterogeneity were observed for most tools across both estimates.

None of the currently available screening tools demonstrate sufficient accuracy for clinical use or population screening, underscoring the need for more nuanced implementation strategies that account for the known limitations of accuracy.

In this systematic review and meta-analysis, the authors aimed to identify developmental screening tools used globally and assess their accuracy in identifying developmental delays. The authors identified 38 distinct tools, but only 9 had enough evidence to assess their accuracy through meta-analysis. Overall, none of the available screening tools demonstrated sufficient accuracy for clinical or population screening, and information about participants' gender and ethnicity was often missing, highlighting the need for more nuanced implementation strategies that account for these limitations in accuracy.

Screening tools for the identification of developmental delay in early childhood: an umbrella review; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024577375.